Assignment:
Write a Respond to two of these #1&2 case studies using one or more of the following approaches:
- Share additional interview and communication techniques that could be effective with your colleague’s selected patient.
- Suggest additional health-related risks that might be considered.
- Validate an idea with your own experience and additional research.
- Each must have at least 2 references no more than 5 years old using APA Format
Response # 1
“The case of physician do not heal thyself”
Three questions I will ask the patient on a visit to my office and rationale thereof.
Major depressive disorder (MDD) is defined as “feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home” and it is one of the most common reasons patients present for medical care worldwide (McConnell, Carter & Patterson, 2019). Childhood traumatic experiences, including physical, sexual, and emotional abuse, neglect, and separation from caregivers, they posit significantly increase the risk of developing mental and physical illnesses later in life.
NO .1
Have you had any thoughts of death or suicide before? Are you having them now? And do you have a current plan to harm or kill yourself? What are the details of that plan?
McConnell,et .al, (2019) posit that clients with MDD often presents with feeling sad or depressed; lack of interest or pleasure in previously enjoyed activities; appetite changes (unintentional weight loss or gain); sleep difficulty (too much or little); lack of energy (fatigue); feeling of guiltiness or worthlessness; moving more slowly or pacing (others observe); difficulty with decision-making, concentration, and thinking; and/or suicidal thoughts.
Patient safety remains a central concern in every healthcare setting (Smith,2018). This patient did report several feelings of Suicide Ideation and Homicidal ideation so patients’ safety should be priority. Although the welfare of patients encompasses a broad range of concerns, the increasing prevalence of suicide in our society compels health care workers to ensure a safe healthcare environment for patients with suicidal ideation. These efforts include the elimination or, at least, the mitigation of physical setting characteristics that enable suicide attempts.
No 2.
Are you depressed? How does this problem make you feel? What makes the problem better?
According to DSM-5 (2013) diagnostic criteria, MDD requires five or more of the following symptoms during the same two-week period and represent a change from previous functioning; at least one symptom is either 1) depressed mood or 2) loss of interest or pleasure (American Psychiatric Association [APA], 2013).
According to the patient’s file, he has experienced five or more of the symptoms of MDD during the same two-week period, on more than one occasion, including depressed mood, recurrent suicidal ideation, and suicide attempts, and was diagnosed with major depression for the first time when he was 23.
NO 3.
How often do you take your medication and how long did you take them before stopping? The patient has a history of stopping his medication, self-medication and non-adherent to treatment. This question is necessary because most antidepressants take a while to build up in the system.
Sources of information
From the social history, patient was married and divorced 3 times, currently single, has no children, nonsmoker no drug abuse, rarely drinks, he’s a Physician and successful businessman. We can elicit information from siblings, extended relatives and even colleagues at work. childhood traumatic experiences, including physical, sexual, and emotional abuse, neglect, and separation from caregivers, significantly increase the risk of developing mental and physical illnesses later in life (
McConnell, et. al, (2019). Colleagues at work and close friends can also be asked about his temperament and attitude at work as this could help with diagnosis and treatment modalities. Also, if patient has access to weapon at home, the relatives might have to make sure it is locked in a safe place or removed if he is currently suicidal.
Physical Exam and Diagnostic tests.
Health assessment will ensure a structured approach that includes comprehensive history taking and meticulous physical examination, carrying out these two parts consecutively enables the examiner to assess the presenting complaint, establish an accurate differential diagnosis and provide any necessary interventions Kennedy & O’Connor, (2016). Physical examination of a patient will include looking at the patient’s overall appearance skin color, turgor and general assessment. Skin for self-injury and discoloration, bruise, vital sign, BMI, general appearance, nutritional status. Gait, balance coordination, reflexes, and involuntary movements, mental status for evidence of mental disorder and thought process.
Electroconvulsive therapy (ECT) according to Birrer & Vemuri, (2004) is a first-line option in patients with depression and psychotic features who have not responded to antipsychotic and antidepressant medications, and patients with severe nonpsychotic depression who have not responded to adequate trials of two antidepressant.
I will in addition to the above check the Erythrocyte Sedimentation Rate (ESR). A change in ESR between two visits was also significantly correlated with a change in PGA, renal, fatigue and joint VAS, (Stojan, Fang, Magder & Petri, 2013). This test is vital to our study because most drugs are eliminated through this media.
Differential Diagnoses
1. I think Major Depressive Disorder (MDD) is the main diagnoses for my client. Major depressive disorder (MDD) is defined as “feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home” and it is one of the most common reasons patients present for medical care worldwide (McConnell, Carter & Patterson, 2019). According to the patient’s file, he has experienced five or more of the symptoms of MDD during the same two-week period, on more than one occasion, including depressed mood, recurrent suicidal ideation, and suicide attempts, and was diagnosed with major depression for the first time when he was 23 (APA, 2013; Stahl, 2011).
1. Borderline personality disorder. The Statistics Manual of Mental Disorders (5th ed.; DSM-5), include fear of abandonment, destructive impulsivity, self-harm, suicidality (evidenced by threats or gestures of self-mutilation), and intense, uncontrollable, or inappropriate anger (American Psychiatric Association, 2013). Per report, patient has depressive symptoms characterized as unhappiness and transient depressed moods of a few days’ duration and with more anxiety than depression, improving without treatment – Actively suicidal and overdosed on his medications.
2. Bipolar II with mixed features; the Diagnostic and Statistical Manual of Mental Disorders (DSM) version 5 stipulates that a diagnosis of BP II disorder cannot be assigned unless the patient has experienced hypomania for four days or longer, however, many studies according to McCraw, S., & Parker, (2016), have shown that the demographic and clinical features of BP II patients with short (i.e. one to three days) hypomanic states are similar to those of patients who meet criteria for DSM-defined hypomania across a range of clinical variables such as age at disorder onset, symptom severity, number of previous episodes of hypomania, number of past hospitalizations, presence of mixed states and family history. Thus, it appears likely that patients with short hypomanic episodes may benefit from the same treatments which are effective for a DSM-defined BP II condition. Patient from report did endorse that since age 23, he has had many episodes lasting a week or more of irritability, inflated self-esteem, increased goal-directed work activity, decreased need for sleep, over talkativeness, racing thoughts, psychomotor agitation and risky behavior; could also experience euphoria or expansiveness to a significant degree but only for 2 or 3 days at most and usually shorter.
