Explain some of the challenges that these opportunities may present a


Post an explanation of at least two opportunities that currently exist for RNs and APRNs to actively participate in policy review. Explain some of the challenges that these opportunities may present and describe how you might overcome these challenges. Finally, recommend two strategies you might make to better advocate for or communicate the existence of these opportunities. Be specific and provide examples.

The Role of the RN/APRN in Policy Evaluation

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POST A: The first opportunity that exists for RNs and APRNs to actively participate in policy review is the professional organizations. There are various professional organizations for the RNs and APRNs (Ironside, 2015). Professional organizations such as the American Nurses Association, Emergency Nurses Association and the American Academy of Nursing can be used by nurses to review a certain policy. Professional organizations ensure that any policy that is implemented is effective and favors the nurses. It is during the review process that this is determined.

The second opportunity is through the workplace. The RNs and APRNs are professionals who have the responsibility and capacity to influence the existing and prospect healthcare delivery programs. The major role of the RNs and APRNs is to promote quality health. Through their workplace, RNs and APRNs stand a chance of influencing a policy review by ensuring that the policies promoted are effective in their places of work (Trueland, 2017). In case a given policy doesn’t promote quality care, the RNs and APRNs can decline it by writing a request for the policy to be reviewed. The workplace ensures that the policies proposed promotes quality care as it is the nurses who know what will work and what will not.

The professional organizations’ opportunity may present the challenge of a complex process when it comes to membership. According to research conducted by Sigma, many nurses have not joined the professional organizations due to the complexity involved in joining them. The challenge of complexity in the membership process can be overcome by establishing a simple and well-understood process that nurses should follow in joining professional organizations.  Some nursing associations are also not much radical due to poor leadership. The leadership in professional nursing associations needs to be reformed (Trueland, 2017).  

The opportunity of the workplace has its challenges too. First, some nurses are not updated on the policies that are being proposed and need their review. In such a case, the nurses need to be informed of the policy changes and the trending policies that are awaiting implementation (Trueland, 2017).  The workplace also has the challenge of disunity among nurses. It is about the time when nurses unite and focus on a common goal.  There is also the challenge of poor leadership which doesn’t give the nurses a chance to grow their leadership skills. The leaders in healthcare facilities should give a chance for all the nurses to expand their leadership skills and make them more confident to question all policies.

The two strategies that lead to better communication of the existence of these opportunities are training and good leadership (Ironside, 2015).  With effective training for the nurses, they can better understand their roles and work environment. Good leadership is crucial in ensuring that the nurses are given a chance to air their views regarding a given policy. It is also the leaders of an organization who determine whether the nurses will have a chance to review a given policy. Training and good leadership are the essential elements of a knowledgeable nursing team.

POST A  above is my response: below is a collegue responding to my post. I need assistance answering

Shannon,

You identify the challenges of getting involved in policy change and development. As you state, joining professional organization and getting involved in the workplace by influencing policy review. Based on your experience with pursuing advanced education, what steps do you believe are needed to encourage and support others to pursuit these goals? What education or training do you believe is most effective to prepare nurses to engage in the process of policy review or evaluation at all levels?

 POST B: How do nurses initially become involved in politics and specifically policy review?  It’s a great way additionally for a nurse to advocate for patient rights.  There are a couple of ways a nurse can become involved on a larger scale with reviewing policies. 

            One way to be involved in policy review is to become a member of your states nurses’ association.  In Colorado, elections are held annually for the Board of Directors and advertised on the Colorado Nurses Association (CNA) home page.  The positions are held for a two-year term, minus the President who is a three-year term.  The Board of Directors partner with the CNA Government Affairs & Public Policy Committee.  As a Nurse Legislator Liaison, you would work directly with Colorado’s 35 Senators and 65 Representatives (Colorado Nurses Association, n.d.). As a liaison, this would allow you to be a part of reviewing different healthcare policies.  A challenge encountered from serving for your state Board of Directors, is that it’s time-consuming.  If you already have a full-time job and a family, it would be challenging to devote the time to the board.  Instead of serving on the board, a nurse could volunteer their time when able, as long as you were a member.

            Another way to be involved in policy review is to either take on an internship with elected officials or to run for an office position.  Holding office can be on a local, state, or federal level.  Currently, two nurses are serving in Congress, Congresswoman Eddie Bernice Johnson (D-TX-30) and Congresswoman Lauren Underwood (D-IL-14) (American Nurses Association, n.d.).  Challenges to running for office may also include time and limited ability due to location.  Ideas to overcome these challenges would be to volunteer on a local level and attend community meetings. 

            Strategies to communicate these opportunities might include having meetings with local healthcare teams to let them know why it’s essential that they’re involved in policy making and review and how to become an advocate.  For nurses that are not members of their state nurses association, they could be notified of the additional benefits of becoming a member and how to get involved. 

