Respond to at least two 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
Case Study: Volume 2, Case #21 focuses on the treatment of an adult client diagnosed with Attention Deficit Hyperactivity Disorder (ADHD).
Questions
Question 1: Are you having problems with your loved one’s due being “argumentative and temperamental”?
Rationale: The client may have additional stress due to broken relationships and this could be due to his disorder. “Emotional dysregulation is increasingly recognized as a core feature of ADHD” (Stralen, 2016). Signs of ADHD include low frustration tolerance and explosive behavior (Stralen, 2016).
Question 2:
What causes you the most anxiety?
It is important to determine the triggers of the anxiety to help the patient prepare for times when he is likely to be in high stress situations. Planning a response when feeling overwhelmed can help the patient remain in control of his emotions and allow the patient to monitor his behavior.
Question 3:
You stated that your father was abusive, was this physical or verbal abuse or both? Do you contribute some of your anxiety from previous issues with your father?
It is important for the provider to understand the client’s point of view in regards to his upbringing. He realizes it has affected in him in some way, as he has obtained psychotherapy in the past. I would want to know if he has ever spoken to his father about this and if his father has ever apologized for his actions.
Questions for family
I would want to talk with his mother to ask her how he did as a child in school and at home in regards to schoolwork, chores and would want to know if he had friends. Although social problems are not part of the diagnostic criteria for ADHD, the peer relationship difficulties faced by youth with this disorder are profound (Hoza, 2007)
Diagnostics & Exams
A full psychiatric evaluation which would include the Adult Self-Report Scale (ASRS). ASRS was been developed by the World Health Organization to determine if an individual (adult) may have ADHD. The scale is made up of 6 questions, and if a client has at least 4 of 6 symptoms, there may need to be a diagnosis of ADHD made by a professional (ADDA, 2018). Seay et al. (2009) suggests the PMHNP should utilize intelligence test, broad-spectrum scales, tests of specific abilities, and brain scans to confirm the diagnosis and to rule out other disabilities, autism, auditory processing disorders or mood disorders. In addition, a full medical work-up by a PCP in order to rule out other medical conditions that could present similarly to ADHD.
Differential DX
General Anxiety Disorder: The patient exhibits symptoms of generalized anxiety disorder, DSM-5 300.02 (F14.1). He has had the symptoms for greater than six months with the symptoms being severe enough to interfere with the patient’s daily functioning. The patient complains of feels of worry that is difficult to control, irritability, restlessness, difficulty concentrating and feeling on edge. The patient symptoms have not been linked to a physical condition or to substance use (Reynolds & Kamphaus,2013).
ADHD: client consistently complains of feeling tense, irritable, and anxious (Stahl Online, 2019). Questions arise once the general anxiety symptoms are resolved and the client is left feeling hyperactive, inattentive, and the inability to focus (Stahl Online).
Post-Traumatic Stress Disorder: The client’s diagnosis of anxiety may have been related to underlying issues related to a traumatic event that he experienced as a child. The client’s father was verbally abusive to him and was an alcoholic. It is a possibility that the client’s issues could have some relations to previous exposure as a child. Post-Traumatic Stress Disorder is a serious condition that can occur in clients who have experienced various incidents including abuse (PTSD, 2018).
Medications
The case states by year six the client has failed to achieve remission on an SSRI, a 5-HT1A receptor partial agonist, an antihistamine anxiolytic and an SGRI (Stahl Online, 2019).
Based on the pharmacological agents, I would select either Cymbalta 60mg or Effexor XR 150mg. Cymbalta did illicit a response, but side effects prevented the escalation of the dosage. Augmenting with guanfacine an alpha-adrenergic agonist proved to be the therapy that elicited remission for this client.
Lessons Learned
I learned to always consider additional differential diagnosis and evaluate and re-evaluate every situation separately to be sure of the correct diagnosis. Patient’s often have comorbid diagnosis and treating both is vital to a successful outcome for the patient. Symptoms of mental illness change overtime making continued care necessary for the patient. The provider must always be approachable and helpful for the client to feel comfortable in his/her presence.
References
Attention Deficit Disorder Association. (2018). Adult ADHD Test. Retrieved from https://add.org/adhd-test/
Generalized Anxiety Disorder. (2018). Anxiety and Depression Association of America. Retrieved from https://adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad
Posttraumatic Stress Disorder. (2018). Anxiety and Depression Association of America. Retrieved from https://adaa.org/understanding-anxiety/posttraumatic-stress-disorder-ptsd
Seay, B., McCarthy, L. F., and Williams, P. (2009). Your complete ADHD/ADD diagnosis guide.
Retrieved from https://www.additudemag.com/adhd-testing-diagnosis-guide/
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical
Applications (4th ed.). New York, NY: Cambridge University Press.
Stralen, J. W. (2016). Emotional dysregulation in children with attention-deficit/hyperactive disorder.
Attention Deficit Hyperactivity Disorder. 8(4). p. 175-187. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5110580/
Hoza B, Mrug S, Gerdes AC, Bukowski WM, Kraemer HC, Wigal T, et al. What aspects of peer relationships are impaired in children with attention-deficit/hyperactivity disorder? Journal of Consulting and Clinical Psychology. 2005b;73:411–423.
Reynolds, C. & Kampaus, R. (2013). Generalized Anxiety Disorder. Pearson. Retrieved from:
www.images.pearsonclinical.com/images/assets/basc-3/basc3resources/DMS-5_
Diagnostic-Criteria_GeneralizedAnxietyDisorder.pdf.
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Post Sheryl
/in Uncategorized /by developerRespond to two colleagues in one of the following ways:
If your colleagues’ posts influenced your understanding of these concepts, be sure to share how and why.