Review of medication
With this patient experiencing MDD mixed with some hypomanic episodes, my first choice of medication will be Abilify (aripiprazole) 15 mg orally daily. This medication exerts its effect by working on the CYP2D6 and 3A4 enzymes which some variations of metabolism in different races (Dean, 2016). I will start low and titrate up to minimize the incidence of side effects and improve patient’s compliance, incase my patient is a poor metabolizer. According to McIntyre, Ng-Mak, Chuang, Halperm, Patel, Rajagopalan, and Loebel (2017), antidepressants should be chosen with caution because they can induce mania and distort mood. The patient is already experiencing mixed features of hypomania; thus, antidepressant will not be initiated. Abilify, an atypical antipsychotic according to Stahl (2014), is first line for MDD with mixed features. Abilify has a monthly injectable, which will might help with compliance. Symptoms may improve in a week, but it takes at least 4-6weeks to determine drug efficacy (Stahl, 2014b). The patient has been non-compliant with his medications, so the injectable might prove worthwhile.
2. My second drug of choice will be Lurasidone 20 mg (Latuda) oral daily; This medication according to Stahl, (2013) treat Bipolar depression, acute mania/mixed mania, other psychotic disorders, bipolar maintenance and treatment-resistant depression. This medication in addition to Olanzapine-fluoxetine combination (OFC), quetiapine (either the standard or the extended release preparation), and lurasidone are the only FDA drugs granted (extended) approval for the (acute) treatment of bipolar depression in adults (Fornaro, De Berardis, Perna, Solmi, Veronese, Orsolini, Bartolomeis, 2017).
The medication exerts its effectiveness by blocking dopamine 2 receptors, reducing positive symptoms of psychosis and stabilizing affective symptoms and blocking serotonin 2A receptors, causing enhancement of dopamine release in certain brain regions and thus reducing motor side effects and possibly improving cognition and affective symptoms.
Lesson Learned
Taking care of patients in the medical field often pose a great challenge. This patient is a typical case of the above. He is a prescriber and is self-medicating and is initiating and ceasing therapy and altering the doses of prescribed medications against the advice from his psychiatric providers. Therefore, nurse practitioners should be able to perform a thorough assessment and conduct the necessary physical examinations on patients.
This patient has a history of noncompliance with medications and self-medicates, he should be monitored weekly and relevant diagnostic tests conducted to ensure compliance with treatment modalities.
Response # 2
This discussion is about a case study of a 60-year-old male, whom has struggled with depression for the past 40 years.
The male has done well with his current treatment until recently. His family noticed that he was less active, not very joyful, feeling hopeless, and worthless. Client has a family history pf mental illness. His medical history includes osteoporosis, hypertension, hypercholesterolemia, enlarged prostate, and arthritis. He has been on different treatments in the past. Diagnostic testing was performed.
Questions
Three questions I would choose the ask my patient would be Are there any significant life changes that occurred in the last five years to trigger an exacerbation in depression? This would allow us to review if anything specifically exacerbated his symptoms. Do you have suicidal thoughts or any past suicidal attempts? We want to make sure that the patient is not at risk of committing suicide (Fried & Nesse, 2015). Lastly, I would ask the patient if they feel safe at home? This is important because our patient’s safety is very important (Laff, 2016).
Family Questions
When assessing a patient, it is nice to allow the family to be involved if they are supportive and want to help the patient’s health improve. Some questions that the provider may want to ask the family are: How are the family dynamics, Does the patient’s symptoms get worse in certain environments, and What does the family member suffering from depression in their home environment? These are important questions to help develop a picture of what is going on with the patient (Laff, 2016).
Physical Exam and Diagnostic Testing
When assessing the patient for Major depressive disorder you want to examine the patients’ depressive symptoms. In the case study the patient had lost interest in activities, feeling sad, no joy, worthless, and hopeless. The patient was having trouble concentrating. Scales are major when screening for depression. The scale cannot diagnose a patient but can help confirm a diagnosis and tell us the severity of the depression. Some appropriate screens include patient health questionnaire (PHQ-2), patient health questionnaire 9 (PHQ9), ZUNG scale, and Beck depression inventory (BDI). Diagnostic testing is useful in ruling out any other diseases/conditions that may be causing the depression. We run a blood test such as complete blood count, comprehensive metabolic panel, and thyroid panel. We want to make sure the patient does not have organic disease, infection or a thyroid disorder that may be causing the depressive symptoms (Ng, How, & Ng, 2016).
Differential Diagnoses
The three differential diagnosis I have chosen are adjustment disorder, persistent depression disorder (dysthymia), and bipolar disorder. Adjustment disorder is an emotional or behavioral reaction over several months of stressful events or changes in a person’s life. Dysthymia is a chronic mood disorder with a duration of at least two years, the person does not experience pleasure, displays other depressive symptoms that can affect the person’s overall quality of life. Bipolar disorder is a mood disorder that has relapsing and remitting spells of mania and depression, the individual experiences depression more than mania (Lee & Swartz, 2017).
Drug Therapy
In this case study, the patient was started on Abilify and venlafaxine. Another good medication choice for initial treatment would be SSRIs. Abilify has side effects of weight gain, increased lipid levels, EPS, nausea, vomiting, and dry mouth. Venlafaxine can increase blood pressure. SSRIs such as Prozac Zoloft, or Celexa. This SSRI has fewer side effects and is safe. The SSRIs turn off the production of new serotonin, sending the message to the brain to continue making serotonin (Edwards, 2018). SSRI’s are do not have dietary restrictions like MAOIs, or cause heart disturbances and orthostatic hypotension SSRI (Bressert, 2017).
