Nursing

Assignment: Evidence-Based Project, Part 1: Identifying Research Methodologies
Assignment: Evidence-Based Project, Part 1: Identifying Research Methodologies
Is there a difference between “common practice” and “best practice”?
When you first went to work for your current organization, experienced colleagues may have shared with you details about processes and procedures. Perhaps you even attended an orientation session to brief you on these matters. As a “rookie,” you likely kept the nature of your questions to those with answers that would best help you perform your new role.
Over time and with experience, perhaps you recognized aspects of these processes and procedures that you wanted to question further. This is the realm of clinical inquiry.
Clinical inquiry is the practice of asking questions about clinical practice. To continuously improve patient care, all nurses should consistently use clinical inquiry to question why they are doing something the way they are doing it. Do they know why it is done this way, or is it just because we have always done it this way? Is it a common practice or a best practice?
In this Assignment, you will identify clinical areas of interest and inquiry and practice searching for research in support of maintaining or changing these practices. You will also analyze this research to compare research methodologies employed.
To Prepare:
Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry. Keep in mind that the clinical issue you identify for your research will stay the same for the entire course.
Based on the clinical issue of interest and using keywords related to the clinical issue of interest, search at least four different databases in the Walden Library to identify at least four relevant peer-reviewed articles related to your clinical issue of interest. You should not be using systematic reviews for this assignment, select original research articles.
Review the results of your peer-reviewed research and reflect on the process of using an unfiltered database to search for peer-reviewed research.
Reflect on the types of research methodologies contained in the four relevant peer-reviewed articles you selected.
Part 1: Identifying Research Methodologies
After reading each of the four peer-reviewed articles you selected, use the Matrix Worksheet template (uploaded) to analyze the methodologies applied in each of the four peer-reviewed articles. Your analysis should include the following:
The full citation of each peer-reviewed article in APA format.
A brief (1-paragraph) statement explaining why you chose this peer-reviewed article and/or how it relates to your clinical issue of interest, including a brief explanation of the ethics of research related to your clinical issue of interest.
A brief (1-2 paragraph) description of the aims of the research of each peer-reviewed article.
A brief (1-2 paragraph) description of the research methodology used. Be sure to identify if the methodology used was qualitative, quantitative, or a mixed-methods approach. Be specific.
A brief (1- to 2-paragraph) description of the strengths of each of the research methodologies used, including reliability and validity of how the methodology was applied in each of the peer-reviewed articles you selected.
By Day 7 of Week 3
Submit your Evidence-Based Project.
TO EDITOR: I’ve uploaded a few articles…some on personality disorders and some on pain management in opioid addicted patients. Whichever one you choose that has the most info is fine with me. Personality disorders interests me more though but it will be the theme for the rest of the semester so whichever has the most info available. I included the database I found them in attached to name of file since that may be relevant to the assignment. Hopefully you can add some other peer reviewed articles as well for more info. Needs two outside resources and two course specific ones.
RUBRIC:
Excellent Good Fair Poor
Part 1: Identifying Research Methodologies
After reading each of the four peer-reviewed articles you selected, use the Matrix Worksheet template to analyze the methodologies applied in each of the four peer-reviewed articles. Your analysis should include the following:

Topic 7, DQ 2
Assessment Description In order to evaluate an evidence-based practice project, it is important to be able to determine the effectiveness of your change. Discuss one way you will be able to evaluate whether your project made a difference in practice.

NRNP 6531 WK 9 HUMAN Assignment
WK 9 Assignment: i-Human Case Study: Evaluating and Managing Musculoskeletal Conditions Patients frequently present with complaints of pain, such as chronic back pain.
They often seek medical care with the intent of receiving drugs to manage the pain. Typically, for this type of pain, narcotic drugs are often prescribed.
This can pose challenges for you as the advanced practice nurse prescribing the drugs. While there is a process for evaluating back pain, it can be difficult to assess the intensity of a patient’s pain since pain is a subjective experience.
Only the person experiencing the pain truly knows whether there is a need for drug treatments. For this Case Study Assignment, you will analyze an i-Human simulation case study about an adult patient with a musculoskeletal condition.
Based on the patient’s information, you will formulate a differential diagnosis, evaluate treatment options, and create an appropriate treatment plan for the patient.
Photo Credit: SCIEPRO / Science Photo Library / Getty Images
To prepare:
Review this week’s Learning Resources. Consider how to assess, diagnose, and treat patients with musculoskeletal conditions.
Access i-Human from this week’s Learning Resources and review this week’s i-Human case study. Based on the provided patient information, think about the health history you would need to collect from the patient.
Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. Reflect on how the results would be used to make a diagnosis.
Identify three to five possible conditions that may be considered in a differential diagnosis for the patient.
Consider the patient’s diagnosis. Think about clinical guidelines that might support this diagnosis.
Develop a treatment plan for the patient that includes health promotion and patient education strategies for patients with musculoskeletal conditions.
Assignment As you interact with this week’s i-Human patient, complete the assigned case study. For guidance on using i-Human, refer to the i-Human Graduate Programs Help link within the i-Human platform.
By Day 7 Complete your Assignment in i-Human.
Submission and Grading Information To submit your completed Assignment for review and grading, do the following:
Please save your Assignment using the naming convention “WK9Assgn+last name+first initial.(extension)” as the name.
Click the Week 9 Assignment Rubric to review the Grading Criteria for the Assignment
Click the Week 9 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK9Assgn+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database. • Click on the Submit button to complete your submission. Grading Criteria
– 80 percent of the class don’t write the risk factors down. So there goes two points or three points right there, which you can have. So, make sure you write the HPI in the right place.
– You have to go to EMR button, click on there and posted in there, and then add your risk factors to your usual onset location and information and guaranteed, that you won’t lose points there.
– As far as testing, you have to research it. There’s just no two ways about it. If your expectation is that you can sit down and just work through the eye human, whether knowledge as a nurse, you are mistaken and because you, you need additional information.
– Make sure that you look at the link that she posted and then will discuss briefly what tests to order. Make sure you look at the link that the instructor posted, and she discusses briefly talking about what tests to order. Now, if you and you don’t get graded down for ordering too many tests. However, if you order X-ray, an MRI and CT scan, for sure, you are going to get graded down because you can’t order all three. Insurance doesn’t allow it. Prior authorization doesn’t allow it.
– However, if you order X-ray, an MRI and CT scan, for sure, you are going to get graded down because you can’t order all three. Insurance doesn’t allow it. Prior authorization doesn’t allow it. So, all you are doing is delaying patient care because you have to do authorization. They call you from x-ray, they call you from CT. They say, well, what do you want? So do familiarize yourself with what you are looking for and which test. It shows that the based as far as the BMP and a CMP, remember what’s on it and then ask yourself, how does knowledge about a BMP relate to back pain?
– So do familiarize yourself with what you are looking for and which taste. It shows that the based as far as the the BMP and a CMP, remember what’s on it and then ask yourself, how does knowledge about a BMP relate to back pain?….There really isn’t!
– So the same with a CBC. What are the two main factors for you to order a CBC? Look at a white blood cell to see if there is an infection there. Or look at the hemoglobin and hematocrit to see if there is anemia. Does anemia relate to back pain? And then of course platelets because low platelets may be an indication of bleeding or
something else going on in the bone, which will be important. So think about it when you order tests, approach it in that manner.
– For instance, with this week well as Sed Rate or is RB valuable? I think so because it’s an indication for acute inflammation.
– It is very true to a real life. So, make sure you ask the appropriate questions or order the appropriate tests. Because it, again, you don’t get graded down, but you will get graded down if you order a CT or MRI or an MRI and back x-ray because it just doesn’t work that way!
So that’s about our testing. Then as far as your differential diagnosis, she still believes that the best way to come up with your differential diagnosis is to look at your symptoms, organize your symptoms in acute and chronic.
So, if a patient arrives with, for instance, let’s lady with back pain and she tells you she’s had back pain for seven years. You really must decide. Does she have chronic back pain or is this an acute event? And for that reason, you then look at what is going on and we’ll walk through it here in a minute specifically.
As far as the Plan, you do not need to write a SOAP NOTE! You write a soap note. I’m not even going to look at it. The score is 0. It is not a soap note. You must follow the outline that is listed below these instructions. You write orders. You don’t have to write in rationale for me, I want to see what your order is.
– Now, some of you still get tripped up with if this is that or if this doesn’t work in that it doesn’t work that way because you write orders for right now patient in front of you. And this is a Case Study not about what needs to be done. It’s orders for RIGHT NOW. You need not list your differential diagnosis or a rationale for your differential diagnosis.
– And then finally, you must have references. And that is you list the references at the bottom. You need three references. But again, no rationale is needed. All right. So, let’s look at back pain, to successfully treat back pain, you have to know that back pain is one of the TOP 5 complaints that patients will present to you in the clinic with it affects more men than women.
– An onset is as early as 40 years of age start coming in with back pain. Now that doesn’t mean that at 21 years of age people are coming in with back pain or an 80 year old can present. This is just the most time they present. Finally, the most common diagnosis itself is herniated discs.
– You should focus your interview on ruling out a herniated disc in my right because that is historically and research shows is the most common complain.
– Knowing that you also need to look at your “Onset”.
