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HCA 501 – Health Care in America essays, exam questions and answers

51. What financial benefit does a small rural hospital reap by qualifying for the designation, Critical Access Hospital?

It can receive specific federal grants for serving vulnerable populations
It can use its beds for either acute care or long-term care as needed
It can increase its profitability by receiving special payments for emergency services
It can receive cost-plus reimbursement under Medicare Part A

52. Which principle of ethics requires caregivers to involve the patient in medical decision making?
Paternalism
Fidelity
Beneficence
Autonomy
53. What is the main drawback of a living will?
It cannot cover all possible situations
The patient’s agent may not act in the patient’s best interest
The person formulating a living will must have a court appointed
guardian HCA 501 – Health Care in America essays, exam questions and answers
It becomes invalid when the patient becomes incompetent
54. To participate in Medicare and Medicaid, a health care facility must be
conditioned
accredited
certified
licensed

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55. Which entity oversees the licensure of health care facilities?
The Joint Commission
Federal government
State government
Local county or city government

HCA 501 – Health Care in America essays, exam questions and answers

56. Institutional theory predicts that
for-profit and nonprofit organizations will imitate each other when faced with similar regulatory and legal constraints
as an enterprise increases in size, its unit overhead costs would
decrease
as a hospital increases in size, its economies of scale dissipate
in competitive markets, both for-profit and nonprofit organizations HCA 501 – Health Care in America essays, exam questions and answers
would deliver certain essential community benefits
57. Under this method, a primary care physician decides whether or not to refer a patient to a specialist.
Preauthorization
Prospective uti I ization review
Disease management
Closed-panel utiIization
58. When an MCO adopts capitation as the primary method of payment, which service is likely to be carved out?
Surgery
Gatekeeping
Mental health
Primary care
59. Which HMO model is likely to require heavy capital outlays to expand into new markets?
Staff model
Group model
Network model
IPA model
60. PPOs were created by __ in response to HMOs’ growing market share.
physicians
insurance companies
hospitals
independent contractors

61. Which of these organizations was specifically created to bring management expertise to physician group practices?
Virtual organizations
Physician-hospital organizations
Provider-sponsored organizations
Management services organizations
62. Where two organizations cease to exist, and a new corporation is formed:
Acquisition
Merger
Joint venture
Alliance

HCA 501 – Health Care in America essays, exam questions and answers
63. Regional health systems are often:
horizontally integrated
vertically integrated
formed into virtual organizations
formed into alliances
64. requires that any health care need is recognized, evaluated, and addressed.
long-term care
health care
individual care
total care
65. What is the primary goal of long-term care?
help patients with increased pain
cure deadly diseases
preventing institutionalization
providing socialization

66. This type of clinical category for long-term care is non-medical care provided to support and requires no active medical treatments. HCA 501 – Health Care in America essays, exam questions and answers.
personal care
nursing care
custodial care
subacute care
67. What is the most common cause of mental retardation in America?
Down’s syndrome
autism
spina bifida
epilepsy
68. The prevalence of HIV in the population has:
increased
decreased
stayed the same
none of the above
69. Which law created two categories for nursing home certification purposes?
Nursing Home Reform Act
Medical Advancement Act
Nursing Home Alternatives Act
None of the above
70. Who is the primary payer for health care services for the elderly?
Medicaid
Medicare
private insurance
none of the above
71. What was the sixth leading cause of death for Hispanic males in 2003?
heart disease
malnutrition
diabetes
homicide

72. What factor has been found to be associated with the highest injury-related mortality rate among Indian children?
cultural
prenatal care
social
poverty
73. Most medically uninsured adults are employed but are not covered because:
their employer does not offer health benefits
they do not work enough hours to qualify for health benefits
they cannot afford the premium HCA 501 – Health Care in America essays, exam questions and answers
all of the above.
74. Education and psychotherapy for children with HIV is an example of:
heatlh-related support services
population-based community health services
personal medical and preventive services
none of the above
75. Who is the principal user of the health care system?
men
children
elderly
women
76. What is defined as a “high-impact” area?
areas with over 3,000 rural health clinics
areas that serve at least 4,000 migrant workers for at least two months per year.
areas that serve at least 12,000 community members per year
none of the above.

77. Which type of patient is most likely to experience disability and more severe medical illnesses?
diabetic
cancer
depressed
elderly
78. All of the following are factors effecting the growth in health spending EXCEPT:
uninsured patients
hospital services
prescription drugs
physician services
79. What is partly responsible for the surplus of specialists in the US?
greater access to financial aid
technology
increased population
none of the above
80. Defensive medicine leads to:
decreased cesarean sections
legal risks
unnecessary tests and services
none of the above
8l. What was the most sweeping price-control initiative for Medicare?
Economic Stabilization Program HCA 501 – Health Care in America essays, exam questions and answers
Balanced Budget Act
Omnibus Budge Reconciliation
none of the above

82. What is NOT an implication for access to health and health care delivery?
access to medical care is one of the key determinants of health
measures of access reflect changes across the board
access is increasingly linked to quality of care
access is a significant benchmark in assessing effectiveness
83. Which main type of access refers to the type, site, and purpose of health services?
potential
realized
equitable
inequitable
84. What do proponents believe regarding clinical practice guidelines?
it reduces utilization
decreases scientific research
it promotes lower costs and better outcomes
increases technology
85. When public policy pertains to or influences the pursuit of health they become:
health policy
population policy
prevention policy
none of the above
86. A problem associated with government involvement in US Health Is: HCA 501 – Health Care in America essays, exam questions and answers
escalating costs
bureaucratic inflexibility
excessive regulation
all of the above

87. An insurance risk pool:
helps people acquire private insurance otherwise unavailable
helps insurance companies decrease their costs
helps employers obtain insurance for their employees
none of the above
88. All BUT which of the following presidents is mentioned in the text as contributing major changes in health policies:
President Lyndon Johnson
President John Kennedy
President Harry Truman
President Bill Clinton
89. Which branch of government is the most active in policymaking?
executive
judicial
legislative
none of the above
90. Which group have policies been created to provide access to health care?
elderly
poor children
poor adults
all of the above
9l. What is the third main concern of health care policy?
cost
research
qualify of care
technology
92. The majority of employers currently offer:
long-term plan
defined benefit plan
deductible health plan
none of the above

93. The greatest challenge in insurance is:
maintaining a balance between healthy and sick enrollees
maintaining a balance between young and elder enrollees
maintaining a balance between premium and nonpremium enrollees
none of the above
94. What is a disadvantage of managed competition?
the medical infrastructure fluctuates
increased government bureaucracy
it cannot guarantee that everyone would have equal access to care
all of the above
95. Infectious diseases and health care must be viewed from a
perspective.
cost
cultural
global
multi-faceted
96. What is a strategy used to deal with nurse shortages?
investments in training
improvement in work environments
opening new schools
all of the above
97. What approach will be used in order to improve quality and productivity? HCA 501 – Health Care in America essays, exam questions and answers
collaborative team approach
collaboration
cross-training
all of the above

98. What is the goal of evidence-based medicine?
increase the amount of patients
increase the availabilty of prescription medicine
increase the value of medicine
none of the above
99. What type of integration is represented by a chain of nursing homes?
Ve integration
Network
Horizontal integration
Diversification
100. Where a new corporation created by two partnering organizations remains independent:
Acquisition
Merger
Joint venture
Alliance

HCA 501 – Health Care in America essays, exam questions and answers

HCA 225 Weekly Essay Assignment Discussion Papers – Week 1 Discussion

Your state legislature is considering the following health policy proposal: 
Mandating that all female students entering the 6thgrade obtain the cervical cancer vaccine
. Discuss the policy and economic questions associated with this proposal.