Follow-ups
Follow-ups are used to evaluate the progression of the patient’s symptoms. Practitioners evaluate medication side effects, the effectiveness of the medication, and the patient’s symptoms. It can take 4-8 weeks to know the effectiveness of a medication. In the case study, they followed up with the patient every four weeks. This case study taught the lesson of thinking outside of the box and using diagnostic tools to help improve the patient’s symptoms. The therapeutic dosages for venlafaxine, the initial dosage is 37.5 mg, the maintenance dose is 75 mg -100 mg, moderate depression is 225 mg, and severe depression is 375 mg (Drugs.com, 2019). This practitioner used blood levels to find the patient’s therapeutic dosage. By doing this the patient developed remission.
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Selecting A Population Health Problem
/in Uncategorized /by developerSelecting a Population Health Problem
As you know, promoting positive social change is a part of the Walden mission. To be an effective agent for social change, nurses must be able to logically and critically analyze population health issues using epidemiologic concepts, and then communicate insights in a succinct and professional manner. This exercise will afford you such an experience.
This week, you will complete Assignment 1 in preparation for Major Assessment 7, in which you will apply epidemiologic principles and develop an intervention for a health problem.
For this Assignment, you will examine a health problem of interest to you, and you will develop a brief paper (2 pages) outlining the significance of the health problem and describing it in terms of person, place, and time. This outline will help your Instructor determine if the topic you selected is appropriate for the Major Assessment paper.
Prepare for Assignment 1 as follows:
To complete:
Write a 2-page paper that addresses the following:
1) Introduction (must end with a purpose statement, e.g. “the purpose of this paper is …)
2) Describe the population health problem in terms of person, place, and time.
3) From the primary research literature and Healthy People 2020, briefly explain the significance of this health problem.
4) Include your preliminary research question or hypothesis. (PICOT format for the research question).
5) A conclusion
By Day 7 (tomorrow Sunday 03/18/2018 at 4 pm latest Submit your a 2-page paper in order to receive feedback on your topic
Required Readings
Friis, R. H., & Sellers, T. A. (2014). Epidemiology for public health practice (5th ed.). Sudbury, MA: Jones & Bartlett.
Chapter 6, “Study Designs: Ecologic, Cross-Sectional, Case Control”
Chapter 7, “Study Designs: Cohort Studies”
Chapter 6 presents an overview of analytic study designs used in epidemiology, differentiating between experimental studies (which will be addressed next week) and observational studies (the focus of this week). In the chapter, the authors address three varieties of observational studies—ecological, cross-sectional, and case control. Chapter 7 addresses cohort studies, another form of observational design.
Doll, R., & Hill, A. B. (1999). Smoking and carcinoma of the lung. Bulletin of the World Health Organization, 77(1), 84–93.
This landmark case-control study established the relationship between smoking and lung cancer.
Framingham Heart Study. (1998). Epidemiological background and design: The Framingham study. Retrieved from https://biolincc.nhlbi.nih.gov/static/studies/framcohort/Epidemiological_Background_and_Design.pdf
The Framingham Heart Study is one of the first and largest cohort studies that measured the distribution of suspected risk factors in a large population and then tracked the development of heart disease in that cohort.
Papathanasiou, A. A., & Zintzaras, E. (2010). Assessing the quality of reporting of observational studies in cancer. Annals of Epidemiology, 20(1), 67–73.
In this article, the authors assess the quality of reporting of observational cancer studies, noting opportunities for improvement.
Von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., & Vandenbroucke, J. P. (2007). Strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. Annals of Internal Medicine, 147(8), 573–577.
A consortium of scientists and medical researchers created a checklist of 22 recommended items that should be included in reports about three common observational study designs: case-control, cohort, and cross-sectional studies. This collaborative effort is an important step toward the goal of improving the quality, credibility, and generalizability of analytical research.
Healthy People 2020. (2011). Topics & objectives index. Retrieved from http://healthypeople.gov/2020/topicsobjectives2020/default.aspx
Healthy People 2020 focuses on improving population health locally and nationally. Review the topics and objectives of Healthy People 2020 as you prepare for Assignment 2.
Required Media
Laureate Education, Inc. (Executive Producer). (2012). Epidemiology and population health: Observational studies [Video file]. Baltimore, MD: Author.
Note: The approximate length of this media piece is 9 minutes.
In this week’s program, the presenters discuss observational studies as a means of establishing an association between an exposure or risk factor and a disease outcome. Two types of observational designs are featured: cohort and case control studies.
Optional Resources
The following ERIC notebook guides present information in a reader-friendly study guide format.
Ibrahim, M., Alexander, L., Shy, C., & Farr, S. (1999). Cohort studies. ERIC Notebook, 3, 1–4. Retrieved from http://cphp.sph.unc.edu/trainingpackages/ERIC/eric_notebook_3.pdf
Ibrahim, M., Alexander, L., Shy, C., & Farr, S. (1999). Incidence measures in cohort studies. ERIC Notebook, 4, 1–4. Retrieved from http://cphp.sph.unc.edu/trainingpackages/ERIC/eric_notebook_4.pdf
Ibrahim, M., Alexander, L., Shy, C., & Farr, S. (1999). Case-control studies. ERIC Notebook, 5, 1–4. Retrieved from http://cphp.sph.unc.edu/trainingpackages/ERIC/eric_notebook_5.pdf
Ibrahim, M., Alexander, L., Shy, C., & Farr, S. (1999). Cross-sectional studies. ERIC Notebook, 7, 1–4. Retrieved from http://cphp.sph.unc.edu/trainingpackages/ERIC/eric_notebook_7.pdf
Ibrahim, M., Alexander, L., Shy, C., & Farr, S. (2000). Ecologic studies. ERIC Notebook, 12, 1–4. Retrieved from http://cphp.sph.unc.edu/trainingpackages/ERIC/eric_notebook_12.pdf
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Selecting Research
/in Uncategorized /by developerWhat are the criteria for selecting qualitative versus quantitative resources in relation to your literature review? Which is quantitative research so important to nursing research?