– We are going back to physiology. I jumped that. So, let’s look at the spine, the spinal discs that are stacked on top of each other. And in-between is this glutinous gel that kind of space it out as well as the muscles on the side that keeps your spinal cord. The kind of stacked up.
– So when you have pain in your back, you have to consider disc problems as well as muscle because those are the two primary things that can cause back pain. So, muscle strain can cause back pain, but it’s got nothing to do with the disk. Whereas a herniated disc or discitis is trauma to a fracture. Fracture to the back can be excruciating painful, but I have nothing to do with the with the muscle itself.
– Don’t get tripped up by that. Because osteoarthritis is degeneration of the disc that glutinous it’s area. It’s sort of this integrates. Now that disc is closer on each other. They wrap around each other. They get displaced. They cause inflammation.
– People start having leaning over this way or they walk that way. Now that I have muscle pain from that too because they are compensating for what’s going on in there in the back. So let me just make sure I have everything. So then if it is a herniation or the location is very important because herniation can be both in the cervical spine, the thoracic spine, or the lumbar spine. So, it’s very important to differentiate if it’s lumbar or thoracic when you call it a herniation.
– Most common differentials then for visiting back pain in the office is going to be osteoarthritis. This irradiation, trauma, blunt force because of a motor vehicle accident, this narrowing and spinal stenosis. But remember you can’t diagnose spice spinal stenosis or a herniation or anything for that matter until you have an X-ray.
– So would I make that? I would put it on my list my list of things going on. But I can’t make the diagnosis. It’s back pain until I can figure out what kind of back pain it or lumbar pain or lumbar lumbar curve is another word that we use. . So, you have to look. You’re going to be guided with acute onset or chronic. So, it’s easy to rule out the chronic. First, you watch your patient walking into the room.
– In fact, in my office, I asked my nurse not to put anybody on the exam and table. Doesn’t matter for what your complaint is. They sit in the chair, get their blood pressure in the
WK 9 i-Human Notes: Gloria Jenkins
Page 4 of 10
chair. And then I ask them to get on there because that is a great way to examine how mobile they are, how uncomfortable they are. So that way you look at them. If they can’t get on the table, you will simply say, “Can you tie a shoe?” Osteoarthritis or the back limits range of motion. So those people can’t bend down to tie their shoe. They can’t move from side to side, reach to the left because they stiff.
– You can quickly figure out if this is an acute problem or a chronic problem. So then we get to the that the list of things that are also back pain. But it’s kind of like the things you want to put in the back of your mind. And I’m going to look at my lips list here. Always. First on my list is history of cancer. If you have been a woman and it can be a 40-year-old that has a history of breast cancer, or it can be a 80 year old that has a history of colon cancer inherit, resected and now they fight.
– Or a history or undiagnosed cancer. Compression fraction is the first thing that comes into my mind. I always put that there. Then medications. So, people use steroids. A young guy that comes in with terrible back pain, and he has point tenderness of the spine. he’s either using steroids, anabolic steroids, do puffed himself up and don’t forget the 60-year-old man that’s getting into it and getting it on. He looks like he’s 70 up here, but his body looks like is a 40-year-old that guides using steroids. Steroids causes bone problems. So you want to put that in the back of your mind. Then piriformis syndrome is another one of my favorites. People forget about. Piriformis syndrome is the nerve that runs through the kind of from the spine through this little hole pair from hole that sits where the gluteus maximus overlaps the gluteus minimus and the leg muscle comes in little hole that goes through.
– – So if you have any inflammation of your muscle, you’re going to have piriformis syndrome and it is not backed by it. It feels like back pain, and it feels like sciatica, but it’s not. Then the other thing you must consider sciatica. Sciatica is deferred pain. That means it is nerve pain that is radiating down the leg. You must have a back problem for you to have sciatica because it’s I had it somewhere that you have a pinched nerve that’s causing radiation TO leg, that is a problem for you. So bear that in mind.
– Other things is a UTI, make sure that they don’t have any symptoms of a UTI. And remember though, if they are not symptomatic in you do find a UA and you will not treat because the only thing it’s back pain. So, make sure it’s kind of hard to say well, I order a U/A. The lady that comes in now because she has very specific symptoms that tells you exactly what the problem is, and I already gave you most of the diagnosis so you should know where to start. Then. Don’t forget about kidney stones can cause back pain, pyelonephritis can aortic dissection, peripheral vascular disease can
claudication. Backload that is imputed to legs can cause it. Already talked about cancers and steroids. Osteoporosis is another one.
– – There is 2 that you definitely cannot miss. Herpes Zoster (shingles), So you have to lift your patient’s gown. Not just feel for it because I’ve done that. I’ve missed disaster ones because I didn’t actually look at it back. And it was clearly this string of vesicles. Make sure you look, you actually visualize it.
– And then lastly, there are people that are malingering. So, if you are seeing somebody that comes in repeatedly for back pain and you’ve ruled everything out. Both inflammatory disorders, which is your lupus or poly myalgia, rheumatic, as well as your your acute in osteoarthritis and your herniated disc or trauma,
– So if you are seeing somebody that comes in repeatedly for back pain and you’ve ruled everything out. Both inflammatory disorders, which is your lupus or poly myalgia, rheumatic, as well as your acute in osteoarthritis and your herniated disc or trauma, you have to at some stage consider malingering and diplomatically address that.
– So what are the symptoms? So we’re going to just quickly look at symptoms. Usually, it’s pain. It can be chronic or acute onset pain. And again, it can be point tenderness of the spine. If you have point tenderness at the spine, they have a herniated disc, but you cannot miss infectious discitis of the left. But you can only have discitis is if you have somebody that has a fever or chills. So CR my ruling this out.
But herniated disc can be trauma, it can be a exercise. It can be somebody that’s moving, and I keep picked up boxes. All of those things can cause it. So pain, make sure that you rule out according to the symptoms associated with it. It can be numbness and tingling. If you have numbness and tingling, report it is in the upper, then you look at a cervical fold, your CT of the cervical spine.
If it is lower extremity, then you have to look at your MRI. – It’s important to know is your do they have sensation? Do they have numbness or tingling? And do they have problems with with stool or urination? So those are the those are the criteria for ordering an MRI. Okay. Now, the other one is muscle weakness.
When you order, when you consider much muscle weakness, something else you have to put in there is deconditioning. So are they do they look like they have sarcopenia, which is muscle wasting. Do they have Is it potentially a stroke?
– Now remember, if you have a stroke, your upper and lower is affected. So you have to decide yourself, what am I going to scan the brain? But you must have the symptoms to prove that you’re going to scan the brain. And then you have paralysis. If you have paralysis, you have a problem. So P and P paralysis is a problem. You need to do an MRI and you need to scan the brain too, because sudden onset paralysis is a problem. If they had a motor vehicle accident. Very possible that they May be acquired.
But you will not be seeing that patient in the office. And if a patient comes to your office with back pain after they’ve been in a motor vehicle accident, you immediately going to defer them to the emergency room because first of all, there’s usually going to be litigation. So, unless you want to be caught up in that litigation and be accused of missing something or in appropriately managing the patient needs to be seen in the emergency room and a proper scan of the of the spine or whatever the problem will be needs to be done.
– With symptoms if they look at and fevers, chills. If they have fever or chills show your primary diagnosis is going to be either they have discitis or have a urinary tract infection and its deferred pain.
– Do you see any edema that is there an open wound, sacred wound? These old people don’t wipe themselves very well. They’re not very well hygiene they sit on there but the whole day then I know that they have sacred author, but there it is. Now it’s causing pain for them. Then numbness and tingling. You always ask about it but there’s no way to examine them if they have numbness and tingling, be aware of that.
– But you can do a filament test way you evaluate this sensation because they may have diabetic neuropathy or just the neuropathy from some other problem. So, you have to document sensation. Then. We already talked about the muscle. Look at is it muscle is the muscle weakness? Is there is the muscle a good tone? Or is it totally muscle wasted? And then if you are concerned about a neurological problem, there’s two ways to do it. You’re going to check reflexes in any case to see if the reflex is intact. But you can also do the anal wink.
– when you examine this patient, you ask them to take take your pants off and you just take your finger and tap it right on the the anus. If there is a contraction there, you will. You have normal reflexes or normal neural nearby neurological nerve innervation to the lower body because it’s right there. Now. It doesn’t mean that now you’re done. You can leave your neurological exam. That’s a whole different ballgame. If you have a neurological problem or suspected, you have to do a neuro exam which is different from a simple back exam.
– Document gait.
– We kind of talked about BMP and CMP, CBC. If you’re going to do that. Inflammatory markers, you don’t need SED Rate and lactic acid and a CPA CRP. One is, is usually enough. I find a sed rate most effective because all it tells you is this inflammation. You can have elevated sed rate with osteoarthritis. But it’s mostly effective for me with the malingering patient that you’ve done all the scans, nothing shows. You do a Sed Rate if that Sed Rate is elevated, they have something going on there. They have inflammation. So, you do have something to treat.
– Standard is the X-ray, spinal X-ray or a hip x-ray or a x-ray of the upper extremity, the femur. So most insurance companies, mostly Medicare and Medicaid, because we have these back problems mostly when they get older, will not jump to an a CT scan or MRI unless an X-ray has been done because the first thing you have to rule out is a fracture, be that a compression fracture or blunt fracture innovation by avulsion fracture, you have to do that if they have deferred pain. So you palpate the spine, you’re going to do an X-ray if they have a lumbar pain but it’s not on the spine but it’s actually on the sides.
