I need a comment for each paragraph

Paragraph 1

 

Health education plays a central role in health promotion. This is because in order to promote healthy living, it is important for individuals to understand why they are engaging in healthy behavior. For example, for an individual to go out of their way to become physically active and avoid junk food, they should have an incentive to do so. Health education provides this incentive as individuals learn of the association between a sedentary lifestyle/ junk food and diseases like diabetes and obesity.  The nursing process is inherently tied to patient health education. This is because part of the nursing duties is to fight for patient advocacy. This means that nurses should ensure that their patients are properly informed about their health in order to make health-centered decisions. A contemporary issue that a family may experience today is a family struggling with obesity. The nurse can address the issue by first meeting with the family together, and then with each member individually. The nurse should focus on health education and discuss the implications of obesity, such as diabetes, high blood pressure, and heart disease. They should inform the family about how much they can positively affect their lives through the addition of regular exercise and healthy eating habits. A critical role of the nurse is to develop realistic health goals for the family and to provide a real plan that can help the family to achieve these goals.

Paragraph 2

According to the World Health Organization (WHO) (2018b), health promotion is “the process of enabling people to increase control over, and to improve their health” (para 1). Health education is defined as “any combination of learning experiences designed to help individuals and communities improve their health, by increasing their knowledge or influencing their attitudes” (World Health Organization [WHO], 2018a, para 1). Nurses are actively involved in both health promotion and health education, providing education that is necessary to help patients achieve control over the promotion of their own health. Similar to all other nursing functions, health education is provided by using the nursing process. The nurse will assess, diagnose, plan, implement, and evaluate to provide the proper health education to the patients. This process can vary from person to person, but the basic foundation stays the same. Some patients have to have revisions so it can get out of order. An acronym we learned in nursing school for the nursing process is ADPIE. It’s really stuck with me over the years, making it easy to remember. A Contemporary issue that many faces globally includes hurricane’s, and forest fires. Even though these can’t be prevented, there are plans that can be devised, resources that can be offered, and tools that can be used to assist with preparation and help to work toward achieving wellness goals. Some local issues some patients face can include, environmental issues like illicit drugs or a high crime neighborhood, lack of transportation making it hard to get to their appointments.

The U.S. Department of Health & Human Services released a comprehensive Clinical Practice Guideline for Treating Tobacco Use and Dependence–2008 Update

https://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/tobacco/clinicians/update/index.html 

The goal of these recommendations is that clinicians strongly recommend the use of effective tobacco dependence counseling and medication treatments to their patients who use tobacco, and that health systems, insurers, and purchasers assist clinicians in making such effective treatments available.

After reading these recommendations answer the following questions.

1. what are the clinical interventions for patients unwilling to quit cigarette smoking?

2. According to the best practices what are the best strategies to help your clients quit smoking?

3. are there any specific smoking cessation recommendations for especial populations such as teenagers or the elderly?

Respond  of your colleagues who were assigned to a different case than you. Explain how you might apply knowledge gained from your colleagues’ case studies to you own practice in clinical settings.

                                               Main Post

                                  Sleep/Wake Disorders

The patient is an obese 70-year-old female with a chief complaint of “being sad.” Her husband passed away several years ago due to coronary artery disease (CAD). She lives at home alone and has a home health aide help her. Her son comes to visit her often. She was feeling well until her hearing began to diminish in both ears. Her mobility has declined, so she has not been able to get out as much. She is often lonely at home. She has daily crying spells, is often very tired, has good insight to her illness, and wants to get better. 

Three Questions to Ask the Patient and Why            

The case study mentioned that the patient is a candidate for cochlear implants, but it is a long way off. Thus, my first question to ask the patient is what is preventing her from getting cochlear implants?  

She began experiencing sadness when she began to lose her hearing and mobility. Therefore, regaining her hearing may help decrease the depression. If its financial reasons, maybe there are resources that can help her. Finding out the reason the patient isn’t getting the implants can help the provider and patient find solutions.             

The patient also mentioned that her sleep was “awful”, stating her legs “ache and jump”, she takes frequent naps during the day, and admits to snoring frequently. Thus, the second question I would ask is what are her sleeping habits like? 

Individuals who have good sleep habits sleep better. Getting better sleep can be obtained by being consistent by going to bed at the same time each night and waking up the same time each day (Centers for Disease Control and Prevention, [CDC], 2016).  Individuals can make sure the room is dark, quiet, and cool (CDC, 2016). Additionally, remove electronic devices, avoid large meals, caffeine, and alcohol can help with getting better sleep (CDC, 2016).              My third question would be what do you do when you are sad? Individuals who are depressed often have a negative view of the world and often think of themselves as worthless (This Way Up, n.d.). They often blame themselves when something bad happens and feel like they are unlucky (This Way Up, n.d.). Thus, helping individuals identify negative thinking and reframe the way they think about life can help improve depressive symptoms (This Way Up, n.d.). 

