Building a Health History 

Thorough and accurate pediatric history is a challenging and very important to children’s wellbeing that allows nurses and patients to establish a nurse-patient therapeutic relationship. History building is also essential in the interpretation of physical examination (Ball et al., 2019). Completing a comprehensive health history and physical examination is a tool used to document patient medical history, physical examination findings, and diagnosis (Sullivan, 2019). Using good communication skills to obtain this information is very important as communication creat a positive patient relationship. In other to develop this positive patient relationship, the nurse practitioner needs to build on courtesy, connection with the patient/guardian, ensure comfort and provide an opportunity for confirmation of what has been discussed to ensure understanding (Ball et al., 2019). Performing an assessment and history taking in children can bring upon anxiety, so practitioners should try to ease the anxiety by making sure the child is in the room with the parent, especially preschoolers (Ball et al., 2019).

Interview and Communication Techniques 

Children in rural areas face risk factors that are particular to their demographic features. Children living in rural areas are more at risk for health and developmental conditions. Performing an assessment and history taking in children can bring upon anxiety, so practitioners should try to ease the anxiety by making sure the child is in the room with the parent, especially preschoolers (Ball et al., 2019). Gaining confident and building practitioner-patient–caregivers relationship that is based on trust is very important as it facilitates with data collection (Mărginean et al., 2017). The practitioner should be empathetic as this will improve communication, be an active listener and observer to pick up any cues that patients might not share like grimacing, use open-ended questions. The use of questionnaire is encouraged too where the parent fills it out and by freely writing down patient concerns without having to answer the questions in person (Ball et al., 2019). 

 Risk Assessment Tool

According to Chung et al. (2016), 20 percent of US children live in poverty in rural, urban, and suburban, so it is critical to know the social determinant of the health of children to assess them better and provide safe and appropriate care needed (Chung et al., 2016). This social determinant includes family financial support, child maltreatment, and child education. Chung et al. (2016), also continues to explain that children who live in poverty are exposed to adverse childhood experiences like toxic stress, developmental delay, and health conditions like asthma and heart diseases. Rural people are usually poor and experience healthcare disparities. According to the center for disease control and prevention (2016), younger children are more likely to experience fatal abuse and neglect than older kids. Risk factors for victimization include child age and special needs that may be as a result of increased caregiver burden from developmental and intellectual disabilities, mental health issues, and chronic physical illnesses (Center for Disease Control and Prevention, 2016).

Targeted Questions

Does your child have any allergies?

Does your child have a good appetite to eat?

Does your family has enough food?

What is the child living situation, has there being any change in the child living situation within the past one month?

What are your family concerns or needs?

Does your child take vaccinations?

Is there anything I can do for you? 

                                                                                      References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Center for Disease Control and Prevention (2016). Preventing Child Abuse and Neglect: A Technical Package for Policy, Norm, and Programmatic Activities. Retrieved from https://www.cdc.gov/violenceprevention/pdf/can-prevention-technical-package.pdf

Chung, E. K., Siegel, B. S., Garg, A., Conroy, K., Gross, R. S., Long, D. A., Lewis, G., Osman, C. J., Jo Messito, M., Wade, R., Jr, Shonna Yin, H., Cox, J., & Fierman, A. H. (2016). Screening for Social Determinants of Health Among Children and Families Living in Poverty: A Guide for Clinicians. Current problems in pediatric and adolescent health care, 46(5), 135–153. doi:10.1016/j.cppeds.2016.02.004

Mărginean, C. O., Meliţ, L. E., Chinceşan, M., Mureşan, S., Georgescu, A. M., Suciu, N., Pop, A., & Azamfirei, L. (2017). Communication skills in pediatrics – the relationship between pediatrician and child. Medicine, 96(43), e8399. doi.10.1097/MD.0000000000008399

Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.

zero plagiarism

I NEED A RESPONSE TO THIS POST

Our cells are filled with intracellular and surface cell receptors (Berg & Clarke, 2018).  These receptor proteins are delineated by structure and bind to a variety of substances responsible for creating a reaction or lack thereof. When a ligand binds to the appropriate receptor, signal transduction activates the receptor and produces a biological response ( Berg & Clarke, 2018).  Changes in shape or activity after binding allow signal transmission outside the cell or significant changes within the cell, creating an altered chemical when binding to a ligand-gated-ion channel ( Berg & Clarke, 2018). This post will discuss the agonist/ antagonist spectrum of psychopharmacological agents, G-proteins and ion-gated channels, and epigenetics and their relevance to practice. 

