Assignment

The background and significance (B&S) paper is a five (5) page paper in APA format (excluding title page, abstract, references and appendices) that could form the introductory section of your clinical scholarly project. 

The B&S will introduce a clinical problem and the clinical context that led you to identify the clinical question. You will review the relevant background literature and theory related to the problem. You will discuss the relevance of this review to a local clinical setting at the unit, organizational, metropolitan, state, national, and international levels as applicable. 

You will discuss the potential benefits and challenges of addressing the clinical question in the local setting, and explore the larger contextual impact related to this problem. 

Please note, this paper will discuss the introductory background literature and theoretical basis related to a clinical problem. 

Clinical Topic Assigned: The Prevalence of Depression and Suicide Ideation Among Adolescents.

To Prepare:

• Reflect on strategies that you can pursue in developing portfolios or portfolio elements that focus on academic achievements.
• Review one or more samples from your own research of resources focused on portfolio development.

BY DAY 3

Post an explanation of at least two strategies for including academic activities and accomplishments into your professional development goals. Then, explain how those goals may align with the University’s emphasis on social change. Be specific and provide examples.

A little about me: I am a behavioral health nurse with 6 years of experience, currently completing my masters in psychiatry nursing 

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List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.

When assessing this patient, it's important to ask questions that will help the provider understand the underlying causes and potential treatment options. Given the patient's recent loss and significant life changes, it's crucial to approach the assessment with sensitivity. Here are three questions I'd like to ask, along with their rationales:

1. Have you observed any changes in your sleep pattern, mood, or feelings since your husband passed away?

Rationale: This question allows the patient to provide insight into the nature and duration of her sleep disturbances and changes in her mood or feelings. Understanding the onset and progression of depression symptoms can related to her recent bereavement following her husband's passing.

2. Could you describe your emotions and have you ever experienced thoughts of self-harm or suicide?

Rationale: This question aims to comprehend a person's emotional state and evaluate the presence of suicidal thoughts or self-harm ideation. It's important to ask such questions without delay in treatment. Since the patient has a history of major depressive disorder (MDD), and her depression has worsened, it's crucial to explore her emotional state.

3. How have you been coping with the loss of your husband, and have you sought support or counseling to help you through this difficult time?

Rationale: Inquiring about coping strategies and support systems is essential for assessing the patient's resilience and identifying potential sources of assistance. Grief counseling or therapy can be invaluable in helping individuals navigate the complex emotions associated with loss. Additionally, it's important to assess whether the patient has been utilizing any resources to manage her depression.

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Identify people in the patient's life you would need to speak to or get feedback from to further assess the patient's situation. Include specific questions you might ask these people and why.

To gain a more comprehensive understanding of the patient's situation and evaluate her social support network, I would identify individuals in the patient's life, such as family members or close friends. Engaging in conversations with these individuals can be beneficial because they may have insights into the patient's emotional well-being and daily functioning. I would ask Questions like: “Could you please share any observations regarding alterations you may have noticed in the patient's behavior, mood, or sleep patterns following her husband's passing?” Family members and close friends are often the first to detect significant shifts in a person's behavior and emotional state. Their observations can offer valuable insights into the patient's emotional condition and the way the loss of her husband has affected her daily life.

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Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.

In evaluating a 75-year-old patient with a chief complaint of insomnia and depression, diabetes (DM), and hypertension (HTN), a thorough assessment should include both physical exams and diagnostic tests: A physical examination should include checking blood pressure, heart rate, heart sounds, peripheral pulses, respiratory rate, and temperature. It should also involve assessing the patient's overall appearance and evaluating their general health.  In addition, assessing mental status, cognitive function, and neurological signs can help identify any neurological issues that may be contributing to sleep disturbances. Consider arranging a sleep study, also known as polysomnography (PSG). This medical test monitors various physiological functions while a person sleeps.

Diagnostic Tests include the following Blood Tests: Complete Blood Count (CBC) will check for anemia or other blood-related issues that can affect sleep and overall health; a Comprehensive Metabolic Panel (CMP), assess kidney and liver function, electrolytes, and glucose levels; The HbA1c (Glycated Hemoglobin) test can monitor her long-term blood glucose control, can provide valuable insights into her diabetes management. The results of these exams and tests will inform a comprehensive treatment plan tailored to the patient's specific needs.

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List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.

When assessing a patient with insomnia, along with chronic medical conditions like diabetes and hypertension, this patient likely has Major Depressive Disorder (MDD). She had no history of MDD before her husband's passing, and the current worsening of her depression may be attributed to his death. Although anxiety can cause insomnia problems, MDD with Bereavement seems most likely. However, we need to ensure there aren't other underlying causes, such as sleep problems or medical issues. To do that, we should conduct thorough assessments and laboratory tests. She needs to seek help from both her regular doctor and a mental health professional to find the right treatment and support.

