A 47-year-old overweight male with a history of atherosclerosis, diabetes mellitus type 2, and coronary artery disease (CAD) is found by a neighbor unconscious and not breathing in his front lawn where he appears to have been mowing his lawn. He is rushed to a local emergency room where it is determined that he has suffered a massive inferior myocardial infarction. He is sent to the intensive care unit in critical condition where he is placed on advanced life support equipment, and several days later it is determined that he has minimal brain activity.

In your initial post answer the following question:

1. After hearing her husband’s condition, his tearful wife asks you how it is possible her husband’s brain might not function if it was his heart that stopped beating. How would you answer?
2. As the next of kin, his wife has the right to make husband’s medical decisions when he is unable to. Because the length of time that this patient was in cardiac arrest appears to have been substantial, the patient’s recovery is highly unlikely. The medical staff gently informs the wife that she has to make a decision regarding his health care: she can withdraw care now or choose to do everything to keep him alive, even though he will most likely die. She asks you what you think she should do. With your knowledge of neurophysiology, how would you answer her?

• 4-6-page argumentative essay on a topic of your choice.
  An argumentative (or persuasive) essay is used to try and change people’s viewpoints or to convince them to accept a new behavior or action. People seldom agree on what is right, so a well-developed and supported argumentative essay can help uncover truth. This type of essay can help you think critically about your own ideas, evaluate different sides, and judge the evidence.
  In professional environments, you may be asked to help gain employee buy-in for changes to a dress code, benefits or compensation, procedures, and so on. You will need to be able to present these changes in a way that will make it easier for everyone to accept them.
  Developing a draft is your chance to see how well you have organized your thoughts. After you write your draft, take a moment to look critically at what you have written. Does your essay say what you wanted it to say? Will a reader understand what you are saying? Do you have a strong thesis statement? Is your argument solid? Have you provided supporting evidence? These are just some of the questions to consider as you work on this assessment. The assessment you submit should be the final version of your essay.
  Note: The assessments in this course build on each other and must be taken in sequence. Assessment 6 is paired with Assessment 7. You must complete Assessment 6 and receive feedback from faculty before you complete Assessment 7.
  Demonstration of Proficiency
  By successfully completing this assessment, you will demonstrate your proficiency in the course competency through the following assessment scoring guide criteria:
  • Competency 2: Apply information and use literacy skills to produce evidence-based written work. 
    • Integrate relevant supporting references from scholarly sources.
  • Competency 3: Apply prewriting, planning, drafting, and revision skills. 
    • Apply accepted conventions of editing and revision.
  • Competency 4: Apply accepted style conventions and written expression skills. 
    • Use accepted methods for arguing an issue.
    • Write content clearly and logically with correct use of APA format, grammar, punctuation, and mechanics.
  • Overview
    In Assessment 6, you developed an outline as part of the prewriting process to help you organize and prepare to write your argumentative essay. In this assessment, you will use that outline, along with the feedback you received from your faculty, to draft and revise the complete essay.
    Instructions
    Write a 4–6-page argumentative essay on a topic of your choice. Your essay should include the following:
  • Develop a draft of your argumentative essay. Be sure you: 
    • Clearly identify your topic. 
      • Think about who your reader is and what you hope to accomplish.
  • Provide academic research, statistics, and other evidence to support your argument.
  • Identify 3–4 main points you want to make that support your argument.
  • Write a clear introductory paragraph, thesis statement, and conclusion.
  • Use relevant evidence to support your statements.
  • Re-read your essay before you submit: 
    • Are there any grammatical or mechanical errors?
    • Are there any typos?
    • Is your writing style clear and concise?
    • Do you have a clear thesis statement and introduction?
    • Is your APA formatting correct?
  • Edit and revise your essay.
  • Explain the steps you followed in your editing and revision process. Do not submit your assessment without this explanation!
  • Additional Requirements
  • Style and Format: Use current APA style for references. Include a title page and references page.
  • Length: Compose 4–6 pages in addition to the title page and references page.
  • Resources: Cite a minimum of three resources.
  • Font: Use Times New Roman, 12 point.

I NEED A RESPONSE TO THIS CASE STUDY

1 PAGE

3 REFERENCES

ZERO PLAGIARISM

Case 1: Volume 2, Case #16: The woman who liked late-night TV

The patient is a 70-year-old female with chief compliant of “being sad.” The patient is exhibiting signs and symptoms of depression due to increased loneliness. She has a home aide to assist her for her ADL’s as well as her son. She is hard of hearing and has extensive medical issues such as HTN, hypothyroidism, CAD, anemia, allergies, and obesity. Patient has never been on psychotropic medications. She has a family history of depression. Her condition became worse when she was unable to sleep perhaps due to restless leg syndrome (RLS). She has been suffering from daily crying spells. 

