Healthcare Policy, Finance, and Regulatory Environments (review proposed legislation affecting health care and provide written comments; participate in advocating for change in policy related to a selected healthcare issue at the local, state, or national level
In what ways could an understanding of systems theory and complexity science impact the role of the NP?
Take a few minutes to reflect on the NP practice model that is most predominant in advanced practice environments you have observed. Are you satisfied with the demonstrated level of interprofessional collaboration?
Briefly consider what appears to be the driving practice model for advanced practice nursing in the state of Nebraska. If your state lags behind in its practice model language, what might you do to facilitate change?
What would be the key function for Humanitarian Work Psychology and nursing? How can you build this connection? It is important to build this connection to your career, as it can help you understand the workings of the healthcare industry.
Case study#4 chapters 14& 15 Chapter 14- Case Study Questions This activity contains 3 questions. An elderly patient presents to his physician’s office with a complaint of insomnia. The patient states he has trouble falling and then staying asleep. He has a history of hypertension and types 2 diabetes mellitus. He takes Lasix 20 mg daily for hypertension and controls his diabetes with a diet. 1. When obtaining the patient’s history, what information should the nurse look for as potential type and cause of insomnia? 2. The physician diagnoses the client with short-term insomnia. What nonpharmacologic causes and interventions should the nurse include in the education for this client? 3. How should the nurse respond when is, " Why can’t I just take a pill to help me sleep?"
You will investigate both a nervous system disorder and a musculoskeletal system disorder. This assignment has two parts. In part one, you will choose a nervous system disorder, and investigate the disorder, In part two you will choose a musculoskeletal disorder, investigate the disorder, and create a written description.
A researcher suspects that the actual prevalence of generalized anxiety among children and adolescents is higher than the previously reported prevalence of generalized anxiety disorder among children and adolescents. The previously reported prevalence of generalized anxiety disorder among children and adolescents is 4.1%, and the researcher conducts a study to test the accuracy of the previously reported prevalence of generalized anxiety disorder by recruiting 98 children and adolescents from various pediatricians’ offices and tests them for generalized anxiety disorder using the DSM-5. The researcher determines that the prevalence of generalized anxiety disorder among the participants of the study is 6.8%. Calculate the z value for the test statistic.
Reflect on the psychopharmacologic treatments you might recommend for assessing and treating patients with sleep/wake disorders.
Examine Case Study: Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.
At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.
Introduction to the case (1 page)
. Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
Decision #1 (1 page)
. Which decision did you select?
. Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
. Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
. Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #2 (1 page)
. Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
. Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
. Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #3 (1 page)
. Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
. Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
. Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Conclusion (1 page)
Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.
LEARNING RESOURCES
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders Links to an external site.(5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Fernandez-Mendoza, J., & Vgontzas, A. N. (2013). Insomnia and its impact on physical and mental health. Current Psychiatry Reports Links to an external site., 15(12), 418. https://doi.org/10.1007/s11920-012-0418-8
Levenson, J. C., Kay, D. B., & Buysse, D. J. (2015). The pathophysiology of insomnia. Chest Links to an external site., 147(4), 1179–1192. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4388122/
Morgenthaler, T. I., Kapur, V. K., Brown, T. M., Swick, T. J., Alessi, C., Aurora, R. N., Boehlecke, B., Chesson, A. L., Friedman, L., Maganti, R., Owens, J., Pancer, J., & Zak, R. (2007). Practice parameters for the treatment of narcolepsy and other hypersomnias of central origin. SLEEP Links to an external site., 30(12), 1705–1711. https://j2vjt3dnbra3ps7ll1clb4q2-wpengine.netdna-ssl.com/wp-content/uploads/2017/07/PP_Narcolepsy.pdf
Morgenthaler, T. I., Owens, J., Alessi, C., Boehlecke, B, Brown, T. M., Coleman, J., Friedman, L., Kapur, V. K., Lee-Chiong, T., Pancer, J., & Swick, T. J. (2006). Practice parameters for behavioral treatment of bedtime problems and night wakings in infants and young children. SLEEP Links to an external site., 29(1), 1277–1281. https://j2vjt3dnbra3ps7ll1clb4q2-wpengine.netdna-ssl.com/wp-content/uploads/2017/07/PP_NightWakingsChildren.pdf
Sateia, M. J., Buysse, D. J., Krystal, A. D., Neubauer, D. N., & Heald, J. L. (2017). Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: An American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine Links to an external site., 13(2), 307–349. https://jcsm.aasm.org/doi/pdf/10.5664/jcsm.6470
Winkleman, J. W. (2015). Insomnia disorder. The New England Journal of Medicine Links to an external site., 373(15), 1437–1444. https://doi.org/10.1056/NEJMcp1412740
Medication Resources
U.S. Food & Drug Administration. (n.d.). Drugs@FDA: FDA-approved drugs Links to an external site.. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm
Links to an external site.
