Respond to the post bellow,  using one or more of the following approaches:

Ask a probing question, substantiated with additional background information, and evidence.

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Offer and support an alternative perspective using readings from  the classroom or from your own review of the literature in the Walden  Library.

Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.

                                           Main Post

 

                          Music Therapy for Dialysis Patients

             The research article that I selected was conducted to see if music  therapy was a good non-pharmacological intervention to manage  hemodialysis patient’s anxiety, stress, and depression. The researchers  recognized that these patients experience anxiety, stress, and  depression due to their dire health issue of end-stage renal disease.  There were 40 subjects who were receiving dialysis and 20 subjects  received music therapy.  Blood pressures and pulses were taken before  and after music therapy. The randomized control group was given  pre-tests, post-tests, and Depression Anxiety Stress Scale Tool (DASS). 

                                       Data & Results

The  data that was collected that lead to their final conclusion was  comparing the vital signs collect before and after music therapy,  demographic survey, DASS, pre and post-tests. The researchers completed a  paired t-test and design table with the data to determine the  effectiveness of the experiment. According  to Fernandas & D’silva   (2019), “To find the association between depression, anxiety and stress  level with selected demographic variables, chi-square test or likelihood  ratio test used” (p. 128). Their conclusion stated that the group that  received music therapy did have a reduction in anxiety, stress, and  depression levels. According to Fernandas & D’silva  (2019), “In the  present study the investigator made an attempt to relieve stress,  anxiety, and depression among haemodialysis patient by providing music  therapy and results shows that there was a significant difference in  depression, anxiety and stress level among the experimental and control  group” (p. 129).

                                 Conclusion & Weakness

The  researchers were able to formulate their conclusion by analyzing the  data and using careful calculations that they collected from their  research. The weakness of the study I believe is that the subjects  weren’t select randomly. The participants were selected by assessing if  they liked or showed interest in music. The dialysis patients that were  interested in music received music therapy. 

                                    Additional Research

I  do believe that further research should be completed to prove the  benefits of music therapy for a dialysis patient. Further studies should  be randomized. I also think one-way researchers could add to testing is  measuring cortisol in saliva. According to Choi, Kim, & Yang  (2014), “Salivary cortisol concentration serves as a biomarker of psychological stress. Cortisol measurements should be carried out in real time”. 

                                            References

Choi,  S., Kim, S., Yang, J. S., Lee, J.H., Joo, C., & Jung, H. (2014).  Real-time measurement of human salivary cortisol for the assessment of  psychological stress using a smartphone. Sensing and Bio-Sensing Research., 2, 8-11. 

Fernandes,  S. T., & D’silva, F. (2019). Effectiveness of Music Therapy on  Depression, Anxiety, and Stress among Haemodialysis Patients. International Journal of Nursing Education, 11(1), 124–129. https://doi-org.ezp.waldenulibrary.org/10.5958/0974-9357.2019.00024.2

 

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Respond  of your colleagues who were assigned to a   different case than you. Explain how you might apply knowledge gained   from your colleagues’ case studies to you own practice in clinical   settings as a Psychiatric Nurse Practitioner.

NOTE: Positive comment

                                            Main Post

The three questions this writer would as the patient are: 

Did your depressive symptoms worsen after the death of your husband? 

How many hours per night do you sleep on average? 

Do you sleep throughout those hours of sleep or do you wake constantly? 

Do you ingest any stimulants like coffee or chocolate before bed? 

Do you sleep during the daytime? 

The rationale behind question one is to gauge the timeline of the  patient’s depression. She appears to have been suffering with untreated  depression for a long time, however the additional symptoms of insomnia  and tearfulness seemed to worsen after his death. With this information  the nurse practitioner will know if her depression is in an acute state  and the severity of her illness.The patient is reporting sleeplessness;  however the nurse practitioner needs to gauge if the patient is  participating in restful sleep. Sleep of two hours or less may only  consist of REM sleep (Boland et al., 2020). If the patient is not  getting restful sleep, she is not benefiting from the bodily repair that  takes place during sleep (Fitzgerald et al., 2017).  This can place her  at an increased risk for other illnesses and heighten depressive  symptoms (Uchmanowicz et al., 2019).Knowing if the patient sleeps  consistently throughout those hours of sleep will provide information to  the nurse about the kind and amount of sleep the patient is getting.  Ingesting certain stimulants like caffeinated drinks, coffee or  chocolate can affects the client’s sleep by providing wakefulness (Ulke  et al., 2017).  If the patient is sleeping during the daytime, her  circadian rhythm could have been reversed where she will need less sleep  during the night time hours (Fitzgerald et al., 2017).

