describes the clinical problem and the following:

• Reason for choosing this topic
• The PICOT question
• Possible integration of the evidenced that you found in clinical practice
• Methods to evaluate the effectiveness of implementation

Vaccination for Infants and Children Worksheet

Complete the following –using references provided in pediatric prep information. (5 points )

Age	Recommended Childhood Vaccines Include route of administration (oral, IM or Subcutaneous) And indicate if a combination vaccine is indicated.	Special Considerations for Age and Vaccine Site of Administration, Angle of Insertion, and Needle and Syringe Size, etc.
Within 12 hours of Birth
2 months
4 months
6 months
12 months
15-18 months
2 years
5 years
11-12 years
16 years
Infants 6 months to 18 years of age

2

Review the technique, sites, angle of insertion, correct sized syringe and needle, combination vaccines, and recommended vaccines for each age group. Here are a few questions to get you thinking… (points 2.5)

1. A 15 month old child is to be immunized.

a. What immunizations will you consider him/her?

b. List supplies needed for these immunizations.

c. What size syringe will you select for these immunizations? What size needle?

d. What angle of insertion will you use in administering these immunizations?

2. A 6 month old infant is to receive all her recommended vaccines today.

a. What is the name of the combination vaccine used that is given at this visit and what are the 3 components?

b. Which site do you select for her injections?

c. What do you tell the child’s parents before they leave the clinic?

3. A seventh grader requests an MMR booster

a. What questions will you ask to determine if he/she is an appropriate candidate?

b. What will you tell the student (client) before he/she leaves the clinic?

Post your cost comparison document from Unit 2. Assuming you might prescribe this drug for your patient, how would you minimize cost or assist the patient in getting the medication at the lowest cost possible. What resources are available to reduce drug costs? Find at least 2 resources for free or reduced cost medications. Respond to two other student posts as per the discussion board rubric.

This is my paper from week 2

Comparing pharmacological alternatives, prescription, and over-the-counter drugs stand out. A good example is “Lisinopril,” a hypertension treatment, and “Ibuprofen,” a painkiller. Consider 10mg “Lisinopril” prescription medication. Both brand-name and generic versions exist. Retail chains, small pharmacies, and internet platforms charge various prices for Lisinopril, which is also affected by geography in the US. In contrast, “Ibuprofen” is an over-the-counter painkiller available without a prescription. Its range of formulas and amounts makes it affordable and widely used. Comparing the generic and brand-name versions of Lisinopril, which have the same active component but cost less, may show the economic benefits of choosing the generic. This comparison between prescription and OTC drugs shows how regulation, accessibility, and cost affect pharmaceuticals. Starting the prescription drugs, Lisinopril is commonly prescribed for the management of hypertension. For a 10mg dose, let us examine the price differences between brand and generic options at different types of pharmacies in different locations in the United States.

Prescription Drug – Lisinopril 10mg (30 tablets)

1. Large Chain Pharmacy – Walgreens (Chicago, IL):

Brand: Prinivil – Cash Price: $45.00

Generic: Lisinopril – Cash Price: $12.00

2. Grocery Store Associate Pharmacy – Publix (Atlanta, GA):

Brand: Zestril – Cash Price: $43.00

Generic: Lisinopril – Cash Price: $10.00

3. Privately Owned Local Pharmacy – Victory Pharmacy (Seattle, WA):

Brand: Qbrelis – Cash Price: $47.00

Generic: Lisinopril – Cash Price: $11.00

4. Pharmacy Associated with Big Box Store – Walmart (Dallas, TX):

Brand: Prinizide – Cash Price: $50.00

Generic: Lisinopril – Cash Price: $9.00

Lisinopril 10mg (30 pills) price among pharmacies and geolocations gives useful information into pharmaceutical cost trends. The study found that generic Lisinopril is much cheaper than brand-name versions at all drugstore types and locations. Walgreens in Chicago sells Prinivil for $45.00 and Lisinopril for $12.00. Zestril, the brand, costs $43.00 at Publix, an Atlanta supermarket store associate pharmacy, whereas Lisinopril costs $10.00. Victory Pharmacy, a Seattle-based private pharmacy, sells Qbrelis for $47.00 and Lisinopril for $11.00. Walmart in Dallas follows this pattern, selling Prinizide for $50 and Lisinopril for $9.00. The consistent price disparity emphasizes the economic logic of adopting generic products wherever available, particularly for financially strapped people seeking cheaper healthcare. This report highlights the significant influence of pharmacy choice on patient spending, pushing consumers to be cautious and aware of the pharmaceutical market.