– Don’t forget your frog leg, hip. They especially if they fell because they can have a site grow for the fracture. They can have a hip fracture, or they can have and I’m just thinking that it’s blowing out. I just had somebody with it in yeah. The piriformis syndrome. So you’re going to do your X-ray. The X-ray will not show you or it will just rule out anything in your back. So it’s a diagnosis of exclusion, a piriformis syndrome point tenderness right on the middle of the butt.
Then your next one will be your CT scan. If you have an X-ray that shows a herniated disc with cause that’s what you’ll see on an X-ray, herniated disc for foramina, stenosis for Amnon, a narrowing. Those are the things you’ll see on you on your X-ray or fractures. If you see an X-ray that shows that you have inflammatory changes because you can see it because they will be shadowing around it, then your next step will be a CT scan. So, when you want to rule out this guide us.
When you have somebody with blunt force trauma that has numbness and tingling, anybody that has signs and symptoms of sciatica, you’re going to start with an x-ray and then you proceed to a CT scan. Or if you have both, you can order both, but you probably going to have to do a prior authorization and they’ll do the X-ray first before they will do the CT scan.
Simply, good money management for that. And then finally your MRI. The MRI is your soft tissue.
– When you write pain medication, you always have to remember that you’re actually increase this person’s chances of getting worse. First of all, they’re going to sit around because they sedated and they think they don’t have it. You need them to move. So what are you going to do to get them moving? If they are narcotics, they don’t want tomove.
They just sit around and do nothing. If you prescribe non-steroidal. You have to know who is a high-risk candidate for still non-steroidal and who is not a high-risk? Is this person appropriate? So for instance, my 80 year old that comes in with back pain, they don’t get any narcotics, aren’t even look at narcotics. Non-steroidal. Last ditch Either like it because it causes GI bleeding and by the time the 80, what is the risk factor GI bleed? So, groom your critical thinking to always say what is in the patient’s best interests.
– Because part of your treatment plan should be grooming your passion of what they pay in expectation is, if you have a disc herniation and you’re not a candidate for any intervention other than medication and physical therapy, European expectation will never be 0. And you just must be honest with your patient. And that’s we respect comes in if you tell them, hey, our goal is going to be keep your pain in the 45 range. They will appreciate you for that.
They will. So, make sure you’re paying expectation is your treatment plan is safe, it’s appropriate medications for the age and that you it doesn’t nobody can walk away with no pain. Then you don’t have to write the dive diagnosis. Right. Orders. I don’t want to see this. If the Tylenol doesn’t help, we will send him to the orthopedist. What is that? That’s not an order. You are managing this, so you must give it a good shot. And just as an FYI, when you refer somebody to a gastroenterologist or a hematologist, they expect a good baseline workup has been completed.
So, the first time somebody presents with back pain, you must at least make a good effort of diagnosing it in treating it before you refer them to a surgeon. Unless of course, it is something that is that you must have back surgery for. But because your X-ray or CT scan shows that, but you must at least have a good workout before you can send them off to refer. Alrighty. Good luck with it. Make sure you do all effort to attain that tutorial on the 25th. It will be recorded, so it will be available for you to watch.
i-Human outline and EXAMPL for the plan
Posted Monday, November 22, 2021 8:32:21 PM Last Edited:Friday, December 3, 2021 12:28:28 PM You MUST follow this outline.
If you write an essay or a book, or a story you will receive ZERO.
Therapeutic & non-therapeutic modalities (should be written as orders or rx. Not an essay) 5 pts (note there may be 8/9 orders or as little as 3/4, but there will be very specific key things that you cannot miss) Additional labs or diagnostic tests 5 pts (note, there may be 3/4 or nothing) Health Promotion 5 pts Patient Education 5 pts
Consults 5 pts Disposition w/ rational 5 pts EXAMPLE PLAN (30 points) : YOU MUST WRITE ORDERS. NO ESSAYS!
Therapeutic and non-therapeutic modalities: (5 points)
Meloxicam 5mg Po Daily
Vitamin D 1000units Po weekly
Tylenol 1000mg Po TID
Alternate Ice and heat
Knee brace on during the day, off at night Additional labs or diagnostic test
1. Rheumatoid factor and Uric Acid Health Promotion: (5 points) -Schedule osteoporosis screening -Goal weight loss is 5% -Update your flu vaccine and take your COVID booster -AHA rec exercise most days of the week: consider water aerobics – Stop smoking Education: (5 points)
You have OA in your knee that is causing pain. First line tx is tylenol. NSAIDs and PT. Avoid Narcotics for risk of fall
Meloxicam can cause BLE edema/CHF and kidney injury. Take only once a day and complete after 7 days. If you notice blood in your stool or swelling in your legs call the office
Avoid repetitive movements like running /walking long distances
You are at risk for fall . Make sure you work on balance and may use a walker
Notify your job that you should limit weight bearing to 10lbs Consult w/ brief rational (5 points)
Orthopedic surgeon: evaluate steroid knee injection
Physical Therapy: strength training F/U and rational (5 points)
1 month to evaluate effectiveness of brace and progress with strength Screen for SE of Nsaid use and effectiveness of plan
WK 9 i-Human Notes: Gloria Jenkins
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Concepts of Epidemiology and Nursing Research to a Communicable Disease
Write a paper (2,000-2,500 words) in which you apply the concepts of and nursing research to a communicable disease.
Refer to “Communicable Disease Chain,” “Chain of Infection,” and the CDC website for assistance when completing this assignment.
Communicable Disease Selection
Chickenpox
Tuberculosis
Influenza
Mononucleosis
Hepatitis B
HIV
Ebola
Measles
Polio
Influenza
Order An Epidemiology Paper Today !!
Epidemiology Paper Requirements
Describe the chosen communicable disease, including causes, symptoms, mode of transmission, complications, treatment, and the demographic of interest (mortality, morbidity, incidence, and prevalence). Is this a reportable disease? If so, provide details about reporting time, whom to report to, etc.
Describe the social determinants of health and explain how those factors contribute to the development of this disease.
Discuss the epidemiologic triangle as it relates to the communicable disease you have selected.
Include the host factors, agent factors (presence or absence), and environmental factors.
Are there any special considerations or notifications for the community, schools, or general population?
Explain the role of the community health nurse (case finding, reporting, data collection, data analysis, and follow-up) and why demographic data are necessary to the health of the community.
Identify at least one national agency or organization that addresses the communicable disease chosen and describe how the organizations contribute to resolving or reducing the impact of disease.
Discuss a global implication of the disease. How is this addressed in other countries or cultures? Is this disease endemic to a particular area?
Provide an example. A minimum of three peer-reviewed or professional references is required.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric.
Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite.
A link to the LopesWrite technical support articles is located in Course Resources if you need assistance. Attachments

NURS 6512 Week 4 Shadow Health Assessment
Name:
Section:
Week 4
Shadow Health Digital Clinical Experience Health History Documentation
SUBJECTIVE DATA: Include what the patient tells you, but organize the information.
Chief Complaint (CC):
History of Present Illness (HPI):
Medications:
Allergies:
Past Medical History (PMH):
Past Surgical History (PSH):
Sexual/Reproductive History:
Personal/Social History:
Immunization History:
Health Maintenance:
Significant Family History (Include history of parents, maternal/paternal Grandparents, siblings, and children):
Review of Systems: From head-to-toe, include each system that covers the Chief Complaint, History of Present Illness, and History).
Remember that the information you include in this section is based on what the patient tells you. To ensure that you include all essentials in your case, refer to Chapter 2 of the Sullivan text.
General: Include any recent weight changes, weakness, fatigue, or fever, but do not restate HPI data here.
HEENT:
Neck:
Breasts:
Respiratory:
Cardiovascular/Peripheral Vascular:
Gastrointestinal:
Genitourinary:
Musculoskeletal:
Psychiatric:
Neurological:
Skin:
Hematologic:
Endocrine:

Epidemiology Paper
Assessment Description
Requires Lopeswrite
Write a paper (2,000-2,500 words) in which you apply the concepts of epidemiology and nursing research to a communicable disease. Refer to “Communicable Disease Chain,” “Chain of Infection,” and the CDC website for assistance when completing this assignment.
Communicable Disease Selection
Chickenpox
Tuberculosis
Influenza
Mononucleosis
Hepatitis B
HIV
Ebola
Measles
Polio
Influenza
Epidemiology Paper
Epidemiology Paper Requirements
Describe the chosen communicable disease, including causes, symptoms, mode of transmission, complications, treatment, and the demographic of interest (mortality, morbidity, incidence, and prevalence). Is this a reportable disease? If so, provide details about reporting time, whom to report to, etc.
Describe the social determinants of health and explain how those factors contribute to the development of this disease.
Discuss the epidemiologic triangle as it relates to the communicable disease you have selected. Include the host factors, agent factors (presence or absence), and environmental factors. Are there any special considerations or notifications for the community, schools, or general population?
Explain the role of the community health nurse (case finding, reporting, data collection, data analysis, and follow-up) and why demographic data are necessary to the health of the community.
