Reply Hollie 

Although there are still many things we do not understand about sleep, it is well known that there are numerous health concerns that can result from inadequate sleep (Hackley & Kriebs, 2017). Both short-term and long-term consequences can result from sleep disturbances. Short-term consequences of inadequate sleep include: increased stress response, headaches, abdominal pain, mood disorders, fatigue, and decreased cognitive performance (Medic, Wille, & Hemels, 2017). Women with sleep issues during perimenopause and menopause are likely to suffer sleep disturbances for an extended period of time due to hot flashes, night sweats, and other factors (Hackley & Kriebs, 2017). These extended episodes of poor sleep may increase the risk of developing long-term consequences. One long term consequence of inadequate sleep is cardiovascular disease (Medic et al., 2017). Long-term sleep issues are associated with hypertension, higher cholesterol levels, increased atherosclerosis risk, and increased risk of myocardial infarction (Medic et al., 2017). Metabolic issues are also associated with long-term sleep disturbances (Medic et al., 2017). Sleep loss is known to affect energy metabolism, which can ultimately impair insulin sensitivity and increase food intake (Medic et al., 2017). These factors are known to contribute to type 2 diabetes and obesity (Medic et al., 2017). A third health concern of long-term sleep disturbance is the development of different types of cancers (Medic et al., 2017). Melatonin, an important hormone involved in the circadian rhythm and in sleep, has numerous important properties including DNA repair, inhibition of tumor growth, and scavenging free radicals (Medic et al., 2017). During clinic visits, it is always important to take the time to revisit healthy bedtime habits. It is always my goal to avoid medication unless absolutely necessary. Sometimes by revisiting healthy routines or discussing nonpharmacological interventions, patients can see great improvement in their sleep. Some basic sleep hygiene interventions include: having a consistent bed time; choosing relaxing activities before bed; avoiding alcohol, coffee, tea, or other stimulants 4 to 6 hours before bed; avoiding smoking before bed; avoiding heavy meals or spicy foods before bed; increasing daytime physical activity; and creating a comfortable sleeping environment (Santos et al., 2018). Patient should be encouraged to read or journal before bed instead of using electronic devices (Santos et al., 2018). Cognitive behavioral therapy has also been proven effective for treating insomnia (Santos et al., 2018).

References

Hackley, B. K., & Kriebs, J. M. (2017). Primary care of women(2nd ed.). Burlington, MA: Jones & Bartlett Learning.Medic, G., Wille, M., & Hemels, M. E. (2017). Short- and long-term health consequences of sleep disruption. Nature and science of sleep, 9, 151–161. doi:10.2147/NSS.S134864

Santos, M., Conceição, A., Ferretti-Rebustini, R., Ciol, M. A., Heithkemper, M. M., & Cruz, D. (2018). Non-pharmacological interventions for sleep and quality of life: A randomized pilot study. Revista Latino-Americana de Enfermagem, 26, e3079. doi:10.1590/1518-8345.2598.3079

Reply Hollie 

Women experiencing perimenopause and menopause often report sleep disturbances. Identify three health concerns related to inadequate sleep and clinically relevant interventions to address these concerns.

Perimenopause                  As a 54-year-old woman currently in perimenopause, I can attest to sleep disturbances. For about a month this past year, I had hot flashes and insomnia. It miraculously all went away, I’m hoping for good. Getting a full night’s rest is so wonderful when you have experienced the opposite. As I’ve learned from my preceptor, you have to have 1 full year with absolutely no bleeding before considered in full menopause; a chapter that I’m sure is in my future.

Inadequate sleep Depression and Anxiety Baker, Zambotti, Colrain, and Bei, (2018) discuss the relationship between sleep problems with menopausal women and depression. In general, depression increases in menopausal women but the tendency is more with women who are sleep deprived (Baker, Zambotti, Colrain, & Bei, 2018). Once study showed that women who have difficulty getting to sleep have more problems with anxiety and those who have their sleep interrupted have problems with depression (Baker, Zambotti, Colrain, & Bei, 2018). The authors discuss the fact that the circadian rhythm, interrupted during sleep deprivation, plays a role in depression in anxiety (Baker, Zambotti, Colrain, & Bei, 2018).To treat insomnia and depressive symptoms during menopause, there are a few options. Hormone replacement therapy (HRT), serotonin reuptake inhibitors, and behavioral therapy have been investigated (Baker, Zambotti, Colrain, & Bei, 2018). Supplements such as soy isoflavones have assisted in reducing menopausal symptoms including sleep deprivation in some women (Baker, Zambotti, Colrain, & Bei, 2018).

Cardiovascular challengesSleep problems interrupt the efficient automaticity of the cardiovascular system and cardiovascular recovery (Baker, Zambotti, Colrain, & Bei, 2018). Insomnia, specifically the shortened amount of sleep has been associated with coronary heart disease, heart failure, hypertension, and acute coronary syndrome (Javaheri & Redline, 2017). Cardiovascular problems are more prevalent when insomnia is chronic; lasting more than three months (Javaheri & Redline, 2017).Behavioral therapy has been known to not only assist with insomnia but with corresponding cardiovascular disease as well (Baker, Zambotti, Colrain, & Bei, 2018).