Over-the-Counter Drug – Ibuprofen 200mg (100 tablets):

1) Large Chain Pharmacy – CVS (New et al.):

Brand: Advil – Cash Price: $10.00

Generic: Ibuprofen – Cash Price: $7.00

2) Grocery Store Associate Pharmacy – Kroger (Houston, TX):

Brand: Motrin – Cash Price: $9.00

Generic: Ibuprofen – Cash Price: $6.00

3) Privately Owned Local Pharmacy – Greenway Pharmacy (San et al.):

Brand: Nurofen – Cash Price: $11.00

Generic: Ibuprofen – Cash Price: $7.50

4) Pharmacy Associated with Big Box Store – Target (Minneapolis, MN):

Brand: Up & Up – Cash Price: $8.00

Generic: Ibuprofen – Cash Price: $5.00

Ibuprofen 200mg (100 pills) pricing across pharmacies and locales reveals an interesting price difference between brand-name and generic choices. This difference highlights the constant benefit of generic versions, supporting the pharmaceutical industry trend. In huge chain pharmacies like CVS in New York City, Advil costs $10.00, and Ibuprofen costs $7.00. Kroger, a Houston grocery store associate pharmacy, sells Motrin for $9.00 and generic Ibuprofen for $6.00. San Francisco's privately held Greenway Pharmacy follows this approach. Brand-name Nurofen costs $11.00, whereas generic Ibuprofen costs $7.50. Even in 'big box' pharmacy sections, Target in Minneapolis perpetuates the idea with $8.00 Up & Up and $5.00 generic Ibuprofen. The constancy of this pattern supports the economic case for buying generic drugs. This decision saves customers money and emphasizes educated consumption. This research highlights how competition and price tactics shape customer choices in the market. It promotes intelligent pharmaceutical selections and cost-effective solutions by encouraging active healthcare expenditure evaluation.

Comparing brand names with generic prescription and over-the-counter medications shows that generics are cheaper across pharmacies. This cost disparity supports educated consumption by choosing generic versions. The results highlight the importance of pharmacy selection in determining medicine procurement costs as individuals traverse the complicated healthcare environment. The long-term trend shows that well-informed healthcare choices may save money and ensure access to excellent treatments.

 

Describe a form of interdisciplinary collaborative care you’ve seen on your current assigned clinical or work site. Then have a discussion about the following questions:

• Who coordinated that care? What was the nurse’s role in ascertaining that the care was provided?
• Was the patient’s outcome met? How or why not? What would you, a novice nurse-leader, have done differently to achieve the patient’s goals?

Week 6 ion channel —2 Peer Response 600w. due 10-12-23

Please read and respond to at least two of your peers' initial postings. You may want to consider the following questions in your responses to your peers:

· Compare and contrast your initial posting with those of your peers.  

· How are they similar or how are they different?

· What information can you add that would help support the responses of your peers?

· Ask your peers a question for clarification about their post.

· What most interests you about their responses? 

Please be sure to validate your opinions and ideas with citations and references in APA format.

IA

This is a very interesting case since Sam is only 19 years old and has a history of major depressive disorder (MDD) and also generalized anxiety disorder (GAD). At a glance, I noticed that his behavior has highs and lows since he has gone from being violent by throwing a chair at a store window to having a “resounding moment” where everything makes sense. Among many other clues, this leads me to believe Sam can be newly diagnosed with bipolar disorder with manic episodes.

After consulting our DSM-5-TR book on page 140, I also realized Sam presents multiple symptoms that represent the diagnosis of bipolar disorder. To start Sam preceded a “psychotic breakdown” along with a history of MDD. He has also presented physiologic changes like diminished sleep, and other signs, and symptoms of a manic episode (Diagnostic and Statistical Manual of Mental Disorders: DSM-5-TR 2022). It also appears he is more talkative than usual by engaging his colleagues for long hours in conversation. Adding on to his symptoms it also appears he has engaged in high-risk behaviors such as drinking and sexual relations which was not his norm before. He has thought of himself as being better than the professors which match the ideas of grandiosity.

At first, I wasn’t sure which medication to prescribe, but it seems he would benefit from lithium since lithium is an antimanic medication primarily used to treat bipolar disorder(Lithium, 2022). Sources such as MedlinePlus indicate lithium is a mood stabilizer and works by releasing dopamine and serotonin in the brain (Lithium: MedlinePlus Drug Information 2023). Just like this case, I have seen many but now I see things differently since I know more in-depth the signs and symptoms as well as researching the proper medication.