Agonists act like ligands, binding to receptors and causing action (Berg & Clarke, 2018).  Ligands or agonists consist of pharmaceuticals, drugs, light, hormones, and nerve impulses. Ligands and agonists jump in and out of receptors, increasing signaling or changes in the cell.  Antagonists block the standard action of ligands, preventing a response from the receptor (Berg & Clarke, 2018).  Competitive antagonists bind to receptors and prevent ligands from attaching to its preferred receptor, inhibiting stimulation, and leaving the receptor unchanged (Berg & Clarke, 2018).  Naloxone is a competitive antagonist to opiate receptors London, 2017).  The naloxone has a stronger affinity for the receptor, making it more desirable.  The medication discontinues the effects of the opiates by taking their place on the receptor. The higher the dose of opiates circulating the more naloxone required. Due to the excess amount of continued competition for receptors, some patients require multiple doses of naloxone before regaining the ability to breath or regain consciousness (London, 2017). 

G-protein coupled receptors (GPCRs) target 30-50% of psychotropic medications (Stahl, 2013).  As the most abundant protein family, GPCR ligands include neurotransmitters such as serotonin, norepinepherine, and dopamine. After  aligand binds to a GPCR, the GPCR undergoes a conformational change (London, 2017).  Alpha subunit exchanges Guanyl nucleotide phosphates, GTP, GPP, and Alpha unit disassociates and regulates target proteins (London, 2017).  Regulation of neurotransmission is imperative in medication management (London, 2017).  The target proteins can then relay signals via a second messenger, and GTP is finally hydrolyzed to GPP (Lambert, 2004). G-protein receptors tend to have a delay in effect due to a requirement for the accumulation of changed cellular function (London, 2017).  

Ion gated channel linked receptors open and close in response to a chemical message changing signal transduction in the synaptic cleft. These ion channels act like pores in the cellular membrane to allow ion passage (Stahl, 2013).  Transmembrane ion channels open and close in response to the binding of a ligand, differentiated by shape.  The binding will cause the channel to open or close, changing the protein conformation of the entire structure (Berg & Clarke, 2018).  When channels open, ions like potassium, sodium, chloride, and calcium can travel through and change the electrical process creating an intracellular electrical response (Berg & Clarke, 2018).  Psychopharmacology relies heavily on these ion channels in medication management.  Ion-channel linked receptors act along an agonist spectrum; medications can produce conformational changes in these receptors to create any state of the agonist spectrum (Stahl, 2013).

The genetic material in the body is referred to as a genome (Stahl, 2013).  Every cell in the body carries the same DNA but only expresses specific genes required for its domain (Stahl, 2013).  For this reason, cells in the dermis only produce cells required to maintain and rejuvenate the dermis.  Epigenetics is the reason why skin cells differ from brain cells or cardiac cells.  Epigenetics is a term used for the external modifications to the DNA affecting the way it is recognized by cells (Stahl, 2013).  There are thee different methods of epigenetics, DNA myelination, histone acetylation, and microRNA (Stahl, 2013).  Genomes are affected by different exposures during development, environmental chemicals, drugs or pharmaceuticals, aging, and diet (Stahl, 2013).  Alterations in genes may result from these exposures and be passed on to offspring causing a change in the epigenome (Stahl, 2013). 