Interest groups do not have the power to pass laws; however, they can and do influence policy decisions. Provide examples and discuss how interest groups have influenced health policy decisions. For example, motorcycle helmet laws – if we know that the use of a safety helmet can protect individuals from severe head and neck injuries in an accident, why do some states not have full helmet laws for all motorcycle riders? HCA 225 Weekly Essay Assignment Discussion Papers.

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Week 2 Discussion

Health policy is profoundly influenced by value-driven issues that cut across the entire U.S. policy landscape. Describe both positions (i.e., for and against) a current debate regarding a value-driven health policy issue.

What interests in health policy do you bring to this class? McLaughlin’s Table 1-1 specifies the knowledge and skills called for in a policy analyst. HCA 225 Weekly Essay Assignment Discussion Papers. Discuss for which of these areas do you currently feel prepared, and in which ones do you want to gain competence? Why?

 

Week 3 Discussion

Argue the following statement: Despite our relatively high level of healthcare expenditure, we may still be getting enough for our money.

Discuss the social forces and other issues behind the move toward industrialization. Does industrialization threaten professional autonomy and control? HCA 225 Weekly Essay Assignment Discussion Papers. If yes, why? If no, why? Please provide examples to support your position.

 

Week 4 Discussion

There may be a great deal of debate about the monopoly power of the medical profession. Discuss whether the following statement is true: “It is clear that the profession once exerted that power and that the power of the profession has been waning.” Please provide examples to support your responses. HCA 225 Weekly Essay Assignment Discussion Papers.

What role should government play in controlling increases in the cost of care and the cost of health coverage? What different choices do state and federal policymakers have in containing costs.

 

Week 5 Discussion

Discuss why those who propose a one-size-fits-all approach to solving health care problems are operating in a simplistic never-never land that ignores the complex interests of many stakeholders.

Discuss why large and small employers seem to have different interests.

 

Week 6 Discussion

Table 5-1 in
Health Policy Analysis: An Interdisciplinary Approach
is long, but it is not intended to exhaust the possibilities. What federal government alternatives would you like to add to that array? Post and defend your alternatives for inclusion in an expanded Table 5-1. HCA 225 Weekly Essay Assignment Discussion Papers.

Discuss why obtaining true free market competition would require considerable government intervention.

 

Week 7 Discussion

Discuss value-driven care initiatives in relation to pay-for-performance and medical home initiatives (demonstration projects).

Discuss the different interests (and why) medical professionals and the institutions they work in can have ? even when they present a united front to the consumer.

***************

Assignments

Week 1 Assignment – Health Policy Reflection Paper

Details:

Think about the complexity of the issues that decision makers must consider when analyzing health policy problems and write a reflective paper of 500?750 words, addressing your position on the following:

Describe how and why a health policy analyst needs to consider policy problems using political and legal analysis.

Prepare this assignment according to the guidelines found in the GCU Style Guide, located in the Student Success Center. HCA 225 Weekly Essay Assignment Discussion Papers.

 

This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the HCA 225 Weekly Essay Assignment Discussion Papers assignment.

 

Week 2 Assignment – Analysis of a Stakeholder Pape

Details:

As the health care debate moves forward, there has been a lot of discussion about stakeholders, and possible winners and losers.

Write a research paper of 750?1,000 words, addressing the following:

Select one stakeholder (e.g., AMA, ANA, insurers, hospitals, drug companies).

Describe the stakeholder’s positions on healthcare reform.

Why has the stakeholder taken these positions?

A minimum of three scholarly sources must be cited. Remember that Wikipedia is not considered a scholarly source.

Prepare this HCA 225 Weekly Essay Assignment Discussion Papers according to the guidelines found in the GCU Style Guide, located in the Student Success Center.

This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.

 

Week 3 Assignment – U.S. Health Care System Paper

Details:

Write a research paper of 500?750 words, addressing the following:

Compare the U.S. health care system to another country’s health care system focusing on why another country can achieve better health outcomes for less money?

A minimum of three scholarly sources must be cited. Remember that Wikipedia is not considered a scholarly source.

Prepare this assignment according to the guidelines found in the GCU Style Guide, located in the Student Success Center.

This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the HCA 225 Weekly Essay Assignment Discussion Papers.

 

Week 4 Assignment – Social Contract Position Essay

Details:

Review “Breaking the Old Social Contract” on page 70 in Health Policy Analysis: An Interdisciplinary Approach and write a paper of 500?750 words reflecting on this new social contract.

If you were to think about a new social contract, what would it be? Think in terms of two contracts: one between the citizenry and the state, and one between the professionals and the health care system.

Prepare this assignment according to the guidelines found in the GCU Style Guide, located in the Student Success Center.

This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the HCA 225 Weekly Essay Assignment Discussion Papers.

 

Week 5 Assignment – Health Reform Plan Paper

Details:

Write a research paper of 500?750 words on the following:

Why did the Clinton Health Reform Plan in the 1990s never pass?

Discuss three changes that would make the healthcare act better.

A minimum of three scholarly sources must be cited. Remember that Wikipedia is not considered a scholarly source.

Prepare this assignment according to the guidelines found in the GCU Style Guide, located in the Student Success Center.

This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.

 

Week 6 Assignment – Health Care Access Paper

Details:

Search for proposal(s) by your state governor to deal with a health care access problem and write a paper of 1,250?1,500 words on the following:

Outline the elements of the current program and the governor’s proposals for improved access.

A minimum of three scholarly sources must be cited. Remember that Wikipedia is not considered a scholarly source.

Prepare this assignment according to the guidelines found in the GCU Style Guide, located in the Student Success Center.

This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment. HCA 225 Weekly Essay Assignment Discussion Papers.

STRAYER HSA 525 Health Financial Management Assignments

Assignment Exercise 4-1: Contractual Allowances

Physician office revenue for visit code 99214 has a full established rate of $72.00. Of ten different payers, there are nine different contracted rates, as follows:

Payer Contracted Rate

FHP $35.70

HPHP 58.85

MC 54.90

UND 60.40

CCN 70.20

MO 70.75

CGN 10.00

PRU 54.90

PHCS 50.00

ANA 45.00

 

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For each payer, compute the contractual allowance.

 

Assignment Exercise 4-2 Revenue Sources and Grouping Revenue

The Metropolis Health System has revenue sources from operations, donations, and interest income. The revenue from operations is primarily received for services. MHS groups its revenue STRAYER HSA 525 Health Financial Management Assignments

first by cost center. Within each cost center the services revenue is then grouped by payer.

For each of the six situations, indicate its number(1 through 6). Then place and X in the column(s) that represent the correct revenue source(s) for the item. The six situations are:

(1) ICU stay billed to employee’s insurance program.-

(2) Lab test paid for by an individual.-

(3) Pathology work performed for the state.-

(4) ICU stay billed to member’s health plan.-

(5) ICU stay billed for Medicare beneficiary.-

(6) Series of allergy tests run for eligible Medicaid beneficiary.-

 

Medicare
 
Medicaid
 
Other Public
 
Patients
 
Commercial
 
Managed

Programs Insurance
 
Care Contracts

(1)

(2)

(3)

(4)

(5)

(6)

 

Assignment Exercise 5-1 Grouping Expenses by Cost Center

The Metropolis Health System’s Rehabilitation and Wellness centre offers outpatient therapy and return-to-work services plus cardiac and pulmonary rehabilitation to get people back to a normal way of living. The Rehabilitation and Wellness Center expenses include the following:

· Nursing Salaries

· Physical Therapist Salaries

· Occupational Therapist Salaries

STRAYER HSA 525 Health Financial Management Assignments

· Cardiac Rehab Salaries

· Patient Education Coordinator Salary

· Nursing Supplies

· Physical Therapist Supplies

· Occupational Therapist Supplies

· Cardiac Rehab Supplies

· Pulmonary Rehab Supplies

· Training Supplies

· Clerical Office Supplies

· Employee Education

Decide how many cost centers should be used for the above expenses at the Center and where each expense should be located.

