skin, nail, hear

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ppt presentetion, with 20 slides about skin, hear, and nail

Write 1 sentence that explains your understanding of communication.

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  • Write 1 sentence that explains your understanding of communication.
  • Expand on your ideas by highlighting the following in your meeting:
    • What are 2 components of the communication process that you think are important, and why?
    • How can you spot miscommunication? Illustrate with an example.

The materials found in the MUSE may help you with this assignment such as the article Elements of Communication. 

Respond to this Discussion.

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Agonist-to-Antagonist Spectrum of Action

The agonist-to-antagonist spectrum refers to the  range of actions that psychopharmacologic agents can have when they  interact with receptors. Agonists activate receptors, while antagonists  block them. Partial agonists and inverse agonists provide intermediate  or opposite actions (Stahl, 2021).

Understanding the agonist-to-antagonist spectrum is  critical for achieving the desired therapeutic effect while minimizing  side effects. For instance, clozapine is an atypical antipsychotic that  acts as an antagonist at various neurotransmitter receptors, including  dopamine D2 and serotonin 5-HT2A receptors. Unlike typical  antipsychotics, which are primarily dopamine D2 antagonists, clozapine’s  broader receptor profile may explain its efficacy in  treatment-resistant schizophrenia as well as its different side-effect  profile (Stahl, 2021).

Partial Agonists: Buspirone is a  partial agonist at serotonin 5-HT1A receptors and is used to treat  generalized anxiety disorder (GAD). Its partial agonist activity allows  for anxiolytic effects without the sedation seen with benzodiazepines,  which are full agonists at GABA receptors (Stahl, 2021).

Inverse Agonists: The antihistamine  loratadine acts as an inverse agonist at the H1 histamine receptor, not  only blocking the action of histamine but reducing the baseline activity  of the receptor, which can be beneficial for controlling allergic  symptoms (Stahl, 2021).

Clozapine, an atypical antipsychotic, acts primarily  as an antagonist at various neurotransmitter receptors, demonstrating  how multi-receptor targeting can be beneficial for certain psychiatric  conditions. On the other hand, buspirone serves as a partial agonist at  5-HT1A receptors, providing anti-anxiety effects with less potential for  sedation. Loratadine, an antihistamine, acts as an inverse agonist,  reducing the baseline activity of H1 histamine receptors.

G-Protein-Coupled Receptors vs. Ion-Gated Channels

G-Protein-Coupled Receptors (GPCRs) and Ion-Gated  Channels are two different types of protein structures that drugs can  target to produce therapeutic effects. GPCRs are involved in slow,  modulatory signaling, while Ion-Gated Channels provide fast synaptic  transmission (Stahl, 2021).

Beta-blockers like propranolol interact with GPCRs,  specifically beta-adrenergic receptors, to modulate cardiac activity by  reducing heart rate and blood pressure. They do this by antagonizing the  beta-adrenergic receptors, thereby inhibiting the action of adrenaline  and noradrenaline (Stahl, 2021)

In contrast, via Ion-Gated Channels, drugs like  gabapentin act on voltage-gated calcium channels, not by blocking them  but by modulating their activity. This makes gabapentin useful for  conditions like neuropathic pain and epilepsy (Stahl, 2021).

Role of Epigenetics in Pharmacologic Action

Epigenetics in pharmacology refers to the  modification of gene expression rather than altering the genetic code  itself. These modifications can affect how an individual responds to  medications (Stahl, 2021).

Antidepressants like fluoxetine (Prozac) may not only  affect neurotransmitter levels but also induce epigenetic changes that  impact long-term mood regulation. They can modify DNA methylation  patterns related to the expression of neuroplasticity-related genes,  possibly contributing to their therapeutic effect (Castrén & Kojima,  2017).

Impact on Prescription Decisions

The impact on prescription decisions refers to how  the aforementioned factors might influence a healthcare provider’s  choice of medication, dosage, and treatment plan for individual  patients(Stahl, 2021).

