Insomnia case – Discussion

For this Discussion, review the case below. Reflect on the case study excerpt and consider the therapy approaches you might take to assess, diagnose, and treat the patient’s health needs.  

Case: An elderly widow who just lost her spouse. 

Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications: 

• Metformin 500mg BID 
• Januvia 100mg daily 
• Losartan 100mg daily 
• HCTZ 25mg daily 
• Sertraline 100mg daily 

Current weight: 88 kg

Current height: 64 inches

Temp: 98.6 degrees F

BP: 132/86 

By Day 3 (Wednesday) of Week 7:

Post a response to each of the following:

• List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions. 
• Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why. 
• Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used. 
• List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why. 
• List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other. 
• For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities? 
• Include any “check points” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on the data provided. 
• Explain “lessons learned” from this case study, including how you might apply this case to your own practice when providing care to patients with similar clinical presentations. 

Throughout your education, you have been asked to research topics and write papers, engage in thought-provoking discussions, consider diverse perspectives, and a host of other challenges that have required you to use both your discipline-specific skills as well as your soft skills. These are called transferable skills, and are skills that you develop that can be transferred and applied within your chosen career. Transferable skills are highly valuable and essential for career success.

Throughout this course, you have been working on a project that allowed you to demonstrate your understanding of the transferable skills. It is now time to submit your project/assignment and add a transferable skills reflection.

To complete this assignment, you will need to do the following:

Part I: Compiling Your Exemplar Project

• Compile all of your completed course project assignment deliverables. Place them in the proper order, and save them in a single Microsoft Word document.

Part II: Transferable Skills Self Reflection

1. In a minimum of 1 full page, using Microsoft Word, write an essay (full introduction and conclusion), which includes the following:
   • Describe the knowledge, skills and/or attitudes regarding each of the transferable skills that you’ve gained as a result of completing this particular project/assignment.
   • Discuss the ways that you are going to incorporate the transferable skills (the transferable skills that you showcased in your exemplary project) into your work within your chosen career field.
   • Describe your future goals based on the transferable skills that you’ve chosen to showcase.
   • Write your paper utilizing proper tone, spelling and grammar.
2. Once you have completed your reflection assignment, add it to the end of the document you compiled in part I. The self-reflection should be the last few pages of your exemplar project. If done correctly, everything will be one document!
3. Save the compiled document to a folder. Then, zip or compress the folder, and submit the zipped folder to the drop box.

 FOLLOW THE INSTRUCTION

ZERO PLAGIARISM

FIVE REFERENCES

Quite often, nurse leaders are faced with ethical dilemmas, such as those associated with choices between competing needs and limited resources. Resources are finite, and competition for those resources occurs daily in all organizations.

For example, the use of 12-hour shifts has been a strategy to retain nurses. However, evidence suggests that as nurses work more hours in a shift, they commit more errors. How do effective leaders find a balance between the needs of the organization and the needs of ensuring quality, effective, and safe patient care?

In this Discussion, you will reflect on a national healthcare issue and examine how competing needs may impact the development of polices to address that issue.

To Prepare:

• Review the Resources and think about the national healthcare issue/stressor you previously selected for study in Module 1.
• Reflect on the competing needs in healthcare delivery as they pertain to the national healthcare issue/stressor you previously examined.

By Day 3 of Week 3

Post an explanation of how competing needs, such as the needs of the workforce, resources, and patients, may impact the development of policy. Then, describe any specific competing needs that may impact the national healthcare issue/stressor you selected. What are the impacts, and how might policy address these competing needs? Be specific and provide examples.

Benchmark – Curriculum Development Issue Paper

Read “Reconceptualizing Program Outcomes” and “Leveling EBP Content for Undergraduate Nursing Students” for a better understanding of issues within curriculum development.

Select an issue within curriculum development that is of interest to you.

Write a paper of 1,250 words on the issue, discussing its affect and relevance to nursing, staff or patient education.

1. Why is this issue a problem at your place of employment?

2. What are your proposed strategies to resolve these issues?

3. Use at least three to five scholarly, peer-reviewed resources less than 5 years old in addition to the course materials. Make sure that you do not use the two sources given in this assignment.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

USING THE TOPIC MEDICATION ERROR IN  A LONG TERM CARE FACILITY

Create an 8- to 9-slide PowerPoint presentation in which you do the following:

• Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)MY FACILITY IS A LONG TERM CARE FACILITY FOR OLDER PATIENTS ABOVE 65YEARS OLD.ISSUE INCLUDE POLY-PHARMACY AND LONGTERM USE OF MEDICATIONS.
• Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general.
• Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered.
• Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation.
• Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change.
• Be sure to provide APA citations of the supporting evidence-based peer reviewed articles you selected to support your thinking.
• Add a lessons learned section that includes the following:
  • A summary of the critical appraisal of the peer-reviewed articles you previously submitted
  • An explanation about what you learned from completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template (1-3 slides)