Tag: Clinical-Nursing

NURS 6630 Week 1 discussion – Agonist to antagonist spectrum of action of psychopharmacologic agents Sample essay

Week 1 Discussion: Initial Post

Foundational Neuroscience

Agonist to antagonist spectrum of action of psychopharmacologic agents

Agonist of psychopharmacologic agents binds to neurotransmitter and caused an activation of receptors; whereas, antagonist agents then binds to those receptors that are activated by agonists, thus preventing them from being in an inactivated state; thus, causing them to be in the state that is desirable (Stahl, 2013). One such example can be seen from the neurotransmitter receptors dopamine, serotonin and norepinephrine.

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G-protein is a protein that binds energy molecules, they are the biggest and most versatile of proteins, their job is to activate intracellular action by signaling pathways and modulate activities of ion channel (Gohar, 2018). Ion channels are transmembrane proteins that regulates the movement of ions across cell membranes and then divide them into groups according to their specificity, some of which includes sodium channels, potassium channels and calcium channels (Gohar, 2018). NURS 6630 Week 1 discussion – Agonist to antagonist spectrum of action of psychopharmacologic agents Sample essay

Ion channel receptors are mostly multimeric proteins that are found in the plasma membrane, they form pathways from one membrane to the next; they are able to open and close chemical and mechanical signals; when these ion channels are in an open site, then they move in and out of the cell, they each have a specific allowing only one ion to pass through (Suitable by Nature, n.d).

G-protein receptors are receptors that interact with neurotransmitters as well as psychotropic medication.  G-protein and ion channel are triggered by neurotransmitters; both starts with a different messenger that binds to a specific receptor that causes activation of different downstream chemical messenger; both G-protein and Ion channels signals transduction; G-protein uses protein kinase, its job is to activate or inactive ion channels or open and close the sequence to regulate ion concentration (Stahl, 2013).

Epigenetics

Epigenetics is described as the formation of genetics that above information coded exclusively by one’s genetic code (Stefanska & MacEwan, 2015).  Epigenetics is a system that determine if there are any gene that is made into RNA and protein specific to that gene, if is silenced; it turns genes on and off by the modification of chromatin structure that is in the cell nucleus (Stahl, 2013).  There are circumstances in which epigenetics pattern of gene activation may change from stabilization  of a silenced gene making it active or an active one, silenced based on what happens to a neuron; where pharmacologic agent can be a factor; it may cause a favorable or unfavorable response; a favorable response can be the good/therapeutic epigenetic effect where one is triggered to learn something or unfavorable effect where one is triggered to e addicted to drugs or develops conditions like anxiety disorder (Stahl, 2013). NURS 6630 Week 1 discussion – Agonist to antagonist spectrum of action of psychopharmacologic agents Sample essay

How we respond to pharmacological agents can be affected by epigenetics; drugs that are epigenetic may help in drug therapies as well as operations and management of pain (Stefanska & MacEwan, 2015).

An example is how those with a diagnosis of schizophrenia is treated; the pharmacological agent that is used to treat it, acts by reducing dopamine levels in the brain; the antagonist of dopamine works by binding the receptors causing a deactivation (Stahl, 2013).

References

Gohar, O. (2018). Ion channel modulation by g-protein coupled receptors. Alomone Labs. Retrieved from https://www.alomone.com/article/issue-no-21?cn-reloaded=1

Stefanska, B., & MacEwan, D. J. (2015). Epigenetics and pharmacology. 
British Journal of Pharmacology
, 
172
(11), 2701–2704. http://doi.org/10.1111/bph.13136

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

Suitable by Nature. (n.d.). Ion Channel | Learn science at suitable. Retrieved from https://www.nature.com/scitable/topicpage/ion-channel-14047658

 

agonist is a drug that activates certain receptors in the brain. An antagonist drug blocks opioids by attaching to the opioid receptors without activating them. Antagonists cause no opioid effect and block full agonist opioids (Stahl, 2013). A GTP-binding protein that relays signals from a plasma membrane signal receptor, known as a G protein-coupled receptor, to other signal transduction proteins inside the cell( Stahl,2013). A protein pore in cellular membranes that opens or closes in response to a signaling chemical (its ligand), allowing or blocking the flow of specific ions. Ion channel receptors are usually multimeric proteins located in the plasma membrane (Stahl, 2015). Each of these proteins arranges itself so that it forms a passageway or pore extending from one side of the membrane to the other. These passageways, or ion channels, have the ability to open and close in response to chemical or mechanical signals. When an ion channel is open, ions move into or out of the cell in single-file fashion. Individual ion channels are specific to particular ions, meaning that they usually allow only a single type of ion to pass through them ( Stahl, 2015).                                                                                                                        Epigenetics is the study of heritable changes in gene expression (active versus inactive genes) that do not involve changes to the underlying DNA sequence — a change in phenotype without a change in genotype — which in turn affects how cells read the genes(  Deans, C. & Maggert ,2015 ). Epigenetic change is a regular and natural occurrence but can also be influenced by several factors including age, the environment/lifestyle, and disease state. Epigenetic modifications can manifest as commonly as the manner in which cells terminally differentiate to end up as skin cells, liver cells, brain cells, etc. Or, epigenetic change can have more damaging effects that can result in diseases like cancer. At least three systems including DNA methylation, histone modification and non-coding RNA (ncRNA)-associated gene silencing are currently considered to initiate and sustain epigenetic change ( Deans, C. & Maggert , 2015 ). NURS 6630 Week 1 discussion – Agonist to antagonist spectrum of action of psychopharmacologic agents Sample essay

Psychotropic drugs are valuable resources in treating many mental health illnesses, but inappropriate prescribing can cause serious harm or possible death. The high numbers of inappropriate prescribing is associated with increased morbidity, mortality and decrease in quality of life ( Curkovic, Dodig-Curkovic , Eric, Kralik & Pivac, 2016  ). It is estimated that 30% of elderly people’s admissions in hospitals is due to problems related to drugs or to toxic effects of drugs ( Curkovic, Dodig-Curkovic , Eric, Kralik & Pivac, 2016 ). The elderly population is at great risk of adverse drug effects. The elderly experience altered pharmacokinetics and pharmacodynamics, which result in prolonged and increased effects of many drugs. The altered pharmacodynamics of the aging brain leads to a higher sensitivity to central nervous system acting agents ( Curkovic, Dodig-Curkovic , Eric, Kralik & Pivac, 2016        ).

Antidepressants, anxiolytics and antipsychotics are the most common potentially inappropriate psychotropics. Tricyclic antidepressants can causes dementia, cardiac conductive abnormalities, chronic constipation, and other adverse reactions (Sharma, Loh,., Nightingale, Mohile, & Holmes,2016 ). Tricyclic antidepressants should be avoided due to the anticholinergic, sedating and orthostatic hypotension   Selective serotonin reuptake inhibitors (SSRIs) should be used with caution, as they may exacerbate or cause syndrome of inappropriate antidiuretic hormone secretion or hyponatremia. Also, some drug-interactions involving antidepressants offer risks, i.e. tricyclic antidepressants and SSRIs, shows increased risk of falls (Sharma, Loh,., Nightingale, Mohile, & Holmes,2016 ). NURS 6630 Week 1 discussion – Agonist to antagonist spectrum of action of psychopharmacologic agents Sample essay

 

 

NURS 6630

Foundational Neuroscience

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

Psychopharmacologic agents induce changes in people’s thinking, mood, and behavior. They act through interaction with target receptors or sites in the nervous system to induce changes in patient’s psychological or physiological functions. According to Stahl (2013), most psychopharmacological drugs target ion channels or enzymes where they lead to production of biological responses among patients. This process is achieved through binding of pharmacological agents to receptors.

In pharmacology, ligands are molecules which bind to receptors. Once they bind to receptors, ligands can lead to production of biological responses or block the production of biological responses. Agonists are ligands responsible for activating receptors to produce biological response. On the other hand, antagonists are ligands which block agonist mediated responses. While agonists execute their task by activating receptors to produce biological responses, the antagonists block receptor activation, thus making it impossible to produce any biological responses.

