Respond of your colleagues who were assigned to a different case than you. Explain how you might apply knowledge gained from your colleagues’ case studies to you own practice in clinical settings as a Psychiatric Nurse Practitioner.
NOTE: Positive comment
Main Post
The three questions this writer would as the patient are:
Did your depressive symptoms worsen after the death of your husband?
How many hours per night do you sleep on average?
Do you sleep throughout those hours of sleep or do you wake constantly?
Do you ingest any stimulants like coffee or chocolate before bed?
Do you sleep during the daytime?
The rationale behind question one is to gauge the timeline of the patient’s depression. She appears to have been suffering with untreated depression for a long time, however the additional symptoms of insomnia and tearfulness seemed to worsen after his death. With this information the nurse practitioner will know if her depression is in an acute state and the severity of her illness.The patient is reporting sleeplessness; however the nurse practitioner needs to gauge if the patient is participating in restful sleep. Sleep of two hours or less may only consist of REM sleep (Boland et al., 2020). If the patient is not getting restful sleep, she is not benefiting from the bodily repair that takes place during sleep (Fitzgerald et al., 2017). This can place her at an increased risk for other illnesses and heighten depressive symptoms (Uchmanowicz et al., 2019).Knowing if the patient sleeps consistently throughout those hours of sleep will provide information to the nurse about the kind and amount of sleep the patient is getting. Ingesting certain stimulants like caffeinated drinks, coffee or chocolate can affects the client’s sleep by providing wakefulness (Ulke et al., 2017). If the patient is sleeping during the daytime, her circadian rhythm could have been reversed where she will need less sleep during the night time hours (Fitzgerald et al., 2017).
The people this writer would interview are:
The patient’s aide
The patient’s son
The patient aide may be able to provide more information about observed sleepiness during the daytime. In addition, she will be able to provide information on the patient’s dietary patterns and physical activity. The questions to the aide would be:
Does she easily nod off during the daytime?
Does she easily become fatigued?
Does she consume a well-balanced diet?
Question one would illicit answers about her getting sleep.
It appears that she in fact getting sleep but because of a revered circadian rhythm she is not able to get the sleep at the night which is the desired time. Question two will help the nurse practitioner gauge the extent of the effects that non sleep has taken on the patient’s life. The patient, if constantly fatigued throughout the day has a life that has been highly impacted by the lack of sleep. The aide would be able to provide a clear, picture of the patient’s diet. The aide would be able to reveal if the patient consumes a vast amount of sugar or caffeine which could interrupt sleep.
Questions to the son would surround the family’s psychiatric history. These questions will help the nurse practitioner construct the family history of the patient and rule out or consider familial history as a cause for her symptoms.
Can you recall any maternal family members with psychiatric disorders including depression and insomnia?
Did the symptoms start after the death of the client’s husband?
This would help the nurse practitioner rule out depressive symptoms as the cause of her insomnia.
Physical Examinations and Tests
Sleep Study:
Polysomnogram – The sleep study or polysomnogram measures the brain waves, blood oxygen, leg movements and breathing during sleep (Meghdadi et al., 2019). The Nurse Practitioner would be able to rule out physiological reason’s ad the cause for the patient’s insomnia.
Actigraphy: This is where a small device is worn on the wrist and it measures the person’s sleep wake cycle for a specified period (Meghdadi et al., 2019). This is convenient for this client and the Nurse Practitioner would be able to monitor the client’s sleep health and gauge the severity of the disruption of her sleep.The nurse practitioner could also physically examine the patient’s nares for septal occlusion.
Septal occlusion or deviation could lead to problems with sleeping even during sleep, this would be important for the nurse practitioner to evaluate as this could be interfering with the patient’s sleep.
Epworth sleepiness scale – assesses the patient’s tendency to nod off in various situations (Meghdadi et al., 2019). For this client it would be necessary for the nurse practitioner to assess the severity of her nodding off during the day time especially at unexpected times like during eating and other activities that would put her safety at risk.
Differential Diagnosis
G47.00 Unspecified Insomnia Disorder– The patient is experiencing insomnia at nighttime that could be related to several factors. She reports staying up late to watch T.V., depressive symptoms, restless leg syndrome, sleep apnea and sleeping during the daytime. Some of these factors have not been ruled out yet as the cause of her anxiety.
G47.23 Persistent Irregular Sleep Wake type severe
F32.9 Unspecified Depressive Disorder
G25.81 Restless legs syndrome
Medications:
Trazodone 50 mg – This medication would be the first choice as it offers antidepressant properties as well as promotes sleep in those diagnoses with insomnia. It is generally safe for the elderly population at low doses (Pagel et al., 2018). The Nurse Practitioner should monitor the patient and evaluate the needs to slowly increase or in some cases decrease the dose.
Rozerem 8 mg- Is a nonbenzodiazepine hypnotic that promotes sleep. The patient would benefit from his, but an added benefit would be that she would be at a diminished risk of falls as this is a concern following the use of hypnotics in the elderly. This drug is reported as one that would prevent less falls from over sedation (Pagel et al., 2018).
Lessons Learned
This writer has learned that it is important to conduct a complete evaluation of the patient and not just focus on the presenting symptoms. There are additional environmental and physiological symptoms that could be attributed to the patient’s insomnia. In this case the patient had several factors that could be contributing her insomnia and they needed to be ruled out. The cause of her insomnia could have been physiological from the sleep apnea or from her habits of staying up tool late at nights and sleeping during the daytime. It is also important to evaluate medications, social and economic factors before the resorting to pharmacological interventions.