The people this writer would interview are:

The patient’s aide 

The patient’s son 

The patient aide may be able to provide more information about  observed sleepiness during the daytime. In addition, she will be able to  provide information on the patient’s dietary patterns and physical  activity. The questions to the aide would be:    

Does she easily nod off during the daytime? 

Does she easily become fatigued? 

Does she consume a well-balanced diet? 

Question one would illicit answers about her getting sleep. 

It appears that she in fact getting sleep but because of a revered  circadian rhythm she is not able to get the sleep at the night which is  the desired time.  Question two will help the nurse practitioner gauge  the extent of the effects that non sleep has taken on the patient’s  life. The patient, if constantly fatigued throughout the day has a life  that has been highly impacted by the lack of sleep. The aide would be  able to provide a clear, picture of the patient’s diet. The aide would  be able to reveal if the patient consumes a vast amount of sugar or  caffeine which could interrupt sleep.

Questions to the son would surround the family’s psychiatric history.   These questions will help the nurse practitioner construct the family  history of the patient and rule out or consider familial history as a  cause for her symptoms.

Can you recall any maternal family members with psychiatric disorders including depression and insomnia? 

Did the symptoms start after the death of the client’s husband?  

This would help the nurse practitioner rule out depressive symptoms as the cause of her insomnia.

Physical Examinations and Tests

Sleep Study:

Polysomnogram – The sleep study or polysomnogram  measures the brain waves, blood oxygen, leg movements and breathing  during sleep (Meghdadi et al., 2019). The Nurse Practitioner would be  able to rule out physiological reason’s ad the cause for the patient’s  insomnia.

Actigraphy: This is where a small device is worn on  the wrist and it measures the person’s sleep wake cycle for a specified  period (Meghdadi et al., 2019). This is convenient for this client and  the Nurse Practitioner would be able to monitor the client’s sleep  health and gauge the severity of the disruption of her sleep.The nurse  practitioner could also physically examine the patient’s nares for  septal occlusion.

Septal occlusion or deviation could lead to problems  with sleeping even during sleep, this would be important for the nurse  practitioner to evaluate as this could be interfering with the patient’s  sleep.

Epworth sleepiness scale – assesses the patient’s  tendency to nod off in various situations (Meghdadi et al., 2019).  For  this client it would be necessary for the nurse practitioner to assess  the severity of her nodding off during the day time especially at  unexpected times like during eating and other activities that would put  her safety at risk. 

Differential Diagnosis

G47.00 Unspecified Insomnia Disorder– The patient is  experiencing insomnia at nighttime that could be related to several  factors. She reports staying up late to watch T.V., depressive symptoms,  restless leg syndrome, sleep apnea and sleeping during the daytime.  Some of these factors have not been ruled out yet as the cause of her  anxiety. 

G47.23 Persistent Irregular Sleep Wake type severe 

F32.9 Unspecified Depressive Disorder 

G25.81 Restless legs syndrome 

Medications:

Trazodone 50 mg – This medication would be the first choice as it  offers antidepressant properties as well as promotes sleep in those  diagnoses with insomnia. It is generally safe for the elderly population  at low doses (Pagel et al., 2018). The Nurse Practitioner should  monitor the patient and evaluate the needs to slowly increase or in some  cases decrease the dose. 

Rozerem 8 mg- Is a nonbenzodiazepine hypnotic that promotes sleep.  The patient would benefit from his, but an added benefit would be that  she would be at a diminished risk of falls as this is a concern  following the use of hypnotics in the elderly. This drug is reported as  one that would prevent less falls from over sedation (Pagel et al.,  2018).

Lessons Learned            

This writer has learned that it is important to conduct a complete  evaluation of the patient and not just focus on the presenting symptoms.  There are additional environmental and physiological symptoms that  could be attributed to the patient’s insomnia. In this case the patient  had several factors that could be contributing her insomnia and they  needed to be ruled out. The cause of her insomnia could have been  physiological from the sleep apnea or from her habits of staying up tool  late at nights and sleeping during the daytime. It is also important to  evaluate medications, social and economic factors before the resorting  to pharmacological interventions. 