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Selection Of Colleagues Responses 19466149
/in Uncategorized /by developerAssignment:
Write a Respond to two of these #1&2 case studies using one or more of the following approaches:
Response # 1
“The case of physician do not heal thyself”
Three questions I will ask the patient on a visit to my office and rationale thereof.
Major depressive disorder (MDD) is defined as “feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home” and it is one of the most common reasons patients present for medical care worldwide (McConnell, Carter & Patterson, 2019). Childhood traumatic experiences, including physical, sexual, and emotional abuse, neglect, and separation from caregivers, they posit significantly increase the risk of developing mental and physical illnesses later in life.
NO .1
Have you had any thoughts of death or suicide before? Are you having them now? And do you have a current plan to harm or kill yourself? What are the details of that plan?
McConnell,et .al, (2019) posit that clients with MDD often presents with feeling sad or depressed; lack of interest or pleasure in previously enjoyed activities; appetite changes (unintentional weight loss or gain); sleep difficulty (too much or little); lack of energy (fatigue); feeling of guiltiness or worthlessness; moving more slowly or pacing (others observe); difficulty with decision-making, concentration, and thinking; and/or suicidal thoughts.
Patient safety remains a central concern in every healthcare setting (Smith,2018). This patient did report several feelings of Suicide Ideation and Homicidal ideation so patients’ safety should be priority. Although the welfare of patients encompasses a broad range of concerns, the increasing prevalence of suicide in our society compels health care workers to ensure a safe healthcare environment for patients with suicidal ideation. These efforts include the elimination or, at least, the mitigation of physical setting characteristics that enable suicide attempts.
No 2.
Are you depressed? How does this problem make you feel? What makes the problem better?
According to DSM-5 (2013) diagnostic criteria, MDD requires five or more of the following symptoms during the same two-week period and represent a change from previous functioning; at least one symptom is either 1) depressed mood or 2) loss of interest or pleasure (American Psychiatric Association [APA], 2013).
According to the patient’s file, he has experienced five or more of the symptoms of MDD during the same two-week period, on more than one occasion, including depressed mood, recurrent suicidal ideation, and suicide attempts, and was diagnosed with major depression for the first time when he was 23.
NO 3.
How often do you take your medication and how long did you take them before stopping? The patient has a history of stopping his medication, self-medication and non-adherent to treatment. This question is necessary because most antidepressants take a while to build up in the system.
Sources of information
From the social history, patient was married and divorced 3 times, currently single, has no children, nonsmoker no drug abuse, rarely drinks, he’s a Physician and successful businessman. We can elicit information from siblings, extended relatives and even colleagues at work. childhood traumatic experiences, including physical, sexual, and emotional abuse, neglect, and separation from caregivers, significantly increase the risk of developing mental and physical illnesses later in life (
McConnell, et. al, (2019). Colleagues at work and close friends can also be asked about his temperament and attitude at work as this could help with diagnosis and treatment modalities. Also, if patient has access to weapon at home, the relatives might have to make sure it is locked in a safe place or removed if he is currently suicidal.
Physical Exam and Diagnostic tests.
Health assessment will ensure a structured approach that includes comprehensive history taking and meticulous physical examination, carrying out these two parts consecutively enables the examiner to assess the presenting complaint, establish an accurate differential diagnosis and provide any necessary interventions Kennedy & O’Connor, (2016). Physical examination of a patient will include looking at the patient’s overall appearance skin color, turgor and general assessment. Skin for self-injury and discoloration, bruise, vital sign, BMI, general appearance, nutritional status. Gait, balance coordination, reflexes, and involuntary movements, mental status for evidence of mental disorder and thought process.
Electroconvulsive therapy (ECT) according to Birrer & Vemuri, (2004) is a first-line option in patients with depression and psychotic features who have not responded to antipsychotic and antidepressant medications, and patients with severe nonpsychotic depression who have not responded to adequate trials of two antidepressant.
I will in addition to the above check the Erythrocyte Sedimentation Rate (ESR). A change in ESR between two visits was also significantly correlated with a change in PGA, renal, fatigue and joint VAS, (Stojan, Fang, Magder & Petri, 2013). This test is vital to our study because most drugs are eliminated through this media.
Differential Diagnoses
1. I think Major Depressive Disorder (MDD) is the main diagnoses for my client. Major depressive disorder (MDD) is defined as “feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home” and it is one of the most common reasons patients present for medical care worldwide (McConnell, Carter & Patterson, 2019). According to the patient’s file, he has experienced five or more of the symptoms of MDD during the same two-week period, on more than one occasion, including depressed mood, recurrent suicidal ideation, and suicide attempts, and was diagnosed with major depression for the first time when he was 23 (APA, 2013; Stahl, 2011).
1. Borderline personality disorder. The Statistics Manual of Mental Disorders (5th ed.; DSM-5), include fear of abandonment, destructive impulsivity, self-harm, suicidality (evidenced by threats or gestures of self-mutilation), and intense, uncontrollable, or inappropriate anger (American Psychiatric Association, 2013). Per report, patient has depressive symptoms characterized as unhappiness and transient depressed moods of a few days’ duration and with more anxiety than depression, improving without treatment – Actively suicidal and overdosed on his medications.
2. Bipolar II with mixed features; the Diagnostic and Statistical Manual of Mental Disorders (DSM) version 5 stipulates that a diagnosis of BP II disorder cannot be assigned unless the patient has experienced hypomania for four days or longer, however, many studies according to McCraw, S., & Parker, (2016), have shown that the demographic and clinical features of BP II patients with short (i.e. one to three days) hypomanic states are similar to those of patients who meet criteria for DSM-defined hypomania across a range of clinical variables such as age at disorder onset, symptom severity, number of previous episodes of hypomania, number of past hospitalizations, presence of mixed states and family history. Thus, it appears likely that patients with short hypomanic episodes may benefit from the same treatments which are effective for a DSM-defined BP II condition. Patient from report did endorse that since age 23, he has had many episodes lasting a week or more of irritability, inflated self-esteem, increased goal-directed work activity, decreased need for sleep, over talkativeness, racing thoughts, psychomotor agitation and risky behavior; could also experience euphoria or expansiveness to a significant degree but only for 2 or 3 days at most and usually shorter.