References
Boland, E. M., Vittengl, J. R., Clark, L. A., Thase, M. E., & Jarrett, R. B. (2020). Is sleep disturbance linked to short- and long-term outcomes following treatments for recurrent depression? Journal of Affective Disorders, 262, 323–332.
FitzGerald, J. M., O’Regan, N., Adamis, D., Timmons, S., Dunne, C. P., Trzepacz, P. T., &
Meagher, D. J. (2017). Sleep-wake cycle disturbances in elderly acute general medical inpatients: Longitudinal relationship to delirium and dementia. Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring, 7, 61–68.
Meghdadi, A. H., Popovic, D., Rupp, G., Smith, S., Berka, C., & Verma, A. (2019). Transcranial Impedance Changes during Sleep: A Rheoencephalography Study. IEEE Journal of Translational Engineering in Health and Medicine, Translational Engineering in Health and Medicine, IEEE Journal of, IEEE J. Transl. Eng. Health Med, 7, 1–7.
Pagel, T., Seithikurippu R. Pandi-Perumal, & Jaime M. Monti. (2018). Treating insomnia with medications. Sleep Science and Practice, (1), 1. Uchmanowicz I, Markiewicz K,
Uchmanowicz B, Kołtuniuk A, & Rosińczuk J. (2019). The relationship between sleep disturbances and quality of life in elderly patients with hypertension. Clinical Interventions in Aging, 155.
Ulke, C., Sander, C., Jawinski, P., Mauche, N., Huang, J., Spada, J., Hegerl, U. (2017). Sleep disturbances and upregulation of brain arousal during daytime in depressed versus non-depressed elderly subjects. World Journal of Biological Psychiatry, 18(8), 633–640.
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Post Renee
/in Uncategorized /by developerThank you for your initial discussion post. It stimulated my thinking, so thank you for that. Specifically on release of information waivers from patients and I remembered reading in the class cafe that you are from Miami and work in a psychiatric facility. While working in transplant I would, with consent of the patient, have access to their electronic medical record at other hospitals. However, one of the records we were not permitted to enter was the psychiatric evaluation due to the sensitivity of the information contained in those records. What are your thoughts on mental health researchers using the confidential records of mental health patients to further evidenced based practices? I have provided a link for you if you would like to refer to an article.
Renee Scialli
https://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.201400200
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Post Samanth Ebp
/in Uncategorized /by developerRespond using one or more of the following approaches:
Ask a probing question, substantiated with additional background information, and evidence.
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Offer and support an alternative perspective using readings from the classroom or from your own review of the literature in the Walden Library.
Note: the answer of this post should be in a positive way
Main Post
Roy’s Adaptation Model
There are nursing theorists who have formulated models that have guided nursing research for years. Many of these models present theories on how humans beings behave and adapt and how nursing is tied in to it all. For this discussion post, this writer explored Roy’s Adaptation Model which explains that humans are viewed as biopsychosocial adaptive systems who cope with who cope with environmental change through the process of adaptation (Polit & Beck, 2017). The systems that Roy refers to in human beings are the four subsystems of physiological/physical, self-concept or group identity, role function and interdependence These subsystems provide mechanisms on how humans deal with stimuli from our environment. This model is broken down to show how each change in our environment affects us and how the body deals with it.
The Physiological subsystem
This writer, researched how to apply Roy’s Adaptation Model to pregnant women who experience nausea vomiting. Many people were never able to explain how this process occurs and why does it happen to more than a few pregnant women in their first trimester of pregnancy. This article obtained from (Davis, 2014), utilized Roy’s theory to explain how the woman’s body deal with this change during pregnancy. The Physiological subsystem states that nausea and vomiting is related to the increased level of the Human Chorionic Gonadotropin hormone in the body when the woman is pregnant (Davis, 2014). The prolonged nausea and vomiting will subsequently affect the woman’s food intake as the inability to keep the food down deters women away from eating. This ultimately will lead the body into metabolic acidosis from the decreased intake in glucose, and the body now has to burn fat stores for energy (Davis, 2014). As a result of this pregnant women many times end up losing weight.
Self-Concept
Nausea and vomiting in pregnancy as it relate to self-concept reflects more on the mother having to spend time nursing themselves back to a healthy state and not spending enough time bonding with their unborn child (Davis, 2014). At this stage many women, may feel the need to end their pregnancy because it is causing them so much discomfort (Davis, 2014). If the woman tries to remedy the problem by taking medications the feeling of guilt may arise as they feel that they have done something to harm their baby. The mother, if she experienced nausea and vomiting throughout the pregnancy may experience some bonding issue with the baby as she was ill throughout most of the pregnancy.
Role Function
Role function as it pertains to nausea and vomiting during pregnancy is explained as the woman feeling that she has lost self-control due to the inability to live up to her roles (Davis, 2014). For example, the woman may not be able to take care of household and career duties which may ultimately affect the control she has over her life.
Interdependence
Roy’s interdependence subsystem explains that while experiencing nausea and vomiting the pregnant woman’s relationship with her mother and spouse are many times disrupted. The cause of this is related to their unwillingness to believe her inability to cope with the ill feelings of nausea and vomiting (Davis, 2014). At many times, her family may believe her symptoms are not as severe as she portrays and this will affect the way they engage with each other.
Basing research off an established model
Basing research off an established model directs the researcher into an area that provides much support for their topic of interest. It provides information that support or offer a base on which the researcher can make comparisons. In addition, it opens up fresh and new perspectives that can enlighten the researcher. Many of these theorists have tested these theories and applied these models to areas in real life. There is tested evidence available for the researcher to use in support of their research.
