case study week 8

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2

Insomnia
31-year-old Male

76-year-old Iranian Male

 

BACKGROUND

This week, we examine a 31-year-old male who presents to the office with a chief complaint of insomnia.

SUBJECTIVE

Patient is a 31-year-old male. He states that his insomnia has gotten progressively worse over the past 6 months. Per the patient, he has never been a “great sleeper” but is now having difficulty both falling asleep and staying asleep at night. The problem began approximately 6 months ago after the sudden loss of his fiancé. The patient states this is affecting his ability to perform his job, which is a forklift operator at a local chemical company. The patient states he has used diphenhydramine in the past to sleep but does not like the way it makes him feel the morning after. He states he has fallen asleep on the job due to lack of sleep from the night before. The patient's medical record from his previous physician states that he has a history of opiate abuse, which began after he broke his ankle in a skiing accident and was prescribed hydrocodone/apap (acetaminophen) for acute pain management. The patient has not received a prescription for an opiate analgesic in 4 years. The patient states recently he has been using alcohol to help him fall asleep, approximately four beers prior to bed.

MENTAL STATUS EXAM

The patient is alert and oriented to person, place, time, event. He makes good eye contact and is dressed appropriately for time of year. He denies auditory/visual hallucinations. Judgement, insight, and reality contact are all intact. Patient denies suicidal/homicidal ideation, and is future oriented.

Decision Point One

Select what you should do:

Zolpidem: 10 mg daily at bedtime

Trazodone 50 mg po at bedtime

Hydroxyzine: 50 mg daily at bedtime

Examine
 Case Study: Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

Introduction to the case (1 page)

· Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Decision #1 (1 page)

· Which decision did you select?

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #2 (1 page)

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #3 (1 page)

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Conclusion (1 page)

· Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

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w5 yi

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Taking into account internal and external criticism that is used to evaluate mid-range theories or their use in research. critique Self-Efficacy theory using the internal and external critique evaluation process.

Nursing Assignment

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Week 3 assignments

UNit 2 Discussion 551

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A 41-year-old male presents to the doctor’s office you work at complaining of a sore throat and headache. Upon examination, he is diagnosed with a virus that is currently prevalent in the area he works. He is told to rest and drink liquids until the virus has run its course. He becomes irate and tells you he wants an antibiotic.

  1. How could you explain to him why he does not need an antibiotic?
  2. What are some alternatives you could consider for a patient who demands an antibiotic?

Instructions: It is a discussion post so 1 page to 1 1/2 pg is good enough. Apa format. Must have 3 references.

interview

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Interview with a Culturally Competent Healthcare Professional

Healthcare Professional Interview:

Interview with a culturally competent Registered Nurse, Nursing Leader, or Advanced Practice Nurse. BSN students must select a nursing professional with a BSN or higher degree in nursing practice. The interview must address the following topics:

  • The practitioner’s philosophy regarding cultural diversity. (10 points)
  • Their strategies for providing culturally congruent healthcare. (10 points)
  • How do they address the uniqueness of cultural health practices? (Provide examples). (10 points)
  • How do they address issues such as cultural bias, language barriers, and client conflict? (10 points)
  • The challenges and benefits of addressing healthcare disparities. (Provide examples). (10 points)

This is an all-or-none assignment. Please ensure that all of the concepts listed above are included in your interview. The interview should be at least one page in length and uploaded. Please pay close attention to spelling and grammar.

BHA370 Delivery of Healthcare Services

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11/10/23, 9:25 AM Case – BHA370 Strategic Delivery of Healthcare Services (2023OCT09FT-1)

https://tlc.trident.edu/d2l/le/content/202712/viewContent/5129368/View 1/2

Module 3 – Case

STRATEGIC CULTURE

Assignment Overview

As a healthcare professional, you have many tools that you can use for various projects. In strategic planning and
delivery, strategic maps are often used to depict an organization’s or department’s strategy. In addition, they provide a
process that aligns organizational targets and initiatives with a defined mission/vision and desired outcomes.