Review of medication
With this patient experiencing MDD mixed with some hypomanic episodes, my first choice of medication will be Abilify (aripiprazole) 15 mg orally daily. This medication exerts its effect by working on the CYP2D6 and 3A4 enzymes which some variations of metabolism in different races (Dean, 2016). I will start low and titrate up to minimize the incidence of side effects and improve patient’s compliance, incase my patient is a poor metabolizer. According to McIntyre, Ng-Mak, Chuang, Halperm, Patel, Rajagopalan, and Loebel (2017), antidepressants should be chosen with caution because they can induce mania and distort mood. The patient is already experiencing mixed features of hypomania; thus, antidepressant will not be initiated. Abilify, an atypical antipsychotic according to Stahl (2014), is first line for MDD with mixed features. Abilify has a monthly injectable, which will might help with compliance. Symptoms may improve in a week, but it takes at least 4-6weeks to determine drug efficacy (Stahl, 2014b). The patient has been non-compliant with his medications, so the injectable might prove worthwhile.
2. My second drug of choice will be Lurasidone 20 mg (Latuda) oral daily; This medication according to Stahl, (2013) treat Bipolar depression, acute mania/mixed mania, other psychotic disorders, bipolar maintenance and treatment-resistant depression. This medication in addition to Olanzapine-fluoxetine combination (OFC), quetiapine (either the standard or the extended release preparation), and lurasidone are the only FDA drugs granted (extended) approval for the (acute) treatment of bipolar depression in adults (Fornaro, De Berardis, Perna, Solmi, Veronese, Orsolini, Bartolomeis, 2017).
The medication exerts its effectiveness by blocking dopamine 2 receptors, reducing positive symptoms of psychosis and stabilizing affective symptoms and blocking serotonin 2A receptors, causing enhancement of dopamine release in certain brain regions and thus reducing motor side effects and possibly improving cognition and affective symptoms.
Lesson Learned
Taking care of patients in the medical field often pose a great challenge. This patient is a typical case of the above. He is a prescriber and is self-medicating and is initiating and ceasing therapy and altering the doses of prescribed medications against the advice from his psychiatric providers. Therefore, nurse practitioners should be able to perform a thorough assessment and conduct the necessary physical examinations on patients.
This patient has a history of noncompliance with medications and self-medicates, he should be monitored weekly and relevant diagnostic tests conducted to ensure compliance with treatment modalities.
Response # 2
This discussion is about a case study of a 60-year-old male, whom has struggled with depression for the past 40 years.
The male has done well with his current treatment until recently. His family noticed that he was less active, not very joyful, feeling hopeless, and worthless. Client has a family history pf mental illness. His medical history includes osteoporosis, hypertension, hypercholesterolemia, enlarged prostate, and arthritis. He has been on different treatments in the past. Diagnostic testing was performed.
Questions
Three questions I would choose the ask my patient would be Are there any significant life changes that occurred in the last five years to trigger an exacerbation in depression? This would allow us to review if anything specifically exacerbated his symptoms. Do you have suicidal thoughts or any past suicidal attempts? We want to make sure that the patient is not at risk of committing suicide (Fried & Nesse, 2015). Lastly, I would ask the patient if they feel safe at home? This is important because our patient’s safety is very important (Laff, 2016).
Family Questions
When assessing a patient, it is nice to allow the family to be involved if they are supportive and want to help the patient’s health improve. Some questions that the provider may want to ask the family are: How are the family dynamics, Does the patient’s symptoms get worse in certain environments, and What does the family member suffering from depression in their home environment? These are important questions to help develop a picture of what is going on with the patient (Laff, 2016).
Physical Exam and Diagnostic Testing
When assessing the patient for Major depressive disorder you want to examine the patients’ depressive symptoms. In the case study the patient had lost interest in activities, feeling sad, no joy, worthless, and hopeless. The patient was having trouble concentrating. Scales are major when screening for depression. The scale cannot diagnose a patient but can help confirm a diagnosis and tell us the severity of the depression. Some appropriate screens include patient health questionnaire (PHQ-2), patient health questionnaire 9 (PHQ9), ZUNG scale, and Beck depression inventory (BDI). Diagnostic testing is useful in ruling out any other diseases/conditions that may be causing the depression. We run a blood test such as complete blood count, comprehensive metabolic panel, and thyroid panel. We want to make sure the patient does not have organic disease, infection or a thyroid disorder that may be causing the depressive symptoms (Ng, How, & Ng, 2016).
Differential Diagnoses
The three differential diagnosis I have chosen are adjustment disorder, persistent depression disorder (dysthymia), and bipolar disorder. Adjustment disorder is an emotional or behavioral reaction over several months of stressful events or changes in a person’s life. Dysthymia is a chronic mood disorder with a duration of at least two years, the person does not experience pleasure, displays other depressive symptoms that can affect the person’s overall quality of life. Bipolar disorder is a mood disorder that has relapsing and remitting spells of mania and depression, the individual experiences depression more than mania (Lee & Swartz, 2017).
Drug Therapy
In this case study, the patient was started on Abilify and venlafaxine. Another good medication choice for initial treatment would be SSRIs. Abilify has side effects of weight gain, increased lipid levels, EPS, nausea, vomiting, and dry mouth. Venlafaxine can increase blood pressure. SSRIs such as Prozac Zoloft, or Celexa. This SSRI has fewer side effects and is safe. The SSRIs turn off the production of new serotonin, sending the message to the brain to continue making serotonin (Edwards, 2018). SSRI’s are do not have dietary restrictions like MAOIs, or cause heart disturbances and orthostatic hypotension SSRI (Bressert, 2017).