1. Do you feel sleepy or do you have occasional sleep attacks during the day? Describe your usual night sleep. (Hours of sleep, frequency of waking up, quality, etc.). Sleep deprivation can lead to depression or worsening depression. Chronic sleep deprivation can lead to depression potentially attributing to neurochemical changes in the brain (Al-Abri, 2015). 
2. Have any of your family members had a history of being depressed? Any mental health issues? History of suicide? Do you have any thoughts of killing yourself? Genetic factors play a huge role in the development of major depressive disorder (MDD) (Lohoff, 2010). 
3. Have you ever suffered from depression, anxiety, or any other mental health issues in the past? Patient’s mother suffered from MDD. Patient reports loneliness. Spouse died. History of traumatic events or history of mother having MDD can cause depression especially now that the patient is lonely. 

The people that would be most closely involved with this patient would be her son and her home aide. Asking them specific questions on how the patient is doing every day. How she performs her ADL’s? What is she describing to them in terms of depression? How is she describing her RLS while she is sleeping? Do they observe her snoring when she sleeps? When does she take “naps?”

An exam to perform would be an actigraphy which is a device that records and measures human rest/activity cycles. It is a small unit that is worn for a week or two and measures gross motor activity, used to assess sleep-wake cycles or circadian rhythms. It is useful for assessing insomnia (Martin & Hakim, 2011).

Another exam to perform would be a polysomnography, also called a sleep study test. It records your brain waves, oxygen in the blood, heart rate, and breathing, as well as eye and leg movements while you sleep. The patient has depression with associated insomnia which a sleepy study can detect a pattern and help treat the insomnia (Hein et al., 2017).

Three Differential Diagnosis: 

1. Major Depressive Disorder (MDD) – a mental health condition which consists of depressed mood that persists for at least 2 weeks duration or longer. Signs and symptoms include poor appetite, insomnia, crying spells, sadness, loss of interest in activities, impairment of daily life, and a combination of biological, psychological, and social sources of distress. MDD is most likely the diagnosis for this patient. 
2. Insomnia – the patient could be having insomnia due to her RLS and the sleeping problem may be the underlying factor towards depression. However, in most cases the patient begins to become depressed and the depression is ultimately what leads to insomnia (Lohoff, 2010). 
3. Persistent depressive disorder – it is unknown when the patient’s depression originated, but the patient must be clinically depressed for over 2 years without remission. 

  Pharmacological methods: 

I would begin treatment with an SSRI such as Celexa 10 mg daily PO and Sonata at 5 mg QHS PO for insomnia. Celexa is a selective serotonin reuptake inhibitor and is classified as an antidepressant. It works by boosting neurotransmitter serotonin, blocks serotonin reuptake pumps, and desensitizes serotonin receptors. (Stahl, 2008). Onset of therapeutic actions typically take up 2-4 weeks and may need to be titrated. Doses of over 20mg/day for elderly patients is not advisable and can cause abnormal changes in electrical activity of the heart in doses over 40 mg/day (Stahl, 2008). Beginning the patient on Sonata which is a non-benzodiazepine hypnotic that binds B selectively to a subtype of the benzodiazepine receptor and May enhance GABA inhibitory actions that provide sedative hypnotic effects more selectively. Inhibitory actions in sleep centers may provide sedative hypnotic effects (Stahl, 2008). Generally, takes about an hour to kick in, and improves quality of sleep. If insomnia does not improve after 7-10 days, the patient needs to be evaluated independently for her RLS and or obstructive sleep apnea. Sonata has a less effect on respiratory depression which would be beneficial for this patient if she does indeed have sleep apnea. Her RLS needs to be evaluated by medical physician and can help her sleep and reduce depression.

Lessons Learned: 

                Geriatric depression can be complicated given all the psychosocial issues that can be involved, as well as comorbidities such as in this case. Side effects become a burden with the elderly population and must be monitored throughout treatment. In this case study, a medical doctor as well as a psychiatrist is needed and possibly different interdisciplinary members. The patient is involved in home health as well which would need to be revisited with the addition of psychotropic medications.

References 

Al-Abri M. A. (2015). Sleep Deprivation and Depression: A bi-directional association. Sultan Qaboos University medical journal, 15(1), e4–e6.