Understanding the agonist-antagonist spectrum can be  vital in cases like dual diagnosis of opioid addiction and anxiety.  Here, a partial agonist like buspirone could be more appropriate than a  benzodiazepine due to its lower potential for abuse. Also, for patients  with treatment-resistant depression, considering a medication like  ketamine that works through different mechanisms and has potential  epigenetic impacts could offer another treatment avenue (Zanos et al.,  2016).

For example, in a patient with a dual diagnosis of  opioid addiction and anxiety, a nurse practitioner might opt for a  partial agonist like buspirone for the treatment of anxiety instead of a  benzodiazepine, which has a higher abuse potential. Similarly, if a  patient has treatment-resistant depression and has not responded to  typical SSRIs, considering an agent like ketamine, which works through  NMDA receptor antagonism and also induces epigenetic changes, could be a  thoughtful next step (Zanos et al., 2016).

 

m7 program critique

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please follow all directions

See Below

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Where can you find evidence to inform your thoughts and scholarly writing? Throughout your degree program, you will use research literature to explore ideas, guide your thinking, and gain new insights. As you search the research literature, it is important to use resources that are peer-reviewed and from scholarly journals. You may already have some favorite online resources and databases that you use or have found useful in the past. For this Discussion, you explore databases available through the Walden Library.

Discussion post ( question to answer)

Using proper APA formatting, cite the peer-reviewed article you selected that pertains to your practice( PHMNP) area and is of particular interest to you and identify the database that you used to search for the article. Explain any difficulties you experienced while searching for this article. Would this database be useful to your colleagues? Explain why or why not. Would you recommend this database? Explain why or why not.

D-Case Study

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due 10-16-23@10am

WK10

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Be sure to provide 5 APA citations of the supporting evidence-based peer-reviewed articles you selected to support your thinking.

Please be sure to follow EACH AND EVERY BULLET POINT.

Make sure to ANSWER EACH QUESTION ACCURATELY.

(TOPIC: In Attachment**)

***Please be sure to include all information from the attachment in the assignment*****

Please use the template attached to complete the assignment.

*****PLEASE VIEW THE VIDEO, AND FOLLOW THE GUIDELINES ATTACHED*********

USE TEMPLATE ATTACHED*****

PLEASE INCLUDE THE FOLLOWING

***INTRODUCTION

***CONCLUSION

***LABS AND THE REASON FOR THEM

***DSM Diagnosis 

https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.x01_Neurodevelopmental_Disorders

powerpoint

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1: Title • Title: Understanding Asthma and COPD

• Subtitle: Essential Knowledge for Nurse Practitioners 

2: Introduction

• Brief overview of the importance of Anti-inflammatory Drugs (Glucocorticoids) and Bronchodilators in healthcare. 

• Mention the aim of the presentation: to provide an understanding of different types of Anti-inflammatory Drugs (Glucocorticoids) and Bronchodilators and their clinical applications. 

3: Management of asthma and COPD 

• Classification of asthma severity 

• Classification of COPD (air flow limitation severity)

4: Types of drug treatments

• Detail the two main categories: Oral and Inhaled Anti-inflammatory drugs (Glucocorticoids) and bronchodilators 

• Mention common examples from each category. 

5: Oral Anti-inflammatory drugs (Glucocorticoids, phosphodiesterase-4 inhibitors) and bronchodilators (Methylxanthine)

• Discuss commonly used oral Glucocorticoids like Prednisone, Montelukast, Roflumilast and Theophylline.

• Emphasize their indications, dosages, and monitoring requirements.

6: Inhaled Anti-inflammatory drugs (Glucocorticoids) and bronchodilators (Anticholinergic, b2 adrenergic agonist)

• Explain the use of inhaled drugs such as Beclomethasone, Cromolyn, Ipratropium, Tiotropium, and Albuterol, Salmeterol.

• Describe when and how these are administered (types of inhalation devices, Meter-dose inhalers, dry-powder inhaler, and nebulizers). 

