SHORT ANSWER

Address the following Short Answer prompts for your Assignment. Be sure to include references to the Learning Resources for this week.

  1. In 3 or 4 sentences, explain the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse. Which drugs are contraindicated, if any, and why? Be specific. What is the timeframe that the patient should see resolution of symptoms?
  2. List 4 predictors of late onset generalized anxiety disorder.
  3. List 4 potential neurobiology causes of psychotic major depression.
  4. An episode of major depression is defined as a period of time lasting at least 2 weeks. List at least 5 symptoms required for the episode to occur. Be specific.
  5. List 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia. Be specific. 

Nursing

Instructions:

1.
Topic Selection: Select a topic that interests you and that is relevant to nursing Pediatric practice. Your topic should be broad enough to allow for an in-depth exploration but narrow enough to be manageable within the scope of a 
500-650 word research paper. You may select a topic related to patient care, nursing education, health promotion, or any other area of nursing practice that interests you. 

2.
Searching for Literature: After choosing a topic and 
obtaining my approval for the topic, use the Library page at the FNU.edu website to search for scholarly sources related to your topic. You must utilize 
at least 3 scholarly sources that have been published 
within the last 5 years. You may use databases such as CINAHL, MEDLINE, Embase, ClinicalKey, The Cochrane Library. Be sure to use appropriate keywords and to apply search filters to limit your search to 
scholarly, peer-reviewed articles.

3.
Evaluating Sources: Once you have identified potential sources, be sure to identify if they are relevant to your topic, written by credible authors, and based on rigorous research methods.

4.
Writing the Paper: Your research paper should follow 
APA 7 guidelines and include an 
introduction and 
conclusion. Be sure 
references are cited throughout the paper and included in a 
reference list at the end of your paper.

5. Please keep in mind that the paper will be checked for plagiarism, and 
similarity above 25% that is not cited will not be accepted for submission. 

6. Please refer to the evaluation rubric for evaluation criteria 

Library Assignment Topics:

1. Breastfeeding vs. Formula Feeding2.

2. Formula vs. Breastfeeding

3. 3. Childhood Developmental Stages

4. 4. Autism in Children

5. 5. Down’s Syndrome in Children

6. 6. Childhood Obesity in the U.S.

7. 7. Childhood Asthma

8. 8. Psychosocial Development of Adolescents

9. 9. Effects of Second-Hand Smoking in Children

10. 10. Childhood Mortality in the US

11. 11. Diabetes Type 1

12. 12. Sudden Infant Death Syndrome (SIDS)

13. 13. Congenital Heart Disorders in Children

14. 14. Eating Disorders in Adolescents

15. 15. Substance Abuse in Adolescents

16. 16. ADHD in Children

17. 17. Importance of Childhood Immunization

18. 18. Preventing Medication Errors in Children

19. 19. Iron Deficiency Anemia in Children

20. 20. Leukemia in Children

21. 21. How Preterm Birth Affects Child Development

22. Effects of Parenting Style on the Child’s Self-Esteem

23. Effects of Child’s Abuse or Neglect

24. Bullying in Children

25. Effects of Social Media on the Child’s Behavior

week 4 reply classmate-



Nicole Fox

The main goal of having an EHR is to improve the quality and safety of patient care (Hebda et al. 2018). More hospitals are turning to EHRs because it's a smoother flow of care and recording without compromising patient privacy. Other benefits include: “improving the accuracy and completeness of patient health information; increasing the speed at which care is provided; enhancing the coordination of care; and increasing transparency of health information for patients and their families, flag potentially dangerous drug interactions, verify medications, and reduce the needs for risky tests and procedures (Hebda et al. 2018).” In this scenario, the patient's PHR is limited because tests were outsourced versus being conducted all at the same facility. This can make patients question their diagnosis especially if they don't have all the information available to them. PHRs allow patients to be involved in the healthcare, however for some it may not be entirely user friendly which can hinder their understanding of the medical care. Additionally, not all patients have the level of technology available to them, whether it be a smartphone, laptop, or tablet, and therefore have limited access to their records. It has definitely been a major step forward in the medical field, and there is always room for improvements. Patients also need to understand the risks of safeguarding their personal information and how to protect their records from being accessed by non approved personnel. Both systems do provide results in real time and therefore both patient and provider can access and discuss already performed tests as well as prepare for future testing, thus ensuring they are both in line with the same goals. To ensure PHR protection, the user creates their own login and password. They are then responsible for keeping both of those safe. 