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List two pharmacologic agents and their dosing that would be appropriate for the patient's antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.

When selecting pharmacologic agents for this 75-year-old patient, the choice of antidepressant therapy should consider pharmacokinetics and pharmacodynamics. Reduced kidney and liver function in elderly individuals can potentially affect both pharmacokinetics and pharmacodynamics.

SSRIs, such as sertraline (Zoloft) and escitalopram (Lexapro), are two preferred for elderly patients. They are generally well-tolerated and have a lower risk of certain side effects, such as sedation or anticholinergic effects, which can be problematic for older adults. Sertraline (Zoloft) 150mg once daily or Escitalopram (Lexapro) 20 mg daily would be appropriate for this patient.

The patient has been taking Sertraline (Zoloft), her start dose was 100mg daily; increase slowly, no more than a maximum Dose of 200 mg once daily; sertraline increases serotonin levels and can be effective in treating depression. Escitalopram is considered perhaps the best-tolerated SSRI, with the fewest cytochrome P450 (CYP450)-mediated drug interactions. (Stahl, 2021). Escitalopram (Lexapro) 20 mg daily is also the appropriate choice.

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For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on ethical prescribing or decision-making. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals based on ethical prescribing guidelines or decision-making?

When prescribing antidepressant therapy, it's important to consider drug contraindications and alterations. For the selected antidepressant, escitalopram (Lexapro), don't use it with MAOIs or within 14 days after stopping an MAOI to prevent serotonin syndrome. This is a contraindication due to the risk of serotonin syndrome, a potentially life-threatening condition characterized by agitation, confusion, rapid heart rate, and other symptoms. Escitalopram is primarily metabolized in the liver; it should be used with caution in patients with severe hepatic impairment or elderly with decreased liver function. In such cases, a lower initial dose and slower titration may be considered, as drug clearance may be reduced.

In all cases, ethical prescribing involves a thorough assessment of the patient's medical history, medication history, and potential contraindications. Dosing adjustments, when necessary, should be made to maximize therapeutic benefits while minimizing risks and adverse effects.

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Include any “checkpoints” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.

In depression treatment, scheduled follow-up appointments are vital for assessing progress, managing side effects, and adjusting treatment. Common intervals are every 4 weeks. At the checkpoint, like follow-up data at weeks 4, 8, 12, etc., make treatment decisions based on the patient's response, side effects, and goals. If there's significant improvement with few side effects, stick with the current dose. If there's limited improvement or major side effects, consider increasing the dose (if not already at the maximum) or trying a different antidepressant. In cases of long-term remission with a low risk of recurrence, think about tapering or discontinuing the medication.

At Week 4 (four weeks after initiating treatment), it's the time to evaluate the patient's initial response to medication. Inquire about changes in mood, sleep patterns, energy levels, and any side effects.

At Week 8 (eight weeks after starting treatment), it's time to reassess the patient's mood and overall well-being. Keep an eye on side effects, whether they're taking the medication as prescribed, any changes in their medical conditions, and any suicidal ideation.

At Week 12 (12 weeks after starting treatment), continue monitoring the patient's mood and how they're responding to treatment. Check for any signs that their depression might be coming back or getting worse.

Ongoing Follow-up (Regularly, every 3-6 months): Continue to monitor the patient's mental health, medication adherence, and any emerging side effects. Evaluate the need for ongoing treatment.

 

Reference:

Levenson JC, Kay DB, Buysse DJ. The pathophysiology of insomnia. Chest. 2015 Apr;147(4):1179-1192. doi: 10.1378/chest.14-1617. PMID: 25846534; PMCID: PMC4388122.

Stahl, S. M. (2021). Stahl's essential psychopharmacology: Neuroscientific basis and practical applications (5th Ed.) Cambridge University Press.

Lexapro Labeling-508; Reference ID: 4036381 https://www.fda.gov/media/135185/download

  Reply to  these posts with a reflection of their response.Minimun 200words each one 

1. In this week’s discussion, I was able to: Integrate nursing and related sciences into the delivery of care to patients. I was also able to analyze quality initiatives to improve patients’ health outcomes.

     Alternative and Complementary medicines are considered health-cultured practices, that are not part of traditional medicine and that have been part of the holistic culture of the populations. They are used as an alternative or in addition to traditional medical treatments with the goal of improving patients’ outcomes (Lee, Richard, et al., 2022). Alternative and Complementary medicines can include therapies such as dietary supplements, herbs, acupuncture, Chinese medicine, yoga, reiki, ayurvedic medicine, complementary supplements, etc (Adeniyi, Washington, et al., 2021). The reasons for using these alternative methods can be many: Cultural, religious, economic, etc. However, as many people use it most of the time, it is important to analyze this point and share our opinion on this matter.