POST C: There are a variety of ways nurses can become involved in the evaluation of policy-making.  The two most common areas are through professional organizations such as the American Nurses Association and their place of employment.  These are the easiest ways for nurses to get involved but there are others.  As stated in this weeks video The Importance of Program Evaluationevaluation is critical to understand and it is critical to think about outcomes when policies are first being developed. Nurses have a good idea of the problem and the potential solutions to those problems.  When policies are being crafted a wide variety of viewpoints is necessary to shape policy that will down the road change and become law or regulation.  

A good example of where this was on display was during the 2018 election in Massachusetts that targeted nursing ratios.  While the nursing union pushed for it, it struggled due to a wide variety of problems with the it.  The nursing union pushed the idea to state leaders to craft legislation.  As the bill was put on the ballot, other state and national organizations started to get involved.  Professional organizations started to dissect the legislative proposal and nurses talked amongst each other to better understand the impacts this will have on the profession. Oostveen (2015) discussed these types of initiatives in the past and determined that key areas that nurses evaluated was the impact of nursing autonomy, nursing authority, and nursing behavior. Many hospital systems in Massachusetts are unionized but not all of them.  The debate raged on from nursing and healthcare executives, physicians, and the public started to weigh in.  The most common way the the public got information was from nurses directly. Some favored it and some opposed it.  In the end, it was less about the politics and more about the outcome.  Would nurses have the same authority, autonomy, and behaviors if this was implemented.  The measure was struck down 75-25%. 

Courses such as this one have added incredible value to the policy process.  McGuire (2017) did research on 187 nursing students before and after taking a course such as this one. What they found was that new nurses coming into the profession had a greater awareness of policy making and tools to evaluate the effectiveness of the policy by going through courses such as this.  Politics is part of our lives regardless if you are political or not. Politics affects our jobs, costs, pay, and patient safety.  We should be part of the process and help develop tools to evaluate the effectiveness of a given policy and let our policy-makers know if the policy works or not.  

INSTRUCTIONS: POST B AND C  ABOVE ARE  CLASSMATES RESPOSE TO THE POST. I NEED ASSISTANCE TO RESPOND WITH FEEDBACK WITH ADDTIONAL INPUT OR QUESTIONS. 2 REFERENCE NEEDED



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Explain some of the challenges that these opportunities may present a


Post an explanation of at least two opportunities that currently exist for RNs and APRNs to actively participate in policy review. Explain some of the challenges that these opportunities may present and describe how you might overcome these challenges. Finally, recommend two strategies you might make to better advocate for or communicate the existence of these opportunities. Be specific and provide examples.

The Role of the RN/APRN in Policy Evaluation

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POST A: The first opportunity that exists for RNs and APRNs to actively participate in policy review is the professional organizations. There are various professional organizations for the RNs and APRNs (Ironside, 2015). Professional organizations such as the American Nurses Association, Emergency Nurses Association and the American Academy of Nursing can be used by nurses to review a certain policy. Professional organizations ensure that any policy that is implemented is effective and favors the nurses. It is during the review process that this is determined.

The second opportunity is through the workplace. The RNs and APRNs are professionals who have the responsibility and capacity to influence the existing and prospect healthcare delivery programs. The major role of the RNs and APRNs is to promote quality health. Through their workplace, RNs and APRNs stand a chance of influencing a policy review by ensuring that the policies promoted are effective in their places of work (Trueland, 2017). In case a given policy doesn’t promote quality care, the RNs and APRNs can decline it by writing a request for the policy to be reviewed. The workplace ensures that the policies proposed promotes quality care as it is the nurses who know what will work and what will not.

The professional organizations’ opportunity may present the challenge of a complex process when it comes to membership. According to research conducted by Sigma, many nurses have not joined the professional organizations due to the complexity involved in joining them. The challenge of complexity in the membership process can be overcome by establishing a simple and well-understood process that nurses should follow in joining professional organizations.  Some nursing associations are also not much radical due to poor leadership. The leadership in professional nursing associations needs to be reformed (Trueland, 2017).  

The opportunity of the workplace has its challenges too. First, some nurses are not updated on the policies that are being proposed and need their review. In such a case, the nurses need to be informed of the policy changes and the trending policies that are awaiting implementation (Trueland, 2017).  The workplace also has the challenge of disunity among nurses. It is about the time when nurses unite and focus on a common goal.  There is also the challenge of poor leadership which doesn’t give the nurses a chance to grow their leadership skills. The leaders in healthcare facilities should give a chance for all the nurses to expand their leadership skills and make them more confident to question all policies.

