Jack is a 54-year-old patient who has difficulty coming in for primary care visits. He sees cardiology, pulmonary clinic, and endocrine clinic for his comorbid conditions of diabetes mellitus, post-coronary artery bypass grafting (CABG) 2 years ago, and mild chronic obstructive pulmonary disease issues from a 30-year pack history of smoking. His last visit with you was over a year ago. Today, your registered nurse brings you a telephone triage call requesting a refill of his Crestor prescription, which was ordered by cardiology soon after his CABG. Per the electronic links to the cardiology service within your facility, the medication was due to be renewed about 2 months ago. His last lipid labs were a year ago and his last complete metabolic panel (CMP) was done at the same time. He was recently at the pulmonary clinic and his last recorded HgA1C was 9.0 from a visit to endocrine 4 months ago.

Review of records include a prescription for his hypertension (Lisinopril 20 mg daily), metformin 1,000 mg twice a day for his diabetes and no known medications for his pulmonary issues. The Crestor prescription appears to have multiple dosing levels over the past few refills.

His last vital signs were blood pressure 170/110 mm Hg, pulse 88, and respirations 22. His body mass index is 30 and he indicates a pain level of 4 out of 5. His pulse oximetry was 92% on room air.

1. How do you respond to this telephonic request?

2. What steps are required to get Jack’s therapeutic plan under control?

3. What is the role of the primary care provider in this scenario?  

A 58-year-old obese white male presents to ED with chief complaint of fever, chills, pain, and swelling in the right great toe. He states the symptoms came on very suddenly and he cannot put any weight on his foot. Physical exam reveals exquisite pain on any attempt to assess the right first metatarsophalangeal (MTP) joint. Past medical history positive for hypertension and Type II diabetes mellitus. Current medications include hydrochlorothiazide 50 mg po q am, and metformin 500 mg po bid. CBC normal except for elevated sedimentation rate (ESR) of 33 mm/hr and C-reactive protein (CRP) 24 mg/L. Metabolic panel normal. Uric acid level 6.7 mg/dl.

  

Therapy for Patients With Sleep/Wake Disorders

From negative changes in mood to problems concentrating, sleep/wake disorders can have a tremendous impact on patients’ lives. When patients suffer from these disorders, they often seek medical care with the intent of receiving medications to manage symptoms. However, many of the medications used to treat sleep/wake disorders may be addictive, making thorough patient assessments and close follow-up care essential. To prescribe appropriate therapies with patient safety in mind, you must understand not only the pathophysiology of these disorders but also the pharmacologic agents used to treat them.

This week, as you study therapies for individuals with sleep/wake disorders, you examine the assessment and treatment of patients with these disorders. You also explore ethical and legal implications of these therapies.

Learning Objectives

Students will:

· Synthesize concepts related to the psychopharmacologic treatment of patients

· Assess patient factors and history to develop personalized therapy plans for patients with sleep/wake disorders

· Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients requiring therapy for sleep/wake disorders

· Synthesize knowledge of providing care to patients presenting for sleep/wake disorders

· Analyze ethical and legal implications related to prescribing therapy for patients with sleep/wake disorders

  

Learning Resources

Required Readings (click to expand/reduce)

https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=cat06423a&AN=wal.DSM5&site=eds-live&scope=site

https://ezp.waldenulibrary.org/login?qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocview%2F2422903356%3Faccountid%3D14872

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4388122/

https://j2vjt3dnbra3ps7ll1clb4q2-wpengine.netdna-ssl.com/wp-content/uploads/2017/07/PP_Narcolepsy.pdf

https://j2vjt3dnbra3ps7ll1clb4q2-wpengine.netdna-ssl.com/wp-content/uploads/2017/07/PP_NightWakingsChildren.pdf

https://jcsm.aasm.org/doi/pdf/10.5664/jcsm.6470

https://ezp.waldenulibrary.org/login?qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocview%2F1720529955%3Faccountid%3D14872

Medication Resources (click to expand/reduce)

https://www.micromedexsolutions.com/micromedex2/librarian/deeplinkaccess?source=deepLink&institution=SZMC%5ESZMC%5ET43537

Note: To access the following medications, use the IBM Micromedex resource. Type the name of each medication in the keyword search bar. Be sure to read all sections on the left navigation bar related to each medication’s result page, as this information will be helpful for your review in preparation for your Assignments.