Assignment Exercise 5-2

Find a listing of expenses by diagnosis or by procedure. The source of the list can be internal or external. Comment upon whether you believe the expense grouping used is appropriate. Would you have grouped the expenses in another way? STRAYER HSA 525 Health Financial Management Assignments

COH 315: Principles of Epidemiology – Final Part 1

Calculations and Interpretations: Answer the following questions in the space provided. Show all of your work.

1. Evidence of an increased risk of lung cancer associated with cigarette smoking was sought by Doll and Hill. In one study, 649 lung cancer cases were matched by age, and gender to 649 controls; 647 of the cases and 622 of the control had a history of smoking cigarettes. COH 315: Principles of Epidemiology.

a. Name the type of study.

b. Create the appropriate 2X2 table for the study. (2 points)

Lung Cancer Controls

Smokers 647 622

Nonsmokers 2 27

Total 649 649

c. Calculate the appropriate measure of association for the study. (4 points)

d. Interpret the results. (2 points)

2. In another study, the smoking habits of 34,445 male physicians were obtained by mailed questionnaires. Deaths among these physicians over the subsequent years were identified though contact with the office of the Registrar General. The death rates from lung cancer of these physicians classified by smoking habits were :

Standardized Death Rates per 1000 Persons Aged 35 or More per Year

Nonsmokers 0.07

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Cigarette Smokers 0.96

a. Name the type of study. (2 points)

b. Calculate the Relative Risk for smokers as compared to nonsmokers. (6 points)

c. Interpret the results (2 points) COH 315: Principles of Epidemiology

Annual Death Rates per 100,000 Persons

Exposure Category Lung Cancer Coronary Heart Disease

Heavy Smokers 166 599

Nonsmokers 7 422

a. Calculate the relative risk from Lung Cancer Mortality for Heavy Smokers compared to non smokers. ( 4 points)

b. Calculate the attributable risk of Lung Cancer from smoking. (4 points)

c. Interpret the results. (2 points)

d. Calculate the percent attributable risk of Coronary Heart Disease due to smoking (4 points)

e. Interpret the results. (2 points)

3. Convert the following incidence rates to attributable risk using the additive model: (5 points)

Incidence Rates Relative Risks

Factor A Factor A

_ + _ +

Factor B – 3.0 9.0

_____________________________________ __________________________________

+ 15.0 21.00

4. Calculate the concordance rate for the following data: (5 points)

Twin 1

Has Leukemia Does Not Have Leukemia

Twin 2 Has Leukemia 14 1

Does Not Have Leukemia 26 36

COH 315: Principles of Epidemiology

NURS 6630 Weekly Discussion Essay Assignment Papers Week 1 discussion

Discussion: Foundational Neuroscience

As a psychiatric mental health nurse practitioner, it is essential for you to have a strong background in foundational neuroscience. In order to diagnose and treat clients, you must not only understand the pathophysiology of psychiatric disorders, but also how medications for these disorders impact the central nervous system. These concepts of foundational neuroscience can be challenging to understand. NURS 6630 Weekly Discussion Essay Assignment Papers Therefore, this Discussion is designed to encourage you to think through these concepts, develop a rationale for your thinking, and deepen your understanding by interacting with your colleagues.

Learning Objectives

Students will:

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Analyze the agonist-to-antagonist spectrum of action of psychopharmacologic agents

Compare the actions of g couple proteins to ion gated channels

Analyze the role of epigenetics in pharmacologic action

Analyze the impact of foundational neuroscience on the prescription of medications

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press *Preface, pp. ix–x

Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Chapter 1, “Chemical Neurotransmission” NURS 6630 Weekly Discussion Essay Assignment Papers.

Chapter 2, “Transporters, Receptors, and Enzymes as Targets of Psychopharmacologic Drug Action”

Chapter 3, “Ion Channels as Targets of Psychopharmacologic Drug Action”

Document: Midterm Exam Study Guide (PDF)

Document: Final Exam Study Guide (PDF)

Required Media

Laureate Education (Producer). (2016i). Introduction to psychopharmacology [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 3 minutes.

Accessible player

Optional Resources

Laureate Education (Producer). (2009). Pathopharmacology: Disorders of the nervous system: Exploring the human brain [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 15 minutes.

Dr. Myslinski reviews the structure and function of the human brain. Using human brains, he examines and illustrates the development of the brain and areas impacted by disorders associated with the brain. NURS 6630 Weekly Discussion Essay Assignment Papers.

Accessible player

Laureate Education (Producer). (2012). Introduction to advanced pharmacology [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 8 minutes.

In this media presentation, Dr. Terry Buttaro, associate professor of practice at Simmons School of Nursing and Health Sciences, discusses the importance of pharmacology for the advanced practice nurse.

Accessible player

To prepare for this Discussion:

Review this week’s Learning Resources.

Reflect on concepts of foundational neuroscience.

Week 3 discussion

Discussion: The Impact of Ethnicity on Antidepressant Therapy

Major depressive disorder is one of the most prevalent disorders you will see in clinical practice. Treatment for this disorder, however, can vary greatly depending on client factors, such as ethnicity and culture. As a psychiatric mental health professional, you must understand the influence of these factors to select appropriate psychopharmacologic interventions. For this NURS 6630 Weekly Discussion Essay Assignment Papers Discussion, consider how you might assess and treat the individuals in the case studies based on the provided client factors, including ethnicity and culture.

Learning Objectives

Students will:

Assess client factors and history to develop personalized plans of antidepressant therapy for adult and geriatric clients

Analyze factors that influence pharmacokinetic and pharmacodynamic processes in adult and geriatric clients requiring antidepressant therapy

Analyze the impact of ethnicity on antidepressant therapy

Evaluate efficacy of treatment plans

Apply knowledge of providing care to adult and geriatric clients presenting for antidepressant therapy

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press. NURS 6630 Weekly Discussion Essay Assignment Papers.

Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Chapter 7, “Antidepressants”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

Note: To access the following medications, click on the The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

amitriptyline

bupropion

citalopram

clomipramine

desipramine

desvenlafaxine

doxepin

duloxetine

escitalopram

fluoxetine

fluvoxamine

imipramine

ketamine

mirtazapine

nortriptyline

paroxetine

selegiline

sertraline

trazodone

venlafaxine

vilazodone

vortioxetine

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Note: Retrieved from Walden Library databases.

Howland, R. H. (2008a). Sequenced treatment alternatives to relieve depression (STAR*D). Part 1: Study design. Journal of Psychosocial Nursing and Mental Health Services, 46(9), 21–24. doi:10.3928/02793695-20080901-06

Note: Retrieved from Walden Library databases.

Howland, R. H. (2008a). Sequenced treatment alternatives to relieve depression (STAR*D). Part 2: Study outcomes. Journal of Psychosocial Nursing and Mental Health Services, 46(19), 21–24. doi:10.3928/02793695-20081001-05

Note: Retrieved from Walden Library databases.

Yasuda, S.U., Zhang, L. & Huang, S.-M. (2008). The role of ethnicity in variability in response to drugs: Focus on clinical pharmacology studies. Clinical Pharmacology & Therapeutics, 84(3), 417–423. Retrieved from https://web.archive.org/web/20170809004704/https://www.fda.gov/downloads/Drugs/ScienceResearch/…/UCM085502.pdf

To prepare for this Discussion:

Note: By Day 1 of this week, your Instructor will have assigned you to one of the following case studies to review for this Discussion. To access the following case studies, click on the Case Studies tab on the Stahl Online website and select the appropriate volume and case number. NURS 6630 Weekly Discussion Essay Assignment Papers.

Case 1: Volume 1, Case #1: The man whose antidepressants stopped working

Case 2: Volume 1, Case #7: The case of physician do not heal thyself

Case 3: Volume 1, Case #29: The depressed man who thought he was out of options

Review this week’s Learning Resources and reflect on the insights they provide.

Go to the Stahl Online website and examine the case study you were assigned.