Case Assignment

In the Module 1 SLP assignment, you identified the mission and vision statement of your strategic plan. For this
assignment, you are to take these statements and create a detailed strategic map. The strategic map will be included
in the final submission of your strategic plan in the Module 4 SLP.

You can find an example of strategy maps and templates at A Complete Strategy Map Template (Including Examples)
https://www.clearpointstrategy.com/complete-strategy-map-template-examples/

Your strategy map must cover at least 4 of the following categories:

1. Clients

2. Financials

3. Internal Actions/Perspective

4. External Actions/Perspective

5. Possibility of Growth and/or Learning

6. Processes

Listen

11/10/23, 9:25 AM Case – BHA370 Strategic Delivery of Healthcare Services (2023OCT09FT-1)

https://tlc.trident.edu/d2l/le/content/202712/viewContent/5129368/View 2/2

Privacy Policy | Contact

7. Application of Technology

8. Service/Product Line

Note: A title or reference page is not needed for this assignment. Explanation or commentary is not required; however,
your strategy map should be comprehensive.

Assignment Expectations

1. Conduct additional research to gather sufficient information for your strategic map.

2. This assignment will be graded based on the Case Assignment rubric.

informatics

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During the course, you have done a thorough analysis of a company and the health care subsector in which the company operates now is the time to look at all your findings and insights and be bold and make at least three predictions of what will happen to this organization or industry. Think in terms of the forces that affect your organization, its infrastructure and workforce challenges, if there are any reforms that may have a major impact? Be bold but NOT too bold. Think of a future that is plausible. 

Peer response week2

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Conc of Pathophys of NSg peers response

· respond to peers thoughtfully, add value to the discussion, and apply ideas, insights, or concepts from scholarly sources, such as: journal articles, assigned readings, textbook material, lectures, course materials, or authoritative websites. For specific details and criteria, refer to the discussion rubric in the Menu (⋮) or in the Course Overview Weekly Discussion Guidelines. 

1st peer post

Samantha WootenSep 11, 2023 at 9:31 AM

Marshall (2022) reports “In anorexia nervosa’s cycle of self-starvation, the body is denied the essential nutrients it needs to function normally.  Thus, the body is forced to slow down all of its processes to conserve energy, resulting in serious medical consequences” (P. 1). Marshall also surmises that lab work up on a patient may look normal, but this does not rule out impending death, death could happen quickly by cardiac arrest caused by electrolyte imbalances (2022. P. 1). 

Cultural and environmental implications affect a large amount of people within all ethnicity, gender, and age however women are largely targeted, the University of East Anglia state “his quite obvious connection between eating disorders and cultural expectations surrounding femininity is woefully neglected in much treatment” (P. 1).  With the technology boom in recent years this is ever more present for this population, a social media environment instills these behaviors in today's society.  

Financial implications that cause anorexia include lack of income and homelessness. Underprivileged populations have no choice but to sacrifice food to prioritize other necessities. Chan (2023) reports 64.7 billion being spent on eating disorders per year, with 23,560 hospitalizations yearly (p. 1). 

In the ED with 16-year-old Jonathan Collins coming into the facility for anorexia nursing interventions would include evaluating the patients diet/exercise regimen and educate on proper diet and exercise with adequate fluid intake. Identify coping strategies and emotions related to weight, allowing the patient time to think and express how they're feeling. This will allow underlying causes to surface for treatment. Lastly, addressing body images issues. Targeting these fears will allow the patient to accept a healthy body weight to maintain health and stay out of the hospital (Belleza, August 9, 2023. P. 1). 

According to Miller, Grinspoon, and Ciampa (2020) vital signs with anorexia tend to include a slower than normal heart rate, hypotension, and hypothermia. Lab values tend to include anemia and in some cases thrombocytopenia. Sodium levels average around 122, with normal levels being 135-145. Average potassium in patients with anorexia being 1.9 with normal values being 3.4-4.8. All of these values contribute to cardiac arrest via electrolyte imbalance. In some anorexia patients there are dysrhythmias due to electrolyte imbalances and hypovolemia. Also of note with women populations are menstrual dysfunction and osteoporosis (P. 1). 