References

Boland, E. M., Vittengl, J. R., Clark, L. A., Thase, M. E., &  Jarrett, R. B. (2020). Is sleep disturbance linked to short- and  long-term outcomes following treatments for recurrent depression? Journal of Affective Disorders, 262, 323–332. 

FitzGerald, J. M., O’Regan, N., Adamis, D., Timmons, S., Dunne, C. P., Trzepacz, P. T., & 

Meagher, D. J. (2017). Sleep-wake cycle disturbances in elderly acute  general medical inpatients: Longitudinal relationship to delirium and  dementia. Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring, 7, 61–68. 

Meghdadi, A. H., Popovic, D., Rupp, G., Smith, S., Berka, C., &  Verma, A. (2019). Transcranial Impedance Changes during Sleep: A  Rheoencephalography Study. IEEE Journal of Translational Engineering  in Health and Medicine, Translational Engineering in Health and  Medicine, IEEE Journal of, IEEE J. Transl. Eng. Health Med, 7, 1–7.  

Pagel, T., Seithikurippu R. Pandi-Perumal, & Jaime M. Monti. (2018). Treating insomnia with medications. Sleep Science and Practice, (1), 1. Uchmanowicz I, Markiewicz K, 

Uchmanowicz B, Kołtuniuk A, & Rosińczuk J. (2019). The  relationship between sleep disturbances and quality of life in elderly  patients with hypertension. Clinical Interventions in Aging, 155. 

Ulke, C., Sander, C., Jawinski, P., Mauche, N., Huang, J., Spada, J.,  Hegerl, U. (2017). Sleep disturbances and upregulation of brain arousal  during daytime in depressed versus non-depressed elderly subjects. World Journal of Biological Psychiatry, 18(8), 633–640.    

 

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Respond  of your colleagues who were assigned to a  different case than you. Explain how you might apply knowledge gained  from your colleagues’ case studies to you own practice in clinical  settings.

NOTE: Positive comment

                                          Main Post

The three questions this writer would as the patient are: 

Did your depressive symptoms worsen after the death of your husband? 

How many hours per night do you sleep on average? 

Do you sleep throughout those hours of sleep or do you wake constantly? 

Do you ingest any stimulants like coffee or chocolate before bed? 

Do you sleep during the daytime? 

The rationale behind question one is to gauge the timeline of the patient’s depression. She appears to have been suffering with untreated depression for a long time, however the additional symptoms of insomnia and tearfulness seemed to worsen after his death. With this information the nurse practitioner will know if her depression is in an acute state and the severity of her illness.The patient is reporting sleeplessness; however the nurse practitioner needs to gauge if the patient is participating in restful sleep. Sleep of two hours or less may only consist of REM sleep (Boland et al., 2020). If the patient is not getting restful sleep, she is not benefiting from the bodily repair that takes place during sleep (Fitzgerald et al., 2017).  This can place her at an increased risk for other illnesses and heighten depressive symptoms (Uchmanowicz et al., 2019).Knowing if the patient sleeps consistently throughout those hours of sleep will provide information to the nurse about the kind and amount of sleep the patient is getting. Ingesting certain stimulants like caffeinated drinks, coffee or chocolate can affects the client’s sleep by providing wakefulness (Ulke et al., 2017).  If the patient is sleeping during the daytime, her circadian rhythm could have been reversed where she will need less sleep during the night time hours (Fitzgerald et al., 2017).

The people this writer would interview are:

The patient’s aide 

The patient’s son 

The patient aide may be able to provide more information about observed sleepiness during the daytime. In addition, she will be able to provide information on the patient’s dietary patterns and physical activity. The questions to the aide would be:    

Does she easily nod off during the daytime? 

Does she easily become fatigued? 

Does she consume a well-balanced diet? 

Question one would illicit answers about her getting sleep. 

It appears that she in fact getting sleep but because of a revered circadian rhythm she is not able to get the sleep at the night which is the desired time.  Question two will help the nurse practitioner gauge the extent of the effects that non sleep has taken on the patient’s life. The patient, if constantly fatigued throughout the day has a life that has been highly impacted by the lack of sleep. The aide would be able to provide a clear, picture of the patient’s diet. The aide would be able to reveal if the patient consumes a vast amount of sugar or caffeine which could interrupt sleep.