In conclusion, Roy’s Adaptive theory provided a new approach on viewing and interpreting many disease states or illnesses. This writer supports this theory, because much of what we experience as humans are rarely just physiological. Most of our illnesses can be explained thoroughly on how it affects our bodies physically but in addition to that, illnesses also affect us psychologically, emotionally, and socially.
References
Davis, M. (2014). Nausea and vomiting of pregnancy an evidence-based review. Journal of
Perinatal & Neonatal Nursing, 18, 312-328.
Gigliotti, E. (2016). The value of nursing models in practice. Dokuz Eylul University School of
Nursing Electronic Journal, 1(1), 42-50.
Mete, S. (2014). Nursing Care of Nausea and Vomiting in Pregnancy: Roy Adaptation Model.
Nursing Science Quarterly, 23(2), 148–155.
Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for
nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.
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Post Samantha 19478671
/in Uncategorized /by developerRespond of your colleagues who were assigned to a different case than you. Explain how you might apply knowledge gained from your colleagues’ case studies to you own practice in clinical settings.
NOTE: Positive comment
Main Post
The three questions this writer would as the patient are:
Did your depressive symptoms worsen after the death of your husband?
How many hours per night do you sleep on average?
Do you sleep throughout those hours of sleep or do you wake constantly?
Do you ingest any stimulants like coffee or chocolate before bed?
Do you sleep during the daytime?
The rationale behind question one is to gauge the timeline of the patient’s depression. She appears to have been suffering with untreated depression for a long time, however the additional symptoms of insomnia and tearfulness seemed to worsen after his death. With this information the nurse practitioner will know if her depression is in an acute state and the severity of her illness.The patient is reporting sleeplessness; however the nurse practitioner needs to gauge if the patient is participating in restful sleep. Sleep of two hours or less may only consist of REM sleep (Boland et al., 2020). If the patient is not getting restful sleep, she is not benefiting from the bodily repair that takes place during sleep (Fitzgerald et al., 2017). This can place her at an increased risk for other illnesses and heighten depressive symptoms (Uchmanowicz et al., 2019).Knowing if the patient sleeps consistently throughout those hours of sleep will provide information to the nurse about the kind and amount of sleep the patient is getting. Ingesting certain stimulants like caffeinated drinks, coffee or chocolate can affects the client’s sleep by providing wakefulness (Ulke et al., 2017). If the patient is sleeping during the daytime, her circadian rhythm could have been reversed where she will need less sleep during the night time hours (Fitzgerald et al., 2017).
The people this writer would interview are:
The patient’s aide
The patient’s son
The patient aide may be able to provide more information about observed sleepiness during the daytime. In addition, she will be able to provide information on the patient’s dietary patterns and physical activity. The questions to the aide would be:
Does she easily nod off during the daytime?
Does she easily become fatigued?
Does she consume a well-balanced diet?
Question one would illicit answers about her getting sleep.
It appears that she in fact getting sleep but because of a revered circadian rhythm she is not able to get the sleep at the night which is the desired time. Question two will help the nurse practitioner gauge the extent of the effects that non sleep has taken on the patient’s life. The patient, if constantly fatigued throughout the day has a life that has been highly impacted by the lack of sleep. The aide would be able to provide a clear, picture of the patient’s diet. The aide would be able to reveal if the patient consumes a vast amount of sugar or caffeine which could interrupt sleep.
Questions to the son would surround the family’s psychiatric history. These questions will help the nurse practitioner construct the family history of the patient and rule out or consider familial history as a cause for her symptoms.
Can you recall any maternal family members with psychiatric disorders including depression and insomnia?
Did the symptoms start after the death of the client’s husband?
This would help the nurse practitioner rule out depressive symptoms as the cause of her insomnia.
Physical Examinations and Tests
Sleep Study:
Polysomnogram – The sleep study or polysomnogram measures the brain waves, blood oxygen, leg movements and breathing during sleep (Meghdadi et al., 2019). The Nurse Practitioner would be able to rule out physiological reason’s ad the cause for the patient’s insomnia.
Actigraphy: This is where a small device is worn on the wrist and it measures the person’s sleep wake cycle for a specified period (Meghdadi et al., 2019). This is convenient for this client and the Nurse Practitioner would be able to monitor the client’s sleep health and gauge the severity of the disruption of her sleep.The nurse practitioner could also physically examine the patient’s nares for septal occlusion.
Septal occlusion or deviation could lead to problems with sleeping even during sleep, this would be important for the nurse practitioner to evaluate as this could be interfering with the patient’s sleep.
Epworth sleepiness scale – assesses the patient’s tendency to nod off in various situations (Meghdadi et al., 2019). For this client it would be necessary for the nurse practitioner to assess the severity of her nodding off during the day time especially at unexpected times like during eating and other activities that would put her safety at risk.
Differential Diagnosis
G47.00 Unspecified Insomnia Disorder– The patient is experiencing insomnia at nighttime that could be related to several factors. She reports staying up late to watch T.V., depressive symptoms, restless leg syndrome, sleep apnea and sleeping during the daytime. Some of these factors have not been ruled out yet as the cause of her anxiety.
G47.23 Persistent Irregular Sleep Wake type severe
F32.9 Unspecified Depressive Disorder
G25.81 Restless legs syndrome
Medications:
Trazodone 50 mg – This medication would be the first choice as it offers antidepressant properties as well as promotes sleep in those diagnoses with insomnia. It is generally safe for the elderly population at low doses (Pagel et al., 2018). The Nurse Practitioner should monitor the patient and evaluate the needs to slowly increase or in some cases decrease the dose.