Take the pretest for the case study.

Review the patient intake documentation, psychiatric history, patient file, medication history, etc. As you progress through each section, formulate a list of questions that you might ask the patient if he or she were in your office.

Based on the patient’s case history, consider other people in his or her life that you would need to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.).

Consider whether any additional physical exams or diagnostic testing may be necessary for the patient.

Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance.

Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient.

Review the posttest for the case study. NURS 6630 Weekly Discussion Essay Assignment Papers.

Week 7 discussion

Discussion: Sleep/Wake Disorders

It is not uncommon to experience a night or two of disrupted sleep when there is something major going on in your life. However, sleep/wake disorders are much more than an occasional night of disrupted sleep. A recent report from the Centers for Disease Control and Prevention estimated that between 50 and 70 million American have problems with sleep/wake disorders (CDC, 2015). NURS 6630 Weekly Discussion Essay Assignment Papers Although the vast majority of Americans will visit their primary care provider for treatment of these disorders, many providers will refer patients for further evaluation. For this Discussion, you consider how you might assess and treat the individuals based on the provided client factors.

Learning Objectives

Students will:

Assess client factors and history to develop personalized therapy plans for clients with sleep/wake disorders

Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for sleep/wake disorders

Evaluate efficacy of treatment plans for clients presenting for sleep/wake therapy NURS 6630 Weekly Discussion Essay Assignment Papers.

Apply knowledge of providing care to adult and geriatric clients presenting for sleep/wake disorders

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Chapter 11, “Disorders of Sleep and Wakefulness and Their Treatment”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication. NURS 6630 Weekly Discussion Essay Assignment Papers.

Review the following medications:

For insomnia

alprazolam

amitriptyline

amoxapine

clomipramine

clonazepam

desipramine

diazepam

doxepin

flunitrazepam

flurazepam

hydroxyzine

imipramine

lorazepam

nortriptyline

ramelteon

temazepam

trazodone

triazolam

trimipramine

zaleplon

zolpidem

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Note: Retrieved from Walden Library databases.

Davidson, J. (2016). Pharmacotherapy of post-traumatic stress disorder: Going beyond the guidelines. British Journal of Psychiatry, 2(6), e16-e18. doi:10.1192/bjpo.bp.116.003707. Retrieved from http://bjpo.rcpsych.org/content/2/6/e16

To prepare for this Discussion:

Note: By Day 1 of this week, your Instructor will have assigned you to one of the following case studies to review for this Discussion. To access the following case studies, click on the Case Studies tab on the Stahl Online website and select the appropriate volume and case number.

Case 1: Volume 2, Case #16: The woman who liked late-night TV

Case 2: Volume 2, Case #11: The figment of a man who looked upon the lady

Case 3: Volume 1, Case #5: The sleepy woman with anxiety

Review this week’s Learning Resources and reflect on the insights they provide.

Go to the Stahl Online website and examine the case study you were assigned.

Take the pretest for the case study. NURS 6630 Weekly Discussion Essay Assignment Papers

Review the patient intake documentation, psychiatric history, patient file, medication history, etc. As you progress through each section, formulate a list of questions that you might ask the patient if he or she were in your office.

Based on the patient’s case history, consider other people in his or her life that you would need to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.). NURS 6630 Weekly Discussion Essay Assignment Papers.

Consider whether any additional physical exams or diagnostic testing may be necessary for the patient.

Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance.

Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient.

Review the posttest for the case study.

Week 9 discussion

Discussion: Presentations of ADHD

Although ADHD is often associated with children, this disorder is diagnosed in clients across the lifespan. While many individuals are properly diagnosed and treated during childhood, some individuals who have ADHD only present with subsyndromal evidence of the disorder. These individuals are often undiagnosed until they reach adulthood and struggle to cope with competing demands of running a household, caring for children, and maintaining employment. For this NURS 6630 Weekly Discussion Essay Assignment Papers Discussion, you consider how you might assess and treat individuals presenting with ADHD.

Learning Objectives

Students will:

Assess client factors and history to develop personalized therapy plans for clients with ADHD

Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for ADHD

Evaluate efficacy of treatment plans

Apply knowledge of providing care to adult and geriatric clients presenting for antidepressant therapy

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear. NURS 6630 Weekly Discussion Essay Assignment Papers.

Clancy, C.M., Change, S., Slutsky, J., & Fox, S. (2011). Attention deficit hyperactivity disorder: Effectiveness of treatment in at-risk preschoolers; long-term effectiveness in all ages; and variability in prevalence, diagnosis, and treatment. Table B. KQ2: Long-term(>1 year) effectiveness of interventions for ADHD in people 6 years and older.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press. NURS 6630 Weekly Discussion Essay Assignment Papers.

To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Chapter 12, “Attention Deficit Hyperactivity Disorder and Its Treatment”

Stahl, S. M., & Mignon, L. (2012). Stahl’s illustrated attention deficit hyperactivity disorder. New York, NY: Cambridge University Press.

To access the following chapter, click on the Illustrated Guides tab and then the ADHD tab.

Chapter 4, “ADHD Treatments”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication. NURS 6630 Weekly Discussion Essay Assignment Papers.

Review the following medications:

For ADHD

armodafinil

amphetamine (d)

amphetamine (d,l)

atomoxetine

bupropion

chlorpromazine

clonidine

guanfacine

haloperidol

lisdexamfetamine

methylphenidate (d)

methylphenidate (d,l)

modafinil

reboxetine

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Note: Retrieved from Walden Library databases.

Optional Resources

Hodgkins, P., Shaw, M., McCarthy, S., & Sallee, F. R. (2012). The pharmacology and clinical outcomes of amphetamines to treat ADHD: Does composition matter? CNS Drugs, 26(3), 245–268. doi:10.2165/11599630-000000000-00000

Psychiatric Times. (2016). A 5-question quiz on ADHD. Retrieved from http://www.psychiatrictimes.com/adhd/5-question-quiz-adhd?GUID=AA46068B-C6FF-4020-8933-087041A0B140&rememberme=1&ts=22072016

To prepare for this Discussion:

Note: By Day 1 of this week, your Instructor will have assigned you to one of the following case studies to review for this Discussion. To access the following case studies, click on the Case Studies tab on the Stahl Online website and select the appropriate volume and case number.

Case 1: Volume 1, Case #13: The 8-year-old girl who was naughty NURS 6630 Weekly Discussion Essay Assignment Papers

Case 2: Volume 1, Case #14: The scatter-brained mother whose daughter has ADHD, like mother, like daughter

Case 3: Volume 2, Case #21: Hindsight is always 20/20, or attention deficit hyperactivity disorder

Review this week’s Learning Resources and reflect on the insights they provide.

Go to the Stahl Online website and examine the case study you were assigned.

Take the pretest for the case study.

Review the patient intake documentation, psychiatric history, patient file, medication history, etc. As you progress through each section, formulate a list of questions that you might ask the patient if he or she were in your office.

Based on the patient’s case history, consider other people in his or her life that you would need to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.).

Consider whether any additional physical exams or diagnostic testing may be necessary for the patient.

Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance.

Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient.

Review the posttest for the case study.

Week 10 discussion

Discussion: Influencing Social Change

Individuals with psychiatric mental health disorders are frequently stigmatized not only by society as a whole, but also by their friends, family, and sometimes healthcare providers. In your role, however, you have the opportunity to become a social change agent for these individuals. For this Discussion, consider how you might make a positive impact for your clients and advocate for social change within your own community. NURS 6630 Weekly Discussion Essay Assignment Papers.

Learning Objectives

Students will:

Apply strategies to become a social change agent for psychiatric mental health

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Angermeyer, M. C., Matschinger, H., & Schomerus, G. (2013). Attitudes towards psychiatric treatment and people with mental illness: Changes over two decades. The British Journal of Psychiatry, 203(2), 146–151. Retrieved from http://bjp.rcpsych.org/content/203/2/146.full

Bui, Q. (2012). Antidepressants for agitation and psychosis in patients with dementia. American Family Physician, 85(1), 20–22. Retrieved from http://www.aafp.org/journals/afp.html NURS 6630 Weekly Discussion Essay Assignment Papers.