Compare and contrast the actions of g couple proteins and ion gated channels

G couple proteins transmit signals from stimuli outside the interior of the cell to its interior. They act as molecular switches inside the cell. Action of G couple proteins is controlled by factors that regulate their ability to bind and hydrolyze guanosine triphosphate (GTP) to guanosine diphosphate (GDP) (Lodish et al, 2000). G couple proteins are turned off when bound to GDP and are turned on when bound on GTP. According to Lodish et al (2000), different mammalian cell-surface receptors have a trimeric signal transducing G protein. Ligands which bind to these receptors activate their relevant G protein, which in turn activates the effector enzyme to produce intracellular second massager (Lodish et al, 2000). It is worth noting that all G protein coupled receptors have 7-membrane spanning areas within their N-terminal segment. NURS 6630 Week 1 discussion – Agonist to antagonist spectrum of action of psychopharmacologic agents Sample essay. On the other hand, ion gated channels are transmembrane proteins of excited cells which only allow ions to pass under specific circumstances (Stahl, 2013). Gated ion channels may be either sodium channels of neurons or voltage gated channels like the acetylcholine

Explain the role of epigenetics in pharmacologic action

Epigenetics are changes occurring in human beings as a result of modifications of gene expression rather than alteration of the real genetic code. According to Stahl (2013), epigenetics affects ways in which cells read genes and produce proteins. Through epigenetics, some genes can be expressed over time or become dormant. Epigenetics makes each person unique and is reversible. It is worth noting that there are many different combinations of genes that can be turned on or off through pharmacologic action thus impacting the health outcome of an individual. For example, if genetic combinations leading to bad states in human health can be eliminated while only maintaining the gene’s states that foster good health, then some health conditions can be successfully eliminated.

According to Lundstrom (2015), epigenetic mechanisms which focus on miRNAs are important as diagnostic biomarkers. The reversible nature of epigenetic modifications makes the inhibition of DNA methylation possible against psychiatric diseases such as bipolar disorders and schizophrenia as well as some forms of cancers and other terminal illnesses. It is important for nurse practitioners to understand how medications impact on the patient’s gene expression among psychiatric patients. Some medications may suppress certain types of gene expression responsible for aggression among mentally ill patients and make them dormant while others may enhance gene expression and result to exacerbation of patient’s symptoms. NURS 6630 Week 1 discussion – Agonist to antagonist spectrum of action of psychopharmacologic agents Sample essay.

C791 Advanced Information Management

Advanced Information Management C791

The Electronic Health Record, also known as EHR is a digital database of both past and current clinical information including everything from demographics to test results and medical conditions (Tan & Payton, 2017). Health information systems have both advantages and disadvantages surrounding their usability, interoperability, scalability and compatibility. They have a direct affect on patient care and documentation and can affect the quality and delivery of nursing care and patient outcomes. Having access to patient records using an EHR allows information to be immediately available to all providers who have access to the EHR – including co-workers in other areas of the same hospital as well as in other hospitals with the same EHR. This can be extremely beneficial to the patient and health care providers alike. Unfortunately, EHRs are very expensive to implement as well as maintain – as they require multiple levels of training as well as periodic upgrades due to changes in healthcare delivery as well as system changes.

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Health Information Systems

A1. There are advantages and disadvantages of the EHR. In the area of usability, young nurses may have only been exposed to EHRs, and in fact most or all of their education may have taken place with electronic textbooks, tests and paper submission. For them, using an EHR may be very easy and they will have an advantage over older nurses, like myself, who learned nursing on pen and paper. All of my nursing schoolwork involved writing papers by hand and testing on paper. Advantages for nurses young and old, however, are the systematic charting methods provided by an EHR. Quick templates for charting  and check-box documentation on the EHR can provide reminders for the nurse to ensure that all problems that the patient is experiencing are addressed. A disadvantage can occur when the n nurse uses only the check-boxes and fails to provide to elaborate on issues occurring which are not addressed in the boxes. Without adding a narrative or written progress note in addition to the check boxes, the nurse may not truly tell the patients’ story, allowing for important details to be omitted. In the area of interoperability, one advantage is that if multiple providers use the same EHR, the patients records may be visible by all providers. For instance, if a patient sees a primary care physician who is aligned with a hospital system, then if the patient is admitted to the hospital he/she is aligned with the notes, diagnoses, lab results and demographics will all be visible by both the office staff and the hospital staff. Additionally, interoperability with lab would ensure that test results would flow into the chart rather than allowing for the chance for human error in entering lab values or times. A disadvantage would be if the patient sees a primary care physician who uses one type of EHR and presents to a hospital with another type of EHR. Most EHRs are only compatible with like EHRs, so the only way to ensure information from a physician office would not be visible by hospital staff or if one hospital system uses one type of EHR and another hospital system uses another type of EHR, there would be no visibility of information if the patient was transferred from one hospital to another. As related to scalability, an advantage would occur if the EHR chosen by a hospital is capable of expanding as healthcare regulations change and as the hospital system grows or expands to include additional service lines. A disadvantage would occur if the EHR chosen had limits on the ability to optimize the use to fit the needs of changing healthcare regulations or if it would not allow for expansion or growth throughout the system. Compatibility of the EHR would be an advantage if the current computer system of the hospital could handle the EHR without purchasing new equipment. When patients’ blood glucose levels are tested, does the information from the glucometer flow directly into the EHR? This would definitely be an advantage. Also it would be advantageous if the EHR had the ability to run on different hardware, as many people have a preference of the system they use. It would be a disadvantage if the EHR only ran on one system, or was only able to function in one area of the hospital. It would be important to ensure that the EHR had platforms for the Emergency Department, Inpatient, Outpatient, Surgery and Testing areas. If it was not capable of crossing over to any area of the hospital the patient might experience during a stay, it would be a disadvantage. C791 Advanced Information Management.

A2. Patient care and documentation can be positively impacted by implementation of an EHR. Using an EHR provides that all patient information is recorded in the exact same manner on each patient and provides continuity of care between shifts. Reminders for labs, medications, tests, and other areas of patient care can be helpful to ensure that the nurses caring for the patient provide all of the care ordered for the patient during their shift.  Additionally, if the patients chart needs to be reviewed for quality indicators or issues, the care is documented in the same manner and in the same area for each patient. If the patient seeks care from another physician or hospital system that uses the same EHR, then their care has the potential to be more appropriate because their history will be available for physicians, nurses and other caregivers with access, resulting in a higher level of care provided.

A3. The quality and delivery of nursing care and patient outcomes can be positively affected with the implementation of the EHR. Quality reviews can take place in real time – while the patient is still a patient- rather than having to wait for paper documentation to be scanned in to a record. Additionally, with paper documentation, there is no way to mine data to measure quality across a unit or a hospital. Data mining is the process of using software to discover or establish relationships (Mastrian & McGonigle, 2017).  If patient data is entered into an EHR, reports can be run to determine what treatments are being used, if they are effective and if proper documentation is happening among many other things. Patient outcomes can be positively affected because chart audits can happen in real time. C791 Advanced Information Management.