The two strategies that lead to better communication of the existence of these opportunities are training and good leadership (Ironside, 2015).  With effective training for the nurses, they can better understand their roles and work environment. Good leadership is crucial in ensuring that the nurses are given a chance to air their views regarding a given policy. It is also the leaders of an organization who determine whether the nurses will have a chance to review a given policy. Training and good leadership are the essential elements of a knowledgeable nursing team.

POST A  above is my response: below is a collegue responding to my post. I need assistance answering

Shannon,

You identify the challenges of getting involved in policy change and development. As you state, joining professional organization and getting involved in the workplace by influencing policy review. Based on your experience with pursuing advanced education, what steps do you believe are needed to encourage and support others to pursuit these goals? What education or training do you believe is most effective to prepare nurses to engage in the process of policy review or evaluation at all levels?

 POST B: How do nurses initially become involved in politics and specifically policy review?  It’s a great way additionally for a nurse to advocate for patient rights.  There are a couple of ways a nurse can become involved on a larger scale with reviewing policies. 

            One way to be involved in policy review is to become a member of your states nurses’ association.  In Colorado, elections are held annually for the Board of Directors and advertised on the Colorado Nurses Association (CNA) home page.  The positions are held for a two-year term, minus the President who is a three-year term.  The Board of Directors partner with the CNA Government Affairs & Public Policy Committee.  As a Nurse Legislator Liaison, you would work directly with Colorado’s 35 Senators and 65 Representatives (Colorado Nurses Association, n.d.). As a liaison, this would allow you to be a part of reviewing different healthcare policies.  A challenge encountered from serving for your state Board of Directors, is that it’s time-consuming.  If you already have a full-time job and a family, it would be challenging to devote the time to the board.  Instead of serving on the board, a nurse could volunteer their time when able, as long as you were a member.

            Another way to be involved in policy review is to either take on an internship with elected officials or to run for an office position.  Holding office can be on a local, state, or federal level.  Currently, two nurses are serving in Congress, Congresswoman Eddie Bernice Johnson (D-TX-30) and Congresswoman Lauren Underwood (D-IL-14) (American Nurses Association, n.d.).  Challenges to running for office may also include time and limited ability due to location.  Ideas to overcome these challenges would be to volunteer on a local level and attend community meetings. 

            Strategies to communicate these opportunities might include having meetings with local healthcare teams to let them know why it’s essential that they’re involved in policy making and review and how to become an advocate.  For nurses that are not members of their state nurses association, they could be notified of the additional benefits of becoming a member and how to get involved. 

POST C: There are a variety of ways nurses can become involved in the evaluation of policy-making.  The two most common areas are through professional organizations such as the American Nurses Association and their place of employment.  These are the easiest ways for nurses to get involved but there are others.  As stated in this weeks video The Importance of Program Evaluationevaluation is critical to understand and it is critical to think about outcomes when policies are first being developed. Nurses have a good idea of the problem and the potential solutions to those problems.  When policies are being crafted a wide variety of viewpoints is necessary to shape policy that will down the road change and become law or regulation.  

A good example of where this was on display was during the 2018 election in Massachusetts that targeted nursing ratios.  While the nursing union pushed for it, it struggled due to a wide variety of problems with the it.  The nursing union pushed the idea to state leaders to craft legislation.  As the bill was put on the ballot, other state and national organizations started to get involved.  Professional organizations started to dissect the legislative proposal and nurses talked amongst each other to better understand the impacts this will have on the profession. Oostveen (2015) discussed these types of initiatives in the past and determined that key areas that nurses evaluated was the impact of nursing autonomy, nursing authority, and nursing behavior. Many hospital systems in Massachusetts are unionized but not all of them.  The debate raged on from nursing and healthcare executives, physicians, and the public started to weigh in.  The most common way the the public got information was from nurses directly. Some favored it and some opposed it.  In the end, it was less about the politics and more about the outcome.  Would nurses have the same authority, autonomy, and behaviors if this was implemented.  The measure was struck down 75-25%. 

Courses such as this one have added incredible value to the policy process.  McGuire (2017) did research on 187 nursing students before and after taking a course such as this one. What they found was that new nurses coming into the profession had a greater awareness of policy making and tools to evaluate the effectiveness of the policy by going through courses such as this.  Politics is part of our lives regardless if you are political or not. Politics affects our jobs, costs, pay, and patient safety.  We should be part of the process and help develop tools to evaluate the effectiveness of a given policy and let our policy-makers know if the policy works or not.  