Note: Retrieved from from the Walden Library databases.

Dingfelder, S. F. (2009). Stigma: Alive and well. American Psychological Association, 40(6), 56. Retrieved from http://www.apa.org/monitor/2009/06/stigma.aspx

Jenkins, J. H. (2012). The anthropology of psychopharmacology: Commentary on contributions to the analysis of pharmaceutical self and imaginary. Culture, Medicine and Psychiatry, 36(1), 78–79. doi:10.1007/s11013-012-9248-0

Note: Retrieved from from the Walden Library databases.

Price, L. H. (2010). Violence in America: Is psychopharmacology the answer? Brown University Psychopharmacology Update, 21(5), 5. Retrieved from http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1556-7532

Note: Retrieved from from the Walden Library databases.

Optional Resources

Bennett, T. (2015). Changing the way society understands mental health. National Alliance on Mental Illness. Retrieved from http://www.nami.org/Blogs/NAMI-Blog/April-2015/Changing-The-Way-Society-Understands-Mental-Health

Mechanic, D. (2007). Mental health services then and now. Health Affairs, 26(6), 1548–1550. Retrieved from https://web.archive.org/web/20170605094514/http://content.healthaffairs.org/content/26/6/1548.full

Rothman, D. J. (1994). Shiny, happy people: The problem with “cosmetic psychopharmacology.” New Republic, 210(7), 34–38.

To prepare for this Discussion:

Reflect on how you might influence social change for psychiatric mental health. NURS 6630 Weekly Discussion Essay Assignment Papers.

NURS 6630 – The woman who liked a late-night TV

Case 1: Volume 2, Case #16: The woman who liked a late-night TV

The patient is a 70-year-old woman who exhibits symptoms of depression due to loneliness. Her son and aide assist in her care. She is hard of hearing and has other cardiological problems. She also has a family history of depression. Her ailment worsened because she was unable to sleep and consequently has s restless leg syndrome. NURS 6630 – The woman who liked a late-night TV.

The three questions I will ask the patient in my office are as follows;

1. Do you feel sleepy or do you have sleep attacks during the day and describe your usual night sleep (Hours of sleep, quality of sleep, etc.)? Lack of sleep results in more health problems and worsens depression.

2. Have any members in your family been depressed? Genetic loading in depression, anxiety or schizophrenia. Get medication effectiveness of family similar to patient’s disorder.

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3. Have you ever suffered from depression, anxiety or similar problems? Pt exhibited symptoms of depression-crying, sadness etc. Patient’s mother has history of depression. NURS 6630 – The woman who liked a late-night TV.

Patient’s son and the home health aide are the persons assisting with his care. So, I will direct my questions to his mother as well as her home health aide about depression history, sleeping pattern, the activity of daily living and patient’s compliance with the medication regimen.

physical exams and diagnostic tests

Actigraphy is a device that measures and records movement. It is worn on the wrist and can be used as a rough measure of the sleep-wake cycle. It is useful for assessing insomnia, circadian rhythm disorders, movement disorders and an assortment of rare events (Sadock, 2015).

Polysomnography is the continuous attended, comprehensive recording of the biophysiological changes that occur during sleep. It is recorded at night and lasts between 6 and 8 hours. Brainwave activity, eye movements, submental electromyography activity, nasal-oral airway flow, respiratory effort, oxyhemoglobin saturation, heart rhythm, and leg movement during sleep are measured (Sadock, 2015). NURS 6630 – The woman who liked a late-night TV.

Three differential diagnoses

1. Major Depressive Disorder (MDD)

A major depressive disorder is a depressed mood that persists for least two weeks duration or longer. Signs and symptoms of major depression include poor appetite, insomnia or hypersomnia, low energy or fatigue, low self-esteem, lack of concentration or difficulty making decisions, and feelings of hopelessness, significant weight loss or weight gain and recurring thought of death or suicide (Sadock, 2015) NURS 6630 – The woman who liked a late-night TV. The predisposing factors to this illness include responses to a significant loss such as grief, a financial ruin from natural disaster, or severe medical illness or disability and other factors such as environmental (stressful life events), genetic and physiological or other psychosocial factors. All currently available antidepressants may take 3 to 4 weeks to exert significant therapeutic effects, although they may begin to show their effects earlier. Examples of antidepressant medications include SSRIs, TCAs, and MAOIs.

2. Insomnia

Sleep is regulated by basic mechanisms, and when these systems go awry, sleep disorders occur. Sleep disorders are both dangerous and difficult to treat. Obstruction Sleep Apnea (OSA) Insomnia is defined as difficulty initiating sleep. DSM-5 defines insomnia disorder as dissatisfaction with sleep quantity or quality with one or more of the following symptoms: difficulty in maintaining sleep with frequent awakenings and early morning inability to return to sleep. Primary insomnia is a condition resulting from too much arousal both at night and day time and may progress to a first major depressive episode (Stahl, 2013). Pharmacologic treatment includes Benzodiazepines, zolpidem, eszopiclone, zaleplon, and Trazodone.

3. Restless Leg Syndrome (RLS)

RLS also known as Ekbom syndrome is an uncomfortable, subjective sensation of the limbs. Usually, the legs, sometimes described as a “creepy crawly” feeling, and the irresistible urge to move the legs when at rest or while trying to fall asleep. Patients often report the sensation or any walking on the skin and crawling feelings in their legs. It worsens at night and moving the legs or walking helps to alleviate the discomfort. RLS is associated with fibromyalgia, rheumatoid arthritis, diabetes, thyroid diseases and COPD. Treatment for RLS includes levodopa, benzodiazepine, opiates, and antiepileptic (Gabapentin) drugs. NURS 6630 – The woman who liked a late-night TV Non- pharmacological treatment is massage, hot baths, hot/cold compress to affected areas, moderate exercises and alcohol avoidance at bedtime (Sadock, 2015).

Insomnia is the major diagnosis for this Patient because it is an ongoing issue.

Two pharmacologic agents for the patient’s sleep/wake therapy

The patient is on Citalopram for depression. Insomnia, fatigue and multiple painful physical complaints are side effects the medication. Citalopram increases in serotonin concentrations at serotonin receptors in parts of the brain and body other than those that cause therapeutic actions. For example, the unwanted actions of serotonin in sleep centers cause insomnia in the patient. These symptoms cause the disorder not to go into remission. Hypnotics medications will enhance remission rates for both patients with major depression and generalized anxiety disorder with insomnia. For example, Eszopiclone added to SSRI will lead to higher remission rate among the clients. Slow wave sleeping enhancing agents can also be administered to augment SSRIs/ SNRIs. These include gabapentin and Trazadone (Stahl, 2013). NURS 6630 – The woman who liked a late-night TV.

1.Eszopiclone

Eszopiclone is a class of non-benzodiazepine hypnotic; alpha 1 isoform selective agonist of GABA-A/benzodiazepine receptors. Eszopiclone is an effective treatment for Primary insomnia, Chronic insomnia, Transient insomnia, Insomnia secondary to psychiatric or medical conditions and Residual insomnia following treatment with antidepressants. Inhibitory actions in sleep centers may provide sedative-hypnotic effects. NURS 6630 – The woman who liked a late-night TV While Eszopiclone is a hypnotic agent with a chemical structure unrelated to benzodiazepines, barbiturates, or other drugs with known hypnotic properties, it interacts with the gamma-aminobutyric acid-benzodiazepine (GABA-BZ) receptor complex. Eszopiclone binds selectively to the brain alpha subunit of the GABA A omega-1 receptor. Side effects include unpleasant taste, Sedation, Dizziness, Dose-dependent amnesia, Nervousness, Dry mouth, headache. Dosages include 2-3mg at bedtime (Drugbank.ca, 2018).

