Angela La Dow 

 

Manage Discussion Entry 

The name of the condition is Neonatal Abstinence Syndrome (NAS). The baby will be born with opioids on board and will require opioids or partial opioid receptor agonists to help the baby through withdrawl and detox. This process can be started while in utero with the mother in medication assisted treatment (MAT). The idea behind MAT is to use opioid agonists that do not fully cover the opioid receptors thereby reducing the euphoria of the full opioid (morphine, hydrocodone, fentanyl, oxycodone, & heroin). There are three treatment modalities for MAT; methadone, buprenorphine or the combo buprenorphine/naltrexone (Suboxone), and naltrexone itself (SAMHSA, 2018

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). Buprenorphine in combination with naltrexone completely blocks the full receptor so the effects can not be overcome by more opioids (to a certain extent) and reduces cravings. Once a patient is in MAT and dosed appropriately with a Suboxone dose that is the smallest dose to keep withdrawl away visits can be extended out if they are working therapy and group therapies such as NA and AA the psychosocial aspect of addiction. When a pregnant women starts MAT the amount of medication that crosses the placenta is the same as the mother’s and the fetus can start to slowly and safely reduce their exposure to full opioids (McQueen and Oikonen, 2016

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). A patient has to be off full opioids for at least 3 days before starting MAT with Suboxone. They are given Imodium, gabapentin, and clonidine to help reduce the withdrawl symptoms. If they are not they will go into full withdrawl with the initiating dose due to the naltrexone. 

Risks for the baby are low birth weight, STI infections, potential abuse and neglect, and preterm birth (McQueen & Oikonen, 2016). Opioid withdrawl for infants is more serious that opioid withdrawl for adults due to the seizures and other neurologic symptoms it can cause. Depending the type of opioid and the amount taken by the mother the severity of withdrawl will be different for each infant. There will be tremors, diarrhea, irritability, tachycardia and tachypnea, poor feeding, and possibly seizures (McQueen and Oikonen, 2016). Long-term effects of NAS are not well studied but it has been found that there can be some behavioral problems and mental health issues with these children as well as abuse and neglect by the parents (McQueen and Oikonen, 2016). 

There is a misconception that a women will automatically be placed in jail if the are using opioids while pregnant once they give birth so they do not seek prenatal care and sometimes will wait until they are in labor to be seen. There was on NAS infant in the hospital I work at who was born to the girlfriend of a MAT patient we were seeing. She left the hospital AMA because she did not tell anyone she was a heroin addict and started withdrawl. She could have been treated appropriately in the hospital and reduced her risk of hemorrhage and death and stayed with her baby. The goal for these women is to get them to bond with the baby, be able to manage their care in their home, and find supports for them over the long term (McQueen and Oikonen, 2016). 

My last preceptor became certified in addiction treatment with Suboxone so I got the opportunity to work with this population and see first hand the initiation of treatment, pride in getting clean, pride in staying clean, and the disappointment of relapse. There are not a lot of providers that are certified to do this treatment and they are only allowed a certain amount of patients per provider. The certifying body that maintains it just opened certification to NPs and PAs to manage patients. Generally recreational drug use and alcohol abuse escalates to heroin use. I saw at least four patients that started with legit prescriptions for opioids and progressed to heroin use. The others started with other recreational drug use and alcohol abuse. My last preceptor stated to me that if a pregnant women seeks MAT and is on it while in labor there are better outcomes for the baby and the mother and child protective services may be willing to work with her.

References

McQueen, K., & Oikonen, J. (2016). Neonatal Abstinence Syndrome. Retrieved from https://www.nejm.org/doi/full/10.1056/NEJMra1600879 

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Links to an external site.

SAMHSA. (2018). Medication assisted treatment. Retrieved from https://www.samhsa.gov/medication-assisted-treatment

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Links to an external site.

   

hi dear,

can help me to finish this assignment with good quality and be on time please?

Please follow the instructor carefully. There are 4 Discussions ,your response to classmates should be at least one paragraph for each Discussion, address the discussion topic or question, be respectful, and add to the discussion. You may draw upon personal experience, course or scholarly references, citing appropriately. Restating the primary response, or agreeing or disagreeing without supporting statements will result in a lower grade. 

In reference to including a paragraph for both primary and peer responses, 4-5 sentences constitute a paragraph.

Discussion one,

  ABX2-7 Smoking in the Workplace: The existing law prohibited smoking tobacco products in enclosed spaces, the new bill would expand that to prohibit smoking in the place of employment. Additionally, this bill no longer allowed for any exemptions for smoking, to include bars, hotels, and banquet halls. (Hernandez, 2016) On the Health Impact Pyramid, the implementation of smoke-free laws as the “changing the context to make individuals’ default decision healthy.” This approach has a large impact on the community and if individuals are not able to smoke in their place of work or other environments where smoking is usually increased, then perhaps the healthier decision will be made more often. ABX2-10 Local Taxes: Authorization: Cigarettes and Tobacco Products: This bill would allow for the imposition of additional taxes that are not already collected on the distribution of tobacco. (Bloom, 2016) In order for there to be additional tax bills passed it had to first be advocated. Advocacy is getting powerful legislators to influence change in policies. SBX2-5 Electronic Cigarettes: Tobacco products are changed to include electronic cigarettes and the vaporized liquids containing nicotine. SBX2-7 Tobacco products: minimum legal age: This bill increases the legal smoking age from age 18 to age 21. However, this does not apply to active duty military with military ID card. This bill was approved by the governor of California on 05/04/2016.ABX2-9 Tobacco Use Programs: This bill expands funding for tobacco prevention programs to promote the education and tobacco free campus’. ABX2-11 Cigarette and Tobacco product licensing: Fee and Funding: the current bill required any distributors, wholesales, retailers, and etc. to obtain a license from the board which previously required a one-time fee. The new bill states that the fee and application renewal would be required every calendar year after Jan 1, 2017.