INSTRUCTIONS: POST B AND C  ABOVE ARE  CLASSMATES RESPOSE TO THE POST. I NEED ASSISTANCE TO RESPOND WITH FEEDBACK WITH ADDTIONAL INPUT OR QUESTIONS. 2 REFERENCE NEEDED



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Comparison and Contrast between Disruptive Mood Dysregulation Disorder and Intermittent Explosive Disorder


Comparison and Contrast between Disruptive Mood Dysregulation Disorder and Intermittent Explosive Disorder

Comparison and Contrast between Disruptive Mood Dysregulation Disorder and Intermittent Explosive Disorder

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Disruptive mood dysregulation disorder (DMDD) is a new condition that was added to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders to eliminate doubts about the over-diagnosis of bipolar disorder among adolescents and children. DMDD clinically presents itself in the form of severe and persistent irritability in the affected population.

The main signs of the condition include severe temper outbursts that recur and manifest through verbal rages or physical aggression, difficulties with emotional regulation, inability to tolerate frustrations, difficulties with behavioral self-control and distress intolerance (Parker & Tavella, 2018).

During comprehensive assessment, professional counselors must assess the frequency of outbursts and age of the patient. Correct diagnosis with the condition occurs when a child experiences outbursts for a minimum of three times every week over a period of one year and across two or more social settings including at home, in school or with their peers (Coccaro, 2018).

The child must also manifest anger or irritable behavior throughout the day to meet the diagnostic criteria. When assessing children for the condition, it is important for professional counselors to focus on those between the ages of six and eighteen. Furthermore, the onset of symptoms must be present before the child reaches ten.

In comparison to DMDD, intermittent explosive disorder (IED) is a disorder that manifests through anger outbursts expressed in the form of verbal attacks or physical aggression. Additionally, similar to DMDD, the anger manifested may cause damage of property or physical harm to other people or animals (Scott et al, 2020)

However, contrary to DMDD where the outbursts are a result of frustrations, stressors or distress, the temper outbursts in IED are not premeditated and occur without any trigger. A child with the listed signs meets the diagnostic criteria if they experience verbal rage or physical aggression for at least twice a week for a period of three months.

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The child must also exhibit three severe anger outbursts that cause damage of property or harm to people or animals over a period of 12 months. Furthermore, IED causes a functional impairment for the patient (Rynar & Coccaro, 2018) During assessment, professional counselors must focus on degree of aggressiveness, the frequency of occurrence of the outbursts and their impact both on the child and on those around them.

References

Coccaro, E. F. (2018). DSM-5 intermittent explosive disorder: relationship with disruptive mood dysregulation disorder. Comprehensive psychiatry84, 118-121. DOI:10.1016/j.comppsych.2018.04.011

Parker, G., & Tavella, G. (2018). Disruptive mood dysregulation disorder: a critical perspective. The Canadian Journal of Psychiatry63(12), 813-815. https://doi.org/10.1177/0706743718789900

Rynar, L., & Coccaro, E. F. (2018). Psychosocial impairment in DSM-5 intermittent explosive disorder. Psychiatry research264, 91-95. doi: 10.1016/j.psychres.2018.03.077

Scott, K. M., De Vries, Y. A., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., Bromet, E. J., … & De Jonge, P. (2020). Intermittent explosive disorder subtypes in the general population: association with comorbidity, impairment and suicidality. Epidemiology and psychiatric sciences29. DOI: https://doi.org/10.1017/S2045796020000517



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future PMHNP practice – Elite Custom Essays


I like the approach you have taken in this discussion post. Values are essential in ensuring competence in PMHNP practice. You have highlighted self-disclosure, experiencing counselling as a client and a desire to nurture others as your core values. A challenge experienced by therapists is whether to use their life experiences as a testimony to patients.

In cases where the patient and therapist have varying opinions on the same issue, self-disclosure might cause the patient to lose trust in the therapist. Other patients view self-disclosure as the therapist switching the attention of the session. Therapists must therefore understand individual patients before self-disclosure.

Nursing is a co

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mpassionate profession (Kumar et al., 2020). PMNHPs give hope and encouragement to psychiatric patients on their ability to heal to ensure their wellbeing. Mental health practitioners are exposed to patients’ trauma which leads to psychological problems (Ayar et al., 2021). They are encouraged to seek psychological help. Mentally unhealthy mental health practitioners cannot offer quality care to their patients.

References

Ayar, D., Karaman, M. A., & Karaman, R. (2021). Work-Life Balance and Mental Health Needs of Health Professionals During COVID-19 Pandemic in Turkey. International journal of mental health and addiction, 1–17. Advance online publication. https://doi.org/10.1007/s11469-021-00717-6

Kumar, A., Kearney, A., Hoskins, K., & Iyengar, A. (2020). The role of psychiatric mental health nurse practitioners in improving mental and behavioural health care delivery for children and adolescents in multiple settings. Archives of psychiatric nursing34(5), 275–280. https://doi.org/10.1016/j.apnu.2020.07.022

 

Second Discussion Response

You have highlighted that one of the most valuable tool a counsellor has is themselves. A counsellor’s personality, genuineness, authenticity and self-awareness affect patient outcomes. Therapists must maintain a healthy and professional relationship with their patients (Gergov et al., 2021). A therapist must practice self-awareness is to ensure a healthy mental state. Therapists must also take part in self-care activities that improve their mental health

The presence of a healthy and psychologically stable therapist translates to his practice. Some therapists tend to seek therapy from clients by sharing their life challenges. Therapists use communication techniques such as humour to improve a patient’s mood without deflecting from the existing problem (Akimbekov & Razzaque, 2021).