Include additional insights you gained.If you think your colleagues might have misunderstood these concepts, offer your alternative perspective and be sure to provide an explanation for them.
Include resources to support your perspective.
Main Post
Agonist-to-Antagonist Spectrum of Action
Molecules that bind to receptors are referred to as ligands (“Pharmacology Corner: Agonists and Antagonists”, 2015). Ligands are capable of binding to receptor sites and producing a biological response. These ligands are called agonists (“Pharmacology Corner”, 2015). The opposite effect can also take place. Ligands that block the responses of agonists are referred to as antagonists. An agonist binds to a receptor site, activates it, and causes a signal to be transmitted. This reaction is called a biological response (“Pharmacology Corner,” 2015). Conversely, an antagonist also binds to a receptor site, but blocks binding from any other agonists, thus preventing any biological response (“Pharmacology Corner”, 2015). Several types of agonists exist on a spectrum. Their place on this spectrum is measured by comparing their binding ability versus endogenous agonists already present in the body (“Pharmacology Corner”, 2015). Endogenous agonists are present in the body. Super agonists produce a greater biological response than endogenous agonists. Next on the spectrum are full agonists, which mimic the efficacy of the endogenous agonists. Next in line are the partial agonists, which only exert a partial biological response as their name suggests (“Pharmacology Corner”, 2015). The next group of agonists are the inverse agonists which act in two ways. They inhibit the normal receptor site activity, and exert the opposite pharmacological activity at the same time. Last on the spectrum are the irreversible agonists which permanently bind and activate the receptor site. Since this action is permanent, it only occurs once and results in the destruction of the receptor (“Pharmacology Corner”, 2015).
G-Couple Proteins and Ion-Gated Channels
Receptors called G-protein-coupled receptors (GPCRs) facilitate most physiological responses to neurotransmitters, hormones, and stimulants in the environment. As such, they have great potential to be targeted for the treatment of many diseases (Rosenbaum, Rasmussen, & Kobilka, 2009). GPCRs comprise the largest group of membrane proteins and are responsible for most cellular responses to neurotransmitters and hormones. They also contribute significantly to the human senses of vision, smell, and taste (Rosenbaum et al., 2009). GPCRs are made up of seven alpha-helical segments separated by intracellular and extracellular looped areas (Rosenbaum et al., 2009).
The fastest and least complex of signal pathways occur with signals whose receptors are gated ion channels (Ahern & Rajagopal, 2019). Gated ion channels consist of many transmembrane proteins that create a hole, or a channel in the cell membrane. Each ion channel will allow the passage of a certain ionic species depending on its type. They are called gated because the passage is controlled by a gate which must be opened to allow the ions to pass (Ahern & Rajagopal, 2019). The opening of the gates is controlled by the binding of a signal to the receptor. This causes the immediate passage of millions of ions across the membrane (Ahern & Rajagopal, 2019).
Epigenetics in Pharmacologic Action
Epigenetics refers to genetic information that exists beyond the information contained solely in the individual’s genetic code (Stefanska & MacEwan, 2015). Human diseases can be caused by a single base genetic mutation. Scientists have made great strides in unraveling the genetic code, recording the first complete sequence of the human genome in 2001 (Stafanska & MacEwan, 2015). These advances have prompted scientists to think beyond treating illness through drugs activating receptors, but in a more global fashion. Epigenetic mechanisms are systems that are able to alter or cancel genetic activation, and are present in all genes (Stefanska & MacEwan, 2015). These mechanisms may affect more than one gene or group of proteins, and can even regulate large groups of genes. Cancer is one disease in which the understanding of epigenetics can be key to more effective treatment (Stefanska & MacEwan, 2015).
Specific Client Example
One example of a common client issue is the opioid epidemic. Naloxone (Narcan) is an opioid antagonist that binds to the opioid receptors in the patient’s brain, reversing or blocking the effects of the opioid (“Opioid overdose reversal with naloxone (Narcan, Evzio)”, 2018). This is essential to save the patient’s life who has accidentally or intentionally overdosed on opiate drugs. Naloxone can quickly restore a normal breathing pattern in a person whose respirations have slowed or stopped as a result of the opiate (“Opioid overdose reversal”, 2018). Naloxone (Narcan) can be administered using a pre-filled delivery device that is sprayed into the nostril while the patient lies supine. This device is simple to use and requires no assembly (“Opioid overdose reversal”, 2018).
References
Ahern, K., & Rajagopal, I. (2019). Ligand-gated Ion Channel Receptors. Retrieved from https://bio.libretexts.org/Bookshelves/Biochemistry/Book:_Biochemistry_Free_and_Easy_(Ahern_and_Rajagopal)/08:_Signaling/8.2:_Ligand- gated_Ion_Channel_Receptors.Opioid overdose reversal with naloxone (Narcan, Evzio). (2018). Retrieved from drugabuse.gov.Pharmacology Corner: Agonists and Antagonists. (2015). Retrieved from aegislabs.com/agonistsRosenbaum, D.M., Rasmussen, S.G.F., & Kobilka, B.K. (2009). The structure and function of G-protein-coupled receptors. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3967846/#_ffn_sectitle.Stefanska, B., & MacEwan, D.J. (2015). Epigenetics and pharmacology. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4439868/#_ffn_sectitle.
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Post Siohba
/in Uncategorized /by developerRespond to the Main post bellow offering one or more additional interaction strategies in support of the examples/observations shared or by offering further insight to the thoughts shared about the future of these interactions.