7: Anti-inflammatory drugs (Monoclonal antibodies) 

• Highlight the benefits and considerations (Blackbox warning) of Omalizumab

8: Monitoring and Safety 

• Discuss the importance of regular monitoring therapy. 

• Address safety concerns.

10: Patient Education 

• Provide key points for patient education regarding Anti-inflammatory drugs (Glucocorticoids) and bronchodilators therapy.

• Emphasize compliance.

11: Conclusion 

• Summarize key takeaways from the presentation.

• Reiterate the importance of nurse practitioners’ role in managing Asthma and COPD therapy. 

12 Resources

• Provide references and recommended readings for further learning.

The group PPT should have a minimum of 20 slides and no more than 40 with speaker notes. (Including group members, outline, reference page). Reference and citations must be in APA format 6th or 7th Ed. 

The presentation should be directed to the pharmacological management of the disease. It should include the following: Drug indications, drug classification, generic name and most common brand name, mechanism of action, side effects, drug interactions, use of the drug in different populations and important pearls.

PLEASE CLICK ON LINKS TO ANSWER QUESTIONS

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Assignment: National Patient Safety Goal

This assignment will be done in the classroom with discussion to follow.

1.  Read the following chapter from the book, “Patient Safety and Quality: An Evidence-Based Handbook for Nurses” and provide a brief overview.

https://www.ncbi.nlm.nih.gov/books/NBK2681/

2.  List the National Patient Safety Goals from the Joint Commission’s website appropriate to the long-term care environment and what precautions should the nurse take relative to EACH safety goal? 

https://www.jointcommission.org/-/media/tjc/documents/standards/national-patient-safety-goals/2022/npsg_chapter_alc_jan2022.pdf

3.  From the book, “Patient Safety and Quality: An Evidence-Based Handbook for Nurses,” select one other chapter to read and provide a brief overview.  Apply the main concepts to the long-term care facility environment.  This could be a situation from work or from school or a personal experience. 

http://www.ahrq.gov/qual/nurseshdbk/

4.  Select a Speak Up brochure developed by The Joint Commission. Follow this link to the proper website: https://www.jointcommission.org/topics/speak_up_campaigns.aspx and answer the following questions.

a.  Identify the brochure you chose and the demographic it applies to. Who else can utilize this information?

b.  Why is the brochure you chose important?

c.  What was done well? What could be improved?

d.  How will patient safety be improved from the chosen brochure?

e.  Discuss how current nursing or healthcare-related research supports the information presented in the brochure.

Title

Assignment:  National Patient Safety Goal

Put X in box to correspond with the SLO (s)

Put X in box to correspond with the Competency (s)

Knowledge/Practice/Ethical Comportment

K

P

E

Student Learning Outcome(s)

Patient-Centered Care

Communication Skills

 

Nursing Process

Learning Needs

Technology

Documentation

Informatics

Nursing Judgment

Prioritization

Nursing Judgment

Professionalism

Professionalism

Ethical/Legal

Quality Improvement

Patient Care Concerns

Systems

Safety

x

Patient Complications

Safe Nursing

x

x

x

Teamwork/Collaboration

Communication

Conflict Recognition 

Managing Care 

Managing Care of the Individual Patient

Assign/Monitor 

Where should this assignment be used:

Classroom

X

Clinical Setting

X

Independent Study

X

Online/Web Based

X

Skills Lab

Simulation

 

Revised from Linda Caputi © (What type of assignment is this?)

Patient Care Assignment

Non-Patient Care Assignments

Patient Care

The assignments are related to the student while providing patient care in the clinical setting.
Example:  Concept mapping care for one or multiple patients. 

Thinking Focused
Assignments encourages critical thinking and clinical reasoning and teaches students to think like a nurse.

Patient Focused

The student focuses on specific aspects of patient care such as safety, falls, diabetes, other diseases, etc.