Organizational Benefits

B1. The EHR provides the opportunity to improve efficiency and quality of patient care, resulting in better outcomes (Mastrian & McGonigle, 2017). Patients come to healthcare facilities with hopes to get better. They do not plan to get sicker or to have complications, known as Hospital Acquired Conditions or HACs, resulting from treatments that they receive (or do not receive) during their hospitalization. In the facility where I work, approximately 3 years ago, a HAC known as Catheter Associated Urinary Tract Infection or CAUTI rates were high, and we set out on a mission to decrease these rates. We tracked and trended the rates of infection and the number of catheter days for each infection, from our EHR for the previous 3 years, and came up with goals for number of catheter days and diagnoses requiring catheterization vs. catheter use for nurse convenience. Additionally, we looked at where the CAUTIs were occurring (what unit), the age of the patient, what the course of treatment was (did the patient go to surgery or other diagnostic areas) and even drilled down to what nurse(s) and aide(s) cared for the patient. Nurse(s) and tech(s) caring for patients who developed a CAUTI were counseled and education was provided to all newly hired employees. Because of the information we gathered, using the EHR our nurse leadership team created a report to run each day to determine what patients might be at greatest risk for a CAUTI. The EHR allows for reports to be very in depth and include information such as what patients have catheters and how many days the catheter has been in place. Knowing the longer the catheter is in, the higher the risk of infection, we work as an interdisciplinary team to determine if the patient needs to continue with the catheter or if it could be discontinued. This, along with other actions such as implementing the use of TheraWorx cleaning have caused a significant decrease in the amount of CAUTIs. In 2015 and 2016, our hospital had seven CAUTIs during each year. In 2018 we had three CAUTIs and year to date in 2019 we have only had two. This is because of reports run and analyzed from the EHR.  HAC rates are continually measured using data from the HER to improve patient outcomes. Another way that quality improvement data collected can lead to measurable improvement is by using the EHR to review charts of patients who have had a negative outcome during a hospital stay, such as a fall with injury or a medication error. C791 Advanced Information Management. In the case of a fall with injury, our quality department will use the EHR to perform a full chart review. Then, they will use the information from the chart review to determine what co-workers were involved in the event, what medications or treatments the patient was receiving, and what the patient was doing at the time of injury. Every patient receives a fall risk assessment at the time of admit, completed in the HER, resulting in a fall risk score which is visible by the bedside nurse and others providing care to ensure the proper precautions are in place. If the patient experiences a fall, a near miss, or a change in condition, the bedside nurse is prompted to complete a new fall risk assessment in the EHR which will result in a new fall risk score. If the event is what as known as a never event, such as a death as a result of the fall, then this is reportable and the EHR will be useful to both the quality and legal department of the hospital as well as federal or state regulatory agencies or legal counsel who obtain access to the EHR.

B2. There are federal guidelines regarding the privacy of health information for EHRs including the Health Insurance Portability and Accountability Act (HIPAA) and Health Information Technology for Economic and Clinical Health (HITECH)  (Mastrian & McGonigle, 2017). Additionally, anyone using an EHR needs to ensure information is secure and network security is managed (Mastrian & McGonigle, 2017). In the hospital where I work, we have a unit for geriatric psychiatric patients. This is a locked unit with limited access and all patients are considered private. Their names are not visible by all on house census reports or other documents. Only co-workers who have electronic access, granted by their leader, can access the records of these patients. Because it is not practical to assume that everyone a patient on this unit comes into contact with would have this electronic access, a level of security known as “breaking the glass” exists in our EHR. C791 Advanced Information Management. This allows for anyone to access their record, but in order to do so they have to “break the glass” which requires them to state the reason they need to be in the chart and agree to quality review to ensure they have the right and the access is necessary. This insures the patients in this high security area are kept as private as possible. Data back-up is also necessary. A few years ago, a Mercy Hospital in Joplin, Missouri was completely destroyed by a tornado. Many patient records were destroyed and while patients were cared for in other facilities in the area, their information was not accessible due to the other hospitals not having compatible EHRs. This data was eventually recoverable, but not in real time. As a result, each Mercy Hospital now has all of its data backed up to a computer system offsite in a database accessible to anyone at any time. The data isn’t just stored on-site, but continually backed up offsite. These measures assure compliance with HIPAA and HITECH.

B3. Patient privacy is protected in many ways in an EHR. In the hospital where I work, a watchdog system is in place to monitor everyone who views a patient’s chart. If at any time, an employee views a patient chart and there is a match of the last name or home address, an alert is sent to the employee’s leader. It is then the leader’s role to investigate the reason the employee viewed the chart. The EHR system we use is EPIC, and the watchdog system reveals all locations in the chart viewed by the employee. If the employee had a reason to be in the patient’s chart, such as checking in the patient in the Emergency Department, but the only part of the chart viewed by the employee was the check-in screen, then there is no reason for disciplinary action. But if that same employee, responsible for checking in the patient to the Emergency Department went on to view previous visits or lab results, then they have violated HIPAA and are disciplined according to the hospital policy for privacy which aligns with HIPAA. Patient privacy is additionally protected through the process of granting employees access to the EHR. Each employee’s leader is responsible for requesting access which aligns with their training and job duties. Kitchen employees have no reason to be in a patient’s chart, so they are not trained in the EHR and do not have access. Nurses are only given access to patients on the floor(s) or department(s) where they will be working. This assures employees are not given access to patient’s private information when not required for the completion of their duties.

B4. Organizational efficiency and productivity will improved by adopting an EHR, although there have been few studies of EHRs with very little reported data (Mastrian & McGonigle, 2017). One way that efficiency is improved is standardization of charting using the EHR. Pathways can be built for standard physician orders for patients with specific conditions such as Chronic Obstructive Pulmonary Disease or COPD. Head to toe assessments are completed by multiple nurses across multiple shifts, but using the EHR, the assessments are completed the same way every time. The same documentation on each patients provides continuity of care for patients across the continuum of care, in addition to providing the ability to view data complied over a whole hospital stay on one screen in the same place every time. Productivity will be improved because the members of the care team will all be able to document at the bedside while care is being performed. In the case of a patient in cardiac arrest, where multiple members of the care team are providing care simultaneously, EPIC EHR provides a “code narrator” allowing for one point person to document all interventions during the code in real time while the code is happening. In the absence of an EHR, this documentation would be done by hand and might not be the same way every time or might cause the nurse doing the documentation to chart after the end of the event taking up time that could be used to care for other patients or to continue care on that patient if they survive. Additionally, once the documentation is entered into the EHR in real time, there is no need to scan any documents or information into the chart which provides a streamlined method of recordkeeping. If patient information is recorded on paper rather than in an EHR, there could be waste as eventually the paper would be scanned into the chart and then shredded to ensure privacy. C791 Advanced Information Management. Efficiency can also be enhanced in the area of human and capital resources. Using an EHR, each time a procedure is performed on a patient, a medication is given or a supply is used, these are recorded in the EHR and automatically charged to the patient account. This decreases the need for someone to enter charges manually into the system, thereby increasing productivity and decreasing the number of people required for care. In addition to the data listed above, there are many other ways organizational efficiency and productivity will improve with the implementation of an EHR.

Essential Stakeholder Roles for System Implementation

There are multiple layers of leadership required for implementing an EHR within a healthcare system, including but not limited to: Implementation Manager, Physician Champion, Information Technology Lead and SuperUser Lead. The Implementation Manager may be associated with the vendor of the EHR. They are responsible for making sure the project is on schedule, monitoring the work plan, maintaining a list of problems at the hospital or vendor level that need resolution, scheduling events surrounding implementation and may include communicating updates to the implementation team. Their expertise would need to be in both the inner workings and implementation of the specific EHR to be implemented (from a vendors perspective) and also in the structure of the implementation team (from the hospital perspective). This person would need to have excellent communication and organizational skills as the success of the implementation really begins and ends with them. They will also need delegation skills, as there is no way they could be expected to accomplish all facets of their role without support. It is never recommended to implement an EHR without a physician champion. A close relationship between the physician champion and the implementation team is imperative to the success of the EHR. Physicians will need the EHR to function clinically in a way that is beneficial to them as well as the patient. The Physician Champion will serve as a liaison between the implementation team and the facility physicians, so good communication skills are also required. It is essential that physicians “buy in” to the EHR, so it will be necessary for them to have a voice in the development, optimization and implementation of the EHR. The Information Technology Lead is the person that every member of the team can go to for answers related to the operation of the software and hardware of the EHR C791 Advanced Information Management. They deploy the workstations or other hardware needed, install the appropriate software and drivers on computers, tablets, scanners, printers and other hardware. They are also responsible for the operation of the software on the deployed hardware. The IT Lead will need to work with Leads from all departments within the hospital (Nurse and other Clinical Leads, Lab and other Ancillary Service Leads) so good communication skills are necessary. They will also need to understand the EHR and how the software is installed and how the hardware is intended to work once the software is installed. They will need to have a working knowledge of all areas of the EHR and what each department can expect to be required to do to login, use, and troubleshoot issues that arise. The SuperUser Lead  creates a network of Super-Users within the organization to provide continued support during and after implementation of the EHR. These SuperUsers must be recruited and trained by the SuperUser Lead. SuperUsers must be personable and willing to help employees with various skills within the organization. They will need to be able to work with very computer savvy employees as well as those who have very little computer expertise. They will provide IT support during implementation as well as assisting with new employees hired after implementation. They will be chosen based on their knowledge of different facets of the EHR so that they can provide very specific and effective assistance to employees.