Note: the answer should be in a positive way
Main Question Post
Nursing Informatics
Nurse informaticists interact with other professionals in my healthcare setting in a variety of ways. One of these ways is through sharing patient information as and when needed. The increased manner in which medical facilities are adopting the use of health information technology means that the nurse informaticists have an integral role that they play in ensuring that patient data is availed when needed (Harrington, 2017). The Nurse informaticists also ensure that patient data is kept accurately and safely so that it can help in proper medical attention of the concerned patients. In so doing, nurse informaticists interact with those who admit patients at the facilities, those in charge of diagnosing and the laboratory technicians to ensure that there is a smooth flow of data from one point to the next (Lee, 2014).
The IT department at my current work place is not physically around or on the floors for night shift, which is when I work. So there isn’t much interaction with the nurse informatistics, but for their physical absence at night there is a contact line that we the employees can access whenever needed. That nurse informatistics has access to mirror what we are seeing on the actual computer screen so that they are able to help in more productive manner. If there is a new feature on the software there will be a super user which are more than likely nurses who have been trained on the new feature to help and aid in the process when needed. For instance, there is a new feature on the software at my work place that involves an innovative way to waste narcotics via the software. Because it has such a huge impact on the hospital they are having an information sessions at various times to accommodate every shift, which will allow a better understanding of the new feature at hand.
One way of improving these interactions will be by increasing familiarity among team members to the extent that every team member knows the strengths, weaknesses, and idiosyncrasies of all team members (Kalisch & Begeny, 2015). In so doing, it will be possible to take decisive measures on who should handle a particular aspect so that its outcome is the most desirable. Increased familiarity will lead to teamwork, which is likely to enhance the productivity of the nurse informaticists and other segments of the medical facility.
I believe that the continued evolution of nursing informaticists is likely to eliminate the physical distances among nurses and their facilities, something that will lead to improved patient outcomes. Nursing informaticist is likely to lead to seamless societies where it is possible to interact with other nurses located very many miles from each other and share their experiences or challenges in their line of duty. In so doing, it will be possible to come up with the most desired patient outcomes.
References
Harrington L. (2017). The role of nurse informaticists in the emerging field of clinical
intelligence. NI 2017: 11th International Congress on Nursing Informatics, June 23-27, 2017, Montreal, Canada. International Congress in Nursing Informatics (11th: 2017: Montreal, Quebec)
Kalisch, B.J. & Begeny, M.J. (2015). Improving nursing teamwork. The Journal of Nursing
Administration, 35 (12) pp 550-556.
Lee, A. (2014). The role of informatics in nursing. Nursing Made Incredibly Easy, 12(4), 55-57. doi:10.1097/01.NME.0000450294.60987.00
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Post Starr 19492611
/in Uncategorized /by developerRespond to at least two 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
Case Study: Volume 2, Case #21 focuses on the treatment of an adult client diagnosed with Attention Deficit Hyperactivity Disorder (ADHD).
Questions
Question 1: Are you having problems with your loved one’s due being “argumentative and temperamental”?
Rationale: The client may have additional stress due to broken relationships and this could be due to his disorder. “Emotional dysregulation is increasingly recognized as a core feature of ADHD” (Stralen, 2016). Signs of ADHD include low frustration tolerance and explosive behavior (Stralen, 2016).
Question 2:
What causes you the most anxiety?
It is important to determine the triggers of the anxiety to help the patient prepare for times when he is likely to be in high stress situations. Planning a response when feeling overwhelmed can help the patient remain in control of his emotions and allow the patient to monitor his behavior.
Question 3:
You stated that your father was abusive, was this physical or verbal abuse or both? Do you contribute some of your anxiety from previous issues with your father?
It is important for the provider to understand the client’s point of view in regards to his upbringing. He realizes it has affected in him in some way, as he has obtained psychotherapy in the past. I would want to know if he has ever spoken to his father about this and if his father has ever apologized for his actions.
Questions for family
I would want to talk with his mother to ask her how he did as a child in school and at home in regards to schoolwork, chores and would want to know if he had friends. Although social problems are not part of the diagnostic criteria for ADHD, the peer relationship difficulties faced by youth with this disorder are profound (Hoza, 2007)
Diagnostics & Exams
A full psychiatric evaluation which would include the Adult Self-Report Scale (ASRS). ASRS was been developed by the World Health Organization to determine if an individual (adult) may have ADHD. The scale is made up of 6 questions, and if a client has at least 4 of 6 symptoms, there may need to be a diagnosis of ADHD made by a professional (ADDA, 2018). Seay et al. (2009) suggests the PMHNP should utilize intelligence test, broad-spectrum scales, tests of specific abilities, and brain scans to confirm the diagnosis and to rule out other disabilities, autism, auditory processing disorders or mood disorders. In addition, a full medical work-up by a PCP in order to rule out other medical conditions that could present similarly to ADHD.
Differential DX
General Anxiety Disorder: The patient exhibits symptoms of generalized anxiety disorder, DSM-5 300.02 (F14.1). He has had the symptoms for greater than six months with the symptoms being severe enough to interfere with the patient’s daily functioning. The patient complains of feels of worry that is difficult to control, irritability, restlessness, difficulty concentrating and feeling on edge. The patient symptoms have not been linked to a physical condition or to substance use (Reynolds & Kamphaus,2013).
ADHD: client consistently complains of feeling tense, irritable, and anxious (Stahl Online, 2019). Questions arise once the general anxiety symptoms are resolved and the client is left feeling hyperactive, inattentive, and the inability to focus (Stahl Online).
Post-Traumatic Stress Disorder: The client’s diagnosis of anxiety may have been related to underlying issues related to a traumatic event that he experienced as a child. The client’s father was verbally abusive to him and was an alcoholic. It is a possibility that the client’s issues could have some relations to previous exposure as a child. Post-Traumatic Stress Disorder is a serious condition that can occur in clients who have experienced various incidents including abuse (PTSD, 2018).