Note: To access the following medications, use the Drugs@FDA resource. Type the name of each medication in the keyword search bar. Select the hyperlink related to the medication name you searched. Review the supplements provided and select the package label resource file associated with the medication you searched. If a label is not available, you may need to conduct a general search outside of this resource provided. Be sure to review the label information for each medication as this information will be helpful for your review in preparation for your Assignments.
alprazolam
amitriptyline
amoxapine
amphetamine
desipramine
diazepam
doxepin
eszopiclone
flunitrazepam
flurazepam
hydroxyzine
imipramine
lemborexant
lorazepam
melatonin
methylphenedate
modafinil
armodafinil
carnitine
clomipramine
clonazepam
nortriptyline
pitolisant
ramelteon
sodium oxybate
solriamfetol
SSRI’s
temazepam
trazodone
triazolam
trimipramine
wellbutrin
zaleplon
zolpidem
Review and respond to the below Discussion post
Valium is a benzodiazepine and is commonly used as a muscle relaxer or anti-anxiety medication. Benzodiazepines act to depress the central nervous system by increase the inhibitory effects of gamma-aminobutyric acid (GABA), the chief neuronal depressant found in the human body. Dizziness is a common side effect of CNS depression, where balance and awareness are compromised by sensory inhibition, these effects are known to worsen with age. The first pass effect is the extent to which the drug is destroyed or diluted prior to reaching its intended target in the body.(Nahler, 2022) Valium is metabolized by the liver, which significantly reduces the overall concentration that reaches target receptors, using different delivery routes, such as intravenous injection is one was to avoid this unwanted dilution. (Roche, 2008)
Diphenhydramine is a common ingredient in many over-the-counter cold remedies, and it is known to cause confusion, especially in older people, due to its anticholinergic effects. Acetylcholine is a prominent neurotransmitter in the brain, and anticholinergic medications, such as Benadryl, can cause inhibition resulting in confusion and short-term memory loss.(López-Álvarez et al., 2019)
Warfarin is metabolized in the kidneys and works to reduce the amount of vitamin K active in the body, thereby preventing the formation of clotting factors. Warfarin has a low molecular weight and is easily able to cross the placental barrier.(Patel et al., 2022)
Hepatic metabolism undergoes rapid changes in the first few weeks of life, with the body adjusting to a lack of maternal blood supply, as a result, “drug-metabolizing capacity by the liver enzymes is reduced in newborns particularly in premature babies but increases rapidly during the first few weeks and months of life.”(Drug Times, 2022, section 2) Many of the isoenzymes systems used in adult liver metabolism are immature at birth, with some, such as glucuronosyltransferase, no reaching adult levels until 3-6 months of age.(Lu & Rosenbaum, 2014a, Table 2)
Protein binding is reduced in neonates, which may allow for more active molecules to be absorbed at active sites, rather than to remain bound with proteins in the plasma. Due to a decreased overall number of available plasma proteins, as well a reduction in binding affinity, there are a likely high number of unbound drug molecules that are able to diffuse across membranes to active receptor sites. (Lu & Rosenbaum, 2014a)
References
Drug Times. (2022, December 19). Drug metabolism and clearance in neonates children and elderly – drug monitoring methods. https://www.drugtimes.org/monitoring-methods/drug-metabolism-and-clearance-in-neonates-children-and-elderly.html
López-Álvarez, J., Sevilla-Llewellyn-Jones, J., & Agüera-Ortiz, L. (2019). Anticholinergic drugs in geriatric psychopharmacology. Frontiers in Neuroscience, 13. https://doi.org/10.3389/fnins.2019.01309
Lu, H., & Rosenbaum, S. (2014a). Developmental pharmacokinetics in pediatric populations. The Journal of Pediatric Pharmacology and Therapeutics, 19(4), 262–276.
Lu, H., & Rosenbaum, S. (2014b). Developmental pharmacokinetics in pediatric populations. The Journal of Pediatric Pharmacology and Therapeutics, 19(4), 262–276. Retrieved January 4, 2022, from https://doi.org/10.5863/1551-6776-19.4.262
Nahler, G. (2022). First pass effect. Dictionary of Pharmaceutical Medicine, 75–75. https://doi.org/10.1007/978-3-211-89836-9_566
Patel, S., Singh, R., Patel, N., & Pruess, C. (2022). Warfarin. Statpearls. Retrieved January 4, 2022, from
Roche. (2008). 013263s083lbl [PDF]. U.S. Food and Drug Administration. Retrieved January 4, 2022, from https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/013263s083lbl.pdf
An advanced practice registered nurse (APRN) is talking with a legislator about the need for a primary care clinic in an underserved area. Which of the following point should the APRN include to gain the legislator’s support? Select all that apply. Access to a regular primary care provider improves chronic disease management Primary care reduces costs related to complications of untreated health conditions. APRNs are educated to provide the same level of care as primary care physicians.
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