Physiologic changes in Inflammation and Immune FunctionAukley (2018) discusses the relationship between sleep deprivation and immune function. In studies involving animal models there was shown to be a link between impaired immune function and a loss of sleep (Aukley, 2018). Asif, Iqbal, and Nazir (2017) inform us that wakefulness, rapid eye movement and non-rapid eye movement regulate the immune response. Inflammatory mediators increase in response to sleep loss (Asif, Iqbal, & Nazir, 2017).In addition to regulation of sleep, melatonin, a pineal hormone plays a role in immune system regulation (Jehan et al., 2017). Melatonin has been known to assist with sleep deprivation and related immune challenges (Jehan et al., 2017)

.References

Asif, N., Iqbal, R., & Nazir, C. F. (2017). Human immune system during sleep. American journal of clinical and experimental immunology, 6(6), 92–96.Aukley, D. (2018). Poor sleep in the hospital: Contributing factors and interventions. Retrieved from https://www.uptodate.com/contents/poor-sleep-in-the-hospital-contributing-factors-and-interventions?search=inadequate sleep&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2Baker, 

F. C., de Zambotti, M., Colrain, I. M., & Bei, B. (2018). Sleep problems during the menopausal transition: prevalence, impact, and management challenges. Nature and science of sleep, 10, 73–95. doi:10.2147/NSS.S125807Javaheri, S., & Redline, S. (2017). Insomnia and Risk of Cardiovascular Disease. Chest, 152(2), 435–444. doi:10.1016/j.chest.2017.01.026Jehan, 

S., Jean-Louis, G., Zizi, F., Auguste, E., Pandi-Perumal, S. R., Gupta, R., … Brzezinski, A. (2017). Sleep, Melatonin, and the Menopausal Transition: What Are the Links?. Sleep science (Sao Paulo, Brazil), 10(1), 11–18. doi:10.5935/1984-0063.20170003

 

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Mrs. Cason brings her 10-year-old child to the clinic stating my son “just isn’t breathing right, he doesn’t want to play, he just sits on my lap or lays on the couch, and this  happens all the time.” Appearance of both mother and child is disheveled. The child’s wheezing can be heard across the room. When asked if her son is better at any certain time of the day the mother responds: “It’s like this all the time and has been for the past year, we just don’t come to the doctor because we don’t have any money.”

Mrs. Cason’s son was diagnosed of asthma.

Discuss short and long term treatment options for this child, inhaled beta2-adrenergic agonists. Include rationale for your recommendations.

What is your educational plan for the child?

All posts must be supported by peer-reviewed references within 5 years of publication. 

Thanks,

 

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Unit 12 Discussion – Psychosocial Problems

 8      8 unread replies.    8      8 replies.         

It is anticipated that the initial discussion response should be in the range of 250-300 words. Response posts must demonstrate topic knowledge and scholarly engagement with peers. This is not the only criteria utilized for evaluation; substantive content is imperative. All questions in the topic must be addressed. Please proofread your response carefully for grammar and spelling. Do not upload any attachments. All responses need to be supported by a minimum of one scholarly resource. Journals and websites must be cited appropriately. Citation and reference must adhere to APA format (6th Ed.).

Classroom Participation

Students are expected to initially address the discussion question by Wednesday of each week. Participation in the discussion forums is expected with a minimum total of three (3) substantive postings (this includes your initial posting and posting to two peers) on three (3) different days per week. Substantive means that you add something new to the discussion, you aren’t just agreeing. This is also a time to ask questions or offer information surrounding the topic addressed by your peers. Personal experience is appropriate for a substantive discussion and should be correlated to the literature.

All discussion boards will be evaluated utilizing rubric criterion inclusive of content, analysis, collaboration, writing and APA. If you fail to post an initial discussion you will not receive these points, you may however post to your peers for partial credit following the guidelines above. Due to the nature of this type of assignment and the need for timely responses for initial posts and posting to peers, the Make-Up Coursework Policy (effective July 2017) does not apply to Discussion Board Participation.

Discussion Prompt [Due Wednesday]

Mildred is a 45-y.o. married female with three children. She presents to you with complaints of fatigue and difficulties sleeping. She states she wants to get a good night’s sleep and is requesting a prescription to help her sleep. Mildred tells you she is awake off and on during the night, frequently thinking about her husband’s recent layoff from construction work and the effect this is having on the family. She lies down often during the day and has been so fatigued that she took some time off from work during the last 2 weeks. She is tearful at times during the visit and looks sad and anxious. On further discussion, she says she feels overwhelmed, helpless, and anxious. She tells you about an episode where she felt her heart beating rapidly, had difficulty catching her breath, felt she was going to have a heart attack, and became frightened until her husband was able to help calm her down. She is not eating as much as usual, and when she reads the newspaper, she doesn’t remember what she has read.