Systems Focused

Assignments help the student understand the clinical world, the nurse’s work therein, and the effect of the system on the nurse and the patient.
Example:  How the system completes medication administration from order to delivery to patient.  

x

x

x

Theoretical and Scientific Foundations of Nursing

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FRAMING A PRACTICE PROBLEM AS A CRITICAL QUESTION WITH MEASURABLE OUTCOMES

Throughout this course you have focused on practice problems to address in applying nursing and interdisciplinary theories, and in the  application of evidence-based practice for quality improvement. This week you begin exploring the components of evidence-based practice by framing a practice problem as a critical question. You will begin a search of the literature for evidence to answer the question and inform a practice change for quality improvement.

Respond to  two of your colleagues  by suggesting a different way of framing their critical question. Cite sources to support your posts and recommend to colleagues.

PEER #1


Shaunagay Kenney

Week 7 Discussion Main Post

A Critical Question with Measurable Outcomes

Question: Will adding pharmacological interventions to nonpharmacological treatments improve post-traumatic stress disorders in adults?

Article Selection

A total of six articles were discovered and appraised using the “Adapted Rating System for the Hierarchy of Evidence” (Dang & Dearholt, 2017; Fineout-Overholt et al., 2010). The type of article and information that supported the purpose statement were used in the selection process.

Critical Question Explanation

            Post-traumatic stress disorder (PTSD) has long been associated with military members

exposed to combat. Before PTSD was coined, Charles Myers used shell “shock” to describe injured soldiers during World War I (Horwitz, 2018). According to Friedman (2019), PTSD is defined as direct or indirect exposure to a traumatic event where a person is severely traumatized based on that event. According to the National Center for PTSD (2021), 60% of men and 50% of women will experience at least one traumatic event in their lives, 6% of the population will have PTSD at some point in their lives, and about 15 million adults have PTSD during a given year. For most individuals, psychotherapy is a sufficient treatment for PTSD, but not for others. Could pharmacological interventions assist individuals where psychotherapy alone does not work?       

Article Synthesis

            For some individuals, psychotherapy alone does not work. Similarly, pharmacological use alone can be ineffective (Raskind et al., 2018; Rasmusson et al., 2017). However, combining SSRIs or other medications with CBT or other therapies may reduce PTSD symptoms in some individuals (Mithoefer et al., 2019; Wagner et al., 2017). Mithoefer et al. (2019) found that MDMA- assisted psychotherapy effectively treated PTSD. According to Wagner et al. (2017), MDMA increases oxytocin, facilitates openness, and enhances the therapy's effectiveness. In the prolonged exposure and sertraline trial conducted by Rauch et al. (2020), PTSD subjects were given strict instructions on collecting their saliva for testing. They made a ground-breaking discovery about cortisol, finding that cortisol levels were lower in individuals with PTSD than those without PTSD (Rauch et al., 2020). Not only was this discovery made, but following the combination treatment of sertraline and prolonged exposure, significant improvements were noted for one year (Rauch et al., 2019). While combining psychotherapy with some drugs improved PTSD symptoms, others did not.

References

Dang, D., & Dearholt, S. (2017). 
Johns Hopkins nursing evidence-based practice: Model and     guidelines (3rd ed.). Sigma Theta Tau International.

Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B. & Williamson, K. M. (2010). Critical   

           appraisal of the evidence: Part I. 
American Journal of Nursing, 110(7), 47-52. 

https://doi.org/10.1097/01.NAJ.0000366056.06605.d2Links to an external site.

Friedman, M. J. (2019, October 14). 
PTSD History and Overview. U.S. Department of Veterans Affairs. 

https://www.ptsd.va.gov/professional/treat/essentials/history_ptsd.aspLinks to an external site.

Horwitz, A. (2018). 
PTSD: A short history. Johns Hopkins University Press

Mithoefer, M. C., Feduccia, A. A., Jerome, L., Mithoefer, A., Wagner, M., Walsh, Z., Hamilton,     S., Yaza-Klosinski, B., Emerson, A., & Doblin, R. (2019). MDMA-assisted psychotherapy for treatment of PTSD: Study design and rationale for phase 3 trials based   on pooled analysis of six phase 2 randomized controlled trials. 
Psychopharmacology,            236(9), 2735-2745. 

https://doi.org/10.1007/s00213-019-05249-5Links to an external site.