Follow-ups
Follow-ups are used to evaluate the progression of the patient’s symptoms. Practitioners evaluate medication side effects, the effectiveness of the medication, and the patient’s symptoms. It can take 4-8 weeks to know the effectiveness of a medication. In the case study, they followed up with the patient every four weeks. This case study taught the lesson of thinking outside of the box and using diagnostic tools to help improve the patient’s symptoms. The therapeutic dosages for venlafaxine, the initial dosage is 37.5 mg, the maintenance dose is 75 mg -100 mg, moderate depression is 225 mg, and severe depression is 375 mg (Drugs.com, 2019). This practitioner used blood levels to find the patient’s therapeutic dosage. By doing this the patient developed remission.
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Selection Of Colleagues Responses
/in Uncategorized /by developerResponse Post #1
Culture is defined as customary beliefs, social forms, and material traits of a racial, religious, or social group (Webster, 2019). Competence suggests having the capacity to function effectively as an individual and an organization within the context of cultural beliefs, behaviors, and needs presented by consumers and their communities (CDC, 2015). In healthcare, it is very important to be aware of different culture backgrounds. It helps with not only being able to communicate effectively but also knowing what diseases, sickness, etc. that the person is at greatest risk for. For example, in the treatment of depression, compared with white Americans, black and Latino patients are actually less likely to receive treatment (Ball et al., 2019).
The patient I was given is a 14 year old biracial male living with his grandmother in a high-density public housing complex. For the purpose of obtain a health history with this particular patient it is important to consider everything about this patient. The patients age, sex, ethnicity, living conditions, etc. will all need to be taken into account. This particular age group are reluctant to talk and have a definite need for confidentiality (Ball et al., 2019). It is important that adolescent patients be given the opportunity to speak to you privately about concerns or issues that they may have (Ball et al., 2019). It is meaningful that you let the patient know the limits of confidentiality and that if any information provided suggests that an adolescence safety or others safety may be at risk, that its grounds to “break” confidentiality (Ball et al., 2019). Prior to the office visit, there a previsit questionnaires and screeners that the patient can fill out and this sometimes helps allow the patient to write down concerns or have a choice of concerns (Ball et al., 2019). Then based off the answers, it can help you ask appropriate questions during the interviewing process.
Based off of the patients age, ethnicity, and living conditions I would use the HEEADSSS screening tool. This screening tool assess the home environment, education/employment, eating, activities, drugs, sexuality, suicide/depression, and safety from injury and violence (Ball et al., 2019). Questions that can be asked needs to be open ended questions such as …
Tell me about where you live?
How are you liking school?
What do you like to do, any activities in school or out of school?
Do you ever hang out with your friends outside of school? What do you like to do? Are you ever in situations that make you uncomfortable? Have you ever tried drugs or alcohol?
In order to assess for suicide/depression, there are screening tools. The screening questions may include asking about sleep disorders, appetite/eating behavior change, feelings of “boredom”, emotional outbursts and highly impulsive behavior, hopeless/helpless feeling, history of family with depression or suicide, suicidal ideation, history of psychosocial/emotional trauma, or those who are gay, lesbian, bisexual, or transgender youth (BCC Hospital, 2019).
Response Post # 2
Diversity and Health Assessments
The human behavior, ideas, attitudes reflect the manner of cultural competency of different patients. These behaviors are their culture, which affects their belief in their treatments. The socioeconomic, spiritual, lifestyle and other cultural factors are changed to one group or a subgroup of the individual, in which the patient-centered care and cultural competence have an overlapping concept (Ball et al., 2019). Poverty and inadequate education disproportionately affect various cultural groups which they have higher rates of dying from an illness compared to those that are educated and economically advantageous. The mode of communication of an individual has a different meaning for different people, which include the use of speech, body language, and space (Ball et al., 2019). An example is a Spanish meet with eye contact in the conversation, Asians, middle eastern cultures may be rude or immodest, and Americans may let the eye wander and say understanding of the communications.
The respect model is an essential consideration in the effectiveness of cross-cultural communication, whether it is verbal, non-verbal, or written. The example of a patient-centered communication on a patient who is a 40-year-old black male recent immigrant from Africa without health insurance is to connect on a social level. The practitioner will verbally acknowledge and legitimatize the patient’s feelings, which reassures the availability of help for them. The practitioner can give particular emphasis to the patient working together to address health problems, especially to resolve health insurance issues for the patient. The practitioner can provide explanations clearly by often checking for understanding. It is essential to respect the patient cultural beliefs, for this is one way of establishing the trust of working to the patient.
In asking questions to the patient, it should have a conceptual structure on evidenced-based guidelines. One of the techniques when asking the issue is the PICO (problem, intervention, comparison, and outcome) acronym. The practitioner can begin to ask what their clinical issues are? How long does their illness going on? What is their previous intervention or exposure related to the disease? Is there any difference in their condition when they take the previous treatments: What is the aggravating factor that causes the problem? These questions can answer the history of the present illness of the patient. The United States Preventive Services Task Force (USPSTF) makes recommendations about clinical preventive services such as screenings, counseling, and preventive medications. The practitioners make their clinical decisions and recommendations based on the excellent quality of scientific pieces of evidence. However, evidence alone is never meant to replace experience and intuition (Dains Baumann, & Scheibel, 2019). The task force also makes its recommendations on benefits based on matrix and grades. So, the practitioner can make their decision to help the patient based on the grading system, and certainty of benefit depends on their assessments to the patient.
The diversity in healthcare is to ensure the best possible care adequately provides all backgrounds, beliefs, ethnicities, and perspectives to a patient with a variety of healthcare providers. An example of this is the case of asthma in the United States that ethnicities share a disproportionate burden of the disease. According to Melton, Graff, Homes, Brown, & Bailey, 2014) that there are disparities result of activities (work & school) among African-American because of a variety of factors which include communication of patient and provider and literacy to healthcare. An individual with higher educational attainment has a higher understanding of their health status. Their culture influences their beliefs to take the medication which African-American have a fear of making the ICS and less knowledge about asthma that they will develop a decreased tolerance of the drug (Melton, Graff, Homes, Brown, & Bailey, 2014).