Medications
The case states by year six the client has failed to achieve remission on an SSRI, a 5-HT1A receptor partial agonist, an antihistamine anxiolytic and an SGRI (Stahl Online, 2019).
Based on the pharmacological agents, I would select either Cymbalta 60mg or Effexor XR 150mg. Cymbalta did illicit a response, but side effects prevented the escalation of the dosage. Augmenting with guanfacine an alpha-adrenergic agonist proved to be the therapy that elicited remission for this client.
Lessons Learned
I learned to always consider additional differential diagnosis and evaluate and re-evaluate every situation separately to be sure of the correct diagnosis. Patient’s often have comorbid diagnosis and treating both is vital to a successful outcome for the patient. Symptoms of mental illness change overtime making continued care necessary for the patient. The provider must always be approachable and helpful for the client to feel comfortable in his/her presence.
References
Attention Deficit Disorder Association. (2018). Adult ADHD Test. Retrieved from https://add.org/adhd-test/
Generalized Anxiety Disorder. (2018). Anxiety and Depression Association of America. Retrieved from https://adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad
Posttraumatic Stress Disorder. (2018). Anxiety and Depression Association of America. Retrieved from https://adaa.org/understanding-anxiety/posttraumatic-stress-disorder-ptsd
Seay, B., McCarthy, L. F., and Williams, P. (2009). Your complete ADHD/ADD diagnosis guide.
Retrieved from https://www.additudemag.com/adhd-testing-diagnosis-guide/
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical
Applications (4th ed.). New York, NY: Cambridge University Press.
Stralen, J. W. (2016). Emotional dysregulation in children with attention-deficit/hyperactive disorder.
Attention Deficit Hyperactivity Disorder. 8(4). p. 175-187. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5110580/
Hoza B, Mrug S, Gerdes AC, Bukowski WM, Kraemer HC, Wigal T, et al. What aspects of peer relationships are impaired in children with attention-deficit/hyperactivity disorder? Journal of Consulting and Clinical Psychology. 2005b;73:411–423.
Reynolds, C. & Kampaus, R. (2013). Generalized Anxiety Disorder. Pearson. Retrieved from:
www.images.pearsonclinical.com/images/assets/basc-3/basc3resources/DMS-5_
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Post Starr
/in Uncategorized /by developerRespond to at least two 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
Case Study: Volume 2, Case #21 focuses on the treatment of an adult client diagnosed with Attention Deficit Hyperactivity Disorder (ADHD).
Questions
Question 1: Are you having problems with your loved one’s due being “argumentative and temperamental”?
Rationale: The client may have additional stress due to broken relationships and this could be due to his disorder. “Emotional dysregulation is increasingly recognized as a core feature of ADHD” (Stralen, 2016). Signs of ADHD include low frustration tolerance and explosive behavior (Stralen, 2016).
Question 2:
What causes you the most anxiety?
It is important to determine the triggers of the anxiety to help the patient prepare for times when he is likely to be in high stress situations. Planning a response when feeling overwhelmed can help the patient remain in control of his emotions and allow the patient to monitor his behavior.
Question 3:
You stated that your father was abusive, was this physical or verbal abuse or both? Do you contribute some of your anxiety from previous issues with your father?
It is important for the provider to understand the client’s point of view in regards to his upbringing. He realizes it has affected in him in some way, as he has obtained psychotherapy in the past. I would want to know if he has ever spoken to his father about this and if his father has ever apologized for his actions.
Questions for family
I would want to talk with his mother to ask her how he did as a child in school and at home in regards to schoolwork, chores and would want to know if he had friends. Although social problems are not part of the diagnostic criteria for ADHD, the peer relationship difficulties faced by youth with this disorder are profound (Hoza, 2007)
Diagnostics & Exams
A full psychiatric evaluation which would include the Adult Self-Report Scale (ASRS). ASRS was been developed by the World Health Organization to determine if an individual (adult) may have ADHD. The scale is made up of 6 questions, and if a client has at least 4 of 6 symptoms, there may need to be a diagnosis of ADHD made by a professional (ADDA, 2018). Seay et al. (2009) suggests the PMHNP should utilize intelligence test, broad-spectrum scales, tests of specific abilities, and brain scans to confirm the diagnosis and to rule out other disabilities, autism, auditory processing disorders or mood disorders. In addition, a full medical work-up by a PCP in order to rule out other medical conditions that could present similarly to ADHD.
Differential DX
General Anxiety Disorder: The patient exhibits symptoms of generalized anxiety disorder, DSM-5 300.02 (F14.1). He has had the symptoms for greater than six months with the symptoms being severe enough to interfere with the patient’s daily functioning. The patient complains of feels of worry that is difficult to control, irritability, restlessness, difficulty concentrating and feeling on edge. The patient symptoms have not been linked to a physical condition or to substance use (Reynolds & Kamphaus,2013).
ADHD: client consistently complains of feeling tense, irritable, and anxious (Stahl Online, 2019). Questions arise once the general anxiety symptoms are resolved and the client is left feeling hyperactive, inattentive, and the inability to focus (Stahl Online).
Post-Traumatic Stress Disorder: The client’s diagnosis of anxiety may have been related to underlying issues related to a traumatic event that he experienced as a child. The client’s father was verbally abusive to him and was an alcoholic. It is a possibility that the client’s issues could have some relations to previous exposure as a child. Post-Traumatic Stress Disorder is a serious condition that can occur in clients who have experienced various incidents including abuse (PTSD, 2018).
Medications
The case states by year six the client has failed to achieve remission on an SSRI, a 5-HT1A receptor partial agonist, an antihistamine anxiolytic and an SGRI (Stahl Online, 2019).
