Selection Of Your Colleagues’ Responses. 2025

Discussion Assignment: Respond to the following Response Post # 1 & 2 Explain how you might apply knowledge gained from the Response case studies to your own practice in clinical settings. · Share additional interview and communication techniques that could be effective with your colleague’s selected patient. · · Suggest additional health-related risks that might be considered. · · Validate an idea with your own experience and additional research. · · Explain your reasoning using at least TWO different references from current evidence-based literature in APA Format. Response Post #: 1 Case 1: Volume 2, Case #16: The woman who liked late-night TV Case Study This is a case study of a 70-year-old female who lives at home by herself. The patient struggles with depression. She is sad, has lost interest in things she used to enjoy, and is fatigued with poor focus and concentration. The patient reports trouble sleeping. The patient also likes to watch late-night TV. Questions Sleeping disturbances affect 1/3 of Americans. Sleep can affect an individual’s memory, health, immune system, and pain. Some questions that we may need to ask the client: How much sleep do you usually get? Do you feel rested when you wake up? Do you have trouble falling asleep, or difficulty getting back to sleep when you wake up in the middle of the night? (Siengsukon, Al-Dughmi, & Stevens, 2017) Family Questions When assessing a patient, it is nice to allow the family to be involved, with the patient’s permission, if they are supportive and want to help the patient’s health improve. Some questions that the provider may want to ask the family are: How are the family dynamics, Does the patient’s symptoms nap during the day, and What does the family member suffering from sleep react throughout the day? These are important questions to help develop a picture of what is going on with the patient (Laff, 2016). Physical Exam and Diagnostic Testing When assessing the patient for a sleeping disorder you want to perform a physical examination to see if the patient has difficulty initiating sleep, maintaining sleep, and their routine before going to bed. As practitioners, we want to look to see if the patient is in pain. Does the patient use any substances such as alcohol, caffeine, nicotine, or any illegal drugs? Laboratory diagnostic tools may include blood work such as blood count, thyroid panel, comprehensive metabolic panel, C-Reactive Protein, ferritin, and vitamin B12. We may need to have the patient have echocardiograms, CT, or EEG performed depending on the lab results. Looking at the patient’s psychiatric history and sleep history. These are just a few tools to help diagnose and help determine the treatment (Riemann et al. 2017). Differential Diagnoses Three differential diagnoses that the patient fits the criteria for are Chronic insomnia disorder, sleep apnea syndrome, and Psychological insomnia. Chronic Insomnia disorder is when the individual has trouble sleeping three-four nights per week for three or more months. sleep apnea syndrome criteria include feeling tired throughout the day and snoring while sleeping. Psychological insomnia criteria are hyperarousal and learned sleep- preventing associations (Suzuki, Miyamoto, & Hirata, 2017). Drug Therapy Doxepin is a medication recommended to help with sleep at lower dosages. The recommended dosages are 3-6 mg (Sateia, Buysse, Krystal, Neubauer, & Heald, 2017). Doxepin binds with high specificity and affinity to the histamine H1 receptor compared with other receptors. At low doses, doxepin selectively antagonizes H1 receptors, which is believed to promote the initiation and maintenance of sleep (Weber, Siddiqui, Wagstaff, & McCormack, 2010). The next treatment option I would choose is Trazodone. The Therapeutic dose for Trazodone in 50 mg -200 mg. Trazodone can help with sleep and depression (Sateia, Buysse, Krystal, Neubauer, & Heald, 2017). Trazodone is an antagonist/blocker for all the targets except for the serotonin receptor, where it acts as an agonist/agonist (Settimo & Taylor, 2018). Follow-up Follow-ups are used to evaluate the progression of the patient’s symptoms. Practitioners evaluate medication side effects, the effectiveness of the medication, and the patient’s symptoms. It can take 4-8 weeks to know the effectiveness of a medication. In the case study, they followed up with the patient every four weeks. Response Post #: 2 Case Study 3 Case Study 3: Volume 1, Case 5: The sleepy woman with anxiety Insomnia is a common household occurrence with many people. This disorder can be attributed to medication, trauma, anxiety, and pain. According to Stahls (2013), sleep is considered to be a vital psychiatric sign during treatment evaluations Additional Evaluation Questions The case study included a lot of information; however, additional information is needed for an accurate diagnosis. 1. How long have you been experiencing a disruption of your sleep? 2. Do you have a problem falling asleep? 3. Do you drink caffeinated beverages before sleep? 4. What is your sleep routine? Do you have a TV in your room? 5. Have you tried nonpharmacological inventions such as (relaxation techniques)? 6. Do you have stressors, trauma, flashbacks that keep you awake? The following questions are asked to find additional information about the patient’s sleep history. Inquiring about past medications and nonpharmacological intervention is important to know when determining the new treatment options. Anxiety and the trauma-related event could cause an individual to lose sleep, especially if the event happens in the night hours. Many victims that experience night time trauma often has flashbacks during that time or increases anxiety. Also, drinking high caffeinated drinks could cause insomnia. The timing of drinking caffeinated beverages could be adjusted to be more beneficial to the patient. Family Questioning I would also include questions for other family members. I would ask them about the patient’s sleep pattern. Also, questions such as “have you witnessed bizarre behaviors from the patient that could affect the lack of sleep.” How much time do you think the patient sleeps daily? Do you think the patient has stressors or anxiety that keep her from sleeping? Many times the family members’ views on the patient’s insomnia can be different from the patient’s account. Testing and Diagnostic When patients are prescribed an antipsychotic, it important for the providers to start with a baseline EKG. According to Brown University Psychopharmacology (2014), Geodon is has known to cause QT prolongation for an individual with a personal or family of cardiac issues. Possible Diagnosis The patient presents with several symptoms and has an intensive mental health history. The three diagnoses that I considered a) post-traumatic syndrome (PTSD), Major Depressive Disorder (MDD), Insomnia Disorder. I think the patient should be treated for insomnia disorder. According to Stahl (2013), insomnia disorders can be linked to other psychiatric disorders and can advance to depressive occurrences. Pharmacological Agents The two-agents that I would consider for this patient are Trazodone and Ambien. Trazodone is a serotonin receptor antagonist, that has an immediate effect on insomnia (Stahl, 2014). The recommended starting dose is 50mg PO nightly. The dose can tamper to produced the desired effect. Ambien is non-benzodiazepine hypnotic and is used to treat short term insomnia (Stahl. 2014). Ambien recommended starting dose is 5mg PO nightly immediate release. This medication would only be prescribed for 7-10 days due to the risk of dependence and worsening symptoms of depression and suicidal ideations. Lesson Learned This case study includes many variables about the patient’s past and present medical history.  Lagerberg et al. (2019) stated that incidents with polypharmacy increase with age and children have the highest incident with 3 or more psychotic drug classes. As an advanced practice nurse, it’s important to assess the medication and the patient history before determining the treatment. The patient indicated that several medications did not work for her but more information was needed to determine if that was an accurate assumption of the medication.

