Discussion: Treatment for a Patient With a Common Condition

Insomnia is one of the most common medical conditions you will encounter as a PNP. Insomnia is a common symptom of many mental illnesses, including anxiety, depression, schizophrenia, and ADHD (Abbott, 2016). Various studies have demonstrated the bidirectional relationship between insomnia and mental illness. In fact, about 50% of adults with insomnia have a mental health problem, while up to 90% of adults with depression experience sleep problems (Abbott, 2016). Due to the interconnected psychopathology, it is important that you, as the PNP, understand the importance of the effects some psychopharmacologic treatments may have on a patient’s mental health illness and their sleep patterns. Therefore, it is important that you understand and reflect on the evidence-based research in developing treatment plans to recommend proper sleep practices to your patients as well as recommend appropriate psychopharmacologic treatments for optimal health and well-being.

Reference: Abbott, J. (2016). What’s the link between insomnia and mental illness? Health. https://www.sciencealert.com/what-exactly-is-the-link-between-insomnia-and-mental-illness#:~:text=Sleep%20problems%20such%20as%20insomnia%20are%20a%20common,bipolar%20disorder%2C%20and%20attention%20deficit%20hyperactivity%20disorder%20%28ADHD%29
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

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?

 

Module 09 Discussion – Mental Healthcare for Adolescence & Children

Scenario

Ryan is a 12 year old diagnosed with Oppositional Defiant Disorder (ODD). As a small child, Ryan was first diagnosed with Attention Deficit, Hyperactivity Disorder. He had just started preschool and was unable to remain in one place for more than a minute or two. His parents had already had a very difficult time in disciplining him, because he would become very upset and throw temper tantrums when he could not do as he wished. He just seemed to be an unhappy, irritable child. This behavior continued in school. As time progressed, Ryan was diagnosed with Oppositional Defiant Disorder, because he continued to refuse to listen to adults and comply with the rules.

By the age of 12, he has begun to bully and annoy others. His parents have decided that the approaches they have used in the past are not working, and they are more afraid his behavior will only get worse.

Initial Post

Provide explanations for these questions and statements:

• Describe the behaviors apparent for each disorder in this scenario (Attention Deficit Hyperactivity Disorder and Oppositional Defiant Disorder).
• If this behavior becomes worse and Ryan starts to violate the rights of others, what medical diagnosis will be given and why?
• Discuss at least two types of medication appropriate to treat Ryan and support your choices with rationale and credible resources
• Describe why therapy for the parent is important in this scenario including at least two supporting rationales.

• Develop a 6–7-page implementation plan for the initiative you proposed in Assessment 1. Include a budget for material, staffing, and capital costs over the first five years of the initiative, as well as projected earnings. In addition, include a timeline, an organizational impact analysis, and an explanation of the effects of environmental changes on the initiative.
  Note: Each assessment in this course builds upon the work you have completed in previous assessments. Therefore, you must complete the assessments in the order in which they are presented.
  SHOW LESSAs a master’s-level health care practitioner, you may be expected to create budgets and implementation plans to ensure that initiatives to take advantage of economic opportunities for the organization are rolled out successfully and can be sustained over multiple years. Additionally, it is important to be able to envision how an initiative could be implemented in different contexts and for different purposes to ensure that the investment remains a viable and positive asset to your organization or care setting.
  Competency Map
  CHECK YOUR PROGRESSUse this online tool to track your performance and progress through your course.
• Toggle DrawerResourcesBudget Development
  The following articles may be helpful in helping you to create a budget.
  
  • Danna, D. (n.d.). Learning and mastering the operating budget. Retrieved from http://www.strategiesfornursemanagers.com/ce_detail/213520.cfm
  • Pritchard, G. (n.d.). How to develop an operating budget for a nursing unit. Retrieved from http://smallbusiness.chron.com/develop-operating-budget-nursing-unit-79824.html
  • SHOW MORE
• Assessment InstructionsDevelop a thorough implementation plan for the economic initiative you proposed in Assessment 1. Your plan must include a budget for material, staffing, and capital costs over the first five years of the initiative, as well as projected earnings. In addition, include:
  
