one or two paragraph answering this post:: APA, reference and citation 

This course has brought a new awareness to formulating researchable problems, using a systematic and scholarly approach that has the power and capability to improve patient outcomes. Through the use of credible scientific, evidence-based research, we as nurses can change the future and develop our research skills further to create new evidence-based changes in not only nursing but in healthcare in general. The experience of developing a possible research proposal on a nursing practice issue has brought a whole new understanding and respect for those individuals who conduct this type of research on a daily basis. The process and efforts involved in the development of a research proposal can be tremendous, and the methodical detail and protocol required take a very disciplined person. However, I am glad I was exposed to the process because I may need to conduct a research project in the future, this class has shown me the process and has decreased my anxiety about the research process.

I learned that there are International Human Research guidelines, protecting human participants in 130 countries around the world. This, however, does not protect human participants in every country, allowing those who wish to conduct unethical and inhumane experiments to continue inflicting harm to their fellow man in the name of “research”. It is very important to maintain ethical standards to prevent violations of human rights and the abuses made in the past when conducting research with human beings. In 1979, the Belmont Commission Report defined few ethical principles for the protection on humans in research serving as guideline for future practice (Rebar, Macnee, Gersch, & McCabe, 2011). Currently, in the participating countries, there are over 1000 laws, regulations, and guidelines on human subject protections that are very specific as to the expectations (Health & Human Services, 2018). Education is the key to reducing unethical practice, by learning and practicing all ethical principles.

Students must review the case study and answer all questions with a scholarly response using APA and include 2 scholarly references. Answer both case studies on the same document and upload 1 document to Moodle.

Case Study 1 & 2 topics change every semester.  Topic TBD

The answers must be in your own words with reference to the journal or book where you found the evidence to your answer. Do not copy-paste or use past students’ work as all files submitted in this course are registered and saved in turn it in the program.

Answers must be scholarly and be 3-4 sentences in length with rationale and explanation. No Straight forward / Simple answer will be accepted.  

Turn it in Score must be less than 25 % or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 25 %. Copy paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement.

All answers to case studies must have reference cited in the text for each answer and a minimum of 2 Scholarly References (Journals, books) (No websites)  per case Study

Students much review the case study and answer all questions with a scholarly response using APA and include 2 scholarly references. Answer both case studies on the same document and upload 1 document to Moodle.

Case Study 1 & 2 topics change every semester. Topics will be determined at due time for this semester

The answers must be in your own words with reference to the journal or book where you found the evidence to your answer. Do not copy-paste or use a past students work as all files submitted in this course are registered and saved in turn it in program.

Turn it in Score must be less than 25 % or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 25 %. Copy-paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement.

All answers to case studies must-have reference cited in the text for each answer and a minimum of 2 Scholarly References (Journals, books) (No websites)  per case Study

 Case Study 1 A 37-year-old male patient came to your primary care clinic c/o of a lesion in his genital area (see pic  below). Pt states that the lesion appeared 7 (seven) days ago. Pt denies pain in the area. Pt states using  some cream with no improvement.   1) What other information you would need from this patient (Please include at least 5 five) 2) What would it be the epidemiological information you may take into consideration in this case? 3) What would it be your first impression diagnosis for this case and what testing/screening labs you  would order (please provide rationale) 4) Would you apply any empiric treatment based on your diagnosis? 5) What type of education you would provide to this patient? ============================================================================== Case Study 2 66-year-old female patient comes to your clinic with a PMH of Hypertension and arthritis in her right  knee. Pt states that 72 hours ago she underwent an infiltration in his right knee at this rheumatologist  doctor’s office because she complained of pain no resolved with NSAID. Today she presented to your primary office with pain in her right knee, with signs and symptoms of  fever (102ºF) and reduced mobility. 1) What do you suspect? 2) What would you order for this patient, and what do you think you would find? 3) What would it be your recommendation in this case? 4) Would you recommend any empirical treatment? For how long 

In collaboration with your approved course mentor, you will identify a specific evidence-based practice proposal topic for the capstone project. Consider the clinical environment in which you are currently working or have recently worked. The capstone project topic can be a clinical practice problem, an organizational issue, a quality improvement suggestion, a leadership initiative, or an educational need appropriate to your area of interest as well as your practice immersion (practicum) setting. Examples of the integration of community health, leadership, and an EBP can be found on the “Educational and Community-Based Programs” page of the Healthy People 2020 website.