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Nursing 2 2025

Clinical Judgment is the process of integrating evidence-based practice, critical-thought, the Nursing Process, knowledge, skills, and attitudes, as well as application of theory to practice in order to promote safe, quality care to clients in all settings. Keeping that in mind, answer the following scenario: You are the Charge Nurse in a large Urban Emergency Department (ED). You nursing staff include: RN with 12 years of Trauma ED experience New RN with 6 months ED experience RN from the Medical Surgical floor with 8 years of experience The following patients are in the ED, which patient will you give to each of the nurses and why? A 76-year-old client who was involved in a motor vehicle accident and has hematuria. A 38-year-old client with kidney stones complaining of severe pain. A 24-year-old diabetic client with an acute urinary tract infection who will require discharge teaching. An 80-year-old client that has not had a bowel movement for 4 days.

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Advance Nursing Research 2025

Woodall, M., & DeLetter, M. (2018). Colorectal cancer: A collaborative approach to improve education and screening in a rural population . Clinical Journal of Oncology Nursing, 22 (1), 69–75. Based on the research article you read, respond to the following prompts: 1. What, if any, was the theoretical framework that was used by article author(s)? 2. Describe the framework; was it from nursing or a borrowed theory? 3. Describe how the framework was used to inform the research study. 4. How much did the researchers write about it in the journal article? For example, was it weaved throughout the paper or mentioned only in the beginning? 5. In your opinion, what other nursing theory might have worked with this research study? Why? APA style. TURNITIN ASSIGNSMENT (FREE OF PLAGIARISM)

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Assignment: Assessing And Treating Clients With Impulsivity, Compulsivity, And Addiction 2025