  • A plan and timeline for rolling out the initiative.
  • An analysis of how the initiative may impact other aspects of the organization or care setting.
  • An explanation how the initiative can remain viable in the face of environmental changes.
  • Sufficient relevant and credible supporting evidence.
  • Note: Remember that you can submit all, or a portion of, your draft implementation plan to Smarthinking for feedback before you submit the final version for this assessment. If you plan on using this free service, be mindful of the turnaround time of 24–48 hours for receiving feedback.
    Requirements
    The requirements for your implementation plan, outlined below, correspond to the scoring guide criteria, so be sure to address each main point. Read the performance-level descriptions for each criterion to see how your work will be assessed. In addition, be sure to note the requirements for document format and length and for supporting evidence.
  • Create a budget for expected costs and earnings over the first five years of your proposed initiative. 
    • What are the expected material, staffing, and capital costs of your proposed initiative over its first five years?
    • What are the projected earnings for your organization or care setting over the first five years of your economic initiative?
    • How does this budget take into account the findings and feedback you received on your business case?
    • What assumptions are you basing your budget on?
  • Create an implementation plan for your proposed initiative that enables achievement of quality or service improvements in an ethical and culturally equitable way. 
    • Did you create a timeline for the rollout?
    • How will you work with relevant stakeholders to ensure that your economic initiative is implemented successfully and sustained?
    • How will you ensure that the rollout is conducted in an ethical and culturally equitable manner?
    • How will you ensure that the desired quality or service improvements your economic initiative will achieve are on track during and after implementation?
  • Analyze the impact of your proposed initiative, once implemented, on other aspects of your organization or care setting and ways in which negative impacts could be mitigated. 
    • What other aspects of your organization or care setting may be positively or negatively impacted by the implementation of your proposed initiative?
    • How will these other aspects of your organization or care setting be affected? (For example, increased workload on a testing department, borrowing of staff hours from another part of the care setting, or better communication with the community.)
    • How could you mitigate at least some of the negative effects on other aspects of your organization or care setting?
  • Explain your strategies for ensuring that your proposed initiative can remain a viable asset to the organization or care setting in the face of dynamic environmental forces. 
    • What are the environmental risks to your economic initiative?
    • How could your initiative, or aspects of it, still be a viable benefit to your organization or care setting if the environment shifts in unpredictable ways?
    • What strategies would you propose implementing to keep all, or a portion of, your initiative a viable net benefit to your organization or care setting?
  • Justify the relevance and significance of the quantitative and qualitative economic, financial, and scholarly evidence you used throughout your plan to support your recommendations. 
    • How is the evidence relevant to your organization or care setting?
    • How is the evidence relevant to your proposed economic initiative?
    • How does the evidence illustrate a solution that has been successful in the past?
    • How does the evidence illustrate that a recommendation is the best course of action for your situation and organization or care setting?
  • Write concisely and directly, using active voice. 
    • Proofread your document before you submit it to minimize errors that could distract readers and make it more difficult for them to focus on the substance of your implementation plan.
  • Adhere to the rules of grammar, usage, and mechanics.
  • Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like:
  • Assessment 3 Example [PDF].
  • ADDITIONAL REQUIREMENTS
    Your assessment should also meet the following requirements:
  • Format: Format your implementation plan using current APA style. Use the APA Style Paper Template [DOCX]. An APA Style Paper Tutorial [DOCX]is also provided to help you in writing and formatting your implementation plan. Be sure to include: 
    • A title page and references page. An abstract is not required.
    • A running head on all pages.
    • Appropriate section headings.
  • Length: Your implementation plan should be 6–7 pages in length, not including the title page and references page.
  • Supporting evidence: Cite 3–5 authoritative and scholarly resources to support your implementation plan. Be sure that your sources include specific economic data.
  • Note: Faculty may use the Writing Feedback Tool when grading this assessment. The Writing Feedback Tool is designed to provide you with guidance and resources to develop your writing based on five core skills. You will find writing feedback in the Scoring Guide for the assessment, after your work has been evaluated.
    Portfolio Prompt: You may choose to save your implementation plan to your ePortfolio.
    Competencies Measured
    By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment scoring guide criteria:
  • Competency 1: Analyze the effects of financial and economic factors (such as cost-benefit, supply and demand, return on investment, and risks) in a health care system on patient care, services offered, and organizational structures and operation. 
    • Create a budget for expected costs and earnings over the first five years of a proposed initiative.
    • Analyze the impact of a proposed initiative, once implemented, on other aspects of an organization or care setting and ways in which negative impacts could be mitigated.
  • Competency 2: Develop ethical and culturally equitable solutions to economic problems within a health care organization in an effort to improve the quality of care and services offered. 
    • Create an implementation plan for a proposed initiative that enables achievement of quality or service improvements in an ethical and culturally equitable way.
  • Competency 3: Justify the qualitative and quantitative information used to guide economic decision making to stakeholders and colleagues. 
    • Justify the relevance and significance of quantitative and qualitative economic, financial, and scholarly evidence used throughout an implementation plan to support recommendations.
  • Competency 4: Develop ethical and culturally equitable economic strategies to address dynamic environmental forces and ensure the future security of an organization’s resources and its ability to provide quality care. 
    •  Explain strategies for ensuring that a proposed economic initiative can remain a viable asset to an organization or care setting in the face of dynamic environmental forces.
  • Competency 5: Produce clear, coherent, and professional written work, in accordance with Capella writing standards. 
    • Write concisely and directly using active voice.
    • Adhere to the rules of grammar, usage, and mechanics

