Advanced Psychopharmacology and Health Promotion

Unit 7 Discussion Case Study 600W. APA. 4 references due 10-17-23.

Case Study:

· Your patient is a 36-year-old woman with bipolar disorder and anxiety. She has been stable on a combination of fluoxetine and olanzapine for two years.  She is morbidly obese at 340 pounds at 5’5” in height, has type II diabetes, hypertension, and hyperlipidemia.  She has concerns about her weight and has tried numerous ‘fad diets’ to no avail.  She explains she has lost, at most, 15 pounds and has been able to keep it off for three months. 

· She has three children, one of which is severely disabled, and a husband who has a terminal diagnosis. She expresses worry that her weight will impact her ability to care for her disabled child when her husband dies.  She reports she eats out frequently due to her children’s busy schedules.  She is a stay-at-home mother but gets little exercise and performs no regular physical activity. 

· She reports feelings of shame that she can no longer orgasm on the rare occasions her husband has the energy and desire to be intimate.

  
Questions: 

· What would be your approach to managing this patient’s weight concern? (Discuss at least two aspects of your approach). Please support your answer with research-based evidence. 

· What would be our approach to the sexual side effects she is experiencing? 

· If you suggested additional medication, look up your state’s prescribing laws. Are PMHNP’s able to prescribe the medication you recommended? 

· Please include the subjective and objective information in this post.

All responses must by supported by correct APA 7th edition formatted citations and references.

1. What would be your approach to managing this patient's weight concern? (Discuss at least two aspects of your approach). Please support your answer with research-based evidence. 

1. Non-pharmacological Approach

2. Pharmacological Approach

2. What would be our approach to the sexual side effects she is experiencing?

· Lifestyle changes, avoidance of stress or anxiety, drug therapy, physical activity, and psychological support. 

3. If you suggested additional medication, look up your state's prescribing laws. Are PMHNPs able to prescribe the medication you recommended?

· Additional medication is Flibanserin, the PMHNP can prescribe this without the supervision of a psychiatrist since PMHNP is Psychiatric-Mental Health Nurse Practitioner which is Board Certified. And/or hormonal therapy which is usually prescribed by a gynecological physician.

Please see the explanation below. 

Step-by-step explanation

Approach to solving the question:

· Identification of clinical problems that a bipolar patient attained, classification of nonpharmacological and pharmacological treatment of a patient, planning for therapies essential in treating the patient, and evaluation of the process for positive outcomes.

1. What would be your approach to managing this patient's weight concern? (Discuss at least two aspects of your approach). Please support your answer with research-based evidence. 

1.
Non-pharmacological Approach

·
Detailed explanation: this is an approach that is essential in managing a patient's weight concern without the involvement of drugs to treat the weight problem. This aim is to provide alternative prevention in treating weight gain without any chemical side effects on the body. 
(Focus (American Psychiatric Publishing). 2021)

·
Examples: (1) Physical activity such as aerobic exercises, can help the patient maintain her within the normal range which will enhance her conditions of type II diabetes, hypertension, and hyperlipidemia and help in improving her sexual desire, (2) Healthy food intake such as fruits, vegetables, whole grains, nonsalty and fatty foods, can reduce the risk of weight gain, and increase blood pressure and cholesterol which can improve her well being, and (3) Peer support which is very helpful in getting motivation from those people who are experiencing the same situation with the patient which increase the chance of preventing to expose her self to stress and anxiety. 

2.
Pharmacological Approach  

·
Detailed explanation: this is an approach that is essential in managing a patient's weight concern with the involvement of drugs to treat the weight problem. This aim is to provide drug prevention to avoid the progression of the presenting clinical manifestation and development of complications. 
(Focus (American Psychiatric Publishing). 2021)

·
Examples: (1) Phentermine-topiramate which is helpful in cutting the cravings, and lessens the appetite during stress and anxiety. This is helpful to increase the chance of weight gain especially when the patient attempted to expose herself to overeating.

2. What would be our approach to the sexual side effects she is experiencing?

· The approach
 to the sexual side effects the patient is experiencing are lifestyle changes, avoidance of stress or anxiety, drug therapy, physical activity, and psychological support. Sexual side effects based on the scenario are linked to the stress, anxiety, and weight gain of the patient. It is important that as a healthcare provider, you must assess the related factors to the presenting problem. For a patient with bipolar disorder, it is important to have a care plan to follow so that the patient will be encouraged to do. Lifestyle changes such as physical activity and eating healthy food are the most important since the patient tends to eat out frequently due to her children's busy schedules, gets little exercise, and performs no regular physical activity. If the patient is healthy, their sexual desire will improve and help her to have orgasms since her hormones are healthy. Avoidance of stress and anxiety is helpful in sexual desire because a patient who is stressed can affect the sympathetic nervous system limiting the blood flow to the genitals to achieve genital arousal. Also, therapies are helpful in correcting abnormal hormones in the body system. 
(Lancet Public Health. 2021)

3. If you suggested additional medication, look up your state's prescribing laws. Are PMHNPs able to prescribe the medication you recommended?