Treatment includes a combination of psychotherapy, family therapy, and medicine according to St. Lukes Hospital (2015), they also state “A combination of treatments can give the person the medical, psychological, and practical support they need. Cognitive behavioral therapy, along with antidepressants, can be an effective treatment for eating disorders. Complementary and alternative (CAM) therapies may help with nutritional deficiencies” (P. 1). 

 

references

Belleza, M. August 9, 2023. Eating disorders: Anorexia & Bulimia Nervosa. Nurse Labs.
Eating Disorders: Anorexia & Bulimia Nervosa – Nurseslabs

Chan, T. H. 2023. Report: Economic Costs of Eating Disorders. Harvard School of Public Health.
Report: Economic Costs of Eating Disorders | STRIPED | Harvard T.H. Chan School of Public Health

Marshall, D. 2022. Anorexia Nervosa. National eating disorders association.
Anorexia Nervosa | National Eating Disorders Association

Miller, K. Grinspoon, S. Ciampa, J. (Marh 14, 2020). Medicla Findings in Outpatients with Anorexia Nervosa. JAMA internal medicine. Doi:10.1001/archinte.165.5.561.

St. Lukes Hospital. April 23, 2015. Complementary and Alternative Medicine of Anorexia Nervosa. A Division of Ebix.
Anorexia nervosa | Complementary and Alternative Medicine | St. Luke's Hospital (stlukes-stl.com)

University of East Anglia. November 13, 2017. Eating disorder treatments need to consider social, cultural implications of the illness. Science Daily.
Eating disorder treatments need to consider social, cultural implications of the illness | ScienceDaily

2nd peer post

Kira DespinsSep 11, 2023 at 3:20 PM

1. Thoroughly explain the pathophysiology of anorexia. Use a scholarly or authoritative source to support your answer.

Anorexia is a medical condition summarized by an inadequate intake of nutrients to regulate an individual’s weight to reduce their BMI and be ‘thin’.  It causes physiological imbalances such as amenorrhea and psychological imbalances such as an obsessive-compulsive need to exercise or an all-encompassing fear of gaining weight. This population exhibits body dysmorphia.  Once begun, this disease is persistent in select populations (Klein, 2004).

1. Examine each of the following three factors related to this disease process. Support all three with a scholarly source.

Cultural:  Western culture perpetuates a standard of beauty based on being thin.  This standard is propagated through social media outlets. Klein (2004) summarizes that popular media not only emphasizes the need to be a thing but perpetuates it through advertisements such as marketing diet fads and fitness trends.

Financial: Relating to the treatment of anorexia, a study by Gatt et al. (2014) found significant household financial stress for those seeking treatment for their eating disorder.  They compared treatment costs to being the second highest after cardiac artery bypass surgery.  As the disease is notoriously difficult to manage by oneself, it would be prudent to establish funding for this patient population so all individuals can access treatment without causing significant burdens on themselves and their families.

Environmental implications: Nature vs. nature has been heavily debated in pursuing the best understanding of anorexia. Klinger (2012) highlights that from an environmental perspective, children who have been neglected and/or abused are more prone to develop anorexia.

1. Identify 3-5 priority nursing interventions for the client in the emergency department.

-Cardiac monitoring due to electrolyte imbalance

-Fall risk prevention related to weakness

-Blood glucose monitoring related to low nutrient intake

1. Describe labs and diagnostic testing you would want to include in client’s plan of care and why. What are critical indicators? Support with a scholarly source.

Metevir, a nutrition counselor, highlights the importance of the following lab and diagnostic tests in anorexic patients (2022):

1. Vital sign monitoring, such as bradycardia, can signify a weak heart-conserving energy.

2. EKG to detect abnormal heart rhythm due to weakened heart muscles.

3. Complete metabolic panel to look for electrolyte imbalances in kidney and liver health. Hypokalemia would be a critical indicator.

4. Blood glucose tests as low food intake results in less glucose, which our brains depend upon

5. Hematology detects if our blood carries enough oxygen to perfuse our organs adequately.

6. Bone density test as low food intact can result in reduced hormone output, leading to weak and brittle bones.

 

1. What members of the interdisciplinary team need to be included for holistic patient-centered care? Provide a rationale and support with a scholarly source.