     It is well-known that many people from the general population are used to taking self-prescribed natural treatments. In the first term, we can name herbal medications. In general culture and even in religion, people believe that herbs have a good effect in the treatment of some diseases such as hypertension or Diabetes Mellitus. Many people think that herbs were created by God in order to provide natural treatment for diseases. Actually, many people believe that herbal medicines are better choices as they don’t have undesirable effects at all. Some people prefer to take natural medication rather than medical treatments, as they think that pharmacological preparations are made of chemical and artificial ingredients that can be harmful to the body. Moreover, people trust natural treatments for cancer, as it is thought that they can potentially inhibit oncology cell growth. However, researchers have determined that about 80% of the patients do take their pharmacological treatment in addition to a natural treatment (Adeniyi, Washington et, al. 2021). However, there are some natural treatments that, in addition to pharmacological treatment, can cause adverse effects, for example, ginkgo can increase the anticoagulant effect; ginseng and some teas can decrease the anticoagulant effect (Izzo 2005). Other natural treatments such as exercises, meditation, yoga, and acupuncture, are also used and well-known as coadjuvants to release stress and that way help improve clinical condition.

     In conclusion, the healthcare team needs to accept that alternative and natural treatments are part of the culture and religion of the population. So it is very important to establish a good and trustable relationship with the patient, so he/she can feel confident enough to tell the healthcare provider about the alternative treatments that are been taken, as sometimes they can help, but sometimes they can be harmful. In the end, a closed and trustable relationship with the patient and a good assessment is the basis for the best possible outcomes.

2. The allopathic or conventional medicine is practiced by doctors and health personnel. Complementary medicine refers to the practice of medicine that complements conventional medicine, that is, it is used in conjunction with conventional medicine. An example includes the use of acupuncture in pain management. Alternative medicine, on the other hand, is the use of complementary and alternative medicine as a replacement for traditional medicine

Complementary and alternative medicine are very varied. Within them, we find natural products related to botanical medicine and probiotics. We also find mind and body therapy, such as meditation techniques, yoga, acupuncture, hypnotherapy, and deep relaxation exercises, among others.

In the treatment of cancer, it has been proven that the use of complementary and alternative therapy has been useful in managing the patient’s symptoms. However, it is not considered a miraculous medicine in the cure of cancer; it simply helps, in conjunction with conventional medicine, to manage some symptoms that cancer patients experience. For example, acupuncture treatment can help alleviate symptoms related to pain, therapeutic massages have been shown according to some research studies to reduce depression, pain, and depressive anxiety disorders related to cancer disease (American Cancer Society, 2019). However, some harmful health effects and interactions with medications have been shown, especially in treatment with botanical medicine, so it is recommended that your doctor be notified of its use before starting treatment to avoid drug interactions and potential harm to health (American Cancer Society, 2019).

Holistic medicine, unlike conventional medicine, is not focused on treating diseases as allopathic medicine does. Rather, it is preventative medicine, although it can be integrated with allopathic medicine in some instances. Holistic medicine is based on the fact that illnesses appear as a consequence or result of environmental, physical, social and/or emotional imbalances (Cannon, 2023). Therefore, its essence is to heal the body and mind with alternative therapies to maintain their balance and prevent the onset of illness. Holistic medicine dates back to ancient times, and after the appearance of conventional medicine, it was somewhat abandoned. However, in around the 1960s in Europe and America, the properties of holistic medicine regained popularity. An example of this is homeopathy, which can be used to recover body vitality as holistic medicine, but it can also be used as an adjunct treatment to allopathic medicine. The use of phytotherapy has had great success in the management of certain diseases, such as those of the immune system, favoring healing.

In the management of high blood pressure and diabetes, the practice of natural medicine plays a fundamental role as an adjunct to integrated medicine; even natural medicine can be used as a technique for the prevention of these diseases. The practice of a balanced and healthy diet, daily physical exercise, relaxation techniques and stress management are determining factors in the prevention of arterial hypertension, cancer, and diabetes. Other natural medicine can be used, for example omega 3 is an essential oil that can be used to prevent special hyperlipidemia in patients with chronic disease.

Both allopathic and holistic medicine have an important role on patient care, and together, they can give the best result in the management of the disease. As a provider, we need to offer the patient different option to treat their condition, but we need to be respectful of patients’ autonomy in their decision.

Healthcare resources are scarce, and policy makers and health planners make choices between alternative uses of resources. Economic evaluation is important when allocating scarce resources. Cost–benefit analysis, cost effectiveness analysis, and cost utility analysis are decision-making tools that help policy makers and planners examine healthcare costs and the consequences of alternative health programs, services, and interventions.Prepare at least a 5-page overview of cost effectiveness analysis and cost–benefit analysis as decision making tools in the allocation of health resources.