Questions to the son would surround the family’s psychiatric history.  These questions will help the nurse practitioner construct the family history of the patient and rule out or consider familial history as a cause for her symptoms.

Can you recall any maternal family members with psychiatric disorders including depression and insomnia? 

Did the symptoms start after the death of the client’s husband?  

This would help the nurse practitioner rule out depressive symptoms as the cause of her insomnia.

Physical Examinations and Tests

Sleep Study:

Polysomnogram – The sleep study or polysomnogram measures the brain waves, blood oxygen, leg movements and breathing during sleep (Meghdadi et al., 2019). The Nurse Practitioner would be able to rule out physiological reason’s ad the cause for the patient’s insomnia.

Actigraphy: This is where a small device is worn on the wrist and it measures the person’s sleep wake cycle for a specified period (Meghdadi et al., 2019). This is convenient for this client and the Nurse Practitioner would be able to monitor the client’s sleep health and gauge the severity of the disruption of her sleep.The nurse practitioner could also physically examine the patient’s nares for septal occlusion.

Septal occlusion or deviation could lead to problems with sleeping even during sleep, this would be important for the nurse practitioner to evaluate as this could be interfering with the patient’s sleep.

Epworth sleepiness scale – assesses the patient’s tendency to nod off in various situations (Meghdadi et al., 2019).  For this client it would be necessary for the nurse practitioner to assess the severity of her nodding off during the day time especially at unexpected times like during eating and other activities that would put her safety at risk. 

Differential Diagnosis

G47.00 Unspecified Insomnia Disorder– The patient is experiencing insomnia at nighttime that could be related to several factors. She reports staying up late to watch T.V., depressive symptoms, restless leg syndrome, sleep apnea and sleeping during the daytime. Some of these factors have not been ruled out yet as the cause of her anxiety. 

G47.23 Persistent Irregular Sleep Wake type severe 

F32.9 Unspecified Depressive Disorder 

G25.81 Restless legs syndrome 

Medications:

Trazodone 50 mg – This medication would be the first choice as it offers antidepressant properties as well as promotes sleep in those diagnoses with insomnia. It is generally safe for the elderly population at low doses (Pagel et al., 2018). The Nurse Practitioner should monitor the patient and evaluate the needs to slowly increase or in some cases decrease the dose. 

Rozerem 8 mg- Is a nonbenzodiazepine hypnotic that promotes sleep. The patient would benefit from his, but an added benefit would be that she would be at a diminished risk of falls as this is a concern following the use of hypnotics in the elderly. This drug is reported as one that would prevent less falls from over sedation (Pagel et al., 2018).

 

Lessons Learned            

This writer has learned that it is important to conduct a complete evaluation of the patient and not just focus on the presenting symptoms. There are additional environmental and physiological symptoms that could be attributed to the patient’s insomnia. In this case the patient had several factors that could be contributing her insomnia and they needed to be ruled out. The cause of her insomnia could have been physiological from the sleep apnea or from her habits of staying up tool late at nights and sleeping during the daytime. It is also important to evaluate medications, social and economic factors before the resorting to pharmacological interventions. 

References

Boland, E. M., Vittengl, J. R., Clark, L. A., Thase, M. E., & Jarrett, R. B. (2020). Is sleep disturbance linked to short- and long-term outcomes following treatments for recurrent depression? Journal of Affective Disorders, 262, 323–332. 

FitzGerald, J. M., O’Regan, N., Adamis, D., Timmons, S., Dunne, C. P., Trzepacz, P. T., & 

Meagher, D. J. (2017). Sleep-wake cycle disturbances in elderly acute general medical inpatients: Longitudinal relationship to delirium and dementia. Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring, 7, 61–68. 

Meghdadi, A. H., Popovic, D., Rupp, G., Smith, S., Berka, C., & Verma, A. (2019). Transcranial Impedance Changes during Sleep: A Rheoencephalography Study. IEEE Journal of Translational Engineering in Health and Medicine, Translational Engineering in Health and Medicine, IEEE Journal of, IEEE J. Transl. Eng. Health Med, 7, 1–7.  