The social history and family history of the patient are essential to assess to determine the support system available to the patient. The practitioner can ask the patient if he is married, where is his family member; and what is the family member’s status in life (If they are healthy or suffering also from illnesses). For example, if the patient has asthma, then the practitioner can ask if he is a smoker and drinks alcohol that may aggravate the disease. If he has any allergies that may trigger the illness. However, requesting a complicated social history can also be performed by a social worker that the patient can get a benefit or support from different agencies. The practitioner can treat the medical condition of the patient in which a medication can be prescribed; the drug can be adjusted; an additional medication can be prescribed to prevent the exacerbation of the disease. Lastly, the own patient understanding of the treatment is essential to assess to ensure compliance with the procedure. The practitioner can ask the patient by their knowledge of the treatment.
Write a Respond to two of these #1&2 case studies using one or more of the following approaches:
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Selection Of Your Colleagues Responses
/in Uncategorized /by developerDiscussion Assignment:
Respond to the following Response Post # 1 & 2
Explain how you might apply knowledge gained from the Response case studies to your own practice in clinical settings.
· Share additional interview and communication techniques that could be effective with your colleague’s selected patient.
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· Suggest additional health-related risks that might be considered.
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· Validate an idea with your own experience and additional research.
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· Explain your reasoning using at least TWO different references from current evidence-based literature in APA Format.
Response Post #: 1
Case 1: Volume 2, Case #16: The woman who liked late-night TV
Case Study
This is a case study of a 70-year-old female who lives at home by herself. The patient struggles with depression. She is sad, has lost interest in things she used to enjoy, and is fatigued with poor focus and concentration. The patient reports trouble sleeping. The patient also likes to watch late-night TV.
Questions
Sleeping disturbances affect 1/3 of Americans. Sleep can affect an individual’s memory, health, immune system, and pain. Some questions that we may need to ask the client:
How much sleep do you usually get?
Do you feel rested when you wake up?
Do you have trouble falling asleep, or difficulty getting back to sleep when you wake up in the middle of the night?
(Siengsukon, Al-Dughmi, & Stevens, 2017)
Family Questions
When assessing a patient, it is nice to allow the family to be involved, with the patient’s permission, if they are supportive and want to help the patient’s health improve. Some questions that the provider may want to ask the family are: How are the family dynamics, Does the patient’s symptoms nap during the day, and What does the family member suffering from sleep react throughout the day? These are important questions to help develop a picture of what is going on with the patient (Laff, 2016).
Physical Exam and Diagnostic Testing
When assessing the patient for a sleeping disorder you want to perform a physical examination to see if the patient has difficulty initiating sleep, maintaining sleep, and their routine before going to bed. As practitioners, we want to look to see if the patient is in pain. Does the patient use any substances such as alcohol, caffeine, nicotine, or any illegal drugs? Laboratory diagnostic tools may include blood work such as blood count, thyroid panel, comprehensive metabolic panel, C-Reactive Protein, ferritin, and vitamin B12. We may need to have the patient have echocardiograms, CT, or EEG performed depending on the lab results. Looking at the patient’s psychiatric history and sleep history. These are just a few tools to help diagnose and help determine the treatment (Riemann et al. 2017).
Differential Diagnoses
Three differential diagnoses that the patient fits the criteria for are Chronic insomnia disorder, sleep apnea syndrome, and Psychological insomnia. Chronic Insomnia disorder is when the individual has trouble sleeping three-four nights per week for three or more months. sleep apnea syndrome criteria include feeling tired throughout the day and snoring while sleeping. Psychological insomnia criteria are hyperarousal and learned sleep- preventing associations (Suzuki, Miyamoto, & Hirata, 2017).
Drug Therapy
Doxepin is a medication recommended to help with sleep at lower dosages. The recommended dosages are 3-6 mg (Sateia, Buysse, Krystal, Neubauer, & Heald, 2017). Doxepin binds with high specificity and affinity to the histamine H1 receptor compared with other receptors. At low doses, doxepin selectively antagonizes H1 receptors, which is believed to promote the initiation and maintenance of sleep (Weber, Siddiqui, Wagstaff, & McCormack, 2010). The next treatment option I would choose is Trazodone. The Therapeutic dose for Trazodone in 50 mg -200 mg. Trazodone can help with sleep and depression (Sateia, Buysse, Krystal, Neubauer, & Heald, 2017). Trazodone is an antagonist/blocker for all the targets except for the serotonin receptor, where it acts as an agonist/agonist (Settimo & Taylor, 2018).
Follow-up
Follow-ups are used to evaluate the progression of the patient’s symptoms. Practitioners evaluate medication side effects, the effectiveness of the medication, and the patient’s symptoms. It can take 4-8 weeks to know the effectiveness of a medication. In the case study, they followed up with the patient every four weeks.
Response Post #: 2
Case Study 3
Case Study 3: Volume 1, Case 5: The sleepy woman with anxiety
Insomnia is a common household occurrence with many people. This disorder can be attributed to medication, trauma, anxiety, and pain. According to Stahls (2013), sleep is considered to be a vital psychiatric sign during treatment evaluations
Additional Evaluation Questions
The case study included a lot of information; however, additional information is needed for an accurate diagnosis.
1. How long have you been experiencing a disruption of your sleep?
2. Do you have a problem falling asleep?
3. Do you drink caffeinated beverages before sleep?
4. What is your sleep routine? Do you have a TV in your room?
5. Have you tried nonpharmacological inventions such as (relaxation techniques)?
6. Do you have stressors, trauma, flashbacks that keep you awake?
The following questions are asked to find additional information about the patient’s sleep history. Inquiring about past medications and nonpharmacological intervention is important to know when determining the new treatment options. Anxiety and the trauma-related event could cause an individual to lose sleep, especially if the event happens in the night hours. Many victims that experience night time trauma often has flashbacks during that time or increases anxiety. Also, drinking high caffeinated drinks could cause insomnia. The timing of drinking caffeinated beverages could be adjusted to be more beneficial to the patient.