People to Speak to with Specific Questions to Ask 

The first person I would want to speak to is the patient’s son. The case study states the son visits her often so he should know the patient’s habits. First, I would ask him the same questions I asked the patient such as what is preventing the patient from getting cochlear implants, what are her sleep habits, and what does she do when she is sad? By asking the son the same questions, insight can be shown on how the son views things and how the patient views things. I would also him when he began to notice her depressive symptoms because that will help provide a timeline as to when it all began.             

The second person I would talk to is her home health aide because she is familiar with the patient. I would ask her what the patient’s home life is like such as how is she maintaining her house? Is she able to clean up after herself? How is she doing with activities of daily living? 

These questions can provide insight on the severity of the patient’s depressive symptoms. 

Physical Exams and Diagnostic Tests and How Results Would Be Used            

The first diagnostic test I would want to perform on the patient is the 9-item Patient Health Questionnaire (PHQ-9). The PHQ-9 is a screening tool for major depression (Na et al., 2018). The test is a reliable and valid measurement of depressive symptoms that also asks about the individual’s thoughts of death or self-injury within the last two weeks (Na et al., 2018). The results would be used to determine the severity of her depression. Another diagnostic test that can be performed on this patient is a polysomnography. A polysomnography is a sleep study that helps providers diagnose sleep apnea, periodic limb movement disorder, restless leg syndrome (RLS), insomnia, and nighttime behaviors (National Sleep Foundation, n.d.). The results would be used to can help determine the cause of her daytime sleepiness such as sleep apnea or RLS. I would also want to run a complete blood count (CBC) with differential on the patient. I would specifically want to obtain a red blood cell count (RBC) and white blood cell count (WBC). Thus, a CBC with differential would help determine if the patient is fatigued due to anemia or an underlying infection.

 Three Differential Diagnosis and Why

The three potential differential diagnoses include:Major Depressive DisorderPersistent Insomnia Disorder Obstructive Sleep Apnea Hypopnea The most likely differential diagnosis is major depressive disorder (MDD). The diagnostic criteria for MDD is five or more symptoms during the same 2-week period and a change from previous functioning (American Psychiatric Association, 2013).  The symptoms include: depressed mood most of the day, marked diminished interest or pleasure in all or almost all activities most of the day, significant weight loss or weight gain, insomnia or hypersomnia neatly every day, psychomotor agitation or retardation nearly every day, fatigue or loss of energy nearly every day, feelings of worthlessness or excessive or inappropriate guilt nearly every day, diminished ability to concentrate, and recurrent thoughts of death (American Psychiatric Association, 2013). The patient fits this diagnosis as evidence by depressed mood, diminished interest in activities she used to enjoy, fatigue, diminished ability to concentrate, and psychomotor retardation.

Two Pharmacological Agents and Dosing and Why 

One pharmacologic agent that can be tried is doxepin 3 mg at bedtime for insomnia. Doxepin works by boosting serotonin and norepinephrine by blocking the serotonin reuptake pump and norepinephrine reuptake pump (Stahl, 2017). At hypnotic doses, doxepin blocks histamine-1 receptors, which promotes sleep (Stahl, 2017). Doxepin is a substrate for CYP450 2D6 and has a half-life of 8-24 hours (Stahl, 2017). In the elderly, the recommended dose for insomnia is 3 mg per day (Stahl, 2017).             Another pharmacologic agent that I would like to start the patient on is bupropion (extended release) XL 150 mg daily in the morning. Bupropion is used to treat MDD and works by boosting norepinephrine and dopamine by blocking the norepinephrine reuptake pump and dopamine reuptake pump (Stahl, 2017). Bupropion inhibits CYP450 2D6, has a parent half-life of 10-14 hours, and a metabolite half-life of 20-27 hours (Stahl, 2017). Thus, since bupropion blocks the dopamine reuptake pump and norepinephrine reuptake pump, this medication is beneficial in improving symptoms of loss of happiness, joy, interest, pleasure, energy, enthusiasm, alertness, and self-confidence (Stahl, 2013). Thus, because of bupropion’s mechanism of action and the patient’s symptoms, I would want this patient to try this medication. 