Rozerem 8 mg- Is a nonbenzodiazepine hypnotic that promotes sleep. The patient would benefit from his, but an added benefit would be that she would be at a diminished risk of falls as this is a concern following the use of hypnotics in the elderly. This drug is reported as one that would prevent less falls from over sedation (Pagel et al., 2018).
Lessons Learned
This writer has learned that it is important to conduct a complete evaluation of the patient and not just focus on the presenting symptoms. There are additional environmental and physiological symptoms that could be attributed to the patient’s insomnia. In this case the patient had several factors that could be contributing her insomnia and they needed to be ruled out. The cause of her insomnia could have been physiological from the sleep apnea or from her habits of staying up tool late at nights and sleeping during the daytime. It is also important to evaluate medications, social and economic factors before the resorting to pharmacological interventions.
References
Boland, E. M., Vittengl, J. R., Clark, L. A., Thase, M. E., & Jarrett, R. B. (2020). Is sleep disturbance linked to short- and long-term outcomes following treatments for recurrent depression? Journal of Affective Disorders, 262, 323–332.
FitzGerald, J. M., O’Regan, N., Adamis, D., Timmons, S., Dunne, C. P., Trzepacz, P. T., &
Meagher, D. J. (2017). Sleep-wake cycle disturbances in elderly acute general medical inpatients: Longitudinal relationship to delirium and dementia. Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring, 7, 61–68.
Meghdadi, A. H., Popovic, D., Rupp, G., Smith, S., Berka, C., & Verma, A. (2019). Transcranial Impedance Changes during Sleep: A Rheoencephalography Study. IEEE Journal of Translational Engineering in Health and Medicine, Translational Engineering in Health and Medicine, IEEE Journal of, IEEE J. Transl. Eng. Health Med, 7, 1–7.
Pagel, T., Seithikurippu R. Pandi-Perumal, & Jaime M. Monti. (2018). Treating insomnia with medications. Sleep Science and Practice, (1), 1. Uchmanowicz I, Markiewicz K,
Uchmanowicz B, Kołtuniuk A, & Rosińczuk J. (2019). The relationship between sleep disturbances and quality of life in elderly patients with hypertension. Clinical Interventions in Aging, 155.
Ulke, C., Sander, C., Jawinski, P., Mauche, N., Huang, J., Spada, J., Hegerl, U. (2017). Sleep disturbances and upregulation of brain arousal during daytime in depressed versus non-depressed elderly subjects. World Journal of Biological Psychiatry, 18(8), 633–640.
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Post Samantha
/in Uncategorized /by developerRespond to the post bellow (positive comment), using one or more of the following approaches:
Ask a probing question, substantiated with additional background information, and evidence.
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Offer and support an alternative perspective using readings from the classroom or from your own review of the literature in the Walden Library.
Validate an idea with your own experience and additional sources.
Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.
Main post
Evidence based Practice is using information and practices obtained from prior research and preferences (Polit & Beck, 2017). When I think of evidenced based practice, I think of current practice utilizing certain practices and procedures because they have been tested and proven in the past. Evidenced based practice can be derived from literature, healthcare workers and patient experiences (Polit & Beck, 2017). There are many practices that we utilize around the hospital today that come from evidenced based practice. We use them so lightly daily and many times not understanding the meaning behind them and that others have tested them making it safe for us to use them. The one thing that came to mind was the use of off label drugs to treat various mental health issues. In Behavioral health it requires various combinations of drugs to gain the warranted effect (Narsa, 2018). When treating bipolar disorder and other mood instabilities there are the well-known medication like lithium, but evidence as presented itself showing that various seizure medicines can elicit the intended result (Narsa, 2018). In Psychiatry they utilize antiepileptic medications such as Depakote, Tegretol and Topamax to stabilize a patient with mood disorders (Demland, 2017). This is many times used in combination with the popular medications such as Lithium. Patients are many times very stunned to find out that they will be placed on such a medication. Many times, these medications will be introduced if the patient has a difficult time adjusting to the medication dosage changes or the intended effect is not seen (Demland, 2017). Many patients have testified to the benefit of these medicines. I think about how evidence-based practice comes in to play here because prior to this medication healthcare providers were only using antiepileptics for seizures only.
Another medicine being used as an off-label drug is Lorazepam. Many in healthcare know this drug as an anxiolytic and never think about its other uses. In Behavioral health this drug is actually used for the opposite effect in patients who are catatonic. When one first thinks of prescribing a drug that is meant to calm a person down and many times sedate them to a patient that is not talking, moving or interacting is seems somewhat bizarre. How will this work? Will it make the patient even more disengaged and possibly sedated? These are all questions myself and many of my coworkers had. In this case, the physicians relied on evidenced based practice to assist them in making such a decision. They utilized such an unpopular treatment but it gained the intended effect. The catatonic patients respond well to this treatment. They can be seen becoming more engaged with peers and staff and taking part in their care.
References
Demland, J. (2017). Use pattern and off-label use of atypical antipsychotics in bipolar disorder,
1998-2002. American Health & Drug Benefits, 2(4), 184–191.
Nasra, K. (2018). An analysis of the high psychotropic off-label use in psychiatric disorders:
The majority of psychiatric diagnoses have no approved drug. Asian
Journal of Psychiatry, 2(1), 29–36.
Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for
nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.