Identify at least one national agency or organization that addresses the communicable disease chosen and describe how the organizations contribute to resolving or reducing the impact of disease.
Discuss a global implication of the disease. How is this addressed in other countries or cultures? Is this disease endemic to a particular area? Provide an example.
A minimum of three peer-reviewed or professional references is required.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Course Resources if you need assistance.
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The Epidemiology of Influenza
The impact of influenza on the global population is enormous. This applies to both individual well-being and the cost of economic opportunity. This is not even taking into account the lost man-hours of economic production. This is what drives the public’s desire for a universal influenza vaccination, particularly in light of the threat of a global pandemic (Jang & Seong, 2019; Phillipson et al., 2019; Paules & Fauci, 2018). Several investigations on the possibility and feasibility of developing a universal influenza vaccination have been conducted. However, this still remains to be a dream for epidemiologists as influenza is still an endemic viral infection that is yet to be mastered and fully controlled by a single vaccine. The purpose of this paper is to discuss the epidemiology of influenza as well as the global outlook of the viral infection.
Causes
Influenza or flu as it is commonly referred to is a viral infection of the upper respiratory tract that is caused by the Hemophilus influenzae virus. Particularly, the types of influenza viruses that cause flu are the ones designated as types A, B, and C. It is usually a seasonal infection that is more prevalent during the cold season but can affect anyone at any time too. According to epidemiologists, rampant seasonal outbreaks are mostly caused by the H. influenzae types A and B. The type known as type C is known to only cause mild outbreaks here and there and so it is not as virulent as the other two subtypes. Influenza is endemic in the general population and exists also on surfaces that can be touched and the virus transferred to the respiratory system (CDC, 2022b; Hammer & McPhee, 2018). Influenza is a very contagious infection and easily moves from one person to another through aerosols or respiratory droplets.
There are vaccines against the influenza viruses. However, it is significant to note that the vaccines only protect against the more virulent types A and B. They do not protect against the subtype C which has no vaccine so far. The subtype A is known by epidemiologists to also occur in different animals as a zoonotic infection. This means that zoonotic transmission to humans is also possible with the influenza subtype A. However, the influenza virus subtype B is known to only occur in humans (Hammer & McPhee, 2018). As stated above, both subtypes A and B infect humans and cause serious disease.
Symptoms
Influenza or flu usually causes mild symptoms but at times may be severe and even lead to death. This is dependent on the vaccination status and immune status of the person infected. For instance, children and the elderly with low immunity may easily suffer serious disease if they get infected by the flu virus. Characteristically there is usually a stuffy nose and rhinorrhea that is watery. This is usually but not always accompanies by a sore throat and fever. There may also be a cough and the patient may feel chills despite being febrile. The body may ache and there may also be a headache and a feeling of fatigue (CDC, 2022b; Hammer & McPhee, 2018). These symptoms do not all occur in everyone who has been infected with flu. Some people may exhibit some of the symptoms and others may not. A case in point is fever. It is not everyone that has flu that will present while febrile. This is a very important diagnostic point to note. As a matter of fact, some patients may even have diarrhea and vomiting when infected with the flu virus. These are however not common manifestations.
Mode of Transmission
The influenza viruses are very contagious viruses and easily jump from one host to another. Transmission is characteristically by aerosol or droplets from infected persons that are coughing and sneezing (CDC, 2022b). This is the rationale for wearing a face covering at times of influenza outbreaks. They provide a physical barrier to prevent the virus in respiratory droplets from being inhaled by a healthy person. A sick person with influenza may also wipe their nose or sneeze into the palm of their hand and then rub the mucus onto surfaces such as door knobs and handles. When another person touches these and then touches their nose or mouth they will get infected with the influenza virus. For persons that are intimate, they may also get infected through actions such as kissing and exchanging saliva (CDC, 2022b; Hammer & McPhee, 2018). These are the most common ways in which the influenza viruses spread and are transmitted.
Epidemiology
Incidence, Prevalence, and Mortality
According to Tokars et al. (2017), the incidence of influenza averages 8% but generally shifts between 3% and 11% depending on the season of the year. The patterns show that children under the age of two years and adults above the age of 65 years are the most affected. Added to these are those whose immunity has been compromised such as persons on chemotherapy or those with HIV (Hammer 7 McPhee, 2018; Tokars et al., 2017). On prevalence, the Centers for Disease control and Prevention approximates a figure of between 9 and 41 million cases (CDC, 2022c). Also, the mortality figure is placed by the CDC at between 12,000 and 52,000 deaths every year. Influenza is a reportable disease outbreak in many states and the reporting is done to the CDC at the time of diagnosis.
Complications
As much as flu appears to be a simple infection that usually wears off within days even without intervention, it can cause serious complications and even death. Some of the most common infections are sinusitis and otitis media. These are infections of the sinuses and the middle ear that more often than not are complicated by bacterial infection (CDC, 2022b; Hammer & McPhee, 2018). The other common complication is pneumonia that is often life-threatening especially for children and the elderly. Less common complications include myositis or an infection of the muscles with muscle tissue breakdown (rhabdomyolysis), sepsis, encephalitis, myocarditis, and multiple organ failure (CDC, 2022b; Hammer & McPhee, 2018). For patients with other respiratory conditions such as chronic obstructive pulmonary disease (COPD) or heart disease, an influenza infection will interfere with the management of these conditions and may cause an exacerbation of their symptoms.
Treatment
The best strategy to prevent and control influenza is to get vaccinated first as a child and then as an adult by getting boosters (CDC, 2022a; Jang & Seong, 2019; Paules & Fauci, 2018; Phillipson et al., 2019). However, it is acknowledged that even those that are vaccinated may still get infected with flu. For this reason, the evidence-based practice or EBP intervention recommended by the CDC is the prescription of antiviral medications. These have the advantage of lessening the severity and duration of the symptoms.
Demography of Interest
The population demographics of interest as far as influenza is concerned are the elderly above the age of 65 years, children under the age of five years, and the immunocompromised (Tokars et al., 2017). These are the most vulnerable groups within the general population and it is them that need to be targeted by health promotion and education. Having said that, the most significant demographic amongst which the preventive intervention of immunization starts are the children under five years.
Social Determinants of Health (SDOH) and their Contribution to Influenza Infection
Social determinants of health or SDOH are conditions under which a person is born, grows in, ages in, and dies in (Powell, 2016). A number of social determinants of health are recognized and they influence the epidemiology of diseases within populations. One of them is low socioeconomic status (low family incomes). This influences flu infection in that the person or family may not afford antiviral medications and have no health insurance leading to complications. The other is poor sanitation and living conditions. This SDOH is tied to low socioeconomic status and facilitates the spread of flu. Under transmission above it has been observed that poor hand hygiene (lack of water) may lead to the virus being transferred to door handles and knobs where others touch them and get infected too.
Yet another SDOH is low educational achievement. This affects flu in that ignorance makes it difficult for the community to be educated and for them to quickly understand the implications of the condition. Last but not least is the SDOH of lack of access to quality healthcare services. Because of poverty, the affected population demographic will not be able to afford healthcare insurance such as provided for by the Affordable Care Act of 2010 (Kominski et al., 2017). This means extreme poverty as the ACA 2010 was meant to cushion poor populations.
Epidemiologic Triangle of Influenza as a Communicable Disease
The epidemiological triangle of influenza like any other communicable disease includes the host factors, the agent (virus) factors, and the environmental factors (Hammer & McPhee, 2018). The host factors for influenza include socioeconomic status, immunity status, and nutritional status amongst others. As already observed, an immunocompromised person will experience serious disease as opposed to a patient that is not. Having been vaccinated also makes a big preventive difference. With malnutrition (especially in children and the elderly), susceptibility to flu is high. Last but not least, poverty will mean that living conditions are poor and so spread of the virus will be fast due to factors such as overcrowding.
Agent factors include virulence and dose. It has been observed above that influenza subtypes A and B are more virulent compared to subtype C. Therefore, a person will definitely get more serious symptoms when infected by either type A or B. by the dose is meant the quantity of virus that a person inhales to make them sick. The more the number of viruses inhaled, the higher the chances of more serious illness. On environmental factors; poor living conditions (dirt), lack of water, and overcrowding lead among the factors that favor the spread of influenza. Special considerations for the community, schools, and the general population concern the maintenance of proper hygiene and the wearing of face coverings for those who have flu.
The Role of the Community Health Nurse (CHN)
The role of the community health nurse in the prevention and management of flu is immense. To begin with, they are responsible for sensitizing the population and for delivering preventive health promotion and education. The CHN also participates in case finding especially since flu outbreaks would need to be reported to the CDC. Whenever cases are identified, the CHN finds out whether there are other cases within the community. The CHN also collects data about flu in the process of case finding and management. This epidemiological data that has been documented will then be used after analysis to plan for public health initiatives such as mass vaccinations. It is also the CHN that will make sure that cases are followed up including through home visitation for health promotion. Epidemiological data is therefore very important for communities because it is that very data that will be used to identify community needs and also to plan for any public health intervention.
The Role Played by the Centers for Disease Control and Prevention (CDC)
The Centers for Disease Control and Prevention (CDC) is a federal organization tasked with sensitizing the public and carrying out research aimed at prevention of illnesses and conditions. It is very instrumental in drafting policies geared towards the prevention and treatment of flu. For instance, the vaccination schedule that includes the influenza vaccine has been drawn by the CDC.