PTSD: National Center for PTSD. (2021, September 10). 
How common is PTSD in adults? U.S.       Department of Veterans Affairs.        

https://www.ptsd.va.gov/understand/common/common_adults.aspLinks to an external site.

Raskind, M. A., Peskind, E. R., Chow, BB., Harris, C., Davis-Karim, A., Holmes, H. A., Hart, K.    L., McFall, M., Mellman, T. A., Reist, C., Romesser, J., Rosenheck, R., Shih, M. C.,           Stein, M. B., Swift, R., Gleason, T., Lu, Y., & Huang, G. D. (2018). Trial of prazosin for     post-traumatic stress disorder in military veterans. 
The New England Journal of         Medicine, 378(6), 507-517. 

https://doi.org/10.1056/NEJMoa1507598Links to an external site.

Rasmusson, A. M., Marx, C. E., Jain, S., Farfel, G. M., Tsai, J., Sun, X., Geracioti, T. D.,    Hamner, M. B., Lohr, J., Rosse, R., Summerall, L., Naylor, J. C., Cusin, C., Lang, A. J.,         Raman, R., & Stein, M. B. (2017). A randomized controlled trial of ganaxolone in   post-traumatic stress disorder
. Psychopharmacology, 234(15), 2245-2257.            

https://doi.org/10.1007/s00213-017-4649-yLinks to an external site.
 

Rauch, S. A. M., Kim, M., Powell, C., Tuerk, P. W., Simon, N. M., Acern, R., Allard, C. B.,         Norman, S. B., Venners, M. R., Rothbaum, B. O., Stein M. B., Porter, K., Martis, B.,            King, A. P., Liberzon, I., Luan Phan, K., & Hoge, C. W. (2019). Efficacy of prolonged        exposure therapy, sertraline hydrochloride, and their combination among combat veterans             with post-traumatic stress disorder. 
JAMA Psychiatry, 76(2), 117-126.             

https://doi.org/10.1001/jamapsychiatry.2018.3412Links to an external site.

Rauch, S. A. M., King, A., Kim, H. M., Powell, C., Rajaram, N., Venners, M., Simon, N. M.,   Hamner, M., & Liberzon, I. (2020). Cortisol awakening response in PTSD treatment:     Predictor or mechanism of change. 
Psychoneuroendocrinology, 118, 1-16.             

https://doi.org/10.1016/j.psyneuen.2020.104714Links to an external site.

Wagner, M. T., Mithoefer, M. C., Mithoefer, A. T., MacAulay, R. K., Jerome, L., Yazar-      Klosinski, B., & Doblin, R. (2017). Therapeutic effect of increased openness:  Investigating mechanism of action in MDMA-assisted psychotherapy. 
Journal of  Psychopharmacology, 31(8), 967-974. 

https://doi.org/10.1177%2F0269881117711712Links to an external site.

PEER # 2

Samir Moneer Nawaf Hamed

 

Critical Question: Nursing burnout and its impact on nurses and patient care.

Nursing burnout is a state of emotional, physical, and mental exhaustion resulting from prolonged and intense stress in the nursing profession. It significantly impacts nurses by causing increased job dissatisfaction, higher turnover rates, and adverse mental and physical health effects (Mudallal et al., 2017). Moreover, burnout has a direct and detrimental impact on patient care, leading to decreased quality, increased medical errors, and reduced patient satisfaction due to compromised nurse-patient interactions and reduced attention to detail (Garcia et al., 2019). Addressing nursing burnout is crucial for maintaining a resilient nursing workforce and ensuring high-quality patient care outcomes.

Synthesis of Scholarly Articles

1. Influence of Burnout on Patient Safety: Systematic Review and Meta-Analysis

This study comprehensively analyzed existing research and found compelling evidence that burnout among healthcare professionals significantly impairs patient safety. The meta-analysis synthesized data from multiple studies, revealing a strong association between burnout and increased risks of medical errors, compromised quality of care, and adverse patient outcomes, highlighting the critical importance of addressing burnout as a crucial factor in ensuring patient safety in healthcare settings (Garcia et al., 2019).

