Discussion: Treatment of Sleep/Wake Disorders

The power of sleep to heal the body cannot be underestimated. Most research indicates that 7–8 hours of sleep are a minimum that people need to stay healthy. Clients who come to the PMHNP’s office frequently complain of sleep problems. It is estimated that 10–20% of patients report some type of sleeping problem.

In this Discussion, you will analyze the diagnostic criteria and evidence-based psychotherapy and psychopharmacologic treatment for sleep/wake disorders.

To prepare for this Discussion:

• By Day 5 of Week 9, your Instructor will have assigned you a sleep/wake disorder, which will be the focus of your original post for this Discussion. ****NIGHTMARE DISORDER*****
• Review the Learning Resources.

Post:

• Explain the diagnostic criteria for your assigned sleep/wake disorder.
• Explain the evidenced-based psychotherapy and psychopharmacologic treatment for your assigned sleep/wake disorder.
• Describe at what point you would refer the client to their primary care physician for an additional referral to a neurologist, pulmonologist, or physician specializing in sleep disorders and explain why.
• Support your rationale with references to the Learning Resources or other academic resource.

Course Scenario

Chaparral Regional Hospital is a small, urban hospital of approximately 60 beds, and offers the following:

• Emergency room services
• Intensive care
• Surgical care
• Obstetrics
• Diagnostic services
• Some rehabilitation therapies
• Inpatient pharmacy services
• Geriatric services
• Consumer physician referral services

Recently, the CEO has been hearing complaints from both patients and staff, varying from long wait times to rude physicians. You have been hired to design and implement a Quality Improvement Plan to help uncover quality problems and to satisfactorily resolve them.

Instructions

The CEO has received some resistance from the Board on undertaking a QI program. She has asked you to develop a set of talking points on the pros and cons of common measurement techniques used in healthcare that she can use the next time she runs into a Board member. 

Talking points are used to quickly explain something by condensing it into a compelling, but easily digestible, list. If the goal is to increase support for a QI program, the talking points must provide the ideas she needs to convey in order to achieve the goal.

Your talking points should be submitted in a Word document. Your talking points should include the pros and cons of implementing a QI program.

Upon completion of your talking points, please prepare a PowerPoint presentation (or other shareable Webware/software you prefer) with narration where you will explain each talking point to the CEO so they clearly understand and can answer questions from the Board.

APA formatting for the talking points, and proper grammar, punctuation, and form are required.  

1. Length of PowerPoint is secondary to the quality of the presentation as a whole.
2. Highlight specific pros and cons of QI programs.
3. Use the Notes area on each slide as needed to expand on the key points.

 Your audio presentation should include an introduction, a concise discussion of each slide, and a conclusion. Make sure to use audience-specific language and tone in your PowerPoint. Remember, you would be presenting this to the CEO of your facility. The presentation will be assessed on your overall knowledge of the content, clarity of your voice, pronunciation of words, organization of your presentation, proper recording of your presentation, overall aesthetics and professionalism, and general clarity of your presentation. 

Community Acquired Pneumonia: Intro

Community-acquired pneumonia (CAP) is a common group of infectious diseases that are responsible for significant global health and economic burden. CAP affects approximately 5.5/1000 people annually, and is a leading cause of hospital admissions, morbidity, and mortality in developed countries (especially for older people). Among all patients with CAP, those aged 65 or older account for about one-third, but they account for more than half of all health costs due to this disease. COPD is one of the most common comorbidities in patients with CAP, characterized by persistent respiratory symptoms.  COPD was the third-most common cause of death in 2008, and the morbidity from COPD is projected to increase by 2020 (Liu, Han, & Liu, 2018).

Brief Summary of Client Case

            Client HH is a 68 year-old male admitted with a diagnosis of community-acquired pneumonia for the past 3 days. This client’s medical HX includes COPD, HTN, hyperlipidemia, and diabetes. Mr. HH is on day three of two empiric antibiotics (ceftriaxone 1 g IV daily and azithromycin 500 mg IV daily). The client’s clinical status has improved since admission, with decreased oxygen requirements. However, he is not tolerating anything PO at this time and complains of nausea and vomiting. The client’s height is 5’8” and he weighs 89 kg. The only known drug allergy is PCN which results in a rash.