Lessons Learned  

Lessons learned during this case study is that geriatric depression can be difficult to treat. They often have multiple comorbidities with the possibility of more pronounced side-effects (Stahl, 2008). Additionally, medications can have contraindications that do not previously exist prior to the patient being put on medication. Thus, providers must be aware of new and old warnings on medications in the event there are changes made to medications. I will apply this information when I am in practice by paying close attention to dosages, side effects, and potential contraindications when providing medication to the geriatric population. 

                                                  References

American Psychiatric Association. (2013). Diagnostic and statistical manual od mental disorders (5th ed.). Washington, DC: Author. Centers for Disease Control and Prevention. (2016). Tips for better sleep. Retrieved from https://www.cdc.gov/sleep/about_sleep/sleep_hygiene.htmlNa, P. J., Yaramala, S. R., Kim, J. A., Kim, H., Goes, F. S., Zandi, P. P.,…Bobo, W. V. (2018). The PHQ-9 item 9 based screening for suicide risk: a validation study of the Patient Health Questionnaire (PHQ-9)-9 item 9 with the Columbia Suicide Severity Rating Scale (C-SSRS). Journal of Affective Disorders, 232, 34-40. doi: https://doi.org/10.1016/j.jad.2018.02.045National Sleep Foundation. (n.d.). Sleep apnea. Retrieved from https://www.sleepfoundation.org/sleep-apneaThis Way Up. (n.d.). How do you feel? Retrieved from https://thiswayup.org.au/how-do-you-feel/sad/Stahl, S. M. (2008). Essential psychopharmacology online. Retrieved from https://stahlonline-cambridge-org.ezp.waldenulibrary.org/viewPdf?page=csEP_16.pdf&vol=2Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical    applications (4th ed.). New York, NY: Cambridge University Press. Stahl, S. (2017). Stahl’s essential psychopharmacology: Prescriber’s guide (6th ed.). San Diego,  CA: Cambridge University Press. 

Review the IOM report, “The Future of Nursing: Leading Change, Advancing Health,” and explore the “Campaign for Action: State Action Coalition” website. In a 1,000-1,250 word paper, discuss the influence the IOM report and state-based action coalitions have had on nursing practice, nursing education, and nursing workforce development, and how they continue to advance the goals for the nursing profession.Include the following:Describe the work of the Robert Wood Foundation Committee Initiative that led to the IOM report, “Future of Nursing: Leading Change, Advancing Health.”Outline the four “Key Messages” that structure the IOM Report recommendations. Explain how these have transformed or influenced nursing practice, nursing education and training, nursing leadership, and nursing workforce development. Provide examples.Discuss the role of state-based action coalitions. Explain how these coalitions help advance the goals specified in the IOM report, “Future of Nursing: Leading Change, Advancing Health.”Research the initiatives on which your state’s action coalition is working. Summarize two initiatives spearheaded by your state’s action coalition. Discuss the ways these initiatives advance the nursing profession.Describe barriers to advancement that currently exist in your state and explain how nursing advocates in your state overcome these barriers.You are required to cite to a minimum of three sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.  Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. 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 Turnitin. 

 Respond to at least two of your colleagues* by either supporting or respectfully challenging their explanation on whether there is an evidence base to support the proposed health policy they described.

  

Introduction

The demand for healthcare and the shortage of providers to offer this care, especially in geographically and economically challenged populations, has put a strain on healthcare availability. The Creating Opportunities Now for Necessary and Effective Care Technologies for Health (CONNECT) Act of 2019 looks to promote access through increased use of telehealth. 

What It Means

Currently, telehealth is limited by geography, billing and reimbursement, and provider restrictions. The CONNECT bill HR 4932, proposes removal of some or all of these stipulations to expand access to care. Specifically, the bill targets Medicare restrictions and lack of coverage to improve access to the elderly and disabled (Wicklund, 2019). 

The Evidence

The evidence to support telehealth expansion has been proven. As discussed by Totten et al., (2016) numerous studies have shown an increase in positive outcomes regarding patient/provider communication, education, and the management of chronic health conditions. Passing of this bill could provide a multitude of benefits to involved parties. 

First and foremost, it would improve access to care for those limited by age, disability, geography, or finances. Improved access to care promotes health prevention and decreases more costly care due to complications associated with delay of treatment. The expansion of telehealth could also reduce the strain placed on providers by the shortage. The bill looks to permit telehealth use by more providers and remove some of the travel and point of origin restrictions. Greater use of telehealth would also encourage better insurance coverage and reimbursement (H.R. 4932, 2019).

Conclusion

With all the changes in healthcare and the concerns over cost and accessibility, the need for legislation to address these issues cannot be ignored. The promotion of telehealth and removal of current restrictions could solve many of these dilemmas. As healthcare providers, we can continue to conduct the research and provide the evidence needed to advocate for legislative change to improve healthcare.