Select one (1) book about children related to palliative care or end of life care

• A children’s book talking with kids about their illness or dying

Once you have read the chosen book discuss the following;
1) Place the title of the material at the beginning
2) Give a brief summary of the content of the material
3) Discuss the significance of the material to your understanding of palliative care and end of life care in

     children
4) Describe how you can utilize this information into your nursing practice

Post your week 14 discussion questions here.

People of Irish Heritage.

People of Italian Heritage.

People of Puerto Rican Heritage.

Read chapter 23, 33 and 34 of the class textbook and review the attached PowerPoint presentations.  Read content chapter 33 and 34 in Davis Plus Online Website.  Once done answer the following questions;

1.  Discuss the organization and the family role in every one of the heritages mentioned about and how they affect (positively or negatively) the delivery of health care.

2.  Identify sociocultural variables within the Irish, Italian and Puerto Rican heritage and mention some examples.

 A minimum of 2 replies to any of your peers sustained with the appropriate references must be posted.  Only the assignment must be attached in a word document in the forum, replies do not.  References must be no older than 5 years.  A minimum of 700 words is required.  Please follow the instructions on how to present the first page and the name of the assignment when you post should be Week 14 discussion questions.

Alzheimer’s Disease
76-year-old Iranian Male

Write a 1- to 2-page summary paper that addresses the following:

• Briefly summarize the patient case study,  including each of the three decisions you took for the patient presented.
• Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.
• What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.
• Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples.

Patient case study: 

Alzheimer’s Disease
76-year-old Iranian MaleBACKGROUND

BACKGROUND

Mr. Akkad is a 76-year-old Iranian male who is brought to your office by his eldest son for “strange behavior.” Mr. Akkad was seen by his family physician who ruled out any organic basis for Mr. Akkad’s behavior. All laboratory and diagnostic imaging tests (including CT-scan of the head) were normal.

According to his son, he has been demonstrating some strange thoughts and behaviors for the past two years, but things seem to be getting worse. Per the client’s son, the family noticed that Mr. Akkad’s personality began to change a few years ago. He began to lose interest in religious activities with the family and became more “critical” of everyone. They also noticed that things he used to take seriously had become a source of “amusement” and “ridicule.”

Over the course of the past two years, the family has noticed that Mr. Akkad has been forgetting things. His son also reports that sometimes he has difficulty “finding the right words” in a conversation and then will shift to an entirely different line of conversation.

SUBJECTIVE

During the clinical interview, Mr. Akkad is pleasant, cooperative and seems to enjoy speaking with you. You notice some confabulation during various aspects of memory testing, so you perform a Mini-Mental State Exam. Mr. Akkad scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall. The score suggests moderate dementia.

MENTAL STATUS EXAM

Mr. Akkad is a 76-year-old Iranian male who is cooperative with today’s clinical interview. His eye contact is poor. Speech is clear, coherent, but tangential at times. He makes no unusual motor movements and demonstrates no tic. The self-reported mood is euthymic. Affect however is restricted. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. He is alert and oriented to person, partially oriented to place, but is disoriented to time and event [he reports that he thought he was coming to lunch but “wound up here”- referring to your office, at which point he begins to laugh]. Insight and judgment are impaired. Impulse control is also impaired as evidenced by Mr. Akkad’s standing up during the clinical interview and walking towards the door. When you asked where he was going, he stated that he did not know. Mr. Akkad denies suicidal or homicidal ideation.

Diagnosis: Major neurocognitive disorder due to Alzheimer’s disease (presumptive)

Decision Point One

Begin Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg orally BID in 2 weeks

RESULTS OF DECISION POINT ONE

•  The client returns to clinic in four weeks
•  The client is accompanied by his son who reports that his father is “no better” from this medication. He reports that his father is still disinterested in attending religious services/activities, and continues to exhibit disinhibited behaviors
•  You continue to note confabulation and decide to administer the MMSE again. Mr. Akkad again scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall

Decision Point Two

Increase Exelon to 4.5 mg orally BID

RESULTS OF DECISION POINT TWO

•  The client returns to the clinic in four weeks
•  Client’s son reports that the client is tolerating the medication well, but is still concerned that his father is no better
•  He states that his father is attending religious services with the family, which the son and the rest of the family is happy about. He reports that his father is still easily amused by things he once found serious

Decision Point Three

Increase Exelon to 6 mg orally BID

Guidance to Student
At this point, the client is reporting no side effects and is participating in an important part of family life (religious services). This could speak to the fact that the medication may have improved some symptoms. you needs to counsel the client’s son on the trajectory of presumptive Alzheimer’s disease in that it is irreversible, and while cholinesterase inhibitors can stabilize symptoms, this process can take months. Also, these medications are incapable of reversing the degenerative process. Some improvements in problematic behaviors (such as disinhibition) may be seen, but not in all clients.
At this point, you could maintain the current dose until the next visit in 4 weeks, or you could increase it to 6 mg orally BID and see how the client is doing in 4 more weeks. Augmentation with Namenda is another possibility, but you should maximize the dose of the cholinesterase inhibitor before adding augmenting agents. However, some experts argue that combination therapy should be used from the onset of treatment.
Finally, it is important to note that changes in the MMSE should be evaluated over the course of months, not weeks. The absence of change in the MMSE after 4 weeks of treatment should not be a source of concern.

APA Citation 4 to 5 Reference within 5 years

Respond to your colleagues, offering additional/alternative ideas regarding opportunities and risks related to the observations shared.

  At least 2 references in each peer responses!

In my healthcare organization, there are many general healthcare technology trends we use daily. Most frequently, the use of the electronic health record (EHR), which is essentially a digital version of a paper chart (HealthIT.gov, 2018c). These EHR’s contain vital information for assessment and treatment for patients. The medical history, allergies, current medications, and treatment plans are all examples of what can be in the EHR (HealthIT.gov, 2018c). In addition to the chart containing all this information, it makes it accessible for all workers involved in the patient’s care to share information over a secure server. For example, physicians, nurses, laboratories, and pharmacies can all view vital healthcare information as well as share information among each other (HealthIT.gov, 2018c).

One potential drawback to using the EHR is patient perception. The use of the computer is vital to patient care and sometimes distances us from the patient or family members. In the last 30 years, the computer has come between this patient-centered approach to patient care (Sobral, Rosenbaum, & Figueiredo-Braga, 2015). It is widely known that a patient-centered approach brings better compliance, patient outcomes, and better patient satisfaction (Sobral, Rosenbaum, & Figueiredo-Braga, 2015). One benefit is that patients can easily access their lab and test results and communicate with physicians at home through patient portals. In the environment we live in, healthcare providers need to have the knowledge and skills necessary to recommend and navigate these digital tools (Skiba, 2017).

The healthcare trend I think is most promising, is telehealth. Just this week, my husband and I have both utilized these services with the COVID-19 restrictions on leaving the house. If someone is exhibiting symptoms of COVID-19, instead of leaving the house to see a doctor for mild symptoms, a call can be made from home and possibly prevent the spread of disease to others. Medicare has even gone so far as to expand payment for telehealth to ensure people feel comfortable using this type of technology in hopes of preventing the spread of COVID-19.