2. Relationship between nurse burnout, patient and organizational outcomes: Systematic review

This study examined a broad range of studies and revealed a clear and intricate relationship between nurse burnout, patient outcomes, and organizational effects. It found that higher levels of nurse burnout are consistently linked to adverse patient outcomes such as increased mortality rates, longer hospital stays, and decreased patient satisfaction. Additionally, burnout has detrimental organizational consequences, including higher nurse turnover and lower overall workplace performance. This study underscores the interconnectedness of nurse well-being, patient care quality, and organizational success, emphasizing the urgency of addressing burnout to improve healthcare outcomes and workplace environments (Jun et al., 2021).

3. Nurse Burnout and Quality of Care: Cross-National Investigation in Six Countries

This study conducted a comprehensive cross-national analysis and identified a consistent and alarming pattern: nurse burnout substantially negatively impacts the quality of patient care across different healthcare systems and countries. The study's findings highlighted that high levels of nurse burnout were associated with lower perceptions of care quality among both nurses themselves and patients. This suggests that addressing nurse burnout is imperative not only for the well-being of healthcare professionals but also for maintaining and improving the quality of care delivered in diverse healthcare settings globally (Poghosyan et al., 2021).

4. Association of resident fatigue and distress with perceived medical errors

This study demonstrates a significant correlation between resident physician fatigue and distress levels and the perception of medical errors. The research findings suggest that higher levels of resident fatigue and distress are associated with increased instances of perceived medical errors. This indicates that addressing the well-being and mental health of healthcare providers, including reducing fatigue and distress, can play a crucial role in improving patient safety and reducing the likelihood of medical errors in healthcare settings, emphasizing the need for interventions and policies aimed at mitigating these factors to enhance patient care quality. (West, 2019)

Value for Stakeholders

Addressing nursing burnout is a moral imperative and a strategic quality improvement initiative. The identified articles provide compelling evidence that nurse burnout directly impacts patient satisfaction, healthcare outcomes, and organizational effectiveness (Mudallal et al., 2017). By investing in interventions to reduce burnout, healthcare organizations can enhance patient care quality, increase staff retention, reduce medical errors, and ultimately improve their bottom line. Moreover, addressing nursing burnout aligns with the mission of healthcare organizations to deliver safe, effective, and patient-centered care, enhancing their reputation and competitiveness in the healthcare industry (Jun et al., 2021).

 

References

Garcia, C. de L., Abreu, L. C. de, Ramos, J. L. S., Castro, C. F. D. de, Smiderle, F. R. N., Santos, J. A. D., & Bezerra, I. M. P. (2019, August 30). Influence of burnout on Patient Safety: Systematic Review and meta-analysis. Medicina (Kaunas, Lithuania). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6780563/

Jun, J., Ojemeni, M., Kalamani, R., Crecelius , M., & Tong , J. (2021, March 26). Relationship between Nurse Burnout, patient and organizational outcomes: Systematic review. International Journal of Nursing Studies. https://www.sciencedirect.com/science/article/abs/pii/S0020748921000742

Mudallal, R. H., Othman, W. M., & Al Hassan, N. F. (2017, January 1). Nurses’ burnout: The influence of leader empowering behaviors, work conditions, and demographic traits. Inquiry : a journal of medical care organization, provision and financing. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5798741/

Poghosyan, L., Clarke, S. P., Finlayson, M., & Aiken, L. H. (2021, August). Nurse Burnout and quality of care: Cross-national investigation in six countries. Research in nursing & health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2908908/#:~:text=Across%20countries%2C%20higher%20levels%20of,quality%20of%20care%20in%20hospitals.

West, C. (2019, September 23). Association of resident fatigue and distress with perceived medical errors. JAMA. https://jamanetwork.com/journals/jama/article-abstract/184625