· Since the patient is already taking combinations of olanzapine which is useful in treating schizophrenic episodes and fluoxetine which is an antidepressant used in bipolar disorder and linked to weight loss, the additional medication that I may recommend is Flibanserin which is an antidepressant helpful in correcting the imbalance of the neurotransmitters in the brain increasing the chance to sexual desire. The PMHNP can prescribe this medication in all states because Flibanserin should be prescribed by a psychiatrist physician and certified nurse practitioners. Another additional medication that I would like to conclude is hormonal therapy like estrogen therapy because the abnormal level of hormones in the body affects the body in sexual desires and can lead to stress and anxiety. 
(Psychiatr Serv. 2018)

REFERENCES:

· Vancampfort D, Firth J, Correll CU, et al.. The impact of pharmacological and non-pharmacological interventions to improve physical health outcomes in people with schizophrenia: a meta-review of meta-analyses of randomized controlled trials. 
Focus (American Psychiatric Publishing).2021;19:116-28. 

· Mitchell K.R., Lewis R., O'Sullivan L.F., Fortenberry J.D. What Is Sexual Wellbeing and Why Does It Matter for Public Health? 
Lancet Public Health. 2021;6:e608-e613. doi: 10.1016/S2468-2667(21)00099-2.  

· Blackmore M.A., Carleton K.E., Ricketts S.M. Comparison of collaborative care and colocation treatment for patients with clinically significant depression symptoms in primary care. 
Psychiatr Serv. 2018;69(11):1184-1187. doi: 10.1176/appi.ps.201700569.

 

Your patient is a 42-year-old female that arrives in the ED with complaints of fever and not feeling well. She is currently undergoing chemotherapy for bladder cancer. She has an indwelling urinary catheter with scant amount of dark, foul smelling urine. She has a temperature of 102.2F, HR 136, BP 110/50 and RR 28. She is allergic to penicillin and Sulfa.

• What type of shock is she experiencing?
• What interventions do you anticipate the doctor will order?
• What can you teach this patient about prevention of infection?
• The doctor orders Bactrim. What should you be concern about? Why?

Minimum of 250 words. 

Original Work, No Plagiarism, Cite and Reference

Using the following 
linkLinks to an external site., watch the video entitled, ”
Data Cherry Picking”
https://ori.hhs.gov/images/ddblock/SCRIPT-03-hi-res.mp4 and answer the following discussion questions:

1. What pressures are being faced by the postdoctoral fellow?

2. How might those pressures change how he conducts his research?

3. What ethical issues are raised if misleading data are presented in a grant application or publication?

4. How do you balance work/home life? Should you be able to discuss these expectations with the PI or clinical director?

Respond to at least two of your colleagues on two different days by offering additional ideas to overcome the barriers to strategies suggested by your colleagues and/or by offering additional ideas to facilitate dissemination.

1.            The first step in the dissemination process is identifying stakeholders. Once stakeholders have been identified, you must build a rapport before presenting your information (Gllagher-Ford et al., 2011). You then need to plan how you are going to engage stakeholders and how you will deliver the information to them.

            Dissemination strategies require clearly defined goals, sources, and audiences (Crable et al., 2023). Strategies that best suit me are a mixture of traditional and social media. For traditional, I would like to create a PowerPoint to present to stakeholders. For social media, I could create a social media platform to raise awareness on the topic being discussed. I chose PowerPoint because they are typically easy for everyone to follow, and it can be printed so stakeholders can take notes during the presentation if they would like. I chose a social media platform because social media allows information to be delivered rapidly to a large group of people (Bhatt et al., 2021).

            Barriers that may be encountered while using PowerPoint to disseminate evidence-based practice are having a computer and a projector to show the information, and depending on where you are presenting, this may not be available. To overcome this barrier, I would go to the site before the presentation and scope out the resources that I may need to bring with me to the presentation. Despite being widely used, stakeholders may have differing opinions on using social media to spread information about their organization.  I would talk with stakeholders beforehand and learn their opinions on the use of social media. It may be that they are okay with using social media, just that there are certain things they do not want to be shared about their organization. Talking with them beforehand would allow me to use social media and respect their opinions.