Based on the pharmacological agents, I would select either Cymbalta 60mg or Effexor XR 150mg. Cymbalta did illicit a response, but side effects prevented the escalation of the dosage. Augmenting with guanfacine an alpha-adrenergic agonist proved to be the therapy that elicited remission for this client.
Lessons Learned
I learned to always consider additional differential diagnosis and evaluate and re-evaluate every situation separately to be sure of the correct diagnosis. Patient’s often have comorbid diagnosis and treating both is vital to a successful outcome for the patient. Symptoms of mental illness change overtime making continued care necessary for the patient. The provider must always be approachable and helpful for the client to feel comfortable in his/her presence.
References
Attention Deficit Disorder Association. (2018). Adult ADHD Test. Retrieved from https://add.org/adhd-test/
Generalized Anxiety Disorder. (2018). Anxiety and Depression Association of America. Retrieved from https://adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad
Posttraumatic Stress Disorder. (2018). Anxiety and Depression Association of America. Retrieved from https://adaa.org/understanding-anxiety/posttraumatic-stress-disorder-ptsd
Seay, B., McCarthy, L. F., and Williams, P. (2009). Your complete ADHD/ADD diagnosis guide.
Retrieved from https://www.additudemag.com/adhd-testing-diagnosis-guide/
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical
Applications (4th ed.). New York, NY: Cambridge University Press.
Stralen, J. W. (2016). Emotional dysregulation in children with attention-deficit/hyperactive disorder.
Attention Deficit Hyperactivity Disorder. 8(4). p. 175-187. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5110580/
Hoza B, Mrug S, Gerdes AC, Bukowski WM, Kraemer HC, Wigal T, et al. What aspects of peer relationships are impaired in children with attention-deficit/hyperactivity disorder? Journal of Consulting and Clinical Psychology. 2005b;73:411–423.
Reynolds, C. & Kampaus, R. (2013). Generalized Anxiety Disorder. Pearson. Retrieved from:
www.images.pearsonclinical.com/images/assets/basc-3/basc3resources/DMS-5_
Diagnostic-Criteria_GeneralizedAnxietyDisorder.pdf.
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Post Tami 19150129
/in Uncategorized /by developerRespond to the Post that is bellow using one or more of the following approaches:
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
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.
NOTE: THE ANSWER THAT YOU ARE GOING TO DO IN REFERENCE OF THIS POST, HAS TO BE IN A POSITIVE WAY, REFLECTING THE POSITIVE OF THE POST THAT THE STUDENT MADE.
Initial Discussion Post
Literature Searches
Nursing is a field filled with numerous policies and procedures. To understand these policies and procedures, the practice of research and knowledge acquisition is essential. The method of incorporating proper research into daily practice is called evidence-based practice (Polit & Beck, 2017). The goal of using evidence-based practice is to move away from traditions and ritual by incorporating tested research evidence that supports clinical practices (Polit & Beck, 2017).
Summary of Article Search
Based on the evidence hierarchy by Polit & Beck (2017), and the levels of evidence presented in class I was able to evaluate research articles (Walden University, 2018). When looking for specific research for my topic, I searched for the highest level of evidence. There are three types of research which are: primary, synthesized or secondary, and others such as expert opinions or practice questions (Polit & Beck, 2017).
My PICOT question is: In patients with acute pain in the emergency department, what is the effect of Ketamine use for the reduction of pain compared to opioid medications during their ED visit? To begin the search, I used the keywords Ketamine, analgesia, sedation and emergency medicine. Using these words, I was able to find 408 results. I further limited my search to ten years which yielded 297 results. Finally, I used systematic reviews, meta-analysis and randomized control trials (RCTs) for my final search narrowing the articles to 111. Upon examination of the articles, I found the articles based on systematic reviews, meta-analysis and RCTs provided detailed research including abstracts, methods of trials, results, discussion, limitations, and conclusion. Each of these sections specifies the purpose of the study in detail.
Using this framework for literature review ensures relevant research is used to answer evidence seeking questions. Davies (2011) comments, “detailed knowledge of the frameworks enables the searcher to refine strategies to suit each particular situation rather than trying to fit a search situation to a framework” (p. 79). By using a timeframe such as the past ten years, it is easier to see the relevance of the information to clinical practice today. An active literature search will yield the most appropriate information for the question being posed.
References
Davies, K. S. (2011). Formulating the evidence-based practice question: a review of the frameworks. Evidence Based Library and Information Practice, 6(2), 75-80. Retrieved from https://ejournals.library.ualberta.ca/index.php/EBLIP/article/viewFile/97418144
Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.
Walden University Library. (2018). Levels of evidence. Retrieved from http://academicguides.waldenu.edu/c.php?g=80240&p=52322
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Post Tami 19196377
/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.
Validate an idea with your own experience and additional sources.
Make a suggestion based on additional evidence drawn from the readings or after synthesizing multiple postings.
Planning for Data Collection
Evidence-based practice is a theory that consists of using research to guide decision making in clinical and nursing settings. For research to be reliable and have validity a significant amount of data collection must first be collected. Whether a research project is using quantitative, qualitative, or mixed-methods design, it is essential to determine what types of information is needed. Due to the emphasis on patient satisfaction in the healthcare world at this time, it is crucial to evaluate how that care is being delivered (Krietz, Winters & Pedowitz, 2016). In this post, I will discuss using a survey method to obtain information representative of the population within a clinic setting.
In the example, I am a nurse working in a local primary care facility which sees thousands of patients annually. To make better clinical decisions regarding patient care and satisfaction, five questions have been created to elicit feedback. The questions are as follows:
To obtain structured data that is self-reported and applicable to the clinic’s objectives, it is vital to determine which instrument would work best for the clientele. Self-report methods can extract information from patients that might otherwise be difficult to get (Polit & Beck, 2017). Allowing the freedom to report their experiences and feelings increases confidence in the clinic’s desire to meet their needs. If researchers know what data they want to obtain, a structured approach with some open-ended and closed questions can garner the information needed to make significant changes (Polit & Beck, 2017). Using a mixture of questions is an attempt to include all patients.