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Post Samatha P Nursing Informatic
/in Uncategorized /by developerRespond to the post bellow, offering additional/alternative ideas regarding opportunities and risks related to the observations shared.
Technology and data sharing have becoming a vital part of the healthcare industry. Information technology has made many strides in the areas of patient care, communication and record storage (Funk, 2015). In the past, retreiving a piece of health record would take an extensive amount of time and records were at risk of being lost on paper files.
Healthcare Technology Trends and Benefits
Through information technology, physicians are able to perform laparoscopic surgeries and bypass invasive procedures. This not only cuts the cost for the patient and facility but in turn decreases the amount of complication the patient could receive from a more extensive surgery (Funk, 2015). In terms of patient care, we are introduced to the electronic medical record. Health team members are able to view patient information and clinicals, even from a remote area. This has expedited patient care as providers are able to make prompt decisions and capable of amending the treatment plan from any location (Funk, 2015). In terms of communication, each discipline has the capability of documenting the patient’s progress to regression and communicate this information to the rest of the healthcare team.
Potential Risks
Potential risks that could ensue from these trends pose a major threat to the patient’s safety. Through electronic medical record, patient’s personal information and healthcare information at risk for theft (Funk, 2015). Many organizations try to manage theft by only allowing data to be transferred over secured networks only (Nash, 2013). Organizations also spend a lot of time on staff education on keeping data safe and recognizing threats such as malware, viruses and hackers that could cause a threat to the information system (Nash, 2013). With providers gaining access to document from remote locations this increases the risk of others outside of the healthcare team viewing the information. It is up to the provider to maintain privacy and keep the patient’s records confidential. In the area of record storage, organizations invest a lot of money into securing these documents and protecting patient information. When patient’s information moves from paper to electronic, the risk for theft and hacking of the information systems increase (Sheffer, 2017). On the other hand, electronic storage of medical records allows easy retrieval of the records which is why it is highly sought after.
The risks involved in using technology in patient care comes from the increased radiation from some very high-tech procedures and less patient care which is result of healthcare members spending too much time on technology and less on actual patient care (Funk, 2015). It appears that the increased pressure placed on healthcare workers to keep up with electronic documentation has cause healthcare workers to spend less time at the bedside and more documenting.
Promising Trends
The one trend that could impact nursing care would be that of documenting from remote areas. At this time, only providers have this benefit in my organization but I believe it could be helpful for nurses to be able to view patient records, check labs and orders and possibly get prepared for their day ahead all by accessing data from a remote area.
References
Funk, M. (2015). As Health Care Technology Advances: Benefits and Risks. American
Journal of Critical Care, 20(4), 285–291.
Nash, D. B. (2013). Technology Trends in Healthcare. American Health & Drug Benefits, 6(1),
1–2.
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Post Samatha
/in Uncategorized /by developerRespond of your colleagues who were assigned to a different case than you. Explain how you might apply knowledge gained from your colleagues’ case studies to you own practice in clinical settings as a Psychiatric Nurse Practitioner.
NOTE: Positive comment
Main Post
The three questions this writer would as the patient are:
Did your depressive symptoms worsen after the death of your husband?
How many hours per night do you sleep on average?
Do you sleep throughout those hours of sleep or do you wake constantly?
Do you ingest any stimulants like coffee or chocolate before bed?
Do you sleep during the daytime?
The rationale behind question one is to gauge the timeline of the patient’s depression. She appears to have been suffering with untreated depression for a long time, however the additional symptoms of insomnia and tearfulness seemed to worsen after his death. With this information the nurse practitioner will know if her depression is in an acute state and the severity of her illness.The patient is reporting sleeplessness; however the nurse practitioner needs to gauge if the patient is participating in restful sleep. Sleep of two hours or less may only consist of REM sleep (Boland et al., 2020). If the patient is not getting restful sleep, she is not benefiting from the bodily repair that takes place during sleep (Fitzgerald et al., 2017). This can place her at an increased risk for other illnesses and heighten depressive symptoms (Uchmanowicz et al., 2019).Knowing if the patient sleeps consistently throughout those hours of sleep will provide information to the nurse about the kind and amount of sleep the patient is getting. Ingesting certain stimulants like caffeinated drinks, coffee or chocolate can affects the client’s sleep by providing wakefulness (Ulke et al., 2017). If the patient is sleeping during the daytime, her circadian rhythm could have been reversed where she will need less sleep during the night time hours (Fitzgerald et al., 2017).
The people this writer would interview are:
The patient’s aide
The patient’s son
The patient aide may be able to provide more information about observed sleepiness during the daytime. In addition, she will be able to provide information on the patient’s dietary patterns and physical activity. The questions to the aide would be:
Does she easily nod off during the daytime?
Does she easily become fatigued?
Does she consume a well-balanced diet?
Question one would illicit answers about her getting sleep.
It appears that she in fact getting sleep but because of a revered circadian rhythm she is not able to get the sleep at the night which is the desired time. Question two will help the nurse practitioner gauge the extent of the effects that non sleep has taken on the patient’s life. The patient, if constantly fatigued throughout the day has a life that has been highly impacted by the lack of sleep. The aide would be able to provide a clear, picture of the patient’s diet. The aide would be able to reveal if the patient consumes a vast amount of sugar or caffeine which could interrupt sleep.
Questions to the son would surround the family’s psychiatric history. These questions will help the nurse practitioner construct the family history of the patient and rule out or consider familial history as a cause for her symptoms.
Can you recall any maternal family members with psychiatric disorders including depression and insomnia?