Write a 500-750 word description of your proposed capstone project topic. Make sure to include the following:

1. The problem, issue, suggestion, initiative, or educational need that will be the focus of the project
2. The setting or context in which the problem, issue, suggestion, initiative, or educational need can be observed.
3. A description providing a high level of detail regarding the problem, issue, suggestion, initiative, or educational need.
4. Impact of the problem, issue, suggestion, initiative, or educational need on the work environment, the quality of care provided by staff, and patient outcomes.
5. Significance of the problem, issue, suggestion, initiative, or educational need and its implications to nursing.
6. A proposed solution to the identified project topic

You are required to retrieve and assess a minimum of 8 peer-reviewed articles. Plan your time accordingly to complete this assignment.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.

Respond to two colleagues in one of the following ways:

If your colleagues’ posts influenced your understanding of these   concepts, be sure to share how and why. Include additional insights you   gained.

If you think your colleagues might have misunderstood these   concepts, offer your alternative perspective and be sure to provide an   explanation for them. Include resources to support your perspective.

                                                  Main Post

Agonist-to-Antagonist Spectrum

The agonist-to-antagonist spectrum of action refers to  the action  that is taken by a neurotransmitter to produces a  conformational change  (Stahl, 2013).  The spectrum starts with the  agonist action, which,  with the help of a second-messenger, can turn on  the full potential of  change (Stahl, 2013). Full agonists can be natural  transmitters used to  produce change.  An antagonist blocks the  conformational change of the  potential of the transmitter for binding  with the intended agonist  (Stahl, 2013).  The role of the antagonist is  to keep the receptors in a  baseline state in order to reverse what the  agonist has done (Stahl,  2013). This is the opposite end of the spectrum  and seeks to block  agonists.  In the middle, some partial agonists  mimic its agonist  partner to a lesser degree, and inverse agonists stop  all activity from  occurring on the receptor (Stahl, 2013).  The  conformational change is  needed for a receptor to open to the action of  drugs, particularly,  psychopharmaceutical medications in this case.

G couple proteins and Ion gated channels

G couple proteins are used at the binding site of a  neurotransmitter  to act as a conduit for enzymes (Stahl, 2013). Whereas,  ion gated  channels exist as targets to regulate chemical  neurotransmitters  (Stahl, 2013).  Ion gated channels consist of channels  and receptors  that can only be opened by the neurotransmitters.   Conversely, G couple  proteins attach to neurotransmitters and conform to  enzymes to serve  as a channel for a second messenger (Stahl, 2013).   Most psychotropic  medications aim for the ion gated channels, which open  through chemical  neurotransmission and initiate the signal transduction  cascade (Stahl,  2013).  The cascade results in faster uptake of  psychotropic  medications into the system.

The Role of Epigenetics

According to DeSocio (2016), epigenetics is the study  of how genomes  that undergo changes with certain molecular compounds and   environmental changes can leave the essential DNA unchanged.  It is a   modification of gene expression that is independent of the DNA  (DeSocio,  2016).  DNA is the code that determines much of who we are.   Changes in  that code can be seen as a result of heredity, the  environment, or  neurotransmission (Stahl, 2013).  These alterations  affect individuals  at a physical, emotional, and psychological level.   Stress and adversity  play a significant role in epigenetics by changing  the genomes, which  in turn leads to changes in a person’s DNA (Park et  al., 2019).  These  alterations influence psychological issues related  to many individuals.   It is essential to know how to combat these  changes when determining a  plan of care for clients.

Implications of Findings to Prescribing

As nurse practitioners, it is essential to have an  extensive  understanding of how the above processes affect the way we  prescribe  medications to clients.  It is also essential to take into   consideration how the environment impacts maintaining optimal health  and  healing (DeSocio, 2016).  Knowing the mechanisms of action for   medications that we are prescribing is vital to providing competent   care.  For example, a patient with a generalized anxiety disorder (GAD)   is prescribed Venlafaxine.  The PMHNP needs to understand that the   Venlafaxine works by boosting the serotonin, norepinephrine, and   dopamine neurotransmitters (Stahl, 2014).  This action blocks serotonin   reuptake, norepinephrine reuptake, and the dopamine reuptake (Stahl,   2014).  Each of these actions then increases these neurotransmissions  in  the brain providing therapeutic results. 

                                          References

DeSocio, J.E. (2016). Epigenetics: An emerging framework for advanced practice psychiatric nursing. Perspectives in Psychiatric Care, 52(3), 201-207. https://doi.org/10.1111/ppc.12118

Park, C.,  Rosenblat, J.D., Brietzke, E.,  Pan, Z., Lee, Y., Cao, B.,  Zuckerman, H., Kalantarova, A., McIntyre,  R.S. (2019). Stress,  epigenetics, and depression: A systematic review. Neuroscience and Biobehavioral Reviews, 102, 139-152. https://doi.org/10.1016/j.neubiorev.2019.04.010

Stahl, S.M. (2014). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

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