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
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

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 the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities?

TOPIC: Health Promotion in cardiovascular diseases. 

4-6 pages including references but no initial page. 

To cover the following topics:

1. Assignment meets all expectations with exceptional depth and breath. A comprehensive purpose statement delineates all requirements of the assignment.

2. Demonstrates the ability to evaluate, apply and integrate key assignment concepts.

3.Synthesizes and justifies (defends, explains, validates, confirms) information gleaned from sources to support major points presented. Uses 3 credible resources for the assignment, including at least 1 scholarly peer-reviewed resource.

4. Uses correct grammar, spelling, and punctuation with no errors. Uses correct APA format with no errors.

Discuss the benefits of qualitative versus quantitative research

·         250-word minimum

·         At least 2 outside scholarly reference is required besides the course textbook .

·         Must answer the discussion question and address the topic in the reply

        post.

Must respond to 1 other discussion question. Reply must be a minimum of 100 w

Turnit it similarity maximum 20%

In clinical settings, some of the most common questions that patients ask are Why do I have this? What caused this disorder? Will it ever go away? These emotional questions can be difficult to ask and to answer. However, for patients to come to terms with their diagnoses and adhere to treatment plans, they must have an understanding of factors that might have caused, or continue to impact, their disorders. As an advanced practice nurse, it is important that you are able to explain disorders, associated alterations and symptoms, and changes that might occur within your patients’ bodies.

To Prepare

• Review this week’s media presentation with Dr. Terry Buttaro. Reflect on the importance of developing an in-depth understanding of pathophysiology.
• Select a disorder from the following list:
  • Adrenal insufficiency (Addison’s disease)
  • Atherosclerosis
  • Cholelithiasis (gallstones)
  • Colon cancer
  • Cystic fibrosis
  • Hemophilia
  • Nephrolithiasis (kidney stones)
  • Osteoporosis
  • Parkinson’s disease
  • Tuberculosis
• Select one of the following patient factors: genetics, gender, ethnicity, age, or behavior. Reflect on how that factor might impact your selected disorder, as well as potential associated alterations and symptoms.
• Identify the pathophysiology of the associated alterations, including the normal and altered cellular function. Consider both intra- and extra-cellular changes that occur.

Post a brief description of a patient scenario involving the disorder and the factor you selected. Explain how the factor might impact your selected disorder, as well as potential associated alterations and symptoms. Finally, explain the pathophysiology of the associated alterations, including changes in cellular function.

 Please do colon cancer 

• Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.
• Develop a PICO(T) question to address the clinical issue of interest you identified in Module 2 for the Assignment. This PICOT question will remain the same for the entire course.
• Use the key words from the PICO(T) question you developed and search at least four different databases in the Walden Library. Identify at least four relevant systematic reviews or other filtered high-level evidence, which includes meta-analyses, critically-appraised topics (evidence syntheses), critically-appraised individual articles (article synopses). The evidence will not necessarily address all the elements of your PICO(T) question, so select the most important concepts to search and find the best evidence available.
• Reflect on the process of creating a PICO(T) question and searching for peer-reviewed research.

The Assignment (Evidence-Based Project)

Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews

Create a 6- to 7-slide PowerPoint presentation in which you do the following:

• Identify and briefly describe your chosen clinical issue of interest.
• Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest.
• Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.
• Provide APA citations of the four relevant peer-reviewed articles at the systematic-reviews level related to your research question. If there are no systematic review level articles or meta-analysis on your topic, then use the highest level of evidence peer reviewed article.
• Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples.

Job burnout is a state of physical or emotional exhaustion that also involves a sense of reduced accomplishment and loss of personal identity (Mayo Clinic Staff, 2018).  Nursing burnout/turnover is negatively impacting healthcare at a national level. With recent reports of pervasive “burnout” and depression among healthcare professionals and the pressure that many influential healthcare organizations exert on clinicians to deliver high-quality, safe care under increasingly heavy patient loads, the use and teaching of EBP may be key not only to providing outstanding care to patients and saving healthcare dollars, but also to reducing the escalating turnover rate in certain healthcare professions (Melnyk & Fineout-Overholt, 2018). This is devastating, yet important, due to the impact this has on patient care and safety.  This being said, my topic of nurse burnout/turnover formed into a PICO(T) question is:

P: Registered Nurse’s in the ED

I: Nurse burnout and turnover rate

C: Other areas of nursing

O: Patient safety and satisfaction

Question: Does Registered Nurse burnout/turnover in the ED impact patient safety and satisfaction?

Databases and Results

When searching for this topic the databases used were MEDLINE, PubMed, and EBSCO through the Walden Library.  The search terms used for MEDLINE and PubMed were nurse burnout narrowing the search to 5 years, humans, journal article, English, and full text.  That generated approximately 813 articles.  After incorporating the Boolean terms AND nurse turnover, it then narrowed the search articles to 402.  Through the Walden Library, the search terms nurse burnout in the ED were used, narrowing to peer-reviewed only and full text.  This generated 8 articles.  To improve these results strategies such as incorporating more Boolean terms, using more specific search terms, and trialing more databases could benefit in a more efficient and effective search.

Conclusion

Clinicians with burnout may have impaired attention, memory, and executive function that decrease their recall and attention to detail placing them and their patients at higher risk for errors and safety (Heath, 2018).  Happy and healthy employees promote happy and healthy patients.  This topic is in need of clinical inquiry at a national level, but also where this nurse is employed.  The turnover rate has been significantly increased where this nurse is employed, leading to short staffing, thus increased workload and unhappy patients.  This kind of work environment is unsafe and warrants change not only for the healthcare professionals sake, but more importantly the patients sake.

References

Heath, S. (2018, September 5). How does provider burnout impact patient care quality, care access? Retrieved from https://patientengagementhit.com/news/how-does-provider-burnout-impact-patient-care-quality-care-access

Mayo Clinic Staff. (2018, November 21). Know the signs of job burnout. Retrieved from https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/burnout/art-20046642

Melnyk, B., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare (4th ed.). Philadelphia, PA: Wolters Kluwer.

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