Did the symptoms start after the death of the client’s husband?
This would help the nurse practitioner rule out depressive symptoms as the cause of her insomnia.
Physical Examinations and Tests
Sleep Study:
Polysomnogram – The sleep study or polysomnogram measures the brain waves, blood oxygen, leg movements and breathing during sleep (Meghdadi et al., 2019). The Nurse Practitioner would be able to rule out physiological reason’s ad the cause for the patient’s insomnia.
Actigraphy: This is where a small device is worn on the wrist and it measures the person’s sleep wake cycle for a specified period (Meghdadi et al., 2019). This is convenient for this client and the Nurse Practitioner would be able to monitor the client’s sleep health and gauge the severity of the disruption of her sleep.The nurse practitioner could also physically examine the patient’s nares for septal occlusion.
Septal occlusion or deviation could lead to problems with sleeping even during sleep, this would be important for the nurse practitioner to evaluate as this could be interfering with the patient’s sleep.
Epworth sleepiness scale – assesses the patient’s tendency to nod off in various situations (Meghdadi et al., 2019). For this client it would be necessary for the nurse practitioner to assess the severity of her nodding off during the day time especially at unexpected times like during eating and other activities that would put her safety at risk.
Differential Diagnosis
G47.00 Unspecified Insomnia Disorder– The patient is experiencing insomnia at nighttime that could be related to several factors. She reports staying up late to watch T.V., depressive symptoms, restless leg syndrome, sleep apnea and sleeping during the daytime. Some of these factors have not been ruled out yet as the cause of her anxiety.
G47.23 Persistent Irregular Sleep Wake type severe
F32.9 Unspecified Depressive Disorder
G25.81 Restless legs syndrome
Medications:
Trazodone 50 mg – This medication would be the first choice as it offers antidepressant properties as well as promotes sleep in those diagnoses with insomnia. It is generally safe for the elderly population at low doses (Pagel et al., 2018). The Nurse Practitioner should monitor the patient and evaluate the needs to slowly increase or in some cases decrease the dose.
Rozerem 8 mg- Is a nonbenzodiazepine hypnotic that promotes sleep. The patient would benefit from his, but an added benefit would be that she would be at a diminished risk of falls as this is a concern following the use of hypnotics in the elderly. This drug is reported as one that would prevent less falls from over sedation (Pagel et al., 2018).
Lessons Learned
This writer has learned that it is important to conduct a complete evaluation of the patient and not just focus on the presenting symptoms. There are additional environmental and physiological symptoms that could be attributed to the patient’s insomnia. In this case the patient had several factors that could be contributing her insomnia and they needed to be ruled out. The cause of her insomnia could have been physiological from the sleep apnea or from her habits of staying up tool late at nights and sleeping during the daytime. It is also important to evaluate medications, social and economic factors before the resorting to pharmacological interventions.
References
Boland, E. M., Vittengl, J. R., Clark, L. A., Thase, M. E., & Jarrett, R. B. (2020). Is sleep disturbance linked to short- and long-term outcomes following treatments for recurrent depression? Journal of Affective Disorders, 262, 323–332.
FitzGerald, J. M., O’Regan, N., Adamis, D., Timmons, S., Dunne, C. P., Trzepacz, P. T., &
Meagher, D. J. (2017). Sleep-wake cycle disturbances in elderly acute general medical inpatients: Longitudinal relationship to delirium and dementia. Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring, 7, 61–68.
Meghdadi, A. H., Popovic, D., Rupp, G., Smith, S., Berka, C., & Verma, A. (2019). Transcranial Impedance Changes during Sleep: A Rheoencephalography Study. IEEE Journal of Translational Engineering in Health and Medicine, Translational Engineering in Health and Medicine, IEEE Journal of, IEEE J. Transl. Eng. Health Med, 7, 1–7.
Pagel, T., Seithikurippu R. Pandi-Perumal, & Jaime M. Monti. (2018). Treating insomnia with medications. Sleep Science and Practice, (1), 1. Uchmanowicz I, Markiewicz K,
Uchmanowicz B, Kołtuniuk A, & Rosińczuk J. (2019). The relationship between sleep disturbances and quality of life in elderly patients with hypertension. Clinical Interventions in Aging, 155.
Ulke, C., Sander, C., Jawinski, P., Mauche, N., Huang, J., Spada, J., Hegerl, U. (2017). Sleep disturbances and upregulation of brain arousal during daytime in depressed versus non-depressed elderly subjects. World Journal of Biological Psychiatry, 18(8), 633–640.
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Post Shannon
/in Uncategorized /by developerRespond to the post bellow, using one or more of the following approaches:
Ask a probing question, substantiated with additional background information, and evidence.
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Offer and support an alternative perspective using readings from the classroom or from your own review of the literature in the Walden Library.
Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.
Main Post
Music Therapy for Dialysis Patients
The research article that I selected was conducted to see if music therapy was a good non-pharmacological intervention to manage hemodialysis patient’s anxiety, stress, and depression. The researchers recognized that these patients experience anxiety, stress, and depression due to their dire health issue of end-stage renal disease. There were 40 subjects who were receiving dialysis and 20 subjects received music therapy. Blood pressures and pulses were taken before and after music therapy. The randomized control group was given pre-tests, post-tests, and Depression Anxiety Stress Scale Tool (DASS).