Pagel, T., Seithikurippu R. Pandi-Perumal, & Jaime M. Monti. (2018). Treating insomnia with medications. Sleep Science and Practice, (1), 1. Uchmanowicz I, Markiewicz K, 

Uchmanowicz B, Kołtuniuk A, & Rosińczuk J. (2019). The relationship between sleep disturbances and quality of life in elderly patients with hypertension. Clinical Interventions in Aging, 155. 

Ulke, C., Sander, C., Jawinski, P., Mauche, N., Huang, J., Spada, J., Hegerl, U. (2017). Sleep disturbances and upregulation of brain arousal during daytime in depressed versus non-depressed elderly subjects. World Journal of Biological Psychiatry, 18(8), 633–640.    

 

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  Respond to the post bellow offering additional/alternative ideas regarding opportunities and risks related to the observations shared.  

                                                      Main Post

                        iPhone technology, secure texting, and telehealth

            The hospital that I currently work for piloted the use  of iPhones in addition to our work station on wheels (WoW). We can use  this iPhone technology for charting simple nursing interventions,  receive STAT orders and discharge orders, and communicate with our  colleagues through texting. Our WoWs enable us to do “secure texting” to  a physician, some physicians prefer the secure texting technology some  don’t, but surely there are times that the answering service may fail to  page them in a timely manner and the secure texting technology becomes  very useful. As nurses, we can see through our WoWs as soon as the  physician reads the text message, that way we know they are aware. This  technology saves us some precious time we spend on the phone waiting on  hold just to page a physician for orders, condition and/or results. Our  hospital also offers telehealth services especially for those who are  likely to be readmitted due to chronic diseases. We mostly see a  telehealth order for a patient with cardiac issues.

Risks and benefits

            The biggest threat that I believe healthcare  technology is at risk for is privacy. According to Chaet, Clearfield,  Sabin and Skimming (2017), privacy and confidentiality are just “as  important in the context of telehealth and telemedicine as in hospital  and office settings” (p. 1138). I surmise, organizations providing this  type of technology in healthcare have an incredible security system in  place. The secure texting technology, we are instructed not to use full  names, instead, we use room numbers of the patients.

            The biggest benefit of the use of telehealth and  mobile devices for healthcare is accessibility. Use of the iPhone  technology in our hospital is quick and easy to navigate, we can get in  touch with virtually anybody logged in for that shift in the whole  hospital. From a distance, telehealth helps those patients who are  unable to manage their chronic illnesses very well.

                                                                                    Trends in healthcare technology

            The most promising healthcare technology to me is  virtual visits, mobile health, telehealth, and telemedicine technology.  One can get in touch with a healthcare provider as long as one has a  smartphone and internet access. It could provide access to so many more  patients in need of healthcare that resides in rural areas or have no  means to transport themselves to the physician’s office. It could save  time and money for patients as we all know healthcare can get expensive  very easily and very fast. According to Abuhaimidd, Meetoo and Rylance  (2018), technology in healthcare with the use of mobile devices can  “truly offer the potential to promote healthcare management and health  behaviour change outside formal clinical settings” (p. 1176). This does  not take away the significance of having a physical visit with a  physician, those visits are intended for more complicated health issues,  but I believe this technology has potential to truly help those with  chronic illnesses to be able to manage their health on their own, make  them accountable for their own wellbeing, patients can share data,  interact with clinicians over a mobile device instead of having to go to  the doctor’s office.

                                                                                                  Telehealth rules

            According to Mastrian and McGonigle (2017), nurses who  participate in telehealth must be “licensed to practice in all of the  states in which they provide telehealth services by directly interacting  with patients” (p. 381). This can be challenging as states have  different rules and regulations regarding licensure, continuing  education requirements are different as well as fees and renewal  process.                                          

References

Abuhaimid, H. A., Meetoo, D., & Rylance, R. (2018). Health  care in a technological world. British Journal of Nursing, 27(20).  1172-1177.

Barreto, E. A., Cohen, A. B., Donelan, K., Estrada, J. J.,  Michael, C., Schwamm, L. H., … Wozniak, J. (2019). Patient and clinician  experiences with telehealth for patient follow-up care. American  Journal of Managed Care, 25(1), 40-44.

Chaet, D., Clearfield, R., Sabin, J. E., & Skimming, K.  (2017). Ethical practice in telehealth and telemedicine. Journal of  General Internal Medicine, 32(10), 1136-1140.

Mastrian, K. G., & McGonigle, D. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

 

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