References

Akimbekov, N. S., & Razzaque, M. S. (2021). Laughter therapy: A humour-induced hormonal intervention to reduce stress and anxiety. Current research in physiology4, 135–138. https://doi.org/10.1016/j.crphys.2021.04.002

Gergov, V., Marttunen, M., Lindberg, N., Lipsanen, J., & Lahti, J. (2021). Therapeutic Alliance: A Comparison Study between Adolescent Patients and Their Therapists. International journal of environmental research and public health18(21), 11238. https://doi.org/10.3390/ijerph182111238

 

 



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Ethical and Legal Implications of Prescribing Drugs HV


Ethical and Legal Implications of Prescribing Drugs HV

Assignment: Ethical and Legal Implications of Prescribing Drugs
What type of drug should you prescribe based on your patient’s diagnosis? How much of the drug should the patient receive? How often should the drug be administered? When should the drug not be prescribed? Are there individual patient factors that could create complications when taking the drug? Should you be prescribing drugs to this patient? How might different state regulations affect the prescribing of this drug to this patient?

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These are some of the questions you might consider when selecting a treatment plan for a patient.

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As an advanced practice nurse prescribing drugs, you are held accountable for people’s lives every day. Patients and their families will often place trust in you because of your position. With this trust comes power and responsibility, as well as an ethical and legal obligation to “do no harm.” It is important that you are aware of current professional, legal, and ethical standards for advanced practice nurses with prescriptive authority. Additionally, it is important to ensure that the treatment plans and administration/prescribing of drugs is in accordance with the regulations of the state in which you practice. Understanding how these regulations may affect the prescribing of certain drugs in different states may have a significant impact on your patient’s treatment plan. In this Assignment, you explore ethical and legal implications of scenarios and consider how to appropriately respond.

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To Prepare
Review the Resources for this module and consider the legal and ethical implications of prescribing prescription drugs, disclosure, and nondisclosure.
Review the scenario assigned by your Instructor for this Assignment.
Search specific laws and standards for prescribing prescription drugs and for addressing medication errors for your state or region, and reflect on these as you review the scenario assigned by your Instructor.
Consider the ethical and legal implications of the scenario for all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.
Think about two strategies that you, as an advanced practice nurse, would use to guide your ethically and legally responsible decision-making in this scenario, including whether you would disclose any medication errors.
By Day 7 of Week 1
Write a 2- to 3-page paper that addresses the following:

Explain the ethical and legal implications of the scenario you selected on all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.
Describe strategies to address disclosure and nondisclosure as identified in the scenario you selected. Be sure to reference laws specific to your state.
Explain two strategies that you, as an advanced practice nurse, would use to guide your decision making in this scenario, including whether you would disclose your error. Be sure to justify your explanation.
Explain the process of writing prescriptions, including strategies to minimize medication errors.
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The College of Nursing Writing Template with Instructions provided at the Walden Writing Center offers an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.



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Advanced Pharmacology Week 6 Alzheimers Disease


Advanced Pharmacology Week 6 Alzheimers Disease

Mr. Akkad is a 76 year old Iranian male who is brought to your office by his eldest son for “strange behavior.” Mr. Akkad was seen by his family physician who ruled out any organic basis for Mr. Akkad’s behavior. All laboratory and diagnostic imaging tests (including CT-scan of the head) were normal.

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According to his son, he has been demonstrating some strange thoughts and behaviors for the past two years, but things seem to be getting worse. Per the client’s son, the family noticed that Mr. Akkad’s personality began to change a few years ago. He began to lose interest in religious activities with the family and became more “critical” of everyone. They also noticed that things he used to take seriously had become a source of “amusement” and “ridicule.”

Over the course of the past two years, the family has noticed that Mr. Akkad has been forgetting things. His son also reports that sometimes he has difficult “finding the right words” in a conversation and then will shift to an entirely different line of conversation.

SUBJECTIVE

During the clinical interview, Mr. Akkad is pleasant, cooperative and seems to enjoy speaking with you. You notice some confabulation during various aspects of memory testing, so you perform a Mini-Mental State Exam. Mr. Akkad scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall. The score suggests moderate dementia.