I believe that family members and friends are included in any team to support and care for those treated with anorexia.  Knowing the care plan, these individuals can best provide care and support to the patient while out of the hospital, setting them up for success.  Joy et al. (2003) believe that a physician, mental health professional, and nutritionist are also integral components of the care team as it affect an individual physically and mentally, and each has an overlapping specialty to assist the patient best.  In an emergency department setting, involving a social worker or case management is integral to establishing resources for patients seeking help in an outpatient or in-patient setting. 

 

References

Gatt, L., Jan, S., Mondraty, N., Horsfield, S., Hart, S., Russell, J., Laba, T. L., & Essue, B. (2014). The household economic burden of eating disorders and adherence to treatment in Australia. BMC Psychiatry, 14. 
https://doi.org/10.1186/s12888-014-0338-0

Joy, E., & Wilson, C., & Varechok, S. (2004). The multidisciplinary team approach to the outpatient treatment of disordered eating. Curr Sports Med Rep, 331(6), 6. https://pubmed.ncbi.nlm.nih.gov/14583163/#:~:text=Team%20members%20include%20a%20physician,of%20individuals%20with%20disordered%20eating.

Klein, D. A., & Walsh, B. T. (2004). Eating disorders: clinical features and pathophysiology. Physiology & Behavior, 81(2), 359–374. 
https://doi.org/10.1016/j.physbeh.2004.02.009

Klinger, D. (2012). Genes or environment: What causes eating disorders? GoodTherapy. 
https://www.goodtherapy.org/blog/genes-environment-what-causes-eating-disorders

Metevier, J. (2022). The eating disorder medical test and nutrition lab guide. Integrated Care Clinic. https://integratedcareclinic.com/blog/the-eating-disorder-medical-test-and-nutrition-lab-guide/#:~:text=Metabolic%2FElectrolyte%20Labs,your%20sugar%20and%20protein%20levels

No plagiarism, 7APA style

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ASSESSING A HEALTHCARE PROGRAM/POLICY EVALUATION

Program/policy evaluation is a valuable tool that can help strengthen the quality of programs/policies and improve outcomes for the populations they serve. Program/policy evaluation answers basic questions about program/policy effectiveness. It involves collecting and analyzing information about program/policy activities, characteristics, and outcomes. This information can be used to ultimately improve program services or policy initiatives.

Nurses can play a very important role assessing program/policy evaluation for the same reasons that they can be so important to program/policy design. Nurses bring expertise and patient advocacy that can add significant insight and impact. In this Assignment, you will practice applying this expertise and insight by selecting an existing healthcare program or policy evaluation and reflecting on the criteria used to measure the effectiveness of the program/policy.

To Prepare:

  • Review the Healthcare Program/Policy Evaluation Analysis Template provided in the Resources.
  • Select an existing healthcare program or policy evaluation or choose one of interest to you.
  • Review community, state, or federal policy evaluation and reflect on the criteria used to measure the effectiveness of the program or policy described.

The Assignment: (2–3 pages)

Based on the program or policy evaluation you selected, complete the Healthcare Program/Policy Evaluation Analysis Template. Be sure to address the following:

  • Describe the healthcare program or policy outcomes.
  • How was the success of the program or policy measured?
  • How many people were reached by the program or policy selected?
  • How much of an impact was realized with the program or policy selected?
  • At what point in program implementation was the program or policy evaluation conducted?
  • What data was used to conduct the program or policy evaluation?
  • What specific information on unintended consequences was identified?
  • What stakeholders were identified in the evaluation of the program or policy? Who would benefit most from the results and reporting of the program or policy evaluation? Be specific and provide examples.
  • Did the program or policy meet the original intent and objectives? Why or why not?
  • Would you recommend implementing this program or policy in your place of work? Why or why not?
  • Identify at least two ways that you, as a nurse advocate, could become involved in evaluating a program or policy after 1 year of implementation.