Plan for Evaluation

Once an Electronic Health Record has been implemented by a team within a hospital setting, it will be important to continually evaluate the success of the EHR in the different areas of the hospital. National professional organizations have developed position papers regarding the importance of evaluation as well as methods for evaluation. One such organization, Healthcare Information and Management System Society or HIMSS, developed a position paper titled Transforming Nursing Practice Through Technology and Informatics. In this paper, they outline the value of nursing informatics, connecting with the consumer, and implications for time and plan of care (“HIMSS,” June 16, 2011). HIMSS believes that nursing should be key stakeholders in not only the development and design of EHR, but also in the evaluation and optimization of EHR (“HIMSS,” June 16, 2011) . The position statement from HIMSS is in alignment with other professional organizations such as the American Nurses Association (ANA), and the Alliance for Nursing Informatics (ANI) (“HIMSS,” June 16, 2011). Having strong nursing informatics leadership will play a key role in evaluating the success of system implementation. These leaders will orchestrate what information will be provided, how patient care is supported by the gathering and documentation of data and what financial and business implications there are as a result of implementation (“HIMSS,” June 16, 2011). National benchmarks exist in all service areas in the hospital. The EHR should allow each service area to easily compile data to measure their area against national benchmarks as well as their peers. The ease in which data is gathered from the EHR will allow more time for changes in practice guidelines or protocols to provide for safer care for the patient and a better work environment for the employee. Continual evaluation by all service areas as well as discussions between unit service area leadership and nursing informatics leadership regarding possible optimizations to the EHR are imperative to a successful EHR implementation. C791 Advanced Information Management.

 

References

Mastrian, K. G., & McGonigle, D. (2017).
Informatics for Health Professionals
(Custom WGU ed.). [Western Governors University]. Retrieved from https://wgu.vitalsource.com/#/books/9781284155402

Position statement on transforming nursing practice through technology and informatics. (June 16, 2011). Retrieved from https://www.himss.org/sites/himssorg/files/HIMSSorg/handouts/HIMSSNIPositionStatementMonographReport.pdf

Tan, J., & Payton, F. C. (2017).
Adaptive Health Management Information Systems: Concepts, Cases, & Practical Adaptions
(Custom WGU ed.). [Western Governors University]. Retrieved from https://wgu.vitalsource.com/#/books/9781284155396 C791 Advanced Information Management

Nurs 6640 week 2 discussion – Sheehan Disability Scale (SDS) Essay examples

The Sheehan Disability Scale

Assessment tools such as the Sheehan Disability Scale (SDS) are important in helping the PMHNP in assessing the functional status and functional impairment of their clients (Wheeler, 2014). The impact of mental disorders on the clients’ life does not only depend on the diagnosis of the condition but on the disability that the disorder causes (Luciano et al., 2010, p. 896). The SDS is an assessment tool that can be done in the waiting room that focuses on three groups of activities including home management, work abilities, the ability to form and maintain relationships and social life (Luciano et al., 2010, p. 897). Nurs 6640 week 2 discussion – Sheehan Disability Scale (SDS) Essay examples.

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In the case of major depressive disorder (MDD) there are associations between the mental illness and functional impairments in the affected client (Sheehan et al., 2015). The impairment associated with MDD have strong social and economic impacts causing clients to miss work, have a reduction in quality relationships, and an increase in family disruption (Sheehan et al., 2015). The SDS is a validated and accepted measure of functional outcome in clients with MDD with higher scores indicating a greater functional impairment (Sheehan et al., 2015).

Sheehan Disability Tool and Psychopharmacology

Psychopharmacology can be an important part in the client’s recovery process. The prescribing of medications for clients with mental illness is a difficult task because medications could exacerbate symptoms or even mask symptoms. It is important to be able to use a reliable assessment tool such as the SDS to determine if the medications prescribed are effective.  It is important to monitor the client’s progress early in the course of antidepressant treatment using a functional assessment such as the SDS can help clinicians determine whether or not medication adjustments are needed (Soares, Zhang, & Boucher, 2017).  Mental health recovery does not only mean symptom remission but the restoration of functional ability and that is where SDS plays a major rule in medication management. Nurs 6640 week 2 discussion – Sheehan Disability Scale (SDS) Essay examples. The SDS is among the most commonly used function scales in clinical trials of antidepressant treatment of MDD (Soares, Zhang, & Boucher, 2017). The SDS shows great potential to enhance the quality of care for mental health clients and may help clinicians determine sooner than later whether treatment adjustments are needed.

It is important for the PMHNP to understand the assessment tools that are used and their limitations. SDS may help clinicians determine sooner than later whether treatment adjustments are needed (Soares, Zhang, & Boucher, 2017). The SDS can not only be used as a primary assessment tool but can also be used to determine the efficacy of the medications being prescribed. Nurs 6640 week 2 discussion – Sheehan Disability Scale (SDS) Essay examples.

Reference

Luciano, J. V., Bertsch, J., Salvador-Carulla, L., Tomás, J. M., Fernández, A., Pinto-Meza, A., … Serrano-Blanco, A. (2010). Factor structure, internal consistency and construct validity of the Sheehan Disability Scale in a Spanish primary care sample.
Journal of Evaluation in Clinical Practice
,
16
(5), 895-901. doi:10.1111/j.1365-2753.2009.01211.x

Sheehan, D. V., Mancini, M., Wang, J., Berggren, L., Cao, H., Dueñas, H. J., & Yue, L. (2015). Assessment of functional outcomes by Sheehan Disability Scale in patients with major depressive disorder treated with duloxetine versus selective serotonin reuptake inhibitors.
Human Psychopharmacology: Clinical and Experimental
,
31
(1), 53-63. doi:10.1002/hup.2500

Soares, C. N., Zhang, M., & Boucher, M. (2017). Categorical improvement in functional impairment in depressed patients treated with desvenlafaxine.
CNS Spectrums
, 1-11. doi:10.1017/s1092852917000633

Wheeler, K. (2014).
Psychotherapy for the Advanced Practice Psychiatric Nurse, Second Edition
. Springer Publishing Company. Nurs 6640 week 2 discussion – Sheehan Disability Scale (SDS) Essay examples.

 

NURS 6640 Week 2: Assessment and Diagnosis in Psychotherapy Assignment

“A sensitively crafted intake assessment can be a powerful therapeutic tool. It can establish rapport between patient and therapist, further the therapeutic alliance, alleviate anxiety, provide reassurance, and facilitate the flow of information necessary for an accurate diagnosis and appropriate treatment plan.”

—Pamela Bjorklund, clinical psychologist

Whether you are treating patients for physical ailments or clients for mental health issues, the assessment process is an inextricable part of health care. To properly diagnose clients and develop treatment plans, you must have a strong foundation in assessment. This includes a working knowledge of assessments that are available to aid in diagnosis, how to use these assessments, and how to select the most appropriate assessment based on a client’s presentation. Nurs 6640 week 2 discussion – Sheehan Disability Scale (SDS) Essay examples.

This week, as you explore assessment and diagnosis in psychotherapy, you examine assessment tools, including their psychometric properties and appropriate use. You also develop diagnoses for clients receiving psychotherapy and consider legal and ethical implications of counseling these clients. NURS 6640 – Assessment and Diagnosis in Psychotherapy Essay Assignment Papers.

NURS 6640 Week 2: Assessment and Diagnosis in Psychotherapy Assignment

NURS 6640 – Assessment and Diagnosis in Psychotherapy Essay Assignment Papers Learning Resources

NURS 6640 Week 2: Assessment and Diagnosis in Psychotherapy Assignment Required Readings

Wheeler, K. (Ed.). (2014). 
Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice
 (2nd ed.). New York, NY: Springer Publishing Company.

Chapter 3, “Assessment and Diagnosis” (pp. 95–168)

Chapter 4, “The Initial Contact and Maintaining the Frame” (pp. 169–224)

American Psychiatric Association. (2013). 
Diagnostic and statistical manual of mental disorders
(5th ed.). Washington, DC: Author. NURS 6640 – Assessment and Diagnosis in Psychotherapy Essay Assignment Papers. Nurs 6640 week 2 discussion – Sheehan Disability Scale (SDS) Essay examples

 

Note:
 It is highly recommended that you use this resource as a reference guide throughout the course. You will access this text from the Walden Library databases.