A Global Implication of Influenza
Influenza is an endemic viral infection in the world. It is present in almost every country and affects the same vulnerable populations as described previously. A global implication of influenza is that it causes sporadic outbreaks every now and then in different areas of the world. Management by other countries is no different to what has been done with the Covid-19 outbreak. That means mass vaccination, use of face coverings, handwashing, and social distancing.
Conclusion
Influenza or flu is a very contagious communicable disease caused by a virus. There are three subtypes of the influenza virus namely A, B, and C. The first two are more virulent than the last one and cause serious illness. The incidence of flu averages 8% and it leads to a significant number of deaths annually all over the world. Treatment of influenza is through antiviral medications that reduce the severity and duration of the symptoms. The CHN plays a crucial role in flu prevention, just as does the CDC in the United States.
References
Centers for Disease Control and Prevention [CDC] (February 17, 2022a). Child and adolescent immunization schedule. https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html
Centers for Disease Control and Prevention [CDC] (July 1, 2022b). Influenza (flu). https://www.cdc.gov/flu/index.htm
Centers for Disease Control and Prevention [CDC] (January 7, 2022c). Disease burden of flu. https://www.cdc.gov/flu/about/burden/index.html#:~:text=CDC%20estimates%20that%20flu%20has,annually%20between%202010%20and%202020
Hammer, D.G., & McPhee, S.J. (Eds). (2018). Pathophysiology of disease: An introduction to clinical medicine, 8th ed. McGraw-Hill Education.
Jang, Y.H. & Seong, B.L. (2019). The quest for a truly universal influenza vaccine. Frontiers in Cellular and Infection Microbiology, 9(344). https://doi.org/10.3389/fcimb.2019.00344
Kominski, G.F., Nonzee, N.J. & Sorensen, A. (2017). The Affordable Care Act’s impacts on access to insurance and health care for low-income populations. Annual Review of Public Health, 38. http://dx.doi.org/10.1146/annurev-publhealth-031816-044555
Paules, C.I. & Fauci, A.S. (2018). A universal flu vaccine is vital. Scientific American, 318(2). https://doi.org/10.1038/scientificamerican0218-8
Phillipson, J.E., Babecoff, R. & Ben-Yedidia, T. (2019). Is a universal influenza vaccine feasible? Therapeutic Advances in Vaccines and Immunotherapy, 7, 1–6. https://doi.org/10.1177/2515135519885547
Powell, D.L. (2016). Social determinants of health: Cultural competence is not enough. Creative Nursing, 24(1), 5-10. http://dx.doi.org/10.1891/1078-4535.22.1.5
Tokars, J. I., Olsen, S. J., & Reed, C. (2017). Seasonal incidence of symptomatic influenza in the United States. Clinical Infectious Diseases, 66(10), 1511–1518. https://doi.org/10.1093/cid/cix1060

A woman with personality disorder
SUBJECTIVE
Rhonda is a 32-year-old Hispanic female who presents to your office for her initial appointment. When you ask what brought her to your office, she states: “I’m at the end of my rope, I don’t know what else to do.” She then bursts into tears. Rhonda explains that she has very few friends left, and everyone seems to have “abandoned” her. Rhonda explains that she goes out of her way to help other people, and to be nice to them, but this does not seem to help. Rhonda then stands up and begins to pace around your office at times using wild hand gestures to explain the circumstances that led up to her making the appointment with you
She describes the recent breakup with her boyfriend as traumatic and explains “when we first met, he was the best guy in the world. He treated me really well. But he just became a complete monster! Even though he broke off the relationship with me, I was glad to see it end. I hate his guts!” Rhonda explains that her current financial situation is also precarious. She states that she recently purchased an automobile, and is not certain how she is going to pay for it. She states that she had a car that was repossessed last year at that time, and that she borrowed some money from a friend to help pay for the car; the friend later turned around and accused her of theft.
“It was my friend’s fault. She told me she would loan me the money and then backed out. I only took the money because she said she would loan it to me … people just can’t go back on their word like that when other people are counting on them.” Rhonda reports that she was “always in trouble” as a kid. She states that people were always picking on her, to which she adds: “the other kids my age were just stupid. They didn’t know how to have fun.” She says “I have always been impulsive, but it’s fun. Sometimes people can be such prudes … you only go around life once, so you have to make the best of it.”
OBJECTIVE
Rhonda is currently single. She has no children. Educationally, she had completed two semesters toward her bachelor of arts degree in fine arts. Rhonda currently works as a waitress at a local restaurant. She has held this job for about 2 weeks. Prior to this, Rhonda worked as a housekeeper for a local hotel chain. She states that she was fired from this job because her coworkers were jealous of her and “planted” evidence of her stealing from hotel patrons.
She was also arrested for cashing checks under an alias, for which she spent 120 days in jail. Rhonda has a history of multiple incarcerations for offences ranging from larceny to possession of controlled substances to possession of an illegal firearm. She was also arrested several times for fighting and on at least one occasion, used a baseball bat to beat up a girl who she thought was trying to “set her up” with the police.
MENTAL STATUS EXAM
Rhonda is alert and oriented × 4 spheres. Her speech is clear, coherent, goal directed, and spontaneous. She reports her mood as “terrible!” Affect is labile and seems to change rapidly with the subject being discussed. Her eye contact is normal, but at times, she appears to stare at you. Rhonda is oriented to person, place, and time. She denies visual/auditory hallucinations, no overt paranoia or delusional thought processes noted. Rhonda denies any suicidal or homicidal ideation.
RESULTS OF DECISION POINT TWO
Client returns to clinic in four weeks Rhonda states that the therapist she was referred to was “a complete waste of time. Do you know he wouldn’t even talk to me?” On further exploration, the PMHNP discovers that the psychotherapist asked Rhonda to talk, which she did, but he did not provide any feedback. Rhonda then states: “he told me that he wants to see me three times a week! Yeah, like that is going to happen!”
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A Woman with Personality Disorder
Introduction
Diagnosis and treatment of psychiatric conditions is a challenging endeavor. That is because it is not a precise medical science, and relies on approximations. This is particularly true for antisocial personality disorder (APD) whose diagnosis relies on information provided by the client. Once diagnosis is conducted, treatment would follow although there is need for regular reviews to determine the treatment effectiveness and whether changes should be made to a particular therapy (Black, 2013). The present analysis conducts a case evaluation of the diagnosis and therapy options available for the management of APD.
Decision #1: Antisocial Personality Disorder (APD)
Which Decision did you select?
The client was diagnosed as having APD.
Why did you select this Decision?
The APD diagnosis was made because the client tended to violate or disregard the rights of the people round. In this case, her personal behavior and experience showed clear deviation from what the society would consider normal behavior, with signs of inflexibility and pervasiveness. Besides that, the APD diagnosis is only presented for persons older than 18 years who consistently exhibit irresponsible behavior that violates social laws and do not show signs of changing even after being punished.
Although there is no indication that she had the same behavior as a child (as would be expected for a classical diagnosis), it is undeniable that she appears charming yet is actually irresponsible, aggressive and irritable with manipulative tendencies that make it difficult to determine whether she is telling the truth or lying (Gilbert, 2015).
Evidence of this can be drawn from the case information. Firstly, she shows a disregard for society’s laws as evidenced by the fact that she remains unrepentant even after being arrested and incarcerated multiple times. For instance, she cashed checks under an alias, engaged in larceny, possessed controlled substance, had an illegal firearm, and fought in public. She would not have engaged in all these illegal activities if she had regard for society’s laws.
Secondly, she violated the emotional and physical rights of others as evidenced by the fact that she beat up another girl on suspicion of being set-up for police arrest. Thirdly, she does not have stability in both her home life and work as evidenced by the fact that her financial situation is precarious and yet she bought a car and is expected to make payments even though she recently had another car repossessed. Additionally, she has been unable to hold jobs for long and is typically fired for some form of misconduct (Gilbert, 2015).
Fourthly, she is aggressive and irritable as evidenced by the fact that she beat another girl using a bat without first confirming whether that girl had actually set her up. Fifthly, she is not remorseful as seen when she talks of taking money from her friend without permission and justifying this action that her friend had promised to loan her the money. Sixthly, she is consistently irresponsible as seen when she only completes two semesters and buys a car without money.
Seventhly, she is impulsive and reckless, a confession that she makes when talking about her childhood antics. Eighthly, she is impulsive as evidenced by the fact that she bought a car but is unsure of how she will make payments. Finally, she had conduct disorder as a child. This is evidenced by the fact that she was always getting into trouble as a child (Black, 2013). In this respect, the behavioral problems support the APD diagnosis.
What were you hoping to achieve by making this Decision?
The diagnosis was based on the results from the client’s psychological assessment, noting her conduct and how she relates with others in the society. It identified the disorder that best matched the existing symptoms. The intention is to facilitate treatment and management of the disorder by matching the symptoms to known disorders then extrapolating the management using established treatment standards (Clarkin, Fonagy & Gabbard, 2010). As such, the APD diagnosis is intended to identify and apply a standardized treatment plan that relieves the existing symptoms while allowing the client to be free from the disorder.
Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?
The expectation from decision #1 was to identify the best differential diagnosis that matched all (if not most of) the client’s symptoms. The decision matches all the symptoms to APD thus showing that there was no difference between expectations and actual results.
Decision #2: Refer to psychodynamic psychotherapy
Why did you select this Decision?
The decision was made to refer the client to psychodynamic psychotherapy. This decision was made for three reasons. Firstly, there is no FDA approved medication for treating the disorder. That is because research has not identified an effective medication. Rather, medication is only prescribed if the client presents a concurrent psychiatry issue for which medication exists for management. Secondly, subjecting her to inpatient care would help in effectively managing the condition, but it is expensive.
The inpatient care program focus on addressing the possible criminal activity with the possible loss of freedom acting as a motivation. The program uses a strict behavioral approach that places the client on a token economy based on progress in treatment. The focus is on feelings, and how the antisocial behavior link with the feelings. The hospitalization option was not selected since the client was unable to pay the high treatment expenses as she is already facing financial difficulties and does not have a steady job or source of income.
In addition, she is not facing any prison time or loss of freedom so that she is not motivated to seek hospitalization (Sperry, 2016). Finally, psychodynamic psychotherapy was selected because it is an effective treatment approach that is not expensive. The approach puts emphasis on the significance of therapeutic relationship building that permits countertransference and transference.
It would use both expressive and supportive elements to allow the client to identify how past experiences have built up to cause the personality disorder thereby allowing her to comprehend and change future outcomes (Widiger, 2012). As a result, the decision to subject the patient to psychodynamic psychotherapy that is both effective (when compared to medication) and inexpensive (when compared to hospitalization).
What were you hoping to achieve by making this Decision?
The decision was intended to ensure that the client is subjected to an effective and inexpensive therapy. Medication is ineffective since there is no FDA approved medication against APD. Hospitalization is effective against APD but expensive thus making it unrealistic for this client who has financial difficulties. Psychodynamic psychotherapy offers an acceptable option since it is both effective and inexpensive (Sperry, 2016).
Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?
The psychodynamic psychotherapy was applied in anticipation that it would ease the previously identified symptoms. In this case, the therapy is applied in an outpatient setting to explore the antisocial issues that include lack of connections between feelings and behavior. For that matter, it was expected that applying psychodynamic psychotherapy in an outpatient setting would result in symptoms reduction and management of the condition. But this was not the case. In fact, a follow up assessment with the client four weeks after the start of the therapy noted that it had been ineffective.
The client reported that the therapy had been a waste of her time since the therapist was non-communicative. Consultation with the therapist noted that there was communication with the client, although no feedback was provided. In addition, the client had been resistant to increasing the number of therapy sessions to three times every week. Based on these circumstances, it is not surprising that the therapy had been ineffective since there was a communication difficulties between the client and therapy. Also, the therapist identified a need to increase the number of weekly sessions and yet the client was not amenable to the changes.
Besides that, it is acknowledged that although the treatment was applied, its effectiveness is limited since it links feelings to antisocial behavior. A more effective treatment would reinforce the suitable behaviors while strengthening the link between feelings and actions. That is because treating the disorder must focus on emotions since clients would typically have limited emotionally rewarding relations as has been exemplified by the present case.
The communication difficulty between the client and therapist can be explained that the client may have been overwhelmed and become intolerant of the therapeutic relationship since trust was not implicit and there was no rapport (Yakeley et al., 2016). Based on this reasons, it was thought prudent to change the treatment modalities by applying a different psychotherapeutic approach to include group therapy.
Decision #3: Refer to Group based cognitive behavior therapy
Why did you select this Decision?
Given that psychodynamic psychotherapy had turned ineffective even after four weeks of use, the decision was made to subject the client to group based cognitive behavior therapy. The social interactions within the group would allow the client to open up emotionally and share experiences and opinions with other clients.
The group would be devoted exclusively to APD management thus giving the client greater reason to share with others with the same condition and contribute towards the discussions. That is because persons with the disorder are more at ease in discussing their behaviors and feelings in front of peers since the group presents a supportive modality. This is based on the assumption that the client would overcome her initial hesitation and fears (Clarkin, Fonagy & Gabbard, 2010).
What were you hoping to achieve by making this Decision?
The decision to apply group based cognitive behavior therapy was anticipated to improve APD management outcomes for the client. That is based on the reason that it creates an environment exclusively comprised of APD patients thus giving them greater reason to share experiences and opinions with others with the group presenting a supportive modality (Beck, Davis & Freeman, 2015).
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
The expectation was that the client would report some treatment progress after attending the group based cognitive behavior therapy for four weeks with marked improvement in how she interacts with others, and greater respect for the law and societal norms (Beck, Davis & Freeman, 2015). As such, the outcome matched the expectations.
Conclusion
One must accept that as the name would suggest, APD results in a tendency to break the law and disrupt social relationships. This is seen through evaluating its symptoms that include arrests and incarceration, and an inability to form close social relationships accompanied with violent behavior among adults. To facilitate treatment, psychodynamic psychotherapy is applied as a more effective and inexpensive therapy when compare to medication and hospitalization.
Still, the strategy turned out to be ineffective when even after using it for four weeks. This resulted in a therapy change with group based cognitive behavior therapy applied as a better alternative that caused marked improvement in how the client interacts with others, and greater respect for the law and societal norms.
References
Beck, A. T., Davis, D. D. & Freeman, A. (2015). Cognitive therapy of personality disorders (3rd ed.). New York, NY: The Guilford Press.
Black, D. W. (2013). Bad boys, bad men: confronting antisocial personality disorder (sociopathy). New York, NY: Oxford University Press.
Clarkin, J. F., Fonagy, P. & Gabbard, G. O. (ed.) (2010). Psychodynamic psychotherapy for personality disorders: a clinical handbook. Washington, DC: American Psychiatric Publishing, Inc.
Gilbert, M. (2015). The mind of a sociopath: your guide to understanding the anti-social personality disorder of sociopaths. New York, NY: CreateSpace Independent Publishing Platform.
Sperry, L. (2016). Handbook of diagnosis and treatment of DSM-5 personality disorders: assessment, case conceptualization, and treatment (3rd ed.). New York, NY: Routledge.
Widiger, T. A. (2012). The Oxford handbook of personality disorders. Oxford: Oxford University Press.
Yakeley, J., Johnston, J., Adshead, G. & Allison, L. (2016). Medical psychotherapy. Oxford: Oxford University Press.

Discussion: The Application of Data to Problem Solving
Discussion: The Application of Data to Problem-Solving
In the modern era, there are few professions that do not to some extent rely on data. Stockbrokers rely on market data to advise clients on financial matters. Meteorologists rely on weather data to forecast weather conditions, while realtors rely on data to advise on the purchase and sale of property. In these and other cases, data not only helps solve problems, but adds to the practitioner’s and the discipline’s body of knowledge.
Of course, the nursing profession also relies heavily on data. The field of nursing informatics aims to make sure nurses have access to the appropriate date to solve healthcare problems, make decisions in the interest of patients, and add to knowledge.
In this Discussion, you will consider a scenario that would benefit from access to data and how such access could facilitate both problem-solving and knowledge formation.
To Prepare:
Reflect on the concepts of informatics and knowledge work as presented in the Resources.
Consider a hypothetical scenario based on your own healthcare practice or organization that would require or benefit from the access/collection and application of data. Your scenario may involve a patient, staff, or management problem or gap.
By Day 3 of Week 1
Post a description of the focus of your scenario. Describe the data that could be used and how the data might be collected and accessed. What knowledge might be derived from that data? How would a nurse leader use clinical reasoning and judgment in the formation of knowledge from this experience?
Excellent Good Fair Poor
Main Posting 45 (45%) – 50 (50%)
Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.
Supported by at least three current, credible sources.
Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
40 (40%) – 44 (44%)
Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.
At least 75% of post has exceptional depth and breadth.
Supported by at least three credible sources.
Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
35 (35%) – 39 (39%)
Responds to some of the discussion question(s).
One or two criteria are not addressed or are superficially addressed.
Is somewhat lacking reflection and critical analysis and synthesis.
Somewhat represents knowledge gained from the course readings for the module.
Post is cited with two credible sources.
Written somewhat concisely; may contain more than two spelling or grammatical errors.
Contains some APA formatting errors.
0 (0%) – 34 (34%)
Does not respond to the discussion question(s) adequately.
Lacks depth or superficially addresses criteria.
Lacks reflection and critical analysis and synthesis.
Does not represent knowledge gained from the course readings for the module.
Contains only one or no credible sources.
Not written clearly or concisely.
Contains more than two spelling or grammatical errors.
Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness 10 (10%) – 10 (10%)
Posts main post by day 3.
0 (0%) – 0 (0%) 0 (0%) – 0 (0%) 0 (0%) – 0 (0%)
Does not post by day 3.
First Response 17 (17%) – 18 (18%)
Response exhibits synthesis, critical thinking, and application to practice settings.
Responds fully to questions posed by faculty.
Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.
Demonstrates synthesis and understanding of learning objectives.
Communication is professional and respectful to colleagues.
Responses to faculty questions are fully answered, if posed.
Response is effectively written in standard, edited English.
15 (15%) – 16 (16%)
Response exhibits critical thinking and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are answered, if posed.