Case Study, in which you will address the chosen organization’s health promotion and disease prevention and management strategies. Specifically, you will critique the organization’s healthy living programs, disease prevention and management programs, and non-programmatic services. You will assess the cultural competence of these services using the population health approach. Be sure to consider issues such as how well the organization’s health promotion and management strategies address a wide range of cultural beliefs and whether the organization’s programs and non-programmatic services help to reduce inequalities among members of the population. 

Reference these resources to complete your milestone assignments: 

Montefiore Medical Center Case Study

Interpreting Services Program 

Specifically the following critical elements must be addressed: 

II. Health promotion and disease prevention and management strategies 

a) Assess the organization on its efforts to promote healthy living by examining programs (e.g., fitness classes, blood pressure clinics, first aid training, nutrition education, etc.) that it may offer to patients. Be sure to provide evidence to support your claims.

b) How appropriate are the organization’s disease prevention and management programs and services (such as discharge planning, home health services, vaccination services, etc.) for addressing factors that determine population health status? Be sure to provide evidence to support your claims. 

c) Assess non-programmatic services(such as transportation, on-site child care, etc.) that may be offered by the organization for their impact on factors that determine population health status. 

d) Identify gaps or deficiencies that may exist in the organization’s health promotion and disease prevention and management efforts, and provide evidence to support your claims. If you feel there are none, be sure to explain your reasoning

Compose a focused paper that explains and describes your healthcare issue/topic from the scientific and mathematical/analytical perspectives of inquiry. (You will cover two perspectives in one paper.)

Address your general topic by forming and answering two levels of research questions for each inquiry.

• Choose a “Level 1 Research Question/Writing Prompt” from both of the lists below to answer in the paper.
• Compose a “Level 2 Research Question/Writing Prompt” for each kind of inquiry that provides detail, specificity, and focus to your inquiry, research, and writing.
• State your research questions in the introduction of your paper.
• Answer each research question and support your assertions with evidence (research) to form the body of your paper.
• In the conclusion of the paper, briefly review the issues, research questions, answers, and insights.

Level 1 Research Questions/Writing Prompts
SCIENTIFIC Perspective of Inquiry
What are the anatomical, physiological, pathological, or epidemiological issues?
Which body systems are affected?
What happens at the cellular or genetic level?
Which chemical or biological issues are most important?
Level 1 Research Questions/Writing Prompts
MATHEMATICAL/ANALYTICAL Perspective of Inquiry
What are the economic issues involved?
Which economic theories or approaches best explain the issue?
What are the statistical facts related to the issue?
Which statistical processes used to study the issue provide for the best explanation or understanding?

Your paper must be five pages in length and reference four to six scholarly, peer-reviewed resources. Be sure to follow current APA Style (e.g., spacing, font, headers, titles, abstracts, page numbering).

Refer to the rubric for evaluation details and to assist in preparing the paper.