American Academy of Child and Adolescent Psychiatry. (1995). 
Practice parameters for the psychiatric assessment of children and adolescents
. Washington, DC: Author. Retrieved from https://www.aacap.org/App_Themes/AACAP/docs/practice_parameters/psychiatric_assessment_practice_parameter.pdf

American Psychiatric Association. (2016). 
Practice guidelines for the psychiatric evaluation of adults
 (3rd ed.). Arlington, VA: Author. Retrieved from http://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760

Walden Library. (2017). NURS 6640 week 2 discussion guide. Retrieved from http://academicguides.waldenu.edu/nurs6640week2discussion

Walden University. (n.d.). Tests & measures: Home. Retrieved February 6, 2017, from http://academicguides.waldenu.edu/library/testsmeasures

Note:
This database may be helpful in obtaining assessment tool information for this week’s Discussion. Nurs 6640 week 2 discussion – Sheehan Disability Scale (SDS) Essay examples

NURS 6640 Week 2: Assessment and Diagnosis in Psychotherapy Assignment Required Media

Laureate Education (Producer). (2015a). Counseling competencies—The application of ethical guides and laws to record keeping [Video file]. Baltimore, MD: Author.

Provided courtesy of the Laureate International Network of Universities.

 

Note:
 The approximate length of this media piece is 23 minutes.

NURS 6640 Week 2: Assessment and Diagnosis in Psychotherapy Assignment Discussion: Assessment Tools

Assessment tools have two primary purposes: 1) to measure illness and diagnose clients, and 2) to measure a client’s response to treatment. Often, you will find that multiple assessment tools are designed to measure the same condition or response. Not all tools, however, are appropriate for use in all clinical situations. You must consider the strengths and weaknesses of each tool to select the appropriate assessment tool for your client. For this Discussion, as you examine the assessment tool assigned to you by the Course Instructor, consider its use in psychotherapy. Nurs 6640 week 2 discussion – Sheehan Disability Scale (SDS) Essay examples.

Learning Objectives

Students will:

Analyze psychometric properties of assessment tools

Evaluate appropriate use of assessment tools in psychotherapy

Compare assessment tools used in psychotherapy

Note:
 By Day 1 of this week, the Course Instructor will assign you to an assessment tool that is used in psychotherapy.

To prepare:

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

Consider the asessment tool assigned to you by the Course Instructor.

Review the Library Course Guide in your Learning Resources for assistance in locating information on the assessment tool you were assigned.

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 Submit, you cannot delete or edit your own posts, and cannot post anonymously. Please check your post carefully before clicking 
Submit! Nurs 6640 week 2 discussion – Sheehan Disability Scale (SDS) Essay examples

By Day 3

Post
 an explanation of the psychometric properties of the assessment tool you were assigned. Explain when it is appropriate to use this assessment tool with clients, including whether the tool can be used to evaluate the efficacy of psychopharmacologic medications. Support your approach with evidence-based literature. NURS 6640 – Assessment and Diagnosis in Psychotherapy Essay Assignment Papers.

Read
 a selection of your colleagues’ responses.

By Day 6

Respond
 to at least 
two
 of your colleagues by comparing your assessment tool to theirs.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 2 Discussion Rubric

Post by Day 3 and Respond by Day 6

To participate in this Discussion:

Week 2 Discussion

 

The assessment tool that I will use for assessing my client will be the Sheehan Disability Scale (SDS). This tool important for the PMHNP to assess the functional status and functional impairment for the clients during assessment (Wheeler, 2014). In client’s life, the impact that the mental illness cause does not just depend on the diagnosing of the condition but also on the disorder that causes disability. This tool can also be useful in the waiting room for assessment which depends on three different groups of programing such as management at home, abilities to work, and ability for a client to have a relationship and maintain it and social life. With clients with major depressive disorder (MDD), the client is effected by the mental illness and functional impairments (Sheehan et al., 2015). These impairments are associated client with MDD have impact on their social and economic affecting their work, having low quality of friendship, and has an increase in disrupting their family.

Sheehan Disability Scale and Psychopharmacology

Psychopharmacology is necessary during client’s process of recovery as a part of treatment for mental illness. For providers to prescribe medications for a mental illness client is very difficult because some medications can cause the illness to be worst or even mask the symptoms. SDS tool plays a very important part in making sure the medications prescribed by the provider will be effective. The provider needs to monitor the progress of the client’s antidepressant regimen by using the functional assessment such as the SDS to find out if the medication is working or need to be adjusted (Soares, Zhang, & Boucher, 2017). SDS plays an important role in medication management for mental illness recovery not only to symptom remission but also to restore the functional ability of the client. This tool is the only tool used in clinical trials for function scales of the antidepressant regimen and it showed a great potential in enhancing the quality of care the providers care for mental illness clients and helps the clinician in determining treatment sooner if it needs to be adjusted or not than waiting for later.

The PMHNP needs to know the and understand the assessment tools used, also know their limit but can be used the primary tool use to determine the efficacy of the medications that the provider is prescribing.

 

References;

Hodgins, D. C. (2013). Reliability and validity of the Sheehan Disability Scale modified for pathological gambling. BMC Psychiatry, 13177. doi:10.1186/1471-244X-13-177

 

Luciano, J. V., Bertsch, J., Salvador-Carulla, L., Tomás, J. M., Fernández, A., Pinto-Meza, A., … Serrano-Blanco, A. (2010). Factor structure, internal consistency and construct validity of the Sheehan Disability Scale in a Spanish primary care sample. Journal of Evaluation in Clinical Practice, 16(5), 895-901. doi:10.1111/j.1365-2753.2009.01211.x

Sheehan, D. V., Mancini, M., Wang, J., Berggren, L., Cao, H., Dueñas, H. J., & Yue, L. (2015). Assessment of functional outcomes by Sheehan Disability Scale in patients with major depressive disorder treated with duloxetine versus selective serotonin reuptake inhibitors. Human Psychopharmacology: Clinical and Experimental, 31(1), 53-63. doi:10.1002/hup.2500

Soares, C. N., Zhang, M., & Boucher, M. (2017). Categorical improvement in functional impairment in depressed patients treated with desvenlafaxine. CNS Spectrums, 1-11. doi:10.1017/s1092852917000633

Wheeler, K. (2014). Psychotherapy for the Advanced Practice Psychiatric Nurse, Second Edition. Springer Publishing Company. Nurs 6640 week 2 discussion – Sheehan Disability Scale (SDS) Essay examples

SHEEHAN, D. V., GASIOR, M., MCELROY, S. L., RADEWONUK, J., HERMAN, B. K., & HUDSON, J. (2018). Effects of Lisdexamfetamine Dimesylate on Functional Impairment Measured on the Sheehan Disability Scale in Adults With Moderate-tosevere Binge Eating Disorder: Results from Two Randomized, Placebo-controlled Trials. Innovations In Clinical Neuroscience, 15(5/6), 22-29. Nurs 6640 week 2 discussion – Sheehan Disability Scale (SDS) Essay examples

Nurs 6551 Week 1 Discussion – Political, Social, and Sociocultural Influences on Women’s Health Sample Essays

Discussion: Political, Social, and Sociocultural Influences on Women’s Health

As an advanced practice nurse, you must remain current on health issues that commonly impact women such as birth control, abortion, family planning, the human papillomavirus (HPV) vaccine, and human immunodeficiency virus (HIV). Many of these women’s health issues are heavily influenced by political, social, and sociocultural factors. These influences might not only affect a woman’s ability or desire to receive care, but also a provider’s ability or willingness to offer care. How might political, social, and sociocultural factors influence your personal perceptions of these women’s health issues? Nurs 6551 Week 1 Discussion – Political, Social, and Sociocultural Influences on Women’s Health Sample Essays

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To prepare:

·        Review this week’s media presentation, as well as Chapter 1 of the Schuiling and Likis text.

·        Select and research one of the following women’s health issues: birth control, abortion, family planning,
human papillomavirus (HPV) vaccine
, human immunodeficiency virus (HIV) in women, or another issue approved by the course Instructor.

·        Consider the impact of political, social, and sociocultural factors on the women’s health issue you selected.

·        Reflect on how the personal perceptions of providers might influence their ability or willingness to care for women in relation to this issue.