I am glad that patients have access to a PHR. I think it's helps provide understanding to their care and allows them to research and identify questions concerning their medical treatments. We oftentimes find that patients can be a little too research happy and find the 1% side affect that they are afraid might happen to them, and can cause a pause in their treatment. I do enjoy being able to discuss with my patients their results and answer questions on a nursing level, but most of the questions are referenced towards the provider. In this case, I feel like the patient could be frustrated because they don't have access to all the information, but that doesn't mean it's not attainable, just a little more difficult and a little more time consuming to put it all together. 

References:

Hebda, T., Hunter, K., & Czar, P. (2018). 
Handbook of Informatics for Nurses & Healthcare Professionals. (6th ed.). Pearson Learning Solutions

Kruse, C. S., Smith, B., Vanderlinden, H., & Nealand, A. (2017). Security Techniques for the Electronic Health Records. 
Journal of medical systems
41(8), 127. https://doi.org/10.1007/s10916-017-0778-4

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5522514/
Links to an external site.

compare and contrast

GH4004 Compare and Contrast Template

Instructions: Complete the Compare and Contrast Template by recording the information in the template as either a bulleted list or in complete sentences. Be sure to reference the scholarly resources consulted in obtaining the information recorded below.

For this Performance Task Assessment, you will compare and contrast health problems and healthcare system data from the United States to health problems and healthcare system data from one other country that is demographically different from the United States.

1.
Explain the health problem you selected and why you chose that problem.

Identify and record the health data for each country for the health problem you selected.

Task

United States

Other Country

2a. Identify the following for each country:

Population and demographics

2b. Identify the following for each country:

Annual per capita income

2c. Identify the following for each country:

Annual per capita spending on healthcare

3. Describe the incidence of the health problem in each country.

4. Describe the prevalence of the health problem in each country.

5. Describe the healthcare system of workers/professionals who are available to serve the population for the health problem in each country:

6a. Explain the following list of factors that may contribute to the existence of the health problem in each country:

Describe the elements of the epidemiological triangle, if applicable

6b. Explain the following list of factors that may contribute to the existence of the health problem in each country:

Describe environmental impacts (including the healthcare delivery system) that may apply to the health problem in each country

7a. Explain the multifactorial relationships for the health problem in each country:

Nutritional considerations, if applicable

7b. Explain the multifactorial relationships for the health problem in each country:

Economic considerations

7c. Explain the multifactorial relationships for the health problem in each country:

The costs of medication and/or treatment in the healthcare system

8. Explain at least two current efforts for containment/mitigation by the healthcare system for the health problem in each country.

U.S. health care system

Research the delivery, finance, management, and sustainability methods of the U.S. health care system. Evaluate the effectiveness of one or more of these areas on quality patient care and health outcomes. Propose a potential health care reform solution to improve effectiveness in the area you evaluated and predict the expected effect. Describe the effect of health care reform on the U.S. health care system and its respective stakeholders. Support your post with a peer-reviewed journal article.

reply 1

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 


Reference:

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

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

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

Nursing Scholarly Assignment: Description of the Theory of Pain

Introduction – Discuss the historical background of theories of pain mechanisms 

Analysis of the underpinning for the theory of pain – discuss the analysis of the underpinning for the theory of pain. Theoretical or background work that has been done in the field that will support formation or creation of theory. 

Applications of the theory of pain – explain how the theory is used in practice 

Suggestion for additional research – discuss the need for additional research

Conclusion – all resources correctly referenced 

MUST USE SIX CURRENT SCHOLARLY REFERENCES off CINAHL Complete Database, MEDLINE Complete Database, LIRN and EBSCO HOST 

Urinary Tract Infection (UTI) pathophysiology

I have attached the rubric on how to do

Nursing help with homework

Quality Improvement

 

Instructions

· Use the following steps to apply quality improvement principles in your current clinical situation.

· Identify a process or procedure that you perform routinely and wish to improve.

· Using a flowchart, delineate each step of the procedure.

· Identify the step in the flowchart where you would insert a change for quality improvement.

· Design a new flowchart that now shows the improved process.

· This paper requires the use of at least one professional resource. 

· You will need:

· An introductory paragraph which explains what you would like to improve

· Another paragraph which explains the step where you hope to change the pattern and insert a quality improvement process

· Another paragraph explaining the new flow after you make the change.

· Please add a cover page with the title of your Quality Improvement project.

Resource: Flowcharts are easily made in Microsoft Word. Here is a video explaining the process:

Bradycardia

 A 60-year-old male patient is admitted with chest pain to the telemetry unit where you work. While having a bowel movement on the bedside commode, the patient becomes short of breath and diaphoretic. The ECG waveform shows bradycardia.

  • What other assessment findings should you anticipate?
  • Why does this patient probably have bradycardia?
  • Does this dysrhythmia need treatment? Why or why not? What intervention would you implement first?
  • What is the drug treatment and dosage of choice for symptomatic bradycardia? How does this drug increase heart rate?

At least 2 page Apa