Psychotropic medications target specific molecular sites to increase neurotransmission. After neurotransmitters release from neurons, they are quickly recollected and utilized again for neurotransmission (Stahl, 2013).  The five essential sites of action for psychotropic medications are 12-transmembrane-region transporter, 7-transmembrane-region-G-protein linked, enzymes, 4-transmembrane-region-ligand-gated ion channel, and 6-transmembrane-region-voltage-gated ion channels (Stahl, 2013).

When cellular alterations occur due to brain injury, neurodegeneration, changes in the extracellular matrix, and changes in voltage and ligand-gated ion channels transpire (Iori, 2018).  A variety of molecular changes, regulation of gene expression, and epigenetic modifications take place as well(Iori, 2018).  As a result, functional impairments such as epilepsy, developmental delay, cognitive/sensory-motor deficits, and drug refractoriness may occur (Iori, 2018).  Many factors affect the outcomes of medication.  Through assessment is required to determine environmental issues, incidents of trauma, and relevant health history. Understanding that many factors influence the effectiveness of the psychotropic medication is imperative when determining the appropriate treatment course (Lambert, 2004).  

Recreational drug use, in combination with prescription medication, is critical to determine.  Like antidepressants, drugs like methylphenidate and cocaine target monoamine transporters; this increases the risk for an oversaturation of serotonin, norepinephrine, or dopamine in the synaptic cleft.  Oversaturation can potentially cause an issue for signal transduction in other neurotransmitters (Stahl, 2013).  This oversaturation of serotonin may cause a toxic level of serotonin, referred to as serotonin syndrome.  Patients with serotonin syndrome/toxicity present with neuromuscular, autonomic, and mental status changes.  Stopping drugs that target monoamine transporters will help decrease levels of serotonin and should return the individual to their normal state of health (Foong, Grindrod, Patel, & Kellar, 2018). 

In conclusion, neurotransmission is the cornerstone of psychopharmacology.  Although enormously complicated, it is imperative providers understand that small changes in cellular function, additional drugs present in the body, and electrolyte imbalances affect prescription medication functions and desired effects.  With a shortage of psychiatric prescribers and a mental health crisis around the world, all healthcare providers must have a proper understanding of psychopharmacology and interactions with other body systems.

References

Berg, K. A., & Clarke, W. P. (2018). Making Sense of Pharmacology: Inverse Agonism and Functional Selectivity. The international journal of neuropsychopharmacology, 21(10), 962–977. https://doi.org/10.1093/ijnp/pyy071

Foong, A. L., Grindrod, K. A., Patel, T., & Kellar, J. (2018). Demystifying serotonin syndrome (or serotonin toxicity). Canadian family physician Medecin de famille canadien, 64(10), 720–727.

Iori, V. (2018). Epigenetic and pharmacological targeting of neuroinflammation as novel therapeutic interventions for epilepsy. Retrieved from
https://hdl.handle.net/11245.1/98bfe10f-44d2-4f42-bc1b-2f3e605c3ece

Lambert, D. G. (2004). Drugs and receptors, Continuing Education in Anaesthesia Critical Care & Pain, 4(6), 181–184, https://doi.org/10.1093/bjaceaccp/mkh049

London, E. D. (2017). Imaging drug action in the brain. Place of publication not identified: Routledge.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press 

Foundational Neuroscience

            The Psychiatric Mental Health Nurse Practitioner (PMHNP) will have to prescribe psychotropic drugs when treating the client with mental health disorders or even for chemical dependency. The clinician must be knowledgeable about how these medications work so that safe and effective treatment can be given to the client. According to Stahl (2013), thirty percent of psychotropic drugs impact the G-protein linked cascade, and twenty percent of psychotropic drugs target the ligand-gated ion channel. Understanding these systems give the practitioner clarity on how these drugs can be useful.