2. Trazodone

Trazodone binds at the 5-HT2 receptor; it acts as a serotonin agonist at high doses and a serotonin antagonist at low doses. Like fluoxetine, trazodone’s antidepressant activity likely results from blockage of serotonin reuptake by inhibiting serotonin reuptake pump at the presynaptic neuronal membrane. If used for long time periods, postsynaptic neuronal receptor binding sites may also be affected. The sedative effect of trazodone is likely the result of alpha-adrenergic blocking action and modest histamine blockade at the H1 receptor. It weakly blocks presynaptic alpha2-adrenergic receptors and strongly inhibits postsynaptic alpha1 receptors. Trazodone does not affect the reuptake of norepinephrine or dopamine within the CNS (Drugbank.ca, 2018).

Dosing for Depression as a monotherapy: initial 150 mg/day in divided doses; can increase every 3–4 days by 50 mg/day as needed; maximum 400 mg/day (outpatient) or 600 mg/day (inpatient), split into two daily doses. Initial 25–50 mg at bedtime; increase as tolerated, usually to 50–100 mg/day, but some patients may require up to full antidepressant dose range. NURS 6630 – The woman who liked a late-night TV Augmentation of other antidepressants in the treatment of depression: dose as recommended for insomnia (Stahl, 2013). Side effects include Nausea, vomiting, edema, blurred vision, constipation, dry mouth, Dizziness, sedation, fatigue, headache, incoordination, tremor, Hypotension, syncope, Occasional sinus bradycardia (long-term), Rare side effects are rash, and priapism NURS 6630 – The woman who liked a late-night TV.

Check points

The patient responded positively to faxes received from therapies. Now that she had her cochlear implant inserted, she can hear people thus ending some of her frustrations. NURS 6630 – The woman who liked a late-night TV She needs to get involved in different activities with people her age. In addition to her medication, the patient will benefit more from non-pharmacological interventions such as psychosocial therapies, social skills training, family-oriented therapies, case management, group therapy, and cognitive behavioral therapy (Sadock, 2015).

Lessons learned

From psychopharmacology point of view, I will not prescribe anti-stimulant to patient. She will be on hypnotics, and I will augment with another SSRIs/SNRIs and gabapentin for neuropathic pain. NURS 6630 – The woman who liked a late-night TV As prescribed medications become effective, she will sleep well at night and the leg pain or spasm will melt away.

Reference

Drugbank, ca (2018). Hypnotics medications. Retrieved July 10th, 2018 from https://www.drugbank.ca/drugs/DB00402

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (Eleventh edition.). Philadelphia: Wolters Kluwer. NURS 6630 – The woman who liked a late-night TV.

Stahl, S. M. (2013).  NURS 6630 – The woman who liked a late-night TVStahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press *Preface, pp. ix–x.

NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology Discussions

NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology

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Syllabus

Course Calendar

Course Overview

Course Information

Resource List

Week 1

Week 2

Week 3

Week 4

Week 5

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Week 6

Week 7

Week 8

Week 9

Week 10

Week 11

Student Support

Walden Links

Guidelines and Policies

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Week 7: Therapy for Clients With Pain and Sleep/Wake Disorders

From negative changes in mood to problems concentrating, pain and sleep/wake disorders can have a tremendous impact on clients’ lives. When clients suffer from these disorders, they often seek medical care with the intent of receiving medications to manage symptoms. NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology Discussions However, many of the medications used to treat pain and sleep/wake disorders may be addictive, making thorough client assessments and close follow-up care essential. To prescribe appropriate therapies with client safety in mind, you must understand not only the pathophysiology of these disorders, but also the pharmacologic agents used to treat them.

This week, as you study therapies for individuals with pain and sleep/wake disorders, you examine the assessment and treatment of clients with these disorders. You also explore ethical and legal implications of these therapies.

Photo Credit: [riskms]/[iStock / Getty Images Plus]/Getty Images

Discussion: Sleep/Wake Disorders

It is not uncommon to experience a night or two of disrupted sleep when there is something major going on in your life. However, sleep/wake disorders are much more than an occasional night of disrupted sleep. A recent report from the Centers for Disease Control and Prevention estimated that between 50 and 70 million American have problems with sleep/wake disorders (CDC, 2015). NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology Discussions Although the vast majority of Americans will visit their primary care provider for treatment of these disorders, many providers will refer patients for further evaluation. For this Discussion, you consider how you might assess and treat the individuals based on the provided client factors.

Learning Objectives

Students will:

Assess client factors and history to develop personalized therapy plans for clients with sleep/wake disorders

Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for sleep/wake disorders

Evaluate efficacy of treatment plans for clients presenting for sleep/wake therapy

Apply knowledge of providing care to adult and geriatric clients presenting for sleep/wake disorders

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology Discussions Be sure to read all sections on the left navigation bar for each chapter.

Chapter 11, “Disorders of Sleep and Wakefulness and Their Treatment”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication. NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology Discussions.

Review the following medications:

For insomnia

alprazolam

amitriptyline

amoxapine

clomipramine

clonazepam

desipramine

diazepam

doxepin

flunitrazepam

flurazepam

hydroxyzine

imipramine

lorazepam

nortriptyline

ramelteon

temazepam

trazodone

triazolam

trimipramine

zaleplon

zolpidem

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Note: Retrieved from Walden Library databases.

Davidson, J. (2016). Pharmacotherapy of post-traumatic stress disorder: Going beyond the guidelines. British Journal of Psychiatry, 2(6), e16-e18. doi:10.1192/bjpo.bp.116.
003707. Retrieved from 
bjpo.rcpsych.org/content/
2/6/e16

To prepare for this Discussion:

Note: By Day 1 of this week, your Instructor will have assigned you to one of the following case studies to review for this Discussion. To access the following case studies, click on the Case Studies tab on the Stahl Online website and select the appropriate volume and case number. NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology Discussions.

Case 1: Volume 2, Case #16: The woman who liked late-night TV

Case 2: Volume 2, Case #11: The figment of a man who looked upon the lady

Case 3: Volume 1, Case #5: The sleepy woman with anxiety

Review this week’s Learning Resources and reflect on the insights they provide.

Go to the Stahl Online website and examine the case study you were assigned.

Take the pretest for the case study.

Review the patient intake documentation, psychiatric history, patient file, medication history, etc. As you progress through each section, formulate a list of questions that you might ask the patient if he or she were in your office.

Based on the patient’s case history, consider other people in his or her life that you would need to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.). NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology Discussions.

Consider whether any additional physical exams or diagnostic testing may be necessary for the patient.

Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance.

Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient.

Review the posttest for the case study.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology Discussions Please check your post carefully before clicking on Submit!

By Day 3

Post a response to the following:

Provide the case number in the subject line of the Discussion.

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

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.

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

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

List two pharmacologic agents and their dosing that would be appropriate for the patient’s sleep/wake 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.

If your assigned case includes “check points” (i.e., follow-up data at week 4, 8, 12, etc.), indicate any therapeutic changes that you might make based on the data provided.

Explain “lessons learned” from this case study, including how you might apply this case to your own practice when providing care to patients with similar clinical presentations. NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology Discussions.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues who were assigned to a different case than you. For example, if you were assigned to Case Study 1, respond to one colleague assigned to Case Study 2 and one colleague assigned to Case Study 3. NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology Discussions Explain how you might apply knowledge gained from your colleagues’ case studies to you own practice in clinical settings.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 7 Discussion Rubric

Post by Day 3 and Respond by Day 6

To participate in this Discussion:

Week 7 Discussion

Assignment: Assessing and Treating Clients With Pain

Pain can greatly influence an individual’s quality of life, as uncontrolled pain negatively impacts mood, concentration, and the overall physical and mental well-being of clients. Although pain can often be controlled with medications, the process of assessing and treating clients can be challenging because pain is such a subjective experience. Only the person experiencing the pain truly knows the intensity of the pain and whether there is a need for medication therapies. NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology Discussions. Sometimes, beliefs about pain and treatments for pain can have an adverse effect on the provider-client relationship. For this Assignment, as you examine the interactive case study consider how you might assess and treat clients presenting with pain.