References:

Diagnostic and statistical manual of mental disorders: DSM-5-TR (5th ed.). (2022). . American Psychiatric Association Publishing.

Stahl, S. M. (2021). Stahl’s essential psychopharmacology: The Prescriber’s Guide (7th ed.). Cambridge University Press.

Townsend., K. I. M., Mary C. (2020). Essentials of Psychiatric Mental Health Nursing, 8th edition. F.A. Davis.

MAM

Week 6, Medication for Bipolar Disorders

What diagnosis do you believe may apply to this individual?

The patient is a young boy presenting with a 'psychotic break,' characterized by reckless behaviors, sudden and unconventional decision-making (such as changing his major in university), distractibility, reduced need for sleep, a heightened sense of knowledge and grandiosity (believing he can teach courses in the university), and unusual beliefs regarding the nature of reality and his newfound appreciation for life. He is also engaging in high-risk behaviors, including excessive drinking, sexual activity, violence, increased spending, and initiating numerous projects without completing any. These symptoms are indicative of a manic episode (if they present more than a week).

Considering the patient's history of Major Depressive Disorder (MDD) and anxiety disorder, the diagnosis of Bipolar I Disorder (BPD) has been established. It is crucial to first rule out any medical problems, brain trauma, substance abuse, and other mental disorders that may be included in the differential diagnosis of BPD. The primary distinction between bipolar I and II lies in the nature of the manic or hypomanic episodes. In bipolar I disorder, individuals experience full manic episodes that typically last for at least one week. On the other hand, bipolar II disorder is characterized by hypomanic episodes, which are milder in intensity and shorter in duration, lasting no more than four days (Stahl, 2021).

Beyond this key difference, there are also variations in the clinical course and family history associated with these two subtypes. Individuals with bipolar II disorder tend to receive their diagnosis later in life, and their first experience of hypomania occurs at an older age compared to those with bipolar I disorder. These distinctions in age of onset and diagnostic patterns contribute to the differentiation between bipolar I and II disorders (Brancati et al., 2023).

Manic often presents with the feeling of being extremely important and having a very high opinion of oneself, sometimes to the point of having false beliefs about one's capabilities (Howse et al., 2023). In this case, the patient believes he is capable of teaching at the university. An experienced Psychiatric Mental Health Nurse Practitioner (PMHNP) can conduct a thorough history assessment to determine whether the psychosis is linked to brain traumas, substance use, schizoaffective disorders, or BPD.

What classifications of medications can be used to treat this disorder? Which medication do you recommend and why?

When the patient is diagnosed with Bipolar disorder, it indicates the need for mood stabilizers. Various mood stabilizers are available, including Lithium, Lamotrigine, Valproic Acid, and Carbamazepine. According to Stahl (2021), Lithium is considered the foundational and standard treatment for bipolar disorder and acute mania. However, this medication comes with several potential side effects, such as tremors, nephrotoxicity (Diabetes Insipidus), hypothyroidism, dyspepsia, nausea, vomiting, diarrhea, weight gain, hair loss, acne, sedation, decreased cognition, and incoordination. It can also lead to EB Stain anomalies in the fetus if taken during pregnancy.

Lithium additionally has a very low therapeutic index, signifying that the lethal dose of this medication is very close to the therapeutic level in the blood. Therefore, monitoring of blood levels of this medication is crucial throughout the treatment process. Regular assessments of kidney function, thyroid hormone levels, and electrolytes are also necessary. Lithium effectively stabilizes mood and reduces the severity of manic episodes (Stahl, 2021). Alongside medication, psychotherapy, such as cognitive-behavioral therapy or family-focused therapy, plays an essential role in treatment. It is equally important to educate the patient's family members about the disease and the treatment process.

References

Brancati, G. E., Nunes, A., Scott, K., O’Donovan, C., Cervantes, P., Grof, P., & Alda, M. (2023). Differential characteristics of bipolar I and II disorders: a retrospective, cross-sectional evaluation of clinical features, illness course, and response to treatment. International Journal of Bipolar Disorders, 11(1), 25. https://doi.org/10.1186/s40345-023-00304-9

Howse, J., Kanter, J., Muhammad, Q. C., & Wojcik, K. D. (2023). Mood disorders with psychotic features: Diagnostic considerations and treatment challenges. Psychiatric Annals, 53(4), 160-165. https://doi.org/10.3928/00485713-20230313-01Links to an external site.

Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical application (5th ed.).