1. What would your focused clinical assessment include?
2. What are your initial differential diagnoses?
3. What major psychological question needs to be addressed?
4. What testing would you order to rule out any medical problems?
5. What is your plan of care?
6. What are the mainstays of treatment?What is your initial follow up plan?
7. What education would you provide to your patient?

Peer Responses/Participation [Due Sunday]   

• Make sure to respond to at least two of your fellow classmates postings as well and challenge each other to go beyond just the surface.
• Share your thoughts on how you support their ideas and explain why.
• Present new references that support your opinions.

Please be sure to validate your opinions and ideas with citations and references in APA format. 

Estimated time to complete: 1 hour

 

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Getting a full and complete background of the patient before an assessment is important to know. Reviewing of systems and establishing a baseline of the systems is significant in treatment of their ailment/condition that are addressing. Observation of rate, rhythm, depth, and effort of breathing needs to be done after the heart sounds are heard. This is because with the cued breathing, the heart might increase in rate, and the nurse practitioner should assess for heart sounds at a resting rate. Evidence of respiratory distress at rest or when walking – eg, obvious breathlessness, talking in short phrases rather than full sentences, use of accessory muscles, exhalation with pursed lips (Henderson, 2015). Conpliance is the ability of the lungs to stretch. This mechanism plays the role in gas exchange in breathing. The more the lungs can stretch, the greater the potential volume of the lungs and the greater the volume of the lungs, the lower the air pressure within the lungs (Anatomy and Physiology, 2013).

During observation, if the patient has COPD, the breathing pattern might be different. Accessory muscle use signals difficulty breathing from COPD or respiratory muscle fatigue (Bickley, 2017). Other clinical observation can be that the COPD patient has delayed expiratory breaths. There might even be a possibility to see retractions with the COPD and asthma patients.

References

Anatomy and Physiology. (2013, March 06). Retrieved from https://opentextbc.ca/anatomyandphysiology/chapter/22-3-the-process-of-breathing/

Bickley, L. S. (2017). Bates’ Guide to Physical Examination and History Taking, 12th Edition. [Vitalsource]. Retrieved from https://online.vitalsource.com/#/books/9781496354709

Henderson, R. (2015, December). Respiratory System History and Examination. Information page. Retrieved from https://patient.info/doctor/respiratory-system-history-and-examination

 

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Ms. Brown comes into the emergency department to secure treatment for a head injury, plus minor bruises and abrasions she reportedly received during an assault that happened about 20 hours ago. Ms. Brown is 34 years old and accompanied by her boyfriend, Roy. She indicates they were sleeping in a protected entrance to an elevator in the city parking garage when two young men began beating and kicking them. The two men took Ms. Brown’s purse, a sack of food she and Roy had accumulated, and Roy’s wallet which contained $5.00.

Ms. Brown indicates she has been homeless for more than a year. She occasionally stays in city shelters but spends most of her time roaming the city and walking to procure meals at the various programs that feed the poor. She is tall and thin, with a variety of skin lesions. She came to the hospital due to dizziness that prevented her from walking to the church, where she could eat. She and Roy occasionally work odd jobs but use the bulk of their income to support Roy’s drug habit. She is trying to get Roy to quit using.

The nurse practitioner (NP) cleans Ms. Brown’s scalp and tapes the traumatic lesion. A contusion is suspected, and the NP suggests Ms. Brown rests for a few days and goes to the neurological clinic if the dizziness worsens. Ms. Brown points out that she has no place to rest and cannot get to the clinic without public transportation. The NP realizes this but indicates it is beyond her control. Because the contusion is not definitively diagnosed, the NP must discharge Ms. Brown with follow-up orders to seek help if things get worse.

Using the Resolution Guidelines with the mnemonic ETHICAL, consider the following questions:

• E—Examine what other data are needed to make informed choices.
• T—Think about who should be involved in the decision-making process and who should make the ultimate decision. Should Roy be involved? What agencies are available in your community to assist Ms. Brown?
• H—Humanize Reflect on all the possible options with resulting consequences and humanize them by constructing a decision tree.
• I—Incorporate the ethical principles (autonomy, beneficence, nonmaleficence, veracity, confidentiality, fidelity, and justice) when appropriate. Are there any legal statutes that apply? What standards of care should be incorporated
• C—Choose an option.
• A—Act on your ethical choice.
• L—Look back and evaluate your option to see if you need to make any other choices. This also will be a guide for the next time a similar situation arises.

Peer Responses/Participation [Due Sunday]   

• Make sure to respond to at least two of your fellow classmates postings as well and challenge each other to go beyond just the surface.
• Share your thoughts on how you support their ideas and explain why.
• Present new references that support your opinions.

 

 

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