Learning Objectives

Students will:

Assess client factors and history to develop personalized therapy plans for clients with pain

Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for pain

Evaluate efficacy of treatment plans for clients presenting for pain therapy

Analyze ethical and legal implications related to prescribing therapy for clients with pain

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus. NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology Discussions.

Required Readings

Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Chapter 10, “Chronic Pain and Its Treatment”

Stahl, S. M., & Ball, S. (2009a). Stahl’s illustrated chronic pain and fibromyalgia. New York, NY: Cambridge University Press. NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology Discussions.

To access the following chapter, click on the Illustrated Guides tab and then the Chronic Pain and Fibromyalgia tab.

Chapter 5, “Pain Drugs”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

For insomnia

amitriptyline

amoxapine

carbamazepine

clomipramine

clonidine (adjunct)

desipramine

dothiepin

doxepin

duloxetine

gabapentin

imipramine

lamotrigine

levetiracetam

lofepramine

maprotiline

memantine

milnacipran

nortriptyline

pregabalin

tiagabine

topiramate

trimipramine

valproate (divalproex)

zonisamide

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Note: Retrieved from Walden Library databases.

National Institute of Neurological Disorders and Stroke. (2016). Pain: Hope through research. Retrieved from 
www.ninds.nih.gov/
disorders/chronic_pain/detail_
chronic_pain.htm#3084_2

Required Media

Laureate Education (2016a). Case study: A Caucasian man with hip pain [Interactive media file]. Baltimore, MD: Author

Note: This case study will serve as the foundation for this week’s Assignment.

To prepare for this Assignment:

Review this week’s Learning Resources. Consider how to assess and treat clients requiring therapy for pain and sleep/wake disorders. NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology Discussions.

The Assignment

Examine Case Study: A Caucasian Man With Hip Pain. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following:

Decision #1

Which decision did you select?

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different? NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology Discussions.

Decision #2

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?

Decision #3

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology Discussions. Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

Also include how ethical considerations might impact your treatment plan and communication with clients.

Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

Please save your Assignment using the naming convention “WK7Assgn+last name+first initial.(extension)” as the name.

Click the Week 7 Assignment Rubric to review the Grading Criteria for the Assignment.

Click the Week 7 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.

Next, from the Attach File area, click on the Browse My Computer button. NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology Discussions Find the document you saved as “WK7Assgn+last name+first initial.(extension)” and click Open.

If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.

Click on the Submit button to complete your submission.

Grading Criteria

To access your rubric:

Week 7 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 7 Assignment draft and review the originality report. NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology Discussions.

Submit Your Assignment by Day 7

To submit your Assignment:

Week 7 Assignment

Making Connections

Now that you have:

Assessed clients presenting with pain and sleep/wake disorders

Developed personalized plans of therapy for clients with pain and sleep/wake disorders

Examined factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for pain and sleep/wake disorders

Explored ethical and legal implications of prescribing therapy to clients with pain and sleep/wake disorders

Next week, you will build on your assessment and treatment skills as you examine clients presenting for therapy for impulsivity, compulsivity, and addiction NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology Discussions.

To go to the next week:

Week 8

HCA 501 Health Care in America

Health Care in America provides a comprehensive overview of the basic structures and operations of the US health system, from its historical origins and resources, to its individual services, cost, and quality. Using a unique “systems” approach, it brings together an extraordinary breadth of information and a solid overview of how the various components fit together.

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Course Objectives

Upon successful completion of this course, students will be able to:

Emphasize why it is important for health care managers to understand the intricacies of the health care delivery system.

Appreciate the implications of the above concepts for medical care delivery and for the promotion of health and prevention of disease. HCA 501 Health Care in America.

Explore some of the recent developments and key forces that will likely shape the delivery of health services in the future.

Differentiate between the concepts of group insurance, self-insurance, individual health insurance, and managed care.

Develop an understanding of the various types of outpatient settings and services.

Analyze the future challenges in wellness and prevention, chronic care, and long-term care. HCA 501 Health Care in America.

NURS 6630 Week 7 Discussion – Case 1: Volume 2, Case #16: The woman who liked a late-night TV

The woman who liked a late-night TV

The patient is a 70-year-old woman who exhibits symptoms of depression due to loneliness. Her son and aide assist in her care. She is hard of hearing and has other cardiological problems. She also has a family history of depression. Her ailment worsened because she was unable to sleep and consequently has s restless leg syndrome.

The three questions I will ask the patient in my office are as follows;

1. Do you feel sleepy or do you have sleep attacks during the day and describe your usual night sleep (Hours of sleep, quality of sleep, etc.)? Lack of sleep results in more health problems and worsens depression. NURS 6630 Week 7 Discussion.

2. Have any members in your family been depressed? Genetic loading in depression, anxiety or schizophrenia. Get medication effectiveness of family similar to patient’s disorder.

3. Have you ever suffered from depression, anxiety or similar problems? Pt exhibited symptoms of depression-crying, sadness etc. Patient’s mother has history of depression.

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Patient’s son and the home health aide are the persons assisting with his care. So, I will direct my questions to his mother as well as her home health aide about depression history, sleeping pattern, the activity of daily living and patient’s compliance with the medication regimen.

physical exams and diagnostic tests

Actigraphy is a device that measures and records movement. It is worn on the wrist and can be used as a rough measure of the sleep-wake cycle. It is useful for assessing insomnia, circadian rhythm disorders, movement disorders and an assortment of rare events (Sadock, 2015). NURS 6630 Week 7 Discussion.

Polysomnography is the continuous attended, comprehensive recording of the biophysiological changes that occur during sleep. It is recorded at night and lasts between 6 and 8 hours. NURS 6630 Week 7 Discussion Brainwave activity, eye movements, submental electromyography activity, nasal-oral airway flow, respiratory effort, oxyhemoglobin saturation, heart rhythm, and leg movement during sleep are measured (Sadock, 2015).

Three differential diagnoses

1. Major Depressive Disorder (MDD)

A major depressive disorder is a depressed mood that persists for least two weeks duration or longer. Signs and symptoms of major depression include poor appetite, insomnia or hypersomnia, low energy or fatigue, low self-esteem, lack of concentration or difficulty making decisions, and feelings of hopelessness, significant weight loss or weight gain and recurring thought of death or suicide (Sadock, 2015). The predisposing factors to this illness include responses to a significant loss such as grief, a financial ruin from natural disaster, or severe medical illness or disability and other factors such as environmental (stressful life events), genetic and physiological or other psychosocial factors. All currently available antidepressants may take 3 to 4 weeks to exert significant therapeutic effects, although they may begin to show their effects earlier. Examples of antidepressant medications include SSRIs, TCAs, and MAOIs.

2. Insomnia

Sleep is regulated by basic mechanisms, and when these systems go awry, sleep disorders occur. Sleep disorders are both dangerous and difficult to treat. Obstruction Sleep Apnea (OSA) Insomnia is defined as difficulty initiating sleep. DSM-5 defines insomnia disorder as dissatisfaction with sleep quantity or quality with one or more of the following symptoms: difficulty in maintaining sleep with frequent awakenings and early morning inability to return to sleep. NURS 6630 Week 7 Discussion Primary insomnia is a condition resulting from too much arousal both at night and day time and may progress to a first major depressive episode (Stahl, 2013). Pharmacologic treatment includes Benzodiazepines, zolpidem, eszopiclone, zaleplon, and Trazodone.