MENTAL STATUS EXAM

Mr. Akkad is 76 year old Iranian male who is cooperative with today’s clinical interview. His eye contact is poor. Speech is clear, coherent, but tangential at times. He makes no unusual motor movements and demonstrates no tic. Self-reported mood is euthymic. Affect however is restricted. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. He is alert and oriented to person, partially oriented to place, but is disoriented to time and event [he reports that he thought he was coming to lunch but “wound up here”- referring to your office, at which point he begins to laugh]. Insight and judgment are impaired. Impulse control is also impaired as evidenced by Mr. Akkad’s standing up during the clinical interview and walking towards the door. When you asked where he was going, he stated that he did not know. Mr. Akkad denies suicidal or homicidal ideation.

Diagnosis: Major neurocognitive disorder due to Alzheimer’s disease (presumptive)

Advanced Pharmacology Nurs 6521
Advanced Pharmacology Nurs 6521

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Solution

Advanced Pharmacology Nurs 6521

Introduction

The case study focuses on Mr. Akkad a 76-year-old Iranian man who was diagnosed with major neurocognitive disorder due to Alzheimer’s disease (presumptive). The MMSE score for the client was 18/30 indicating moderate dementia. This paper, therefore, aims to make three decisions on the mediations to prescribe to the client. In addition, the ethical considerations likely to affect communication and the treatment plan for the client will be discussed.

Decision Point One

The first pharmacological agent that was selected for the client is to begin Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg orally BID in 2 weeks. The rationale for selecting rivastigmine is due to the medication’s efficacy in treating dementia and Alzheimer’s Disease. According to Su et al (2015), pathological changes associated with dementia of Alzheimer type include deficits in cholinergic neuronal pathways. Accordingly, the rivastigmine works by enhancing the cholinergic function by stopping the breakdown of acetylcholine. This improves the synaptic transmissions within the brain and thus improves memory as well as other cognitive functions (Kandiah et al, 2017). Because the client has dementia of Alzheimer type, he has low quantities of acetylcholine in the brain and thus rivastigmine will improve the symptoms the client is manifesting. Additionally, Birks et al (2015) explain that FDA recommended that the initial dose should be 1.5 mg BID and if the client does not experience significant side effects and tolerates the initial dose well after taking rivastigmine for two weeks, the dose should be increased to 3 mg BID.

Selection of this decision expected that the cognitive performance, behavior, function, as well as the ability to conduct activities of daily living for the client,  would improve. This is because the efficacy of Exelon (rivastigmine) in treating has been demonstrated in several studies (Kandiah et al, 2017).

However, the expected outcome and the actual outcome of the first decision were different. This is because there was no symptom improvement as the son reported and also there was no change in the MMSE score. The lack of symptom improvement can be attributed to the low dose of rivastigmine prescribed to the client. The low dose of rivastigmine did not avail adequate levels of acetylcholine in the brain that could have led to symptom improvement (Kandiah et al, 2017).

Decision Point Two

The second decision that was selected is to have the rivastigmine dose increased to 4.5 mg orally BID. The reason for increasing the dose is because evidence indicates that an increased dose of rivastigmine has higher efficacy for people with Alzheimer’s Disease (Stahl, 2014). Evidence has shown that the efficacy of rivastigmine is dose-dependent when it comes to symptoms such as activities of daily living, cognitive functions, and global functioning. Therefore, it is expected that an increased dose will be more effective (Su et al, 2015).

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The decision to increase the dose to 4.5 mg orally BID hoped that the cognitive function and other symptoms for this client would improve. It was also expected that the client would tolerate the higher dose well (Birks et al, 2016).

The actual outcome of the selected decision and the expected outcome were relatively similar. This is because the client manifested slight symptom improvement as evidenced by his attendance to religious service with the family. This shows that the increased dose of rivastigmine led to symptom improvement for the client, however slight (Kandiah et al, 2017). Moreover, as anticipated, the client tolerated the increased dose well as he did not report any side effect with the higher dose.

Decision Point Three

The last decision was to have the rivastigmine dose increased to 6 mg orally BID. As aforementioned, higher dose of rivastigmine increases the amount of acetylcholine within the brain and thus increases the efficacy of the medication (Sadowsky et al, 2015).

The decision to increase the dose to 6 mg orally BID hoped that there will be notable symptom improvement for the client, especially with the cognitive functioning and the capacity to carry out activities of the daily living. A study performed by Su et al (2015) showed that the administration of higher doses of rivastigmine to people with Alzheimer’s disease led to better symptom improvement especially symptoms such as cognitive functioning and the capacity to carry out activities of daily living. Since cholinesterase inhibitors like rivastigmine can only improve symptoms and not reverse the generative process, it will be important to educate the client and the son as well about how the medication works (Stahl, 2014).

Another expectation was that the client would still tolerate the increased dose of rivastigmine and thus will not experience significant side effects.