   

· alprazolam

· amitriptyline

· amoxapine

· amphetamine

· desipramine

· diazepam

· doxepin

· eszopiclone

· flunitrazepam

· flurazepam

· hydroxyzine

·  imipramine

· lemborexant

· lorazepam

· melatonin

· methylphenedate

· modafinil

· armodafinil

· carnitine

· clomipramine

· clonazepam

· nortriptyline

· pitolisant

· ramelteon

· sodium oxybate

· solriamfetol

· SSRI’s

· temazepam

· trazodone

· triazolam

· trimipramine

· wellbutrin

· zaleplon

· zolpidem

Required Media (click to expand/reduce)

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/DT/week_11/index.html

Required Media (click to expand/reduce

  

Assignment 1: Short Answer Assessment

As a psychiatric nurse practitioner, you will likely encounter patients who suffer from various mental health disorders. Not surprisingly, ensuring that your patients have the appropriate psychopharmacologic treatments will be essential for their overall health and well-being. The psychopharmacologic treatments you might recommend for patients may have potential impacts on other mental health conditions and, therefore, require additional consideration for positive patient outcomes. For this Assignment, you will review and apply your understanding of psychopharmacologic treatments for patients with multiple mental health disorders.

Photo Credit: Getty Images/Collection Mix: Sub

To Prepare

· Review the Learning Resources for this week.

· Reflect on the psychopharmacologic treatments that you have covered up to this point that may be available to treat patients with mental health disorders.

· Consider the potential effects these psychopharmacologic treatments may have on co-existing mental health conditions and/or their potential effects on your patient’s overall health.

To complete:

Address the following Short Answer prompts for your Assignment. Be sure to include references to the Learning Resources for this week.

1. In 3 or 4 sentences, explain the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse. Which drugs are contraindicated, if any, and why? Be specific. What is the timeframe that the patient should see resolution of symptoms?

2. List 4 predictors of late onset generalized anxiety disorder.

3. List 4 potential neurobiology causes of psychotic major depression.

4. An episode of major depression is defined as a period of time lasting at least 2 weeks. List at least 5 symptoms required for the episode to occur. Be specific.

5. List 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia. Be specific. 

Assignment 2: Assessing and Treating Patients With Sleep/Wake Disorders

Sleep disorders are conditions that result in changes in an individual’s pattern of sleep (Mayo Clinic, 2020). Not surprisingly, a sleep disorder can affect an individual’s overall health, safety, and quality of life. Psychiatric nurse practitioners can treat sleep disorders with psychopharmacologic treatments, however, many of these drugs can have negative effects on other aspects of a patient’s health and well-being. Additionally, while psychopharmacologic treatments may be able to address issues with sleep, they can also exert potential challenges with waking patterns. Thus, it is important for the psychiatric nurse practitioner to carefully evaluate the best psychopharmacologic treatments for patients that present with sleep/wake disorders.

Reference: Mayo Clinic. (2020). Sleep disorders. https://www.mayoclinic.org/diseases-conditions/sleep-disorders/symptoms-causes/syc-20354018

To prepare for this Assignment:

· Review this week’s Learning Resources, including the Medication Resources indicated for this week.

· Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients with sleep/wake disorders.

The Assignment: 5 pages

Examine Case Study: Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

Introduction to the case (1 page)

· Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Decision #1 (1 page)

· Which decision did you select?

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #2 (1 page)

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #3 (1 page)

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Conclusion (1 page)

· Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

NOTE

FOR THIS ASSIGNMENT, YOU WILL WORK WITH :

DECISION 1: TRAZADONE 50-100 MG DAILY AT BEDTIME.

DECISION 2: DECREASE TRAZADONE TO 25 MG AT BEDTIME

DECISION 3 : CONTINUE TRAZADONE AND ENCOURAGE SLEEP HYGIENE.