For this scenario, the questionnaire is a sampling of both types of questions and is the most popular method (Keough & Tanabe, 2011). The study will be given to individuals 18 and over. The questionnaire and a pen will be given to the patient by the nurse prior at the start of their appointment with the physician. An explanation of the questionnaire will be provided with instructions to return their questionnaire to the drop-box on the countertop in the room after their exam. The goal for participation is 500 patient responses over six months. Responses will be collected and responses logged into the computer on Fridays by the nurse manager. After the six months, results will be calculated, and staff will be informed of the results and clinical implications for patient care.
Implementing change processes requires the support of clinical staff and providers. Since patient care is seen as an essential component of healthcare, working together as a staff to create a warm, friendly, and improved patient experience is the ultimate objective (McNicholas et al., 2017). With excellent leadership and teamwork, the clinic can attain staff satisfaction and patient satisfaction simultaneously.
References
Keough, V.A., & Tanabe, P. (2011). Survey research: An effective design for conducting nursing research. Journal of Nursing Regulation, 1(4), 37-44. doi:/10.1016/S2155-8256(15)30315-X
Krietz, T., Winters, B., & Pedowitz, D. (2016). The influence of wait time on patient satisfaction in the orthopedic clinic. Journal of Patient Experience, 3(2), 39-42. doi:/10.1177/2374373516652253
McNicholas, A., McCall, A., Werner, A., Wounderly, R., Marichak, E., & Jones, P. (2017). Improving patient experience through nursing satisfaction. Journal of Trauma Nursing, 24(6), 371-375. doi:/10.1097/JTN.0000000000000328
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 Tami 19205257
/in Uncategorized /by developerRespond by offering additional thoughts regarding the examples shared, Systems Development Life Cycle SDLC-related issues, and ideas on how the inclusion of nurses might have impacted the example described by your colleagues.
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Systems Development Life Cycle
The systems development life cycle (SDLC) is a process whereby a company or entity determines the need for the implementation of new technology. SDLC provides information systems that are effective at incorporating the company’s business plan (McGonigle & Garver Mastrian, 2018). It is essential that a working knowledge of the problems or issues are understood. In the case of healthcare organizations, this means establishing an assessment that discovers the needs of each department (McGonigle & Garver Mastrian, 2018). Most of the time when analyzing these needs an outside company is brought in to assess, interview, and determine the type of system that would benefit the company.
Consequences of Lack of Inclusion of Nurses
In the application of any new technology or policy, it is essential to trial it with the individuals that will be using it. When considering an update or new system in the healthcare setting, it is beneficial to involve nurses in the decision-making process. The Agency for Healthcare and Research (n.d.a) report that it is important to consult with nurses in the preliminary period of development. By incorporating nurses into the initial design, the researchers learn nursing processes, possible new tasks, effect the technology will have on patient care, staffing needs, and usability of the design. This analysis of workflow is used to determine the best use of technology (McGonigle & Garver Mastrian, 2018). Including nurses in this process opens routes for discussion and collaboration that will benefit the designers and users.
Failure to include nurses in the planning stages of technology design is detrimental to the intended use of the new system. A researcher or computer designer could miss critical elements of the nursing process due to their lack of knowledge regarding nursing procedures. McGonigle & Mastrian (2018) state, “nursing informatics professionals should always be included in these activities to represent the needs of clinicians and to serve as a liaison for technological solutions to process problems” (p. 250). The role of the informatics nurse and a nurse, in general, can play in designing technology is critical. Their contribution to the analysis of workflow and clinical implications is invaluable information needed for the formation of a system that will be used to its potential.
An Example of Collaboration
A study was done in Canada to determine the impact of the initiation of computerized order entries for medications on nursing workflow and reduction of medication errors. Registered nurses participated in a study where interviews and observations were used to study the effects of digital technology on the nursing process (Vito, Borycki, Kushniruk, & Schneider, 2017). The researchers spent considerable time observing and recording how the technology affected nurses and the influence it made on time spent with patients. This study is one example of the impact that nurses can have on the design and implementation of technology in the healthcare setting.
Current Healthcare Facility
When our facility transitioned to electronic health records (EHR) as an ER nurse, I was not involved in the planning. The nurse informaticist I assume worked with the company to create templates that are in use today. Within the ER portion of the EHR, there have been changes made because of nursing input. As a unit, we have asked for an ED narrator to be developed with our order sets, documentation narrators, and medication administration policies. Recently we asked for changes to our trauma narrator to include additional documentation options for different trauma levels. As a group we have also discussed missing pieces of data that is beneficial for everyday use and discussed this with our leaders. The leaders take this information to the information technology (IT) individuals that work directly with the EHR company and changes are then made. There are times when the nurse’s input is not embraced due to financial constraints or leadership ability to see the need. The size of the healthcare organization plays a significant role in the inclusion of nurses in decision-making practices. Many variables exist to modification of technology in healthcare. In an ideal setting, it would be ideal to include nurses throughout the design process.
References
Agency for Healthcare Research and Quality (n.d.a). Health IT evaluation toolkit and evaluation measures quick reference guide. Retrieved April 17, 2019, from https://healthit.ahrq.gov/sites/default/files/docs/page/impact-of-hit-on-nurses-quick-reference-guide.pdf
McGonigle, D., & Garver Mastrian, K. (2018). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning, LLC.