Data & Results
The data that was collected that lead to their final conclusion was comparing the vital signs collect before and after music therapy, demographic survey, DASS, pre and post-tests. The researchers completed a paired t-test and design table with the data to determine the effectiveness of the experiment. According to Fernandas & D’silva (2019), “To find the association between depression, anxiety and stress level with selected demographic variables, chi-square test or likelihood ratio test used” (p. 128). Their conclusion stated that the group that received music therapy did have a reduction in anxiety, stress, and depression levels. According to Fernandas & D’silva (2019), “In the present study the investigator made an attempt to relieve stress, anxiety, and depression among haemodialysis patient by providing music therapy and results shows that there was a significant difference in depression, anxiety and stress level among the experimental and control group” (p. 129).
Conclusion & Weakness
The researchers were able to formulate their conclusion by analyzing the data and using careful calculations that they collected from their research. The weakness of the study I believe is that the subjects weren’t select randomly. The participants were selected by assessing if they liked or showed interest in music. The dialysis patients that were interested in music received music therapy.
Additional Research
I do believe that further research should be completed to prove the benefits of music therapy for a dialysis patient. Further studies should be randomized. I also think one-way researchers could add to testing is measuring cortisol in saliva. According to Choi, Kim, & Yang (2014), “Salivary cortisol concentration serves as a biomarker of psychological stress. Cortisol measurements should be carried out in real time”.
References
Choi, S., Kim, S., Yang, J. S., Lee, J.H., Joo, C., & Jung, H. (2014). Real-time measurement of human salivary cortisol for the assessment of psychological stress using a smartphone. Sensing and Bio-Sensing Research., 2, 8-11.
Fernandes, S. T., & D’silva, F. (2019). Effectiveness of Music Therapy on Depression, Anxiety, and Stress among Haemodialysis Patients. International Journal of Nursing Education, 11(1), 124–129. https://doi-org.ezp.waldenulibrary.org/10.5958/0974-9357.2019.00024.2
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Post Sherry 19179703
/in Uncategorized /by developerRespond to the post bellow, offering additional/alternative ideas regarding opportunities and risks related to the observations shared.
MAIN POST
Introduction
In my psychiatric facility, we have introduced telepsych which is the same as telehealth. This is where the psychiatrist can see patients briefly from a remote location. The doctor can be in another country and still see his patients, give orders to the nurse to write, and do initial psych assessments. This is all done through the web via chatting, video, skype and phone. All these new technologies are very convenient for the doctor. This is an inpatient facility but it can also be done from home when a patient needs to see the doctor for non-emergent issues.
Benefits and Risks
There are benefits and risks to using telehealth. According to Harper, there are 5 benefits. Those are convenience, less time in the waiting room, expedited transmission of MRI’s or X-rays for a second opinion, privacy assurance (Harper, 2012, p. 1). These are benefits that help the patient. Some benefits for the physician would be that they can see more patients and from remote places. On the other hand, there are a few risks as well. Some risks include, electronic glitches, physician resistance, and inadequate assessment. Physician resistance would be about change and change is hard to do. The nurse is a big part of the telehealth scene as the doctor will be giving her orders via phone or video. Telehealth is still a new and evolving technology; while the offsite interventions or contacts often lead to less time being wasted on non-care oriented tasks because of the efficiencies offered by the technology applications, its use must never be associated with less care (McGonigle & Mastrian, 2018, p. 361). Glitches can be inherent to this type of technology and potential hackers can disrupt internet/web using technology. Privacy can ultimately be at risk.
Legislatively, December 21, 2017 – Some 63 pieces of legislation focusing on telehealth or telemedicine were approved by 34 state Legislatures this year, according to the Center for Connected Health Policy (“Mobile healthcare, telemedicine, telehealth, BYOD,” 2017, p. 1). It seems that each state is adding to the services of telehealth and it appears there is an ongoing discussion of regulations as far as Medicare and private payer insurances are concerned.
Most Promising Trends
The most promising trends in healthcare today, in my own opinion, would be the Electronic Health Record (EHR). My facility is hesitant to join this trend and therefore we still use paper for everything. This technology is already impacting healthcare. In nursing practice, it saves a lot of time, it is efficient for treatment planning, its is able to be shared amongst all disciplines. The significance of the EHR to nursing cannot be underestimated. Although EHRs on the surface suggest a simple automation of clinical documentation, in fact their implications are broad, ranging from the ways in which care is delivered, to the types of interactions nurses have with patients in conjunction with the use of technology, to the research surrounding EHRs that will inform nursing practice of tomorrow (McGonigle & Mastrian, 2018, p. 267).
References
2017: A Look Back At The Year In State Telemedicine Legislation. (2017). Retrieved from https://mhealthintelligence.com/news/2017-a-look-back-at-the-year-in-state-telemedicine-legislation
Harper, J. (2012, July 24, 2012). Pros and Cons of telemedicine for todays worker. US NEWS, 1-6. Retrieved from https://health.usnews.com/health-news/articles/2012/07/24/pros-and-cons-of-telemedicine-for-todays-workers
McGonigle, D., & Mastrian, K. G. (2018). Nursing informatics and the foundation of knowledge. Burlington, MA: Jones & Bartlett Learning.
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Post Sherry Health Assessment
/in Uncategorized /by developerPost a summary of the interview and a description of the communication techniques you would use with your assigned patient. Explain why you would use these techniques. Identify the risk assessment instrument you selected, and justify why it would be applicable to the selected patient. Provide at least five targeted questions you would ask the patient.