Discussion 2,

  This first bill that took my interest is ABX2-7 Tobacco use programs (Thumand). The bill would expand funding for the tobacco use prevention program to include Charter School. The would require the State Department of Education to require that all school districts and county offices to adopt and enforce a tobacco-free campus prohibiting any use of the drug including nicotine. It also requires anyone participating to display signs at all entrances to school property stating, “Tobacco is prohibited.” The second bill that peaked by intrigue is the SBX2-7. Tobacco products: minimum legal age. This bill authorizes the State Department of Public health to conduct random onsite inspections of tobacco retailers to selling to any persons under the age of 21. However, there is an exception for any person who is active duty military, they are able to purchase tobacco products at the age of 18. It is great to see that we are going to great lengths to stop tobacco addiction, especially with our youth. I am just now learning that government buildings and schools are intentionally putting up tobacco-free signs because of funding offered through the state. As a tax payor, this is a great cause but I am surprised that this isn’t common knowledge.

Discussion 3,

  A coalition is a group of people who come together to reach a common goal.  Some goals that coalitions may focus on are having an impact in developing or changing public policy, helping individuals to change or stop a target behavior, and helping the community in becoming a healthier environment.  

The most essential members of a coalition are the stakeholders, community opinion leaders and policy makers. The stakeholders are the individuals who may be affected by whatever issue they coalition is focused on, as well as the people who are given jobs within the coalition itself. Community opinion leaders are those who are highly regarded within the community such as civic or business leaders. Policy makers are the state representatives that are actively involved in creating policies or laws within the community.The coalition I found is the Smoke Free Partnership (SFP) Coalition. The main goal of this coalition is the promotion and support of smoking prevention using advocacy development aimed at tobacco control policies (Aranudova). Currently there are 42 partners within this coalition including Action on Smoking and Health, FCA Framework Convention Alliance on Tobacco Control, and Life: Regional Advocacy Center.

Discussion 4,

  A coalition is individuals and/or organizations that group together due to shared similar interests and work together to complete a similar goal. Some coalitions form for short time periods, meaning they separate after completion of a specific goal. Three common goals that coalitions focus on are to influence public policies, change people’s behaviors, and build a healthier community. Three of the most essential coalition members include stakeholders, community opinion leaders, and policy makers. Stakeholders are those that are most effected by the issues, they are usually formal and informal helps that carry out community functions. Community Opinion Leaders are those members that can influence others, such as clergy or business leaders. Policy Leaders are state representatives and political leaders that add credibility to a coalition. (Rabinowitz, 2018) Kentucky Kids Eat is a coalition that is dedicated to end childhood hunger. Partnering with Share our Strength, Kentucky Association of Food Banks, and Kentucky Agriculture Development Board, the KY Kids Eat coalition ensured that kids are provided food through free school meals (breakfast and lunch) and summer meal programs.

Thanks,

Please, respond to the following discussion by using peer-reviewed Nursing Journal not older than 5 years. APA format required.

 

Nursing Research and Evidence-Based Practice

Evidence based practice (EBP) is related to nursing research in several ways. Evidence based practices use researched knowledge in order to improve a practice. A fundamental part of EBP is using the best presented research evidence and integrating it with other factors in making clinical decisions to improve the outcomes (Polit & Beck, 2018). Nurses need to understand a research in order to use it and to center the evidence of its practice in order to adjust it to possibly perform an EBP.

Nursing research and EBP have their differences as well. There are different requirements for nurses to do either. Any nurse can perform an EBP. They can use a knowledge in nursing and improve the results of a practice by changing a few things. A group of RNs’ on a rehabilitation unit can give group talk sessions about fall prevention measures with patients and family member and record if there are less falls in the unit as a result of this practice. Nurses need a higher education in order to perform researches. Many researches companies require that nurse acquire a master’s in nursing, or even a doctorate, prior to be hire. Both nursing research and EBP has a different set of steps to follow. Nursing research involves concepts, constructs, theories, variable, and research data (Polit & Beck, 2018). Nursing researches can be based on nursing, medical, or any other science that could relate with nursing. EBP, on the contrary, will use of a research knowledge, find a group to test, perform an intervention, compare the results, check for outcomes and make better decisions based on the best evidence. Also, there are four essential EBP skills which are asking a practice question using the PICO method, retrieving evidence from the literature, appraising the evidence, and synthesizing the evidence (Howe & Close, 2016).

In conclusion, a nursing research is a development of a new knowledge based on a study perform by nurses with a higher education while EBP can be performed by a nurse with the knowledge already known and with better evidences will improve its application. 

  

In this critical thinking assignment, examine various viewpoints of the ethical debate related to profit in healthcare. How does profit in healthcare impact providers’ decisions? To what extent does profit in healthcare influence competition and pricing? ( include Saudia Arabia )

Develop a PowerPoint presentation meeting the following structural requirements. Your presentation must:

1. Be organized, using professional themes and transitions.
2. Consist of 6 slides, not including the title and reference slides (seven 8).
3. Provide in each slide detailed speakers notes—a minimum of 100 words in length. Notes must draw from, and cite relevant reference materials.
4. Provide support for your statements with in-text citations from a minimum of four scholarly articles. Two of these sources may be from the class readings, textbook, or lectures, but the others must be external. 
5. Follow APA writing standards.
6. Add cited images.
7. No plagiarism
8. The references should not be before 5 years ago.