Vito, R., Borycki, E., Kushniruk, A., & Schneider, T. (2017). The impact of computerized provider order entries on nursing practice. Studies in Health Technology and Informatics, 234, 364-369. doi:/10.3233/978-1-61499-742-9-364
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Post Tami 19264601
/in Uncategorized /by developerRespond on two different days by explaining how the leadership skills they described may impact your organization or your personal leadership, or by identifying challenges you see in applying the skills described.
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A healthy atmosphere and morale in the workplace are essential to provide the best possible experience for employees. Quality leadership is a result of the hard work an individual has done to establish personal and professional goals. They have a passion for leading people and helping the staff to grow. In this post, I will discuss insights from transformational leadership and the role of emotional intelligence in the workplace.
Transformational Leadership and Emotional Intelligence
The hallmark of transformational leadership is the ability of the leader to inspire workers by acknowledging the beliefs, values, attitudes, and motivations of their workers (Wang, Tao, Bowers, Brown & Zhang, 2018). Transformational leadership is associated with a decrease in the number of nurse turnovers rates due to job satisfaction and healthy well-being (Wang, Tao, Bowers, Brown & Zhang, 2018). This type of leadership also improves patient satisfaction and reduction in nursing errors. As a transformational leader with emotional intelligence, it is possible to engage staff by providing employee empowerment, strategy, innovation, and opportunity (Holmwood, 2019). What is the key to transformational leadership? Research is stating emotional intelligence.
Emotional intelligence is “the ability to perceive, understand, manage, and use emotions in self and others, comprises a key factor in interpersonal relationships that are inherent in actualizing leadership, communication, and teamwork in healthcare” (Cox, 2018, p. 649). Emotional intelligence is also a “measure of how we challenge ourselves to collaborate, how we employ our curiosity to dig into conversations, are centered and positively engaged in our world, and are accepting of our surroundings” (Holmwood, 2019). Transformational leadership, mixed with emotional intelligence establishes an understanding and awareness of how we influence our environment, which leads to a sense of well-being and positive growth. Leaders are present and show up for their employees. They are authentic and have excellent communication skills (Marshall, 2011).
In my last job, I had a leader who sought to include everyone and was present. She planned events just for staff, took time to get to know each employee, and took into consideration employee’s goals and thoughts. It was not without conflict, but when conflict arose, she would bring them to her office and talk it out. The employees knew she was their cheerleader and trusted her decisions. The environment was positive, and the employees had friendships outside of work together.
Another example of emotional intelligence in leadership that I experienced was working for a nursing professor. This professor spent time with each student helping them to discover their passions and talents in order to apply them to their current work. She placed us on teams to collaborate and learn from one another. This work experience increased my self-confidence and helped me discover my passion for nursing.
In contrast, a manager who leads by micro-managing, using punitive discipline, and lacks communication skills can deflate, and individuals purpose for their work. With transformational leadership, there is a sense of trust between the manager and employee, but with authoritarian leadership, the sense of trust is not present. As a leader, finding the balance between leading and serving is challenging, but worth the exploration.
Reference
Cox, K.M. (2018). Use of emotional intelligence to enhance advanced practice registered nursing competencies. Journal of Nursing Education, 57(11). 648-654. doi:/10.3928/01484834-20181022-04
Holmwood, T. (2019). Greater emotional intelligence is your key to superior team performance. Governance Directions, 71(4), 215-218. https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=bth&AN=136273758&site=eds=live&scope=site.
Marshall, E., & Broome, M. (2017). Transformational leadership in nursing: From expert to clinician to influential leader (2nd ed.). New York, NY: Springer.
Wang, L., Tao, H., Bowers, B., Brown, R., & Zhang, Y. (2018). When nurse emotional intelligence matters: How transformational leadership influences intent to stay. Journal of Nurse Management, 57(11). 648-654. doi:/10.3928/01484834-20181022-04
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Post Tami 19270647
/in Uncategorized /by developerRespond on two different days by making recommendations for how they might strengthen the leadership behaviors profiled in their CliftonStrengths Assessment, or by commenting on lessons to be learned from the results that can be applied to personal leadership philosophies and behaviors.
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Leadership Profile
Leadership of people begins with a leader who knows themselves and can cultivate the strengths in others. Personal and professional growth occurs when time is spent reflecting on your strengths and weaknesses. Marshall (2011) states, “your daily reflection might include where you improved trust, how you promoted respect, where you feel pride, and what happened to instill joy. From your reflection can also emerge your sense of direction” (p. 29). As a person and as a leader, it is essential to have a mission or purpose for your life.
Assessment Findings
Taking the Gallup StrengthsFinder Assessment provided definitive insight into my personality. The top 5 signature themes of talent that were dominant in my life are learner, developer, input, empathy, and belief. Each of these themes resounded with my observations and further enlightened my understanding of who I am. As a lifelong learner, the goal has never been to finish but to be continually learning something new every day. By being a life-long learner, it increases self-esteem, satisfaction with personal development, reduces negative emotions, and is part of a pursuit to a meaningful and better life (Lee, 2016). This strength ties into my other strengths of input and developer. Empathy, however, is a fundamental skill for getting through life that many individuals are never able to actualize. For me, empathy is the ability I experience to share in and understand other’s lives (Cameron et al., 2019). This strength pairs well with belief. I have a firm belief in people and in their ability to show resiliency and experience growth in their lives. In order to have a belief, empathy has to be present.
Values, Strengths, and Characteristics
Values that are important in my life are deep relationships and being a life-long learner. Being a person that pays attention to the thoughts and feelings of others; I find it easy to move past superficial conversations quickly to really get to know someone. Working in the Emergency Department, I have found this skill very helpful. By peeling away the small talk in order to help my patients, I can discover their thought patterns and help them better. This skill helps with the value of being a life-long learner. I believe you can learn something from everyone you meet. These experiences help you to grow as an individual and professionally.