  

Mr. Boyd Case Study

You are a home health nurse visiting an older couple in the community in order to assess the couple’s functional ability and the potential for their needing assistance with ADLs. Mr. and Mrs. Boyd are 72 and 67 years old, respectively, and have been married for 45 years. They have lived in the same neighborhood since Mr. Boyd retired from his bank manager job 12 years ago. Mrs. Boyd has been a housewife since their marriage. Mr. and Mrs. Boyd have one child, a son who lives in another city about 500 miles away. There are no other family members in their community. As you sit with both of them at the kitchen table, Mrs. Boyd tells you to direct all your questions to her because Mr. Boyd has trouble understanding questions. She goes on to explain that Mr. Boyd used to garden and maintain the yard but no longer seems interested in doing anything. He sleeps a great deal, seems to be eating less and has lost 10 pounds, He is often uncommunicative when she speaks to him. She says that her husband is getting quite forgetful, has received a diagnosis of early dementia and that this worries her because he was always socially engaging and a man who could speak on several subjects. Mrs. Boyd tells you that she makes all the decisions and spends most of her time planning meals, doing housework, and attending her ladies’ church group. She says that she could really use some help with outdoor tasks because these tasks had been handled by Mr. Boyd until just recently. When you ask what she means by “recently,” Mrs. Boyd replies that a change seems to have occurred within the last 6 months. You thank Mrs. Boyd for sharing this information with you, and you indicate that most of the questions can be directed to her but that you will be asking Mr. Boyd some questions as part of the assessment. Mrs. Boyd seems concerned by this but agrees to give you an opportunity to try and ask some questions of Mr. Boyd. You begin your assessment by asking Mr. Boyd about his ADLs, and clarifying the information with Mrs. Boyd. Mr. Boyd was unable to offer any additional information and seemed overwhelmed by the questions and began to cry. Mrs. Boyd added the additional information that Mr. Boyd needs help with all of his ADL’s, showering, getting dressed and brushing his teeth. He needs reminders to eat but eats poorly about a third of his meals. He has had 2 falls recently but was not hurt. He wandered out of the house and got lost a week ago. He does not complain about pain but does seem to be massaging his legs from time to time. He has a grimace on his face at this time. Mrs. Boyd begins to cry and hold Mr. Boyd’s hand. Once you have completed your assessment on Mr. Boyd use the information from the case study to complete your Basic Nursing Care Client Assessment, and the Pain and Morse Falls assessments.

Upon completion of your Assessments on Mr. Boyd, organize the data as if you were gathering it to enter on an EHR under assessment. Create an SBAR note on one of the problem you identified through your assessment (see sample and review chapters on documentation to be sure you remember how to do this) regarding needing to call the physician about the problem. Then create a nurses note inclusive of all of the problems that you identified and would document on the HER as a nurses note (review documentation chapter and ATI documentation to refresh how to do this). Lastly you will create a plan of care for one of your client’s problems by completing the concept map that uses the Nursing Process (Review the chapters on nursing process if needed to refresh). Identify the problem your patient has (ex. At risk for falling) by using the data (subjective and objective) that supports that this is a problem. You will need to set a specific, measurable outcome (goal) to achieve with a timeframe for when you will hope to achieve the goal. Find interventions (things you do to solve the problem) in your Perry and Potter textbook in the chapters that are relevant to the problem you identified for your patient (put the page # and source for the interventions you used) and then cite your full reference on the concept map. Evaluate what you would like to have happen if the interventions you chose worked out for your patient. This is a work alone and not a team assignment. Submit everything on canvas.

The purpose of this assignment is to analyze a health care risk management program.

Conduct research on approaches to risk management processes, policies, and concerns in your current or anticipated professional arena to find an example of a risk management plan. Look for a plan with sufficient content to be able to complete this assignment successfully. In a 1,000‐1,250-word paper, provide an analysis of the risk management plan that includes the following:

1. Summary of the type of risk management plan you selected (new employee, specific audience, community‐focused, etc.) and your rationale for selecting that example. Describe the health care organization to which the plan applies and the role risk management plays in that setting.
2. Description of the standard administrative steps and processes in a typical health care organization’s risk management program compared to the administrative steps and processes you identify in your selected example plan. (Note: For standard risk management policies and procedures, look up the MIPPA-approved accrediting body that regulates the risk management standards in your chosen health care sector, and consider federal, state, and local statutes as well.)
3. Analysis of the key agencies and organizations that regulate the administration of safe health care in your area of concentration and an evaluation of the roles each one plays in the risk management oversight process.
4. Evaluation of your selected risk management plan’s compliance with the standards of its corresponding MIPPA-approved accrediting body relevant to privacy, health care worker safety, and patient safety.
5. Proposed recommendations or changes you would implement in your risk management program example to enhance, improve, or secure the aforementioned compliance standards.

In addition to your textbook, you are required to support your analysis with a minimum of three peer‐reviewed references.