Main Post
Communication/Interviewing
This is a 40 -year old black man recently migrated from Africa. He is currently uninsured. To begin communicating with this individual, I would make sure he was able to speak English and that we under stand each other. If language is a barrier, I would get an interpreter on the interpretation Line. Communication techniques doesn’t always have to be spoken word, it can be pointing to an area of the body or using pictures. Communicating across language barriers is a challenge for clinicians and health systems. Federal law requires linguistic services for patients with LEP. Title VI of the US Civil Rights Act states that people cannot be discriminated against as a result of their national origin, race, or color, which has been extrapolated to include primary language by the US Office for Civil Rights and Department of Health and Human Services (Karliner, 2018). If the patient can speak some English the target would be to make sure our words mean the same thing and that’s where pointing to items and using hand gestures could come in handy. I would keep the questions fairly short with simple as possible terminology.
Risk Assessment
Being that this patient is newly immigrated to the U.S., I would want to give this patient resources that are free due to not having insurance but certainly would not deny treatment to the patient. I would focus on screening for any diseases that need immunizations, for one. Components of the health assessment for immigrants and refugees include addressing patient health concerns, screening for diseases associated with the country of origin and migration history, initiating age-appropriate immunizations, and routine health care maintenance (Walker, Barnett, & Stauffer, 2019). The question would be “have you had any illness, sicknesses, or hospitalizations that required any type of medications? Any immunizations? Any infections in your body or out breaks on your skin?” I would also ask about the living conditions and the nutritional conditions.
Other Potential Health Risks
Because of the ethnicity, the age and gender, I would certainly screen for any cardiac issue, hypertension, diabetes, and cancer. The acquisition of risk factors for chronic diseases such as coronary artery disease, hypertension, diabetes and cancer is poorly understood among African immigrants. More information must be gathered in the broad categories of chronic disease, health attitudes and health access to better promote the health of African immigrants (Venters & Gany, 2011).
Screening tool
Because of the area from which this patient came from. I would start by screening for infectious disease. I would focus on food and water exposure for things like Giardia or E. Coli, turn to the lungs and check for tuberculosis and so on. These screenings would require blood, urine, and fecal samples and a chest X-ray as most foreign folks get the Bacille Calmette-Guérin immunization and can cause a false positive when given the skin test.
5 Target Questions
I had mentioned some questions earlier but other questions would be
1. Have you had any coughing with bloody sputum,
2. Can you tell me about where you used to live in Africa?
3. Are you married? Are you sexually active with more than one partner?
4. Have you had any infections or illnesses?
5. Any diarrhea, nausea, or vomiting?
References
Karliner, L. S. (2018, April 2018). When Patients and Providers Speak Different Languages. AHRQ. Retrieved from https://psnet.ahrq.gov/webmm/case/440/when-patients-and-providers-speak-different-languagesVenters, H., & Gany, F. (2011, April 13, 2011). African immigrant health. US National Library of Medicine, 333-344. https://doi.org/doi: 10.1007/s10903-009-9243-xWalker, P. F., Barnett, E., & Stauffer, W. (2019). Medical screening of adult immigrants and refugees. Retrieved from https://www.uptodate.com/contents/medical-screening-of-adult-immigrants-and-refugees
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Post Sherry
/in Uncategorized /by developerRespond to this post with a positive response :
Ask questions to help clarify the scenario and application of data, or offering additional/alternative ideas for the application of nursing informatics principles.
Main Post
Nurses rely on gathered information, statistics, and trends to help them in their day to day operations. Nurse managers rely on what is trending when it comes to Performance Improvement. The trending information helps the nurse manager pinpoint where the trouble lies and able to go to the source of the problem and educate the staff and fix the problem. For example, during chart audits, it has come to the attention of the auditor that the smoking cessation education check box has been missed in about 50% of the charts that were checked. This data that was collected was entered into a computer program to break down and pinpoint what area of the hospital it was coming from or from whom. This information was given to the nurse manager to share with the staff from which this trend had occurred. Education was able to be given to correct this problem. Information and information processing are central to the healthcare worker. A healthcare professional is also known as a knowledge worker because he or she deals with and processes information on a daily basis to make it meaningful and inform his or her practice (McGonigle & Mastrian, 2018, p. 21). Nurses have to have a knowledge base in order to do the basics of nursing. Most of the knowledge that a nurse will further acquire is on the job. Such as the scenario given above, nurses have to be trained in the policy and procedures of their facility. Gathering information to be able to educate nurses on what is missing in there charting or other paperwork that is required of them is helpful to create proficient nurses.
Healthcare informatics is defined as “the integration of healthcare sciences, computer sciences, information science, and cognitive science to assist management of healthcare information (Sweeney, 2017). By gathering the data, we were able to break it down and create a bar graph of each unit and how many unchecked boxes for the smoking education that did not get done correctly. We could see if any one nurse was trending and gave direction on how to proceed with the educating of the staff. This information came from our PI department to the nurse managers then down to the staff for correcting. According to N. L. Nagle et al., knowledge innovation and generation provides guidance and support to others (nurses, patients) in the application and use of emerging knowledge… (Nagle, Junger, & Bloomberg, 2017, p. 219).
References
McGonigle, D., & Mastrian, K. G. (2018). Nursing Informatics and the Foundation of Knowledge (4 ed.). Burlington, MA: Jones and Bartlett Learning.
Nagle, L. M., Junger, A., & Bloomberg, L. S. (2017). Evolving Role of the Nursing Informatics Specialist. Forecasting Informatics for Nurses in the Future of Connected Health, 212-221.
Sweeney, BSN, RN, J. (2017, Feb 2017). Healthcare Informatics. OJNI, 21.
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