The Assignment: Examine Case Study: A Puerto Rican Woman With Comorbid Addiction . You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes. At each decision point stop to complete the following: · Decision #1 · o Which decision did you select? o Why did you select this decision? Support your response with evidence and references to the Learning Resources. o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. o Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different? · Decision #2 · o Why did you select this decision? Support your response with evidence and references to the Learning Resources. o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. o Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different? · Decision #3 · o Why did you select this decision? Support your response with evidence and references to the Learning Resources. o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. o Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different? Note: Support your rationale with a minimum of three academic resources no more than five years old. Co-morbid Addiction (ETOH and Gambling) 53-year-old Puerto Rican Female BACKGROUND Mrs. Maria Perez is a 53 year old Puerto Rican female who presents to your office today due to a rather “embarrassing problem.” SUBJECTIVE Mrs. Perez admits that she has had “problems” with alcohol since her father died in her late teens. She reports that she has struggled with alcohol since her 20’s and has been involved with Alcoholics Anonymous “on and off” for the past 25 years. She states that for the past two years, she has been having more and more difficulty maintaining her sobriety since they opened the new “Rising Sun” casino near her home. Mrs. Perez states that she and a friend went to visit the new casino during their grand opening at which point she was “hooked.” She states that she gets “such a high” when she is gambling. While gambling, she “enjoys a drink or two” to help calm her during high-stakes games. She states that this often gives way to more drinking and more reckless gambling. She also reports that her cigarette smoking has increased over the past two years and she is concerned about the negative effects of the cigarette smoking on her health. She states that she attempts to abstain from drinking but that she gets such a “high” from the act of gambling that she needs a few drinks to “even out.” She also notices that when she drinks, she doesn’t smoke “as much” but enjoys smoking when she is playing at the slot machines. She also reports that she has gained weight from drinking so much- she currently weights 122 lbs., which represents a 7 lb. weight gain from her usual 115 lb. weight. Mrs. Perez is quite concerned today because she has borrowed over $50,000 from her retirement account to pay off her gambling debts. She is very concerned because her husband does not know that she has spent this much money. MENTAL STATUS EXAM The client is a 53 year old Puerto Rican female who is alert, oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. Her speech is clear, coherent, and goal directed. Her eye contact is somewhat avoidant during the clinical interview. As you make eye contact with her, she looks away or looks down. She demonstrates no noteworthy mannerisms, gestures, or tics. Her self-reported mood is “sad.” Affect is appropriate to content of conversation & self-reported mood. She visual or auditory hallucinations, no delusional or paranoid thought processes are readily appreciated. Insight and judgment are grossly intact, however, impulse control is impaired. She is currently denying suicidal or homicidal ideation. Diagnosis: Gambling disorder, alcohol use disorder Decision Point One: Select what the PMHNP should do: Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal region every 4 weeks RESULTS OF DECISION POINT ONE Client returns to clinic in four weeks Mrs. Perez said that she felt “wonderful” as she has not “touched a drop” to drink since receiving the injection Client reports that she has not been going to the casino, as frequently, but when she does go she “drops a bundle” (meaning, spends a lot of money gambling) Client She is also still smoking, which has her concerned. She is also reporting some problems with anxiety, which also have her concerned Decision Point Two: Select what the PMHNP should do next: Add on Valium(diazepam) 5 mg orally TID/PRN/anxiety RESULTS OF DECISION POINT TWO Client returns to clinic in four weeks Mrs. Perez reports that when she first received the valium, it helped her tremendously. She states “I was like a new person- this is a miracle drug!” However, she reports that she has trouble “waiting” between drug administration times and sometimes takes her valium early Client is asking today for you to increase the valium dose or frequency Decision Point Three: Select what the PMHNP should do next: Continue current dose of Vivitrol, increase Valium to 10 mg orally TID/PRN/anxiety. Refer to counseling for her ongoing gambling issue Guidance to Student Anxiety is a common side effect of Vivitrol. Mrs. Perez reports that she is doing well with this medication, and like other side effects, the anxiety associated with this medication may be transient. The psychiatric mental health nurse practitioner should never initiate benzodiazepines in a client who already has issues with alcohol, or other substance dependencies. Additionally, benzodiazepines are not to be used long-term. Problems associated with long-term benzodiazepine use include the need to increase the dose in order to achieve the same therapeutic effect. This is what we are seeing in Mrs. Perez’s case. The most appropriate course of action in this case would be to continue the current dose of Vivitrol, while decreasing the Valium with the goal of discontinuation of the drug within the next two weeks. At this point, we need to evaluate whether or not the side effect of anxiety associated with Vivitrol persists. Increasing the dose of Valium would not be appropriate, neither would maintaining her on the current dose of Valium. Additionally, the client should be referred for counseling to help with her gambling addiction, as there are no FDA approved medications gambling disorder. Medication should never be added treat side effect of another medication, unless that side effect is known to be transient (for instance, benzodiazepines are sometimes prescribed to overcome the initial problem of “activation” associated with initiation of SSRI, or SNRI therapy). However, in a client with multiple addictive disorders, benzodiazepines should never be used (unless they are only being used for a limited duration of therapy such as acute alcohol detoxification to prevent seizures). Additionally, it should be noted that Mrs. Perez continues to engage in problematic gambling, at considerable personal financial cost. Mrs. Perez needs to be referred to a counselor who specializes in the treatment of gambling disorder and should also be encouraged to establish herself with a local chapter of gamblers anonymous. The PMHNP needs to discuss smoking cessation options with Mrs. Perez in order to address the totality of addictions, and to enhance her overall health.

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