3. Restless Leg Syndrome (RLS)

RLS also known as Ekbom syndrome is an uncomfortable, subjective sensation of the limbs. Usually, the legs, sometimes described as a “creepy crawly” feeling, and the irresistible urge to move the legs when at rest or while trying to fall asleep. Patients often report the sensation or any walking on the skin and crawling feelings in their legs. It worsens at night and moving the legs or walking helps to alleviate the discomfort. RLS is associated with fibromyalgia, rheumatoid arthritis, diabetes, thyroid diseases and COPD. Treatment for RLS includes levodopa, benzodiazepine, opiates, and antiepileptic (Gabapentin) drugs. Non- pharmacological treatment is massage, hot baths, hot/cold compress to affected areas, moderate exercises and alcohol avoidance at bedtime (Sadock, 2015).

Insomnia is the major diagnosis for this Patient because it is an ongoing issue.

Two pharmacologic agents for the patient’s sleep/wake therapy

The patient is on Citalopram for depression. Insomnia, fatigue and multiple painful physical complaints are side effects the medication. Citalopram increases in serotonin concentrations at serotonin receptors in parts of the brain and body other than those that cause therapeutic actions. For example, the unwanted actions of serotonin in sleep centers cause insomnia in the patient. These symptoms cause the disorder not to go into remission. Hypnotics medications will enhance remission rates for both patients with major depression and generalized anxiety disorder with insomnia. For example, Eszopiclone added to SSRI will lead to higher remission rate among the clients. Slow wave sleeping enhancing agents can also be administered to augment SSRIs/ SNRIs. These include gabapentin and Trazadone (Stahl, 2013). NURS 6630 Week 7 Discussion.

1.Eszopiclone

Eszopiclone is a class of non-benzodiazepine hypnotic; alpha 1 isoform selective agonist of GABA-A/benzodiazepine receptors. Eszopiclone is an effective treatment for Primary insomnia, Chronic insomnia, Transient insomnia, Insomnia secondary to psychiatric or medical conditions and Residual insomnia following treatment with antidepressants. Inhibitory actions in sleep centers may provide sedative-hypnotic effects. NURS 6630 Week 7 Discussion While Eszopiclone is a hypnotic agent with a chemical structure unrelated to benzodiazepines, barbiturates, or other drugs with known hypnotic properties, it interacts with the gamma-aminobutyric acid-benzodiazepine (GABA-BZ) receptor complex. Eszopiclone binds selectively to the brain alpha subunit of the GABA A omega-1 receptor. Side effects include unpleasant taste, Sedation, Dizziness, Dose-dependent amnesia, Nervousness, Dry mouth, headache. Dosages include 2-3mg at bedtime (Drugbank.ca, 2018).

2. Trazodone

Trazodone binds at the 5-HT2 receptor; it acts as a serotonin agonist at high doses and a serotonin antagonist at low doses. Like fluoxetine, trazodone’s antidepressant activity likely results from blockage of serotonin reuptake by inhibiting serotonin reuptake pump at the presynaptic neuronal membrane. If used for long time periods, postsynaptic neuronal receptor binding sites may also be affected. The sedative effect of trazodone is likely the result of alpha-adrenergic blocking action and modest histamine blockade at the H1 receptor. It weakly blocks presynaptic alpha2-adrenergic receptors and strongly inhibits postsynaptic alpha1 receptors. Trazodone does not affect the reuptake of norepinephrine or dopamine within the CNS (Drugbank.ca, 2018).

Dosing for Depression as a monotherapy: initial 150 mg/day in divided doses; can increase every 3–4 days by 50 mg/day as needed; maximum 400 mg/day (outpatient) or 600 mg/day (inpatient), split into two daily doses. Initial 25–50 mg at bedtime; increase as tolerated, usually to 50–100 mg/day, but some patients may require up to full antidepressant dose range. Augmentation of other antidepressants in the treatment of depression: dose as recommended for insomnia (Stahl, 2013). Side effects include Nausea, vomiting, edema, blurred vision, constipation, dry mouth, Dizziness, sedation, fatigue, headache, incoordination, tremor, Hypotension, syncope, Occasional sinus bradycardia (long-term), Rare side effects are rash, and priapism NURS 6630 Week 7 Discussion.

Check points

The patient responded positively to faxes received from therapies. Now that she had her cochlear implant inserted, she can hear people thus ending some of her frustrations. She needs to get involved in different activities with people her age. In addition to her medication, the patient will benefit more from non-pharmacological interventions such as psychosocial therapies, social skills training, family-oriented therapies, case management, group therapy, and cognitive behavioral therapy (Sadock, 2015).

Lessons learned

From psychopharmacology point of view, I will not prescribe anti-stimulant to patient. She will be on hypnotics, and I will augment with another SSRIs/SNRIs and gabapentin for neuropathic pain NURS 6630 Week 7 Discussion. As prescribed medications become effective, she will sleep well at night and the leg pain or spasm will melt away.

Reference

Drugbank, ca (2018). Hypnotics medications. Retrieved July 10th, 2018 from https://www.drugbank.ca/drugs/DB00402

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (Eleventh edition.). Philadelphia: Wolters Kluwer.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press *Preface, pp. ix–x. NURS 6630 Week 7 Discussion.

Nurs 6565 Self-Assessment of Clinical Skills Practicum Essay Assignment paper

A self-assessment is an opportunity for you to review what you have learned in the program, evaluate your clinical skills, and develop goals before exiting the NP program. For this assignment, you will complete the Risk Control Self-Assessment Checklist for Nurse Practitioners and identify your areas of strength and weakness. You also will explain how you plan to improve on these weaknesses, as well as how you plan to master clinical skills you have not obtained prior to exiting NP program.

To prepare:

Complete the Risk Control Self-Assessment Checklist for Nurse Practitioners (http://www.hpso.com/Documents/Risk%20Education/individuals/NP_RM_Checklist_2012.pdf). Nurs 6565 Self-Assessment of Clinical Skills Practicum Essay Assignment paper.

Review preceptor and faculty evaluations in Meditrek for all completed clinical courses. Consider your strengths and weaknesses. Review types of patients treated and clinical procedures performed

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Write a 2- to 3-page paper that addresses the following:

Identify at least three strengths (eagerness to learn, ability to relate, compassion, Confidence)

Explain why you consider these strengths and what you can do to maintain them in your practice

Identify at least three weaknesses ( novice skills, Blunt personality, being more flexible)

Explain how you plan to address each weakness. Nurs 6565 Self-Assessment of Clinical Skills Practicum Essay Assignment paper.

Examine at least three clinical skills you need to obtain prior to exiting the program.

Explain how you plan to master the clinical skills before exiting NP program

Analyze the history of advanced practice nurses and the emerging role of your specialty area, and discuss what contributions you plan to make to advance the nursing profession

 

resources

https://www.aanp.org/images/documents/FAANPForum/2015-3.pdf

https://class.waldenu.edu/bbcswebdav/institution/USW1/201770_27/MS_NURS/NURS_6565/artifacts/USW1_NURS_6565_Week01_Hamrick.pdf. Nurs 6565 Self-Assessment of Clinical Skills Practicum Essay Assignment paper.

https://www.aanp.org/images/documents/publications/primarycare.pdf

Kooienga, S.A. & Carryer, J.B. (2015). Globalization and advancing primary care health care nurse practitioner practice.
TheJournal for Nurse Practitioners, 11(8)
, 804–811. doi:10.1016/j.nurpra.2015.06.012

http://content.healthaffairs.org/content/29/5/893.full.pdf+html

http://www.aacn.nche.edu/government-affairs/NGA-Nurse-Practitioner-Paper.pdf

http://c.ymcdn.com/sites/www.nonpf.org/resource/resmgr/competencies/npcorecompetenciesfinal2012.pdf Nurs 6565 Self-Assessment of Clinical Skills Practicum Essay Assignment paper