Strengths are not necessarily skills. Often, I heard it said that my strength is being able to start an IV. That is a skill, whereas strength is something inherent to who I am. I believe I have insight into people’s emotions and vulnerabilities. I notice people, their body language, sense their moods, and adapt accordingly to help them feel comfortable. This leads to my second strength, and that is an ability to make people feel comfortable and heard. People are most comfortable around others who can relate with them and reassure them that their pain is real.
Lastly, there are characteristics that I would like to strengthen in myself. I have always been able to listen to others, but I desire to be more present in my daily life by working on being an active listener. Actively looking to listen instead of talk or provide reassurance. I also desire to have a lasting positive impact on people. In order to do this, I need to be in a good place emotionally, physically, cognitively, and spiritually. This means making time to be refreshed outside of the work environment. It is said that empty people cannot help empty people. As future nurse practitioners, I believe this is one of the hardest and yet most important things we can do to show others the value of rest.
References
Cameron, C. D., Hutcherson, C. A., Ferguson, A. M., Scheffer, J. A., Hadjiandreou, E., & Inzlicht, M. (2019). Empathy is hard work: People choose to avoid empathy because of its cognitive costs. Journal of Experimental Psychology, 148(6), 962-976. doi:/10.1037/x.xge0000595
Lee, S. (2016). Lifelong learning as a path to happiness? Adult Education & Development, 83, 68-73. Retrieved from https://ezp.waldenlibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edb&AN=121879727&site=eds-live&scope=site
Marshall, E. (2011). Transformational Leadership in Nursing. New York, NY: Springer Publishing Company, LLC.
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Post Tami 19446005
/in Uncategorized /by developerRespond to two colleagues in one of the following ways:
If your colleagues’ posts influenced your understanding of these concepts, be sure to share how and why. Include additional insights you gained.
If you think your colleagues might have misunderstood these concepts, offer your alternative perspective and be sure to provide an explanation for them. Include resources to support your perspective.
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Agonist-to-Antagonist Spectrum
The agonist-to-antagonist spectrum of action refers to the action that is taken by a neurotransmitter to produces a conformational change (Stahl, 2013). The spectrum starts with the agonist action, which, with the help of a second-messenger, can turn on the full potential of change (Stahl, 2013). Full agonists can be natural transmitters used to produce change. An antagonist blocks the conformational change of the potential of the transmitter for binding with the intended agonist (Stahl, 2013). The role of the antagonist is to keep the receptors in a baseline state in order to reverse what the agonist has done (Stahl, 2013). This is the opposite end of the spectrum and seeks to block agonists. In the middle, some partial agonists mimic its agonist partner to a lesser degree, and inverse agonists stop all activity from occurring on the receptor (Stahl, 2013). The conformational change is needed for a receptor to open to the action of drugs, particularly, psychopharmaceutical medications in this case.
G couple proteins and Ion gated channels
G couple proteins are used at the binding site of a neurotransmitter to act as a conduit for enzymes (Stahl, 2013). Whereas, ion gated channels exist as targets to regulate chemical neurotransmitters (Stahl, 2013). Ion gated channels consist of channels and receptors that can only be opened by the neurotransmitters. Conversely, G couple proteins attach to neurotransmitters and conform to enzymes to serve as a channel for a second messenger (Stahl, 2013). Most psychotropic medications aim for the ion gated channels, which open through chemical neurotransmission and initiate the signal transduction cascade (Stahl, 2013). The cascade results in faster uptake of psychotropic medications into the system.
The Role of Epigenetics
According to DeSocio (2016), epigenetics is the study of how genomes that undergo changes with certain molecular compounds and environmental changes can leave the essential DNA unchanged. It is a modification of gene expression that is independent of the DNA (DeSocio, 2016). DNA is the code that determines much of who we are. Changes in that code can be seen as a result of heredity, the environment, or neurotransmission (Stahl, 2013). These alterations affect individuals at a physical, emotional, and psychological level. Stress and adversity play a significant role in epigenetics by changing the genomes, which in turn leads to changes in a person’s DNA (Park et al., 2019). These alterations influence psychological issues related to many individuals. It is essential to know how to combat these changes when determining a plan of care for clients.
Implications of Findings to Prescribing
As nurse practitioners, it is essential to have an extensive understanding of how the above processes affect the way we prescribe medications to clients. It is also essential to take into consideration how the environment impacts maintaining optimal health and healing (DeSocio, 2016). Knowing the mechanisms of action for medications that we are prescribing is vital to providing competent care. For example, a patient with a generalized anxiety disorder (GAD) is prescribed Venlafaxine. The PMHNP needs to understand that the Venlafaxine works by boosting the serotonin, norepinephrine, and dopamine neurotransmitters (Stahl, 2014). This action blocks serotonin reuptake, norepinephrine reuptake, and the dopamine reuptake (Stahl, 2014). Each of these actions then increases these neurotransmissions in the brain providing therapeutic results.
References
DeSocio, J.E. (2016). Epigenetics: An emerging framework for advanced practice psychiatric nursing. Perspectives in Psychiatric Care, 52(3), 201-207. https://doi.org/10.1111/ppc.12118
Park, C., Rosenblat, J.D., Brietzke, E., Pan, Z., Lee, Y., Cao, B., Zuckerman, H., Kalantarova, A., McIntyre, R.S. (2019). Stress, epigenetics, and depression: A systematic review. Neuroscience and Biobehavioral Reviews, 102, 139-152. https://doi.org/10.1016/j.neubiorev.2019.04.010
Stahl, S.M. (2014). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
Stahl, S.M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications. (4th ed.). New York, NY: Cambridge University Press.
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