Provides clear, concise opinions and ideas that are supported by two or more credible sources.
Response is effectively written in standard, edited English.
13 (13%) – 14 (14%)
Response is on topic and may have some depth.
Responses posted in the discussion may lack effective professional communication.
Responses to faculty questions are somewhat answered, if posed.
Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
0 (0%) – 12 (12%)
Response may not be on topic and lacks depth.
Responses posted in the discussion lack effective professional communication.
Responses to faculty questions are missing.
No credible sources are cited.
Second Response 16 (16%) – 17 (17%)
Response exhibits synthesis, critical thinking, and application to practice settings.
Responds fully to questions posed by faculty.
Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.
Demonstrates synthesis and understanding of learning objectives.
Communication is professional and respectful to colleagues.
Responses to faculty questions are fully answered, if posed.
Response is effectively written in standard, edited English.
14 (14%) – 15 (15%)
Response exhibits critical thinking and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are answered, if posed.
Provides clear, concise opinions and ideas that are supported by two or more credible sources.
Response is effectively written in standard, edited English.
12 (12%) – 13 (13%)
Response is on topic and may have some depth.
Responses posted in the discussion may lack effective professional communication.
Responses to faculty questions are somewhat answered, if posed.
Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
0 (0%) – 11 (11%)
Response may not be on topic and lacks depth.
Responses posted in the discussion lack effective professional communication.
Responses to faculty questions are missing.
No credible sources are cited.
Participation 5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days.
0 (0%) – 0 (0%) 0 (0%) – 0 (0%) 0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on 3 different days.
Total Points: 100
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Solution
Nursing Informatics: The Application of Data to Problem Solving
The scenario chosen in this case is that of a 72 year-old male patient in a nursing home who fell after getting out of bed to reach a bottle of water and losing balance. He broke his left femur and got a concussion as well. He is now incapacitated and his condition has worsened given that he is also suffering from major neurocognitive disorder or dementia (APA, 2013).
The data that could be used in the case of this patient is dashboard data on the number of patient falls in the nursing home per 1,000 patient stays, taken as an outcome measure. To access this data and collect it, one must have the rights to access the electronic health record (EHR) system of the nursing home (Alotaibi & Federico, 2017). This requires requesting the nurse informaticist to do this or having her provide a password for access (McGonigle & Mastrian, 2017). The dashboard metrics will be able to show the current rate of patient falls (falls per 1,000 patient stays) and compare it with an earlier period.
The knowledge that might be derived from the data in this case includes (i) the number of patients that have suffered falls within the last six months, one year, or any other period desired; (ii) the cost to the nursing home of treating the falls victims since the Centers for Medicare and Medicaid Services (CMS) no linger reimburses for healthcare services rendered to fall victims (Fehlberg et al., 2017); and (iii) the direct mortality figures attributable to accidental falls within the facility.
A nurse leader would use clinical reasoning and judgment in the formation of knowledge in the case of the above patient by analyzing the above data. This analysis will reveal trends that can then be used to inform the search for evidence-based interventions that can help reduce the accidental falls rate in the nursing home. Data alone means nothing. It must first be analyzed to derive knowledge and information from it. In this, the nurse manager needs to partner with the nurse informaticist to collect and collate this knowledge before presenting it for quality improvement (QI).
References
Alotaibi, Y., & Federico, F. (2017). The impact of health information technology on patient safety. Saudi Medical Journal, 38(12), 1173–1180. https://doi.org/10.15537/smj.2017.12.20631
American Psychiatric Association [APA] (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th ed. Author.
Fehlberg, E.A., Lucero, R.J., Weaver, M.T., McDaniel, A.M., Chandler, M., Richey, P.A., Mion, L.C., & Shorr, R. I. (2017). Impact of the CMS no-pay policy on hospital-acquired fall prevention related practice patterns. Innovation in Aging, 1(3), 1-7. http://dx.doi.org/10.1093/geroni/igx036
McGonigle, D., & Mastrian, K.G. (2017). Nursing informatics and the foundation of knowledge, 4th ed. Jones & Bartlett Learning.

Assignment: Policy /regulation fact sheet
Assignment: Policy/Regulation Fact Sheet
As a professional nurse, you are expected to apply your expertise to patient care. On occasion, you will also be expected to share that expertise.
With evolving technology and continuous changes to regulations designed to keep up these changes, there is usually a need to share information and expertise to inform colleagues, leadership, patients, and other stakeholders.
In this Assignment, you will study a recent nursing informatics-related healthcare policy, and you will share the relevant details via a fact sheet designed to inform and educate.
To Prepare:
Review the Resources on healthcare policy and regulatory/legislative topics related to health and nursing informatics.
Consider the role of the nurse informaticist in relation to a healthcare organization’s compliance with various policies and regulations, such as the Medicare Access and CHIP Reauthorization Act (MACRA).
Research and select one health or nursing informatics policy (within the past 5 years) or regulation for further study.
The Assignment: (1 page not including the title and reference page)
Create a 1-page fact sheet that your healthcare organization could hypothetically use to explain the health or nursing informatics policy/regulation you selected. Your fact sheet should address the following:
Briefly and generally explain the policy or regulation you selected.
Address the impact of the policy or regulation you selected on system implementation.
Address the impact of the policy or regulation you selected on clinical care, patient/provider interactions, and workflow.
Highlight organizational policies and procedures that are/will be in place at your healthcare organization to address the policy or regulation you selected. Be specific.
Use APA format and include a title page, in-text citations, and reference page.
Use the Safe Assign Drafts to check your match percentage before submitting your work.
By Day 5 of Week 11
Submit your completed Policy/Regulation Fact Sheet.
Excellent Good Fair Poor
Create a 1-page fact sheet that your healthcare organization could hypothetically use to explain the health or nursing informatics policy/regulation you selected. Your fact sheet should address the following:
· Briefly and generally explain the policy or regulation you selected.
· Address the impact of the policy or regulation you selected on system implementation.
· Address the impact of the policy or regulation you selected on clinical care, patient/provider interactions, and workflow.
· Highlight organizational policies and procedures that are/will be in place at your healthcare organization to address the policy or regulation you selected. Be specific.
77 (77%) – 85 (85%)
A fully developed and detailed Fact Sheet is provided for the Assignment.
The responses accurately and thoroughly explain in detail the policy and regulation selected.
The responses accurately and thoroughly explain in detail the impact of the policy or regulation selected on system implementation.
The responses accurately and thoroughly explain in detail the impact of the policy or regulation selected on clinical care, patient/provider interactions, and workflow.
Specific and accurate responses thoroughly highlight in detail the organizational policies and procedures that are/will be in place at a healthcare organization to address the policy or regulation selected.
Includes: 3 or more peer-reviewed sources and 2 or more course resources.
68 (68%) – 76 (76%)
A developed Fact Sheet is provided for the Assignment.
The responses explain the policy or regulation selected.
The responses explain the impact of the policy or regulation selected on system implementation.
The responses explain the impact of the policy or regulation selected on clinical care, patient/provider interactions, and workflow.
Accurate responses highlight the organizational policies and procedures that are/will be in place at a healthcare organization to address the policy or regulation selected.
Includes: 2 peer-reviewed sources and 2 course resources.
60 (60%) – 67 (67%)
A vague or inaccurate Fact Sheet is provided for the Assignment.
The responses explaining the policy or regulation selected are vague or inaccurate.
The responses explaining the impact of the policy or regulation selected on system implementation are vague or inaccurate.
The responses explaining the impact of the policy or regulation selected on clinical care, patient/provider interactions, and workflow are vague or inaccurate.
The responses highlighting the organizational policies and procedures that are/will be in place at a healthcare organization to address the policy or regulation selected are vague or inaccurate.
Includes: 1 peer-reviewed source and 1 course resource.
0 (0%) – 59 (59%)
A vague and inaccurate Fact Sheet is provided for the Assignment, or is missing.
The responses explaining the policy or regulation selected are vague and inaccurate, or are missing.
The responses explaining the impact of the policy or regulation selected on system implementation are vague and inaccurate, or are missing.
The responses explaining the impact of the policy or regulation selected on clinical care, patient/provider interactions, and workflow are vague and inaccurate, or are missing.
The responses highlighting the organizational policies and procedures that are/will be in place at a healthcare organization to address the policy or regulation selected are vague and inaccurate, or are missing.
Includes: 1 or fewer resources.
Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.
5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.
3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%- 79% of the time.