Post
at least 250 words APA format (no introduction or conclusion)

1.     pick on subject from above

2.     explain the political impact of this women’s health issue,

3.     social factors of this women’s health issue

4.     sociocultural factors on this women’s health issue

5.     Explain how personal perceptions of providers might influence their ability or willingness to care for women in relation to this issue. Nurs 6551 Week 1 Discussion – Political, Social, and Sociocultural Influences on Women’s Health Sample Essays

Resource

Schuiling, K. D., & Likis, F. E. (2013).
Women’s gynecologic health
(2nd ed.). Burlington, MA: Jones and Bartlett Publishers

 

NURS 6551 Week 1 Discussion – As an advanced practice nurse, you must remain current on health issues that commonly impact women such as birth control, abortion, family planning, the human papillomavirus (HPV) vaccine, and human immunodeficiency virus (HIV). Many of these women’s health issues are heavily influenced by political, social, and sociocultural factors. These influences might not only affect a woman’s ability or desire to receive care, but also a provider’s ability or willingness to offer care. How might political, social, and sociocultural factors influence your personal perceptions of these women’s health issues?

To prepare FOR NURS 6551 Week 1 Discussion:

  Review this week’s media presentation, as well as Chapter 1 of the Schuiling and Likis text.

Select and research one of the following women’s health issues: birth control, abortion, family planning, human papillomavirus (HPV) vaccine, human immunodeficiency virus (HIV) in women, or another issue approved by the course Instructor.

Consider the impact of political, social, and sociocultural factors on the women’s health issue you selected.

Reflect on how the personal perceptions of providers might influence their ability or willingness to care for women in relation to this issue.

Post
 at least 250 words APA format (no introduction or conclusion)

1.     pick on subject from above

2.     explain the political impact of this women’s health issue,

3.     social factors of this women’s health issue

4.     sociocultural factors on this women’s health issue

5.     Explain how personal perceptions of providers might influence their ability or willingness to care for women in relation to this issue.

NURS 6551 Week 1 Discussion Resource

Schuiling, K. D., & Likis, F. E. (2013). 
Women’s gynecologic health
 (2nd ed.). Burlington, MA: Jones and Bartlett Publishers

NURS 6551 Week 9 Discussion

To prepare Assignment 1: Application – Comprehensive Patient Assessment ON Abnormal Uterine Bleeding

Reflect on your Practicum Experience and select a female patient whom you have examined with the support and guidance of your Preceptor. Nurs 6551 Week 1 Discussion – Political, Social, and Sociocultural Influences on Women’s Health Sample Essays

Think about the details of the patient’s background, medical history, physical exam, labs and diagnostics, diagnosis, treatment and management plan, as well as education strategies and follow-up care.

To complete

Write an 8- to 10-page comprehensive 
soap Note paper on
 
Abnormal Uterine Bleeding
 , that addresses the following:

Age, race and ethnicity, and partner status of the patient

Current health status, including chief concern or complaint of the patient

Contraception method (if any)

Patient history, including medical history, family medical history, gynecologic history, obstetric history, and personal social history (as appropriate to current problem)

Review of systems

Physical exam

Labs, tests, and other diagnostics

Differential diagnoses

Management plan, including diagnosis, treatment, patient education, and follow-up care.

References

Schuiling, K. D., & Likis, F. E. (2013). 
Women’s gynecologic health
 (2nd ed.). Burlington, MA: Jones and Bartlett Publishers.

Chapter 5, “Gynecologic Anatomy and Physiology” (pp. 81–101)

Chapter 6, “Gynecologic History and Physical Examination” (pp. 103–131)

Tharpe, N. L., Farley, C., & Jordan, R. G. (2013).
 Clinical practice guidelines for midwifery & Women’s health
 (4th ed.). Burlington, MA: Jones & Bartlett Publishers.

Chapter 6, “Care of the Well Woman Across the Life Span

“Preventive Health Care for Well Women” (pp. 263–265)

. Retrieved from 
http://www.womenshealth.gov/screening-
tests-and-vaccines/screening
-tests-for-women/
Screening tests and vaccines
U.S. Department of Health and Human Services. (2012b). Care of the Well Woman: Health Assessment and Screening” (pp. 265–270)

Society for Reporoductive Endocrinology and Infertility. (2012). Abnormal uterine bleeding. Retrieved from 
http://www.socrei.org/BOOKLET_abnormal_uteine_bleeding/
Taran, F. A., Stewart, E. A., & Brucker, S. (2013). Adenomyosis: Epidemiology, risk factors, clinical phenotype and surgical and interventional alternative to hysterectomy. 
Geburtshilfe Frauenheilkunde, 73
(9), 924-931. Nurs 6551 Week 1 Discussion – Political, Social, and Sociocultural Influences on Women’s Health Sample Essays

Nurs 6640 week 1 discussion Post Response

Great post Daniel on the cultural beliefs effect psychotherapy. I agree when you said that it is important that the PMHNP needs to be culturally competent and aware of the different stigmas that culture can play on the perception of psychotherapy. The concept of cultural competence is especially true when dealing with the Navajo nation because even the use of the word “belief’ can cause problem because of the way their culture interprets its meaning. The Navajo regard psychotherapy as a practice pertaining to illness and healing and the terminology used becomes important (Lewis-Fernández, 2011, p. 5). When the word belief is applied to aspects of therapy it carries the connotation of falsehood, instead of saying what is your belief on mental illness and psych therapy one should use the terms values, attitudes on, view, but never beliefs (Lewis-Fernández, 2011, p. 6). Nurs 6640 week 1 discussion Post Response

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The feeling of shared cultural beliefs and values plays an important role in psychotherapy. If a client feels that you do not understand where they are coming from because of cultural differences, it can cause negative effects. There are some studies that show that ethnically similar clients and therapists can result in more favorable outcomes. The increase in more favorable outcomes could be because the ethnic minority clients may view ethnically similar psychotherapists as a more credible source of help because the assume a shared culture or values (Meyer & Zane, 2013, p. 3).

Through your research have you found any data that supports racial matching of clients causing more favorable outcomes? Do you think that racial matching is appropriate in todays society? Nurs 6640 week 1 discussion Post Response. Again Daniel this was a very informative post and I look forward to reading more from you in the future.

 

Reference

Lewis-Fernández, R. (2011). Commentary on “Elements of Psychotherapy in Navaho Religion”: A Perspective from Contemporary Cultural Psychiatry.
Psychiatry: Interpersonal and Biological Processes
,
74
(4), 293-300. doi:10.1521/psyc.2011.74.4.293

Meyer, O. L., & Zane, N. (2013). THE INFLUENCE OF RACE AND ETHNICITY IN CLIENTS’ EXPERIENCES OF MENTAL HEALTH TREATMENT.
Journal of Community Psychology
,
41
(7), 884-901. doi:10.1002/jcop.21580. Nurs 6640 week 1 discussion Post Response

Katharine Kolcaba’s Theory of Comfort nursing essay

Discuss 
two different types
 of comfort interventions that can be utilized by the advanced practice nurse in the clinical setting as per Katharine Kolcaba’s Theory of Comfort. Identify 
one
 MSN Essential that most relates to application of this theory in practice and explain your choice.

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**As a reminder,
 all questions must be answered to receive
 
full credit for this discussion
.
 
please include your name in the title bar of the discussion. Discussion posts must be minimum of 250 words and reply posts minimum 100 words. 
Also, make sure to use scholarly sources to support your discussion.** Katharine Kolcaba’s Theory of Comfort nursing essay

social and economic costs of this health problem for society, families, and individuals

What are the economic costs of this health problem for society, families, and individuals?

What are the social costs (cost in any means such as time, human resource, social burden) associated with this health problem for society and individuals?

Use data (statistics) from credible sources to support your discussion.

Using APA format, create a reference list citing all the sources used in writing your paper.

Interpret and include at least 
one graph or table
 that relates to the content of your paper. You will discuss the graph or table as part of your narrative and include the graph or table in an Appendix at the end of your paper. Cite the source for the tables or graphs below each one and in the reference list using APA format.

ORDER A PLAGIARISM-FREE PAPER HERE

Each focus paper must be written in a scholarly manner using proper APA format (6th edition).