Ethical Considerations

Ethical considerations applicable to this client involve capacity determination, the ability of the client to make treatment decisions, and informed consent as well. In regard to capacity determination and the ability to make treatment decisions, symptoms of Alzheimer’s disease and dementia such as impairment in the cognitive functioning may hamper the ability of the client to understand and make treatment decisions (Fields & Calvert, 2015). In addition, it will be important for the PMHNP to explain to the client and the son about all the available treatment choices in order to enable them to make an informed decision (Fields & Calvert, 2015).

Conclusion

The initial medication that was selected is Exelon (rivastigmine) 1.5 mg. This is because the medication works by improving the cholinergic function and thus improves symptoms like cognitive functioning. With this decision, the client did not report any symptom improvement. Therefore, the second decision was to increase the dose of rivastigmine to 4.5 mg and the client showed some symptom improvement as he started attending religious functions with the family. The last decision was also to increase the dose to 6 mg orally BID. The increased dose aimed to increase the efficacy of the medication because higher-doses of rivastigmine are associated with increased efficacy. The ethical considerations applicable to this client encompass capacity determination, the ability of the client to make treatment decisions, and the informed consent.

References

Birks J, Chong L & Grimley J. (2015). Rivastigmine for Alzheimer’s disease. Cochrane Database of Systematic Reviews. 9(2).

Farlow M, Grossberg G, Sadowsky C, Meng X & Somogyi M. (2013). A 24-Week, Randomized, Controlled Trial of Rivastigmine Patch 13.3 mg/24 h Versus 4.6 mg/24 h in Severe Alzheimer’s Dementia. CNS Neurosci Ther. 19(10): 745–752.

Fields L & Calvert J. (2015). Informed consent procedures with cognitively impaired patients: A review of ethics and best practices. Psychiatry and Clinical Neurosciences. 1(69): 462–471.

Kandiah N, Pai M, Looi I, Ampil E, Park K, Karanam A & Christopher S. (2017). Rivastigmine: the advantages of dual inhibition of acetylcholinesterase and butyrylcholinesterase and its role in subcortical vascular dementia and Parkinson’s disease dementia. Clin Interv Aging. 1(12), pp: 697–707.

Sadowsky C, Micca J, Grossberg G & Velting D. (2014). Rivastigmine From Capsules to Patch: Therapeutic Advances in the Management of Alzheimer’s Disease and Parkinson’s Disease Dementia. Prim Care Companion CNS Disord. 16(5).

Stahl, S. M. (2014). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

Su J, Liu Y, Liu Y & Ren L. (2015). Long-term effectiveness of rivastigmine patch or capsule for mild-to-severe Alzheimer’s disease: a meta-analysis. Expert Rev Neurother.



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The Postanesthesia Care Unit – Elite Custom Essays


Mrs. Miyagi, a Japanese American, has been admitted to your care from the postanesthesia care unit after having undergone a major surgical procedure. She refuses pain medicine, although she appears to be in pain. As the hours pass, Mrs. Miyagi continues to refuse pain medication, so eventually the nurses stop asking.

■ Do you assume that she is experiencing no pain?

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■ Are you or the other nurses stereotyping her for her cultural response to pain?

■ What would you do?

■ make list of assessment questions for Mr. Yang to determine potential problems and subsequent interventions.

200 words

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Expert Answer

ANSWER 1) She is experiencing pain but she is not telling because she don’t want to use medi………PURCHASE TO GET THE FULL ANSWER

The Three Main Types Of Research Designs



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Discuss your rationale for the interventions identified.


observe the simulated “Home Visit With Sallie Mae Fisher” video (http://lc.gcumedia.com/zwebassets/courseMaterialPages/nrs410v_vp01Alt.php).

Refer to “Sallie Mae Fisher’s Health History and Discharge Orders” for specifics related to the case study used to inform the assignment.

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Using “Home Visit With Sallie Mae Fisher” and “Sallie Mae Fisher’s Health History and Discharge Orders,” complete the following components of this assignment:

Essay Portion

After viewing the home visit, write an essay of 500-750-words in which you do the following:

  1. Identify,      prioritize, and describe at least four problems.( problems identify are as follows

Mrs. Fisher’s number one problem is dehydration. In the video her vital signs are: Heart rate 58, blood pressure 90/56, respiratory rate 24 and temperature 97.8F (GCU, 2017). Her physical assessment reveals poor skin turgor, tenting, dry mucus membranes, hypoactive bowel sounds, no bowel movement for three days and a 14 pound weight loss in one week (GCU, 2017). She admits to “not having an appetite.” She is taking Lasix, a diuretic further contributing to her fluid loss.  All of these finding are consistent with dehydration. Dehydration can lead to a kidney injury, seizures and hypovolemic shock (Mayo Clinic, 2017). 