Bhatt, N. R., Czarniecki, S. W., Borgmann, H., van Oort, I. M.,Esperto, F., Pradere, B., van Gurp, M., Bloemberg, J., Darraugh, J., Roupret, M., Loeb, S., N’Dow, J., Ribal, M. J., & Giannarini, G. (2021). A Systematic Review of the Use of Social Media for Dissemination of Clinical Practice Guidelines. European Urology Focus, 7(5), 1195–1204. https://doi.org/10.1016/j.euf.2020.10.008

Erika L. Crable, Colleen M. Grogan, Jonathan Purtle, Scott C. Roesch, & Gregory A. Aarons. (2023). Tailoring dissemination strategies to increase evidence-informed policymaking for opioid use disorder treatment: study protocol. Implementation Science Communications, 4(1), 1–14. https://doi.org/10.1186/s43058-023-00396-5

Gallagher-Ford, L., Fineout-Overhold, E., Melnyk, B.M. &  Stillwell, S.B. (2011). Evidence-based practice step-by-step:  Implementing an evidence-based practice changeLinks to an external site.. American Journal of Nursing, 111(3), 54-60

2. To disseminate EBP, I would be most likely to use posters and social media. Posters are versatile and can help merge the strengths of oral presentations and published works (White et al., 2021, p. 257) Depending on where information is disseminated, presenters can verbally present information while having a visual aid for passersby. One barrier to poster use would be choosing what information to present with limited space. There are certain standards for research posters, but with an EBP project, the presenter may have control over fonts and colors to make it visually appealing. Posters also give presenters the option to interact with interested parties. They can add anecdotes and personality to the poster. While listeners may not remember all the information on the poster, they are much more likely to remember a funny story or a smiling face.  My second choice of dissemination would be social media. There are several nuances to using social media and navigating and not being in control of how information is received and redistributed can be a barrier, but it is undoubtedly the most timely and cost-effective way to reach vast and diverse audiences. Posts/tweets, online newsletters, and blogs are all possibilities for distributing information. It may not be the best way to present lots of statistics and technical information, but it can be used to start discussions and help people engage with research (Lord et al., 2019). It also allows the public to be aware of new advancements. Social media can be used to divulge high points and digestible information and offer to link full studies for those interested. Social media is also immediate making it a timelier option. The method I would be least inclined to use is journal publications. Every journal has specific formats for the articles they publish. If my goal is to get published, my reporting and organization methods would need to reflect those standards. Manuscripts are permanent once published. They can be updated or debunked but, like social media, there will always be proof of it. The biggest barrier to manuscripts is the length of time it takes from the study to publication. As we see, healthcare moves fast, and best practices are constantly changing. It may take years to research, complete the study/project, and make all revisions necessary to get published. By then, the research may be obsolete. This is a universal problem but as a DNP, the focus is improving the practice of nursing. That is not possible to do with outdated information. While it is important that research reaches wide audiences, it is my philosophy to personally connect with nurses working directly with patients to improve nursing practice at the patient-facing level. It’s imperative that those nurses be included in quality improvement efforts to ensure that new protocols are feasible and create better workflows (Siedlecki, 2023). 

References 

Lord, S. E., Seavey, K. M., Oren, S. D., Budney, A. J., & Marsch, L. A. (2019). Digital presence of a research center as a research dissemination platform: Reach and resources. JMIR Mental Health, 6(4), e11686. https://doi.org/10.2196/11686 

Siedlecki, S. L. (2023). Translational science. Clinical Nurse Specialist, 37(2), 54–57. https://doi.org/10.1097/nur.0000000000000728 

White, K. M., Dudley-Brown, S., & Terhaar, M. F. (2021). Translation of evidence into nursing and healthcare (3rd ed., pp. 255–268). Springer Publishing Company. 

You have been promoted to nurse manager of your unit. You realize that to function effectively, you must have a better understanding of your organization’s structure and, specifically, the chain of command.

Find and analyze the organizational chart of the healthcare organization you are currently working for or for one that you have encountered in your nursing experience.

• Give a brief description of the organization of the healthcare structure used in your facility.
• Describe the chain of command used in your organization and identify the people you report to and those who report to you.
• Consider the following and discuss how the chain of command is used to implement change.
  • Based on the organization chart, what leadership structure is used in the organization—hierarchical or flat?  How does this affect implementing change?
  • Does this organization use a shared governance model for nursing?
  • When nurses have an idea for changing a process and they make a decision as a group, where do they go with their suggestions? (the director? the unit manager?)
• Explain why understanding this information is important to your success.

APA format.

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