0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation 5 (5%) – 5 (5%) Uses correct grammar, spelling, and punctuation with no errors. 4 (4%) – 4 (4%) Contains a few (1-2) grammar, spelling, and punctuation errors. 3.5 (3.5%) – 3.5 (3.5%) Contains several (3-4) grammar, spelling, and punctuation errors. 0 (0%) – 3 (3%) Contains many (? 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list. 5 (5%) – 5 (5%) Uses correct APA format with no errors. 4 (4%) – 4 (4%) Contains a few (1-2) APA format errors. 3.5 (3.5%) – 3.5 (3.5%) Contains several (3-4) APA format errors. 0 (0%) – 3 (3%) Contains many (? 5) APA format errors. ORDER A PLAGIARISM-FREE PAPER HERE !! Solution 21st Century Cures Act The act was passed into law in December 2016. It works to cut the lengthy bureaucracies involved in progress of science, enhances data sharing and privacy protection of researchers, improves the support for next generation of biomedical researchers and increases funding to the National Health Institute for biomedical research initiatives (Hudson and Collins,2017). Impacts on System implementation The act seeks to enhance the use of electronic heath records by facilitating the exchange of data and records, access and the use of electronic heath information. Electronic health programs must be designed with interfaces to enhance data sharing, and tested for interoperability. To achieve this, the act will set out a Trusted Exchange Framework which will provide a common method of authenticating software, a common set of rules for trusted exchange of records, organizational and operational policies governing exchange between institutions, a process of fining non-compliant members and a directory of all health information networks incorporated in the program. The act has also increased funding to the National Health Institute (NHI) for several innovations like the BRAIN initiative and Precision Medicine Initiative (PMI) (Hudson and Collins,2017). The Impact of the 21st Century Cures Act on Clinical Care, Patient/Provider Interactions, and Workflow By ruling out the Paper Reduction Act, the act has speeded up the initiation of research in generation of new knowledge for clinical advancement The act has allowed scientists to share knowledge through scientific conferences, hence increasing the knowledge pool for clinical use (Reins, 2015). Act enhances monitoring of Antimicrobial resistance (Thompson et al,.2018). Advancement of research through sharing of data to several scientists through the online platforms (Grossman et al.,2016). Act provides guidelines for protection of the privacy of participants of scientific research Act enables data sharing through telemedicine and social media links between various users (Lye et al.,2018). Advances biomedical research by providing opportunities for young scientists Encourages diversity and inclusivity in the National Health Institute for Americans of all Stripes (Hudson and Collins,2017). Measures to Address the 21st Century Cures Act in my Organization The organization is allocating funds annually for research and innovations. The forms an evidence based approach for all the medical managements Organization uses telehealth and sharing of data within selected hospitals, hence increasing the diagnostic approach between varied specialists Data shared is well leveraged to protect the identity of our patients References Grossman, R. L., Heath, A. P., Ferretti, V., Varmus, H. E., Lowy, D. R., Kibbe, W. A., & Staudt, L. M. (2016). Toward a shared vision for cancer genomic data. New England Journal of Medicine, 375(12), 1109-1112. https://www.nejm.org/doi/full/10.1056/NEJMp1607591 Hudson, K. L., & Collins, F. S. (2017). The 21st Century Cures Act—a view from the NIH. New England Journal of Medicine, 376(2), 111-113. https://www.nejm.org/doi/full/10.1056/NEJMp1615745 Lye, C. T., Forman, H. P., Daniel, J. G., & Krumholz, H. M. (2018). The 21st Century Cures Act and electronic health records one year later: will patients see the benefits? Journal of the American Medical Informatics Association, 25(9), 1218-1220. https://academic.oup.com/jamia/article/25/9/1218/5060211?login=true Rein, L. (2015). How the federal travel crackdown hits scientists especially hard. Washington Post, 25. Thompson, R. M., Ferraro, M. J., & Hindler, J. A. (2018). Impact of 21st century cures act on breakpoints and commercial antimicrobial susceptibility test systems: progress and pitfalls. Journal of clinical microbiology, 56(5). ).https://jcm.asm.org/content/56/5/e00139-18.short

NURS 6630 WK 7 Discussion
Discussion: Treatment for a Patient with a Common Condition Insomnia is one of the most common medical conditions you will encounter as a PNP.
Insomnia is a common symptom of many mental illnesses, including anxiety, depression, schizophrenia, and ADHD (Abbott, 2016). Various studies have demonstrated the bidirectional relationship between insomnia and mental illness.
In fact, about 50% of adults with insomnia have a mental health problem, while up to 90% of adults with depression experience sleep problems (Abbott, 2016).
Due to the interconnected psychopathology, it is important that you, as the PNP, understand the importance of the effects some psychopharmacologic treatments may have on a patient’s mental health illness and their sleep patterns.
Therefore, it is important that you understand and reflect on the evidence-based research in developing treatment plans to recommend proper sleep practices to your patients as well as recommend appropriate psychopharmacologic treatments for optimal health and well-being.
Reference: Abbott, J. (2016). What’s the link between insomnia and mental illness? Health. https://www.sciencealert.com/what-exactly-is-the-link-between-insomnia-and-mental-illness#:~:text=Sleep%20problems%20such%20as%20insomnia%20are%20a%20common,bipolar%20disorder%2C%20and%20attention%20deficit%20hyperactivity%20disorder%20%28ADHD%29
Discussion, review the case Learning Resources and the case study excerpt presented.
Reflect on the case study excerpt and consider the therapy approaches you might take to assess, diagnose, and treat the patient’s health needs.
Case: An elderly widow who just lost her spouse.
Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits.
The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year.
Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle.
Patient currently takes the following medications:
Metformin 500mg BID
Januvia 100mg daily
Losartan 100mg daily
HCTZ 25mg daily
Sertraline 100mg daily
Current weight: 88 kg Current height: 64 inches Temp: 98.6 degrees F BP: 132/86
By Day 3 of Week 7 Post a response to each of the following:
List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.
Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.
List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.
List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.
For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on ethical prescribing or decision-making. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals based on ethical prescribing guidelines or decision-making?
Include any “check points” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.
NURS6630 WK 7 Discussion
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NURS6630 WK 7 Discussion
List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions
Since the demise of your spouse, how many hours of sleep do you get prior to when he was alive? Obtaining this information would facilitate a quality understanding of the cause of the insomnia. The PNP will gain understanding of whether the problem is as a result of psychiatric illness or psychosomatic.
What soothing activities that attract sleep do you participate? Understanding the relaxation methods that the patient uses would help the PNP to understand the appropriate medication for the patient.
What type of thoughts do you get during the night? Understanding what the patient feels and thinks about their life would help to understand the real cause of insomnia.
Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation
The patient care primary physician would be the first person that I would share with as a PNP. I would inform the physician of how the patient presented herself and the narrative she gave during the evaluation process.
The Primary care physician has the capability of providing their professional observations, knowledge and compliance concerning the medical treatment and adherence of healthy lifestyle (Patel, Steinberg & Patel, 2018).
The close friend of a patient or neighbor is the second person that I would inform. These are the individuals who clearly know how the patient behaves in private and public organizational setting.
They would inform me of behaviors such as irritability and withdrawal of the patient.
Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used
For the purpose of determining the patient orientation, attention/calculation, language and recall would be determined by the mini mental status examination.
These tests would help to determine the functionality of the patient in her particular stage of insomnia. A patient’s health questionnaire would also be the second mental status examination.
The questionnaire would play a significant role in determining the possibility of depression in the patient (Salvemini et al., 2019). Based on the results of the two examinations, the PNP would have an understanding of the appropriate medication therapy.
Differential diagnosis
Poor hygienic sleep- These are disturbances of sleep that impact the impairment of behaviors and clinical stress. In my opinion, the active depression episode experienced by the patient has caused the poor sleep hygiene. However, when the patient routinely follows the physician’s advice on the ways of inducing sleep, her symptoms progressively resolves.
Acute stress disorder- It is a reaction that is transient and expected to subside within a week’s period (Salvemini et al., 2019). The disorder engages a range of anxiety, mood and behavioral responses that portrays trauma.
Treatments
Bupropion (Wellbutrin) 100mg PO daily
Clonazepam 2.5mg PO qhs
The anxiolytic effect of clonazepam is the reason why it would be appropriate for the patient. It is a medication that belongs to the class of benzodiazepine.
This class of medication has been proven to have a prophylactic effect on recurrence depression. Recommending the patient, a 2.5mg of the medication per day and at night encourage the sleep episodes and reduction depression symptoms.
Contraindications
Insomnia patients suffering from comorbidities such as narrow angle glaucoma or liver disease are contraindicated for the usage of clonazepam usage. The liver plays a role in metabolization of clonazepam.
According to Abad & Guilleminault (2018), in absence of metabolism of medication by the liver, the medication accumulates resulting to sedation and distress to the patient. For people above the age of 65years, initial dosages required for them should be lower due to an increase in sensitivity.
The difficult issue in the prescription of this medication is its dependence for sleep. If the patient lacks any problem with the liver, the adverse risks are also minimal.
Therapeutic changes
Based on a four-week follow up of the medication through clinical visits, the medication dosage can either be increased, decreased or change the medication’s regimen.
My hope is that the patient will report an improved mood and sleep. Based on the side effects reported by the patient, I will consider adjusting the medications.
References
Abad, V. C., & Guilleminault, C. (2018). Insomnia in elderly patients: recommendations for
pharmacological management. Drugs & aging, 35(9), 791-817.
https://doi.org/10.1007/s40266-018-0569-8
Patel, D., Steinberg, J., & Patel, P. (2018). Insomnia in the elderly: a review. Journal of Clinical
Sleep Medicine, 14(6), 1017-1024. https://doi.org/10.5664/jcsm.7172
Salvemini, A., D’Onofrio, G., Ciccone, F., Greco, A., Tullio, A., Addante, F., … & Greco, A.
(2019). Insomnia and information and communication technologies (ICT) in elderly
people: a systematic review. Medical sciences, 7(6), 70.
https://doi.org/10.3390/medsci7060070