Each focus paper must be at least 750 words in length. The 750 words do not include the title page, reference list or appendix. social and economic costs of this health problem for society, families, and individuals

Your paper should not consist of more than 10% of direct quotes. This means that in a 750-word paper, no more than 75 words can be directly quoted from a source. Points will be deducted from papers exceeding the 10% limit. Instead of quoting, paraphrase the information in your own words.

Your papers must be submitted as 
MS Office Word
 documents, using a 12-point font, double spaced and with page numbers upper right corner of each page.

In each focus paper, you must use 
at least three
 different credible, professional references to support your discussion.  Your references should be 
cited in-text
 and in 
a reference list
 using proper APA format.

The order of your paper should be: title page, body of your paper, reference list and appendix. social and economic costs of this health problem for society, families, and individuals

Puerto Rican Woman With Comorbid Addiction Assignment: Assessing and Treating Clients with Impulsivity, Compulsivity, and Addiction

The Assignment

Examine 
Case Study
 
: A Puerto Rican Woman With Comorbid Addiction
. 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:

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· 
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? Puerto Rican Woman With Comorbid Addiction

· 
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? 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?

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 14, “Impulsivity, Compulsivity, and Addiction”

Stahl, S. M., & Grady, M. (2012). 
Stahl’s illustrated substance use and impulsive disorder
 New York, NY: Cambridge University Press.

 

To access the following chapter, click on the 
Illustrated Guides
 
tab and then the 
Substance Use and Impulsive Disorders
 
tab.

· Chapter 10, “Disorders of Impulsivity and Compulsivity”

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

For obsessive-compulsive disorder

· Citalopram

· clomipramine

· escitalopram

· fluoxetine

· fluvoxamine

· paroxetine

· sertraline

· venlafaxine

· vilazodone

 

For alcohol withdrawal

· chlordiazepoxide

· clonidine

· clorazepate

· diazepam

· lorazepam

· oxazepam

 

For bulimia nervosa and binge eating

· fluoxetine

· topiramate

· zonisamide

For alcohol abstinence

· acamprosate

· disulfiram

 

For alcohol dependence

· nalmefene

· naltrexone

 

For opioid dependence

· buprenorphine

· naltrexone

For nicotine addiction

· bupropion

· varenicline

 

Book Excerpt:
 Substance Abuse and Mental Health Services Administration. (1999). Treatment of adolescents with substance use disorders. 
Treatment Improvement Protocol Series, No. 32
. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK64350/

· Chapter 1, “Substance Use Among Adolescents”

· Chapter 2, “Tailoring Treatment to the Adolescent’s Problem”

· Chapter 7, “Youths with Distinctive Treatment Needs”

University of Michigan Health System. (2016). Childhood trauma linked to worse impulse control in adulthood, study finds. Retrieved from https://www.sciencedaily.com/releases/2016/01/160120201324.htm

Note:
 Retrieved from Walden Library databases.

Grant, J. E., Odlaug, B. L., & Schreiber, L. N. (2014). Pharmacological treatments in pathological gambling. 
British Journal of Clinical Pharmacology, 77
(2), 375–381. doi:10.1111/j.1365-2125.2012.04457.x

Note:
 Retrieved from Walden Library databases.

Loreck, D., Brandt, N. J., & DiPaula, B. (2016). Managing opioid abuse in older adults: Clinical considerations and challenges. 
Journal of Gerontological Nursing, 42
(4), 10–15. doi:10.3928/00989134-20160314-04

Note:
 Retrieved from Walden Library databases.

Salmon, J. M., & Forester, B. (2012). Substance abuse and co-occurring psychiatric disorders in older adults: A clinical case and review of the relevant literature. 
Journal of Dual Diagnosis, 8
(1), 74–84. doi:10.1080/15504263.2012.648439

Note:
 Retrieved from Walden Library databases.

Sanches, M., Scott-Gurnell, K., Patel, A., Caetano, S. C., Zunta-Soares, G. B., Hatch, J. P., & … Soares, J. C. (2014). Impulsivity in children and adolescents with mood disorders and unaffected offspring of bipolar parents. 
Comprehensive Psychiatry, 55
(6), 1337–1341. doi:10.1016/j.comppsych.2014.04.018

Note:
Retrieved from Walden Library databases. Puerto Rican Woman With Comorbid Addiction

Required Media

Laureate Education (2016c). 
Case study: A Puerto Rican woman with comorbid addiction
 [Interactive media file]. Baltimore, MD: Author

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

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 “WK8Assgn+last name+first initial.(extension)” as the name.

· Click the 
Week 8 Assignment Rubric 
to review the Grading Criteria for the Assignment.

· Click the 
Week 8 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. Find the document you saved as “WK8Assgn+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 8 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 8 Assignment draft and review the originality report.

Nursing Assignment by Day 7

To submit your Assignment:

Week 8 Assignment

Making Connections

Now that you have:

· Assessed clients presenting with impulsivity, compulsivity, and addiction

· Developed personalized plans of therapy for clients with impulsivity, compulsivity, and addiction

· Examined factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for impulsivity, compulsivity, and addiction

· Explored ethical and legal implications of prescribing therapy to clients with impulsivity, compulsivity, and addiction

Next week, you will build on your assessment and treatment skills as you examine clients presenting for therapy for ADHD.

 

The Assignment

Examine Case Study: A Puerto Rican Woman With Comorbid Addiction. 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:

A Puerto Rican Woman With Comorbid Addiction Decision #1

Which decision did you select?NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment

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 Essay Assignment

A Puerto Rican Woman With Comorbid Addiction 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?

A Puerto Rican Woman With Comorbid Addiction 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? 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?

BACKGROUND

Mrs. Maria Perez is a 53 year old Puerto Rican female who presents to your office today due to a rather “embarrassing problem.”

SUBJECTIVE

Mrs. Perez admits that she has had “problems” with alcohol since her father died in her late teens. She reports that she has struggled with alcohol since her 20’s and has been involved with Alcoholics Anonymous “on and off” for the past 25 years. She states that for the past two years, she has been having more and more difficulty maintaining her sobriety since they opened the new “Rising Sun” casino near her home. Mrs. Perez states that she and a friend went to visit the new casino during their grand opening at which point she was “hooked.” She states that she gets “such a high” when she is gambling. While gambling, she “enjoys a drink or two” to help calm her during high-stakes games. She states that this often gives way to more drinking and more reckless gambling. She also reports that her cigarette smoking has increased over the past two years and she is concerned about the negative effects of the cigarette smoking on her health.

She states that she attempts to abstain from drinking but that she gets such a “high” from the act of gambling that she needs a few drinks to “even out.” She also notices that when she drinks, she doesn’t smoke “as much” but enjoys smoking when she is playing at the slot machines. She also reports that she has gained weight from drinking so much- she currently weights 122 lbs., which represents a 7 lb. weight gain from her usual 115 lb. weight. Puerto Rican Woman With Comorbid Addiction

Mrs. Perez is quite concerned today because she has borrowed over $50,000 from her retirement account to pay off her gambling debts. She is very concerned because her husband does not know that she has spent this much money.A Puerto Rican Woman With Comorbid Addiction

MENTAL STATUS EXAM

The client is a 53 year old Puerto Rican female who is alert, oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. Her speech is clear, coherent, and goal directed. Her eye contact is somewhat avoidant during the clinical interview. As you make eye contact with her, she looks away or looks down. She demonstrates no noteworthy mannerisms, gestures, or tics. Her self-reported mood is “sad.” Affect is appropriate to content of conversation & self-reported mood. She visual or auditory hallucinations, no delusional or paranoid thought processes are readily appreciated. Insight and judgment are grossly intact; however, impulse control is impaired. She is currently denying suicidal or homicidal ideation.A Puerto Rican Woman With Comorbid Addiction

Diagnosis: Gambling disorder, alcohol use disorder

Decision 1: Antabuse (Disulfiram) 250mg orally daily

Decision 2: continue current dose of Antabuse and refer to counseling for ongoing gambling issues.

Decision 3: Explore the issues that Mrs. Perez is having with her counselor and encourage her to continue attending the Gambling Anonymous meeting, and discuss smoking cessation.

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

In summary: What needs to be in the essay.

-Introduction regarding disease state

-High-level summary of patient case

-Purpose of the essay statement

1, Decision 1

-What options were listed

-What option did you choose?