Analysis

 The client in this scenario is responding well to the current antibiotic therapy, as evidence by a drop in WBC count from 18.2 upon admission to 14.6 currently (normal range is between 5.0 and 10). It is also pleasing that the client’s O2 saturation is now 92% on room air alone, compared to 90% while requiring 4L of supplemental oxygen upon admission. Overall, the client’s lab results are not significantly concerning. Neutrophil (normal range 40-60%) and band (normal range 0.0-03%) percentages are slightly elevated as expected given the infectious process (NIH, 2020). Aside from an elevated WBC count that is trending down, a marginally elevated blood glucose, and a HCO3 elevated eight points above the normal limit, the other lab results are within the normal ranges of a healthy adult male (Farinde, 2019). The issues of concern in this client case are the client’s inability to tolerate a diet due to nausea and vomiting, elevated temperature, and continuing antibiotics to treat the pneumonia.

Treatment Considerations

 According to Donovan (2019), the client’s empiric antibiotic regime is consistent with what is recommended by the Infectious Diseases Society of America (IDSA). Initial empiric antimicrobial treatment should be initiated until laboratory results can be obtained to guide more specific therapy. Also, a combination of a beta-lactam (ceftriaxone 1 g IV q24h or cefotaxime 1 g IV q8h or ceftaroline 600 mg IV q12h) plus azithromycin 500 mg IV q24h is consistent with IDSA guidelines for a client with comorbidities such as COPD and diabetes. This therapy should be continued for minimum of 5 days, the client should be afebrile for 48-72 hours, have a stable blood pressure, an adequate oral intake, and have a room air oxygen saturation of greater than 90%; longer treatment duration may be required in some cases (Donovan, 2019). In addition to these criteria, the client’s temperature should be below 100.9º F before switching to oral antibiotics. Zofran or another antiemetic medication will be considered if the client is still unable to tolerate meals at the 5 day mark. However, we expect that the nausea will resolve as the antibiotics work to treat the lung infection. If this client meets all criteria and maintains it for 24 hours, the antibiotic therapy will be switched from IV to oral (Kaysin & Viera, 2016). According to the National Clinical Guideline Centre (2019), inpatient stay remains appropriate for patients with pneumonia only as long as hospital care is delivering management that cannot safely be delivered at home. Thus, once the client is able to tolerate oral antibiotics and his temperature drops below 100.9, discharge should be considered. Ultimately, the client would be discharged and sent home with a course of oral antibiotics. Since the client has a PCN allergy, the client would be started on an oral fluoroquinolone. According to Noreddin and Elkhatib (2010), the efficacy and tolerability of levofloxacin 500mg daily for 10 days in patients with CAP are well established.

            The client in this case has COPD, which is an important comorbidity to consider. Furthermore, COPD increases the risk of developing CAP, which is thought to be associated with a poorer prognosis. Therefore, the association between CAP and COPD is important for providers to pay close attention to. Patients with COPD are more often older, male, and more likely to suffer from respiratory failure, severe pneumonia, or comorbidities. However, COPD is a common and important predisposing comorbidity in patients who develop CAP, and often intensifies the clinical symptoms of patients with CAP. While it may complicate treatment, it generally does not tend to affect prognosis (Liu, Han, & Liu, 2018).

 Possible Patient Education Strategy

 An appropriate patent education strategy for this client would be for the disease management nurse to meet with this client prior to discharge and provide the client with handouts as well as conduct an educational session on community acquired pneumonia. The information disseminated should include an explanation of what pneumonia is, how it’s diagnosed, and how it is treated. Tips to facilitate a quicker recovery should also be discussed. These pointers include: getting plenty of rest, deep breathing exercises, hand washing, coughing/sneezing etiquette, drinking plenty of water, and eating a balanced diet. Strategies to avoid developing pneumonia should also be included, such as; getting a flu vaccine, avoiding smoking, properly managing preexisting respiratory conditions (e.g., asthma or COPD), receiving a pneumonia vaccine, and staying active (Nursing2020, 2010).

I NEED A RESPONSE FROM THIS TOPIC

3 REFERENCES NOT MORE THAN 5 YEARS 

Differentiate between acute and chronic pain, the different assessment tools that can be used depending on the age of the patient, and management of pain. List 3 pain assessment tools used (Newborn, Toddler, Adult).

Your response should be at least 250 words. 

APA formatted paper (Title page, Introduction, Conclusion, Reference Page)

Reference should be within 5 years.