Hein, M., Lanquart, J. P., Loas, G., Hubain, P., & Linkowski, P. (2017). Similar polysomnographic pattern in primary insomnia and major depression with objective insomnia: a sign of common pathophysiology?. BMC psychiatry, 17(1), 273. https://doi.org/10.1186/s12888-017-1438-4

Lohoff F. W. (2010). Overview of the genetics of major depressive disorder. Current psychiatry reports, 12(6), 539–546. https://doi.org/10.1007/s11920-010-0150-6

Martin, J. L., & Hakim, A. D. (2011). Wrist actigraphy. Chest, 139(6), 1514–1527. https://doi.org/10.1378/chest.10-1872

Stahl, S. M. (2008). Essential Psychopharmacology Online. Retrieved from: https://stahlonline-cambridge-org.ezp.waldenulibrary.org/prescribers_drug.jsf?page=9781316618134c24.html.therapeutics&name=Citalopram&title=Therapeutics

 

Mr. Nguyen is a 58-year-old patient that had septic shock and developed Acute Respiratory Distress Syndrome. He is orally intubated and on a mechanical ventilator. He is paralyzed and sedated.

• What manifestations might you observe for a patient with ARDS?
• What complications can Mr. Nguyen develop from being mechanically ventilated?
• List priority nursing interventions to prevent complications associated with ventilatory support.
• What interventions can be implemented specifically to prevent the development of Ventilator Acquired Pneumonia (VAP)?
• You are orienting in the ICU, the nurse you are working with is not implementing the VAP interventions. What would you do?
• Include intext citation and 3 References

Hi, this is my research method, that was redone but the professor said that it was done incorrectly and this it is still meta-analysis which I’m guessing know she does not want

Here are something that I’ve added this time that can help you formulate the Research Method 

Click http://expertjournals.com/how-to-write-a-research-methodology-for-your-academic-article/ link to open resource.

and I also uploaded something as well 

Here’s an example of a student’s research method, the professor said it well done: 

Re: Using Cannabis As A Therapeutic Tool For Epilepsy

The data was collected using a meta-analysis methodology. The researcher summarized the results of several studies to come up with their report. The information was collected from several scientific studies and journals, synthesized and compiled. Preference was given to studies that used randomized trial method. Different studies were assessed with the main focus being on those that did experiments (lasting a month or more) and recorded results before the study and compared them with the results after the study. For this study, the case study approach was used in which the researcher collected data from past researchers and did an analysis of the secondary data. The researcher was keen to focus only on qualitative and quantitative data that was collected first hand from experiments and observations.

A meta-analysis method was preferred because it was both cost and time effective and provided deep insights on the topic of choice. During the collection of the data, a two-step approach was taken. First, the researcher identified credible sources of information relating to the topic from journals by filtering data using key words. The main key words of choice consisted of a combination of terms; “Epilepsy cure with cannabis” and “therapeutically cure of epilepsy with CBD.” After collecting studies that fitted into the key terms, the researcher then checked the year of publication with only recent studies qualifying (5 years). By reading the abstracts, relevant articles were chosen to be used as data for the study. The second approach entailed deriving data from the chosen sources, synthesizing and analyzing them to create new data. Particular emphasis was on the effects of CBD in the therapeutic cure of epilepsy by comparing the quantities and duration of CBD administration to the symptoms and effects in the patients after approximately two weeks.

 Discussion Forum: Research Methods

1. Formulate the Research Methods of your selected topic. Based on the chosen methods, please ensure that your incorporate all appropriate elements. 

2. Post your Research Methods.

3. Then, read the posts submitted by two other classmates and provide meaningful feedback for improvement.

This is mine :

Case Study: This is a qualitative research method that facilitates a close assessment of the data within a particular context. A researcher selects few individuals to be the study’s subject (Wilson, 2016). Further, this method helps the researcher to study and investigate opioid education for the youth as a contemporary real-life phenomenon. This exploration and investigation are done through an in-depth contextual analysis of a restricted events’ number relating to the subject of the study.

Phenomenology Method: This qualitative research method enables a researcher to emphasize and focus on studying individual youth’s lived experiences within the world of drugs. It will be easier to study the structure of different types of youth’s experiences ranging from emotion, perception, and imagination regarding the use of opioids. The method builds a complex account of semi-permanent awareness, spatial awareness, and awareness of a person’s experience (Qutoshi, 2018). A researcher can also describe the nature of experience just as he finds it in his experience. Thus, the method is based on a description of the lives of youths who abuse opioids as a surviving mechanism. An interpretation of the type of experience that links or closely connect with relevant features of the context in the study plays a crucial role in the research.

Tools 

Under the case study method, a researcher can use documentation review as a tool for increasing validity (Wilson, 2016). Documents and data get analyzed to establish sensitive information regarding the subject of the study.

Within the phenomenology method, depth interviews are used as a tool where the respondents are less, and the research focuses on a particular issue or situation.

References

Qutoshi, S. B. (2018). Phenomenology: A philosophy and method of inquiry. Journal of Education and Educational Development, 5(1), 215-222.

Wilson, V. (2016). Research Methods: Design, Methods, Case Study… oh my!. Evidence Based Library and Information Practice, 11(1 (S)), 39-40.

What the professor said: You have again incorrectly formulated it. Your method is meta-analysis! Check the in-class practice and replicate that on your study.