-Why did you select that option?

-Why didn’t you select the other two options?

-What was your goal of treatment

-Was the outcome what you expected? Why?

2, Decision 2

-What options were listed

-What option did you choose?

-Why did you select that option?

-Why didn’t you select the other two options?

-What was your goal of treatment

-Was the outcome what you expected? Why?

3, Decision 3

-What options were listed

-What option did you choose?

-Why did you select that option?

-Why didn’t you select the other two options?

What was your goal of treatment

-Was the outcome what you expected? Why?

-Conclusion with Ethical 
considerations

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

SAMPLE

Excerpt from Case Study :

Puerto Rican Woman with Comorbid Addiction: A Case Study

Ms. Perez is a 53-year-old Puerto Rican female who has complained that she is suffering from co-morbid addictions of alcoholism and gambling. Ms. Perez has sought treatment for alcoholism in the past but the combination of living near a casino and the availability of alcohol has caused her to relapse as well as to engage in gambling on a regular basis. Her gambling has negatively impacted her marriage and has also caused her to borrow significant sums from her retirement account. The patient is exhibiting the symptoms of depression, including a sad and lethargic demeanor.A Puerto Rican Woman With Comorbid Addiction

Decision One

One option for the patient is prescribing Antabuse (Disulfiram), a medication which “blocks an enzyme that is involved in metabolizing alcohol intake” and “produces very unpleasant side effects when combined with alcohol in the body” (“Antabuse,” 2017). The drug is designed to interfere with the rewards drinking alcohol produces in the patient, given that alcoholism is an addiction with both physical and mental components. Antabuse has the benefit of being specifically prescribed to treat alcohol addiction, in contrast to other medications such as Naltrexone (Vivitrol), which is prescribed for both opioid and alcohol-related addictions. Naltrexone has the disadvantage of being injected versus taken orally, and the patient has a greater sense of control over the administration of this particular drug when taken orally, which may enhance long-term compliance.A Puerto Rican Woman With Comorbid Addiction

Another possible pharmaceutical intervention is Campral (acamprosate), a drug which is also exclusively prescribed to treat alcohol dependence. However, Campral can produce very unpleasant side effects in some patients, including drowsiness “that may impair your thinking or reactions,” according to its warning label, and users are instructed to “be careful if you drive or do anything that requires you to be awake and alert” (“Campral,” 2017). Although side effects are also reported with Antabuse, drowsiness is listed as a less common side effect (“Antabuse,” 2017). The hope is to reduce the patient’s reliance upon alcohol without causing effects that could act as a deterrent in her pursuit of sobriety Puerto Rican Woman With Comorbid Addiction

Existential-humanistic therapy – Assignment 1: Practicum – Week 8 Journal Entry

Assignment 1: Practicum – Week 8 Journal Entry

For 
Part 1
, select a client whom you observed or counseled this week (other than the client used for this week’s Discussion). Then, address the following in your Practicum Journal:

Explain whether existential-humanistic therapy would be beneficial with this client. Include expected outcomes based on this therapeutic approach.

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Explain any legal and/or ethical implications related to counseling this client. Support your approach with evidence-based literature.

References

Michael Price, M. (2011). 
Searching for meaning
. American Psychological Association. Vol. 42, No.10. P. 58

Wheeler, K. (Ed.). (2014). 
Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice
 (2nd ed.). New York, NY: Springer Publishing Company.

· Chapter 10, “Humanistic-Existential and Solution-Focused Approaches to Psychotherapy” (Review pp. 369–406)

American Psychiatric Association. (2013). 
Diagnostic and statistical manual of mental disorders
(5th ed.). Washington, DC: Author. Existential-humanistic therapy – Assignment 1: Practicum – Week 8 Journal Entry

 

Note:
 You will access this text from the Walden Library databases.

Nagy, T. F. (2011). 
Ethics in psychotherapy
. In Essential ethics for psychologists: A primer for understanding and mastering core issues (pp. 185–198). Washington, DC: American Psychological Association. doi:10.1037/12345-010

 

Note:
 You will access this text from the Walden Library databases.

Required Media

Sommers-Flanagan, J., & Sommers-Flanagan, R. (2013). 
Counseling and psychotherapy theories in context and practice
 [Video file]. Mill Valley, CA: Psychotherapy.net.

 

Note:
 For this week, view Existential Therapy, Person-Centered Therapy, and Gestalt Therapy only. You will access this media from the Walden Library databases

Laureate Education (Producer). (2012b). 
Clinical supervision follow-up
 [Video file]. Baltimore, MD: Author.

 

Note:
 This is a follow-up to the Thompson family media piece in Week 5. The approximate length of this media piece is 9 minutes.

 

Accessible player

Laureate Education (Producer). (2015d). 
On a hamster wheel
 [Video file]. Baltimore, MD: Author.

 

Note:
 The approximate length of this media piece is 2 minutes.

 

Accessible player

Bugental, J. (n.d.). 
Existential-humanistic psychotherapy
 [Video file]. Mill Valley, CA: Psychotherapy.net.

 

Note:
 You will access this media from the Walden Library databases. The approximate length of this media piece is 108 minutes.

Optional Resources

May, R. (n.d.). 
Rollo May on existential psychotherapy
 [Video file]. Mill Valley, CA: Psychotherapy.net.

 

Note:
You will access this media from the Walden Library databases. The approximate length of this media piece is 61 minutes. Existential-humanistic therapy – Assignment 1: Practicum – Week 8 Journal Entry

Steinert , T. (2016). 
Ethics of coercive treatment and misuse of psychiatry
. Psychiatric Services. doi:10.1176/appi.ps.201600066. Retrieved from http://ps.psychiatryonline.org/doi/10.1176/appi.ps.201600066

This week’s topic  is :  The case of  “I can’t catch my breath”

John, a healthy twenty-eight year old electrical engineer, was driving home from work one evening when he experienced sudden stabbing pain in his right pectoral and right lateral axillary regions. He began to feel out of breath and both his respiratory rate and heart rate increased dramatically. As luck would have it, John passed a hospital each day on his way home and was able to get himself to the hospital’s emergency room. The emergency room physician listened to John’s breathing with a stethoscope and requested blood gas analysis and a chest x-ray. John answered a few of the doctor’s questions. The doctor noted that John had no history of respiratory problems but was a heavy smoker. The case of  “I can’t catch my breath” Essay

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After viewing the chest radiograph, the doctor informed John that he had experienced a spontaneous pneumothorax, or what is commonly called a collapsed lung. The doctor explained that a hole had opened in John’s right lung and that this hole had allowed air to leak into the cavity surrounding the lung. Then, as a result of the lung’s own elastic nature, the lung had collapsed. The doctor said he could not be certain of the cause of thepneumothorax, but smoking cigarettes had certainly increased the likelihood of it happening. He told John he was fortunate the pneumothorax was small, which meant that relatively little air had escaped from the lung into the surrounding cavity, and it should heal on its own. He instructed John to quit smoking, avoid high altitudes, flying innon pressurized aircraft, and scuba diving. He also had John make an appointment for a re-check and another chest x-ray.

Case Background

Spontaneous pneumothorax occurs when a blister on the surface of the lung opens, allowing air from the lung to move into the pleural cavity. This occurs because alveolar pressure is normally greater than the pressure in the pleural cavity. As air escapes from the lung, the lung tissues will recoil, and the lung will begin to collapse. The lung will continue to collapse until the difference between the alveolar pressure and pleural pressure disappears or until the collapsing of the lung causes the opening to seal. The case of  “I can’t catch my breath” Essay

The pneumothorax decreases the efficiency of the respiratory system, which in turn results in decreased blood oxygen concentration, increased respiratory rate, and increased heart rate. If the pneumothorax is small, the air that escapes into the pleural cavity can be reabsorbed into the lung once the opening has sealed shut. If thepneumothorax is large, a needle or chest tube may have to be inserted into the pleural cavity to draw the air out and allow for the re expansion of the lung.

Utilizing the med terms you learned this week answer the following questions

Why was John instructed to avoid high altitudes and flying in non pressurized aircrafts?

That is, what are the effects of high altitudes and or decreased air pressures on the respiratory system. The case of  “I can’t catch my breath” Essay