Family Questioning
I would also include questions for other family members. I would ask them about the patient’s sleep pattern. Also, questions such as “have you witnessed bizarre behaviors from the patient that could affect the lack of sleep.” How much time do you think the patient sleeps daily? Do you think the patient has stressors or anxiety that keep her from sleeping? Many times the family members’ views on the patient’s insomnia can be different from the patient’s account.
Testing and Diagnostic
When patients are prescribed an antipsychotic, it important for the providers to start with a baseline EKG. According to Brown University Psychopharmacology (2014), Geodon is has known to cause QT prolongation for an individual with a personal or family of cardiac issues.
Possible Diagnosis
The patient presents with several symptoms and has an intensive mental health history. The three diagnoses that I considered a) post-traumatic syndrome (PTSD), Major Depressive Disorder (MDD), Insomnia Disorder. I think the patient should be treated for insomnia disorder. According to Stahl (2013), insomnia disorders can be linked to other psychiatric disorders and can advance to depressive occurrences.
Pharmacological Agents
The two-agents that I would consider for this patient are Trazodone and Ambien. Trazodone is a serotonin receptor antagonist, that has an immediate effect on insomnia (Stahl, 2014). The recommended starting dose is 50mg PO nightly. The dose can tamper to produced the desired effect. Ambien is non-benzodiazepine hypnotic and is used to treat short term insomnia (Stahl. 2014). Ambien recommended starting dose is 5mg PO nightly immediate release. This medication would only be prescribed for 7-10 days due to the risk of dependence and worsening symptoms of depression and suicidal ideations.
Lesson Learned
This case study includes many variables about the patient’s past and present medical history. Lagerberg et al. (2019) stated that incidents with polypharmacy increase with age and children have the highest incident with 3 or more psychotic drug classes. As an advanced practice nurse, it’s important to assess the medication and the patient history before determining the treatment. The patient indicated that several medications did not work for her but more information was needed to determine if that was an accurate assumption of the medication.
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Self Assessment 19471475
/in Uncategorized /by developerFrom self assessment below ,please give a brief description of your results from the Strengths Finder assessment Below. Then, briefly describe two core values, two strengths, and two characteristics that you would like to strengthen based on the results of your Strengths Finder assessment. Be specific. In addition,
Do you believe you have the traits to be an effective leader? Perhaps you are already in a supervisory role, but as has been discussed previously, appointment does not guarantee leadership skills.
How can you evaluate your own leadership skills and behaviors from the assessment that you completed? And please identify your personal strengths, which have been shown to improve motivation, engagement, and academic self-conference. Through this assessment, you will discover your top five themes—which you can reflect upon and use to leverage your talents for optimal success and examine how the results relate to your leadership traits. In addition, RANK STRENGTH
1Individualization
LEARN MORE
RELATIONSHIP BUILDING
People who are especially talented in the Individualization theme are intrigued with the unique qualities of each person. They have a gift for figuring out how people who are different can work together productively.
2Ideation
LEARN MORE
STRATEGIC THINKING
People who are especially talented in the Ideation theme are fascinated by ideas. They are able to find connections between seemingly disparate phenomena.
3Achiever
People who are especially talented in the Achiever theme have a great deal of stamina and work hard. They take great satisfaction from being busy and productive.
4
Competition
People who are especially talented in the Competition theme measure their progress against the performance of others. They strive to win first place and revel in contests.
5Learner
LEARN MORE
STRATEGIC THINKING
People who are especially talented in the Learner theme have a great desire to learn and want to continuously improve. In particular, the process of learning, rather than the outcome, excites them.
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Self Assessment And Reflection
/in Uncategorized /by developerThis assignment focuses on the tenet of conscious leadership, the importance of self-assessment, and reflection. Self-awareness is essential for developing management and leadership skills. Recognizing your own strengths, weaknesses, and values, and understanding emotional intelligence and learning styles can help you to be a more effective leader. Becoming self-aware is an ongoing process requiring introspection. The more often people practice self-reflection, the more opportunities they have to understand their own behaviors and adapt their approaches to working with other people, which can improve both your own and other’s abilities to meet their professional goals.
Self-Assessment
For this assignment, you have the opportunity to take a variety of self-assessments to learn more about yourself and identify your assets and weaknesses as a leader. This will assist you in discovering how you can improve your own self-leadership skills. You will be asked to think critically about your results and submit a reflection as directed below. As a starting point, review the resources on conscious capitalism at: http://www.consciouscapitalism.org/. There are several helpful resources, including white papers and speech transcripts, available under the Content tab on the main page of this site. Conduct additional research beyond this website on the principle of conscious leadership.
Refer to the “Self-Assessment Links” resource in Topic Materials and complete each test. Be sure to document the results of each assessment to assist you in completing the reflection portion of the assignment below.
Self-Assessment Reflection
After completing the self-assessments, write a 1,000-1,250 word reflection in which you discuss the following:
Include at least four academic references for this assignment to support your analysis and reflection.
This assignment uses a checklist. Please review the checklist prior to beginning the assignment to become familiar with the expectations for successful completion.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.
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Self Awareness And Conflict Resolution
/in Uncategorized /by developerFor the C3P Self -Awareness and Conflict Resolution assignment, you will write a Professionalism Strategies Paragraph as directed by your instructor:
In a well-developed paragraph, identify the most important characteristics of professionals in your chosen career field. Describe strategies that you could use to develop those characteristics and maintain an appropriate professional image.
Note : My career field is Medical Coding and Billing
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Self Care Model By Dorothea Orem
/in Uncategorized /by developerDiscussion of the theorist’s view of the four basic concepts of the nursing metaparadigm and two other concepts unique to the theory.
Do one page
Provide references.
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Self Improvement Project Report On Budgeting
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