Instructions: Read the following case study and answer the reflective questions. Please provide rationales for your answers. Make sure to provide citations/references for your answers in APA format.

CASE STUDY: Active Labor: Susan Wong 

Mrs. Wong, a first-time mother, is admitted to the birthing suite in early labor after spontaneous rupture of membranes at home. She is at 38 weeks of gestation with a history of abnormal alpha-fetoprotein levels at 16 weeks of pregnancy. She was scheduled for ultrasonography to visualize the fetus to rule out an open spinal defect or Down syndrome, but never followed through. Mrs. Wong and her husband disagreed about what to do (keep or terminate the pregnancy) if the ultrasonography indicated a spinal problem, so they felt they did not want this information.

 Reflective Questions 

1. As the nurse, what priority data would you collect from this couple to help define relevant interventions to meet their needs?

 2. How can you help this couple if they experience a negative outcome in the birthing suite? What are your personal views on terminating or continuing a pregnancy with a risk of a potential anomaly? What factors may influence your views? 

3. With the influence of the recent Human Genome Project and the possibility of predicting open spinal defects earlier in pregnancy, how will maternity care change in the future?

Assignment 2: Week 2 Practicum Journal: Safe Prescribing

There is probably no greater responsibility that the psychiatric mental health nurse practitioner assumes than the responsibility of prescribing medications. While someone can be harmed by psychotherapy, the level and intensity of the harm generally does not come to the same level of harm that can occur from improper prescribing. The PMHNP must understand his/her responsibility both at a state and federal level when it comes to prescribing medications.

In this Practicum Journal Assignment, you will explore the legalities associated with prescribing controlled substances, as well as what a DEA number is, how to obtain one, and, most importantly, how to prescribe controlled substances in your state.

Students will:

• Analyze roles of the Drug Enforcement Administration
• Analyze PMHNP responsibilities when issued a DEA number
• Analyze DEA number application procedures
• Analyze state requirements for safe prescribing and prescription monitoring
• Analyze PMHNP responsibilities for safe prescribing and prescription monitoring
• Analyze Schedule II-V drug levels

To prepare for this Practicum Journal:

• Review the Learning Resources.

In 2-3 pages:

• Describe the role of the Drug Enforcement Administration (DEA) as it pertains to the PMHNP.
• Explain your responsibilities when having a DEA number.
• Explain how you apply for a DEA number.
• Explain your state’s requirements for a safe prescribing and prescription monitoring program. Explain your responsibility as a PMHNP to follow these requirements.
• Provide an example of a drug you may prescribe from each of the Schedule II-V drug levels.

LINKS:

https://www.dea.gov/sites/default/files/drug_of_abuse.pdf

https://www.deadiversion.usdoj.gov/pubs/manuals/pract/pract_manual012508.pdf

Please reply to this post with a minimum of two paragraphs with two references, APA Style, and no plagiarism. 

-The management of acute and chronic pain often includes opioid therapy. In both the acute and chronic pain settings, however, opioids have several disadvantages including risk of nausea and vomiting, somnolence, constipation, respiratory depression, androgen deficiency, physical dependence, and tolerance. Opioid medications also carry a risk of abuse or addiction by either the patient or non-medical users. For these reasons, consideration of non-opioid strategies for pain management is beneficial. While opioids will certainly continue to have a place in pain management despite their disadvantages, the use of non-opioid medication options may limit the amount of opioid necessary or even result in improved pain control. In fact, given that the majority of both acute and chronic pain is thought to be complex and multi factorial, a multi modal analgesic approach is ideal for management. Acetaminophen is typically considered first-line therapy for chronic pain conditions, including osteoarthritis (OA) and chronic pain associated with total knee arthroplasty. However, many times patients are treated inappropriately with opioids instead.

Acetaminophen is considered first-line treatment for many pain conditions because of its safety advantages. Compared with other analgesics available, acetaminophen is associated with very few adverse events and is considered safe to use chronically. Healthcare providers strive to “first do no harm.  Therefore, for most chronic pain conditions, a trial of acetaminophen should be used and monitored for effect before initiating other analgesics, including opioids. However, acetaminophen is not without risks. Safety concerns associated with acetaminophen include serious liver damage if ingestion is greater than the recommended total daily dose of 4,000 mg. Long-term high doses of acetaminophen and accidental overdose from inadvertently consuming multiple acetaminophen products are the leading causes of acute liver failure in the U. S. For this reason it is important that the patients who are utilizing acetaminophen chronically for pain are educated on proper dosing and administration, and are aware of any other acetaminophen-containing products they may use. The disadvantage of acetaminophen is that it often cannot provide a sufficient analgesic effect and does not exert a specific anti-inflammatory effect, causing many patients to discontinue or switch therapies.

REFERENCES

Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain United States, 2016. MMWR Recomm Rep. 2016; 65(1):1-49.

Culturally safe care and communication is imperative to person’s having effective person-centred care. Nurses are required to consider how they engage and will approach situations in which individuals have experienced previous harm. This harm may be related to healthcare, previous life trauma or generational behaviours. The use of person-centred therapeutic skills in integral to providing safe care that aligns to the registered nurse standards for practice. The use of the case study below allows students to consider how they will approach situations where individuals are reluctant to seek care.  

Learning Outcomes

• Identify verbal and non-verbal communication strategies and standards that enable therapeutic communication and interprofessional relationships
• Explain how cultural sensitivity and cultural safety aid in the establishment of effective communication with Aboriginal and Torres Strait Islander people and other multicultural communities
• Demonstrate a high level of written and spoken English according to academic conventions and professional nursing standards
• Identify, access and effectively utilise relevant and credible evidence-based research for person-centred practice
• Demonstrate effective communication through clinical handover and the legal documentation of essential information in healthcare records to ensure patient safety

Task Instructions

Read the following case study.

Leo is a 50-year-old man living in your local community. Leo has a past history of Type 2 Diabetes, Coronary Artery Disease and Hypertension. Leo is aboriginal and lives with his wife and three children (aged 12 – 20). Leo disengaged from healthcare due to a previous bad experience where he felt judged due to his cultural background. He has heard you are a new nurse working in his area and has been convinced by his wife and children to attend for a health check-up and care plan. 

1. Discuss how you will utilise communication, cultural sensitivity and safety to develop a therapeutic relationship with Leo, using your knowledge of communication and culture learnt from this unit. The discussion should also include key information and requirements for documentation of your nursing interaction with Leo.
2. Discuss the therapeutic communication tools that you will utilise to develop a connection with Leo.
3. Discuss how will you develop a culturally safe and sensitive interaction with Leo? The written work should also include what strategies/ approach you will take to record your interaction with Leo providing clinical reasoning (explaining why).
4. Read the following instructions for writing an essay:

• Introduction: gives background to the topic and states precisely what the essay intends to cover
• Body Text: shows evidence of critical thinking and analysis; and uses current evidence-based research to support the argument
• Conclusion draws evidence together, does not over-generalise or introduce new material.
• Well structured, logically sequenced essay in appropriate English
• Correct referencing technique

Word counts- 1,500 / References – APA7th standard not more than 10years old and has to be at least 17 journal articles