Agonist to Antagonist Spectrum

            Receptors are specialized proteins found in the cells or on the surface of neurons. (Nutt et al., 2007). Post-synaptic receptors generally regulate the actions of the released neurotransmitter (Nutt et al., 2007). Drugs may be referred to as agonists, partial agonists, antagonists, or inverse agonists, which means that they affect the level of neurotransmission at the post-synaptic neuron (Stahl, 2013). An agonist imitates the action of endogenous neurotransmitters.  Agonists may directly bind to the neurotransmitter site (which may cause a change in the shape of the receptor) or may indirectly cause an increase in the level of neurotransmitters released. A partial agonist also causes an increase in neurotransmission effects but does not have as high and effect as a full agonist would. An antagonist, on the other hand, may either block normal neurotransmission or cause a reversal in the shape of the receptor so that the effects are opposite to the agonist (Stahl, 2013). For example, in schizophrenia, it is believed that overactive or high levels of dopamine contribute to the illness; hence a D2 antagonist (such as Haldol) may be given to inhibit dopamine release (Guzman, 2019). An agonist will increase neurotransmitter signals or levels by a significant amount; partial agonist with also increase levels but not to the extent of the full agonist, while an antagonist will inhibit signals or reverse what an agonist has done.

G couple proteins and Ion Gated channels

            As stated earlier, G couple proteins and Ion gated channels are molecular targets for psychotropic drugs. Both G couple proteins and Ion- gated channels are activated by neurotransmitters which then activate genes in the cell nucleus (Stahl, 2013). G couple protein works have a cascade involving cAMP (cyclic adenosine monophosphate) and protein kinase A. On the other hand, the ion gated channel works through calcium, and it activates different kinase called calcium-dependent protein kinase (Stahl, 2013). Both systems affect gene expression; however they do so at via separate systems.

Epigenetics

            Neurotransmission seeks to modify the cell function of gene expression, meaning, turning some genes on and others off. When the cell nucleus changes, it is because the structure of chromatin is modified; hence, gene expression is modified. Epigenetics speaks to changes in the genes that lead to long term changes in how the gene is expressed. This is important in pharmacology as some illnesses such as cancer may have several mutations and, as such, may be challenging to treat (Stefanksa and MacEwan, 2015). However, if the changes in the genes that lead to cancer are studied, then drugs that target those genetic changes can be developed, hence, solving the root of the problem rather than trying to eradicate cancer. Simply put, change gene expression so that it does not lead to cancer (Stefanksa and Mac Ewan, 2015).

How It Impacts the Way Medications are Prescribed

As previously mentioned, prescribers/ clinicians need to know this information for safe, effective, and efficient treatment. Understanding the neuroscience can reduce prescriber error. Stahl (2013) discusses the fact that twenty percent of Asians are poor metabolizers of the Cytochrome CYP 2C19. Hence, the practitioner needs to know that psychotropic drugs metabolized by this enzyme need to be closely monitored as the drug can quickly build up in the patient’s bloodstream. Watching dosing strengths, as well as other medications that may further inhibit this enzyme, could cause an increase in drug levels in the body.

References

Andrade, C., & Sathyanarayana Rao, T. (2016, June). Classification of psychotropic drugs: Problems, solutions, and more problems. Indian Journal of Psychiatry, 58(2), 111-113. doi:10.4103/0019-5545.183771

Guzman, F. (2019, June 27). First-Generation Antipsychotics: An Introduction. In Psychopharmacology Institute. Retrieved from https://psychopharmacologyinstitute.com/publication/first-generation-antipsychotics-an-introduction-2110?canonical=/publication/first-generation-antipsychotics-an-introduction-2110

Guzman, F. (2019, June 27). D2 Receptors in Psychopharmacology. In Psychopharmacology Institute. Retrieved from https://psychopharmacologyinstitute.com/publication/d2-receptors-in-psychopharmacology-2116

Nutt, D., & Lingford-Hughes, A. Key concepts in Psychopharmacology. Psychiatry, 263-267. doi: 10.1016/j.mppsy.2007.05.00

• Type of paperResearch Paper
• SubjectNursing
• Number of pages5
• Format of citationAPA
• Number of cited resources4
• Type of serviceWriting

The community is Tenafly, New Jersey and the Health Care needs is diabetes type 2 and the teaching is dietary Follow the Rubric which will be sent and all sections should be answered completely