The next problem is an unsafe living environment. In in video we see a loose rug on the floor, prescriptions on the table and mail on the couch. This lack of organization and Mrs. Fisher’s age put at risk for a fall. The Center for Disease Control and Prevention (CDC) states, “One out of five falls in an older adult causes a serious injury such as broken bones or a head injury” (CDC, 2017).

Then we look at her lack of understanding surround her discharge. She is supposed to be on home oxygen but didn’t have it delivered because she thinks she will, “Be in the poor house” due to cost of her medications and medical supplies. The final problem is her depression. Mrs. Fisher explains her husband died. She now lives alone and, “doesn’t even care, is so lonesome and misses him so” (GCU, 2017). 

  1. Provide      substantiating evidence (assessment data) for each problem identified.
  2. Identify      and describe at least four medical and/or nursing interventions.
  3. Discuss      your rationale for the interventions identified.

Prepare this step of the assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

Scripted Dialogue Portion

Utilizing the information learned from the home visit, health histories, and discharge orders, write a scripted dialogue in which you provide Sallie Mae with education that describes her problems and the interventions identified to improve her condition. Consider Sallie Mae’s physiological, psychosocial, educational, and spiritual needs when developing your dialogue.

Your dialogue should resemble a script. The following is an example of a few sentences from a scripted dialogue:

Nurse: “Good morning, Salle Mae, my name is ______ and I will be your nurse today. I understand you are experiencing problems with ________.”

APA format is not required for this part of the assignment, but solid academic writing is expected.

Refer to “Home Visit With Sallie Mae Fisher Grading Criteria.”

Entire Assignment

You are required to submit this assignment to Turnitin. Refer to the directions in the Student Success Center. Only Word documents can be submitted to Turnitin.

NRS410V.R.SallieMaeFishersHealthHistoryandDischargeOrders_Student_02-11-13.docxNRS410V.R.HomeVisitWithSallieMaeFisherGradingCriteria_Student_02-11-13.docx



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Evaluate the planning and implementation of evidence-based interventions used to address a health care issue


 Practicum Learning Objectives

Life is a succession of lessons which must be lived to be understood.

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—Ralph Waldo Emerson

The practicum experience provides a significant hands-on opportunity to cultivate your professional growth and development. This course includes a 216-hour practicum as part of the 1,000 clinical hours that are required for the DNP credential.

During your practicum experience for this course, you will cultivate effective interactions to promote the implementation, evaluation, and dissemination of an evidence-based project. In addition, you should pay close attention to the role of leadership in such endeavors and reflect on your own development of leadership competencies, including skillful communication. As you do this, also think about how you may meaningfully contribute to the organization during your remaining time in the setting.

This week you prepare for the practicum experience by developing a plan, including learning objectives and activities. (This is addressed in this week’s Discussion as well).

To prepare:

  • Think      about learning objectives that will guide your practicum hours, as well as      the activities you will undertake to achieve those objectives. Draft three      learning objectives that are related to the AACN Essentials, your practice area specialty competencies,      and the focus of this course (see course outcomes below).
  • Develop      a timeline for your practicum experience.

Complete by Friday May 31, 2019 before 10 pm America/New York time

Write a 2-page paper in APA format with at least 3 scholarly references that includes the level one headers as numbered below: (refer to the DNP Essential IV in the attached file named “AACN 2006 DNP Essential” to write the objectives).

1) Three learning objectives for your practicum hours that are aligned to the AACN Essentials, your specialty area competencies, and the focus of this course (i.e., implementation, evaluation, and dissemination of an evidence-based project).

2) Key leadership and other activities you will undertake to fulfill your identified learning objectives

3) A proposed timeline for accomplishing your practicum hours (please divide 216 hours over a ten weeks period).

Required Readings

The Learning Management Corporation. (n.d.). Developing clear learning outcomes and objectives. Retrieved from http://www.thelearningmanager.com/pubdownloads/developing_clear_learning_outcomes_and_objectives.pdf

Osters, S., & Tiu, F. S. (n. d.). Writing measurable learning outcomes. Retrieved from http://www.gavilan.edu/research/spd/Writing-Measurable-Learning-Outcomes.pdf

Course Outcomes

By the conclusion of this course, you should be able to:

  • Synthesize      principles of evidence-based practice and appropriate theoretical      frameworks in order to evaluate the interventions utilized to address a      health care problem at the aggregate, systems, or organizational level
  • Evaluate      the planning and implementation of evidence-based interventions used to      address a health care issue
  • Appraise      the evaluation process of implemented evidence-based interventions to      address health care issues at the aggregate, systems, or organizational      level
  • Engage      in the scholarly dissemination of evidence-based practice activities that      promote quality and improved health outcomes
  • Demonstrate      leadership skills during the practicum experience that demonstrate      advanced nursing practice knowledge



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