Participant Characteristics/Sociodemographic Findings

· Must be descriptive and comprehensive

· Describe participant characteristics or sociodemographic findings

· Describe the findings of Tables/Figures to provide comprehensive information about participant characteristics as article provided

All other Results/Findings

· Describe ALL Other Results/Findings besides above participant characteristics in the article in detail for each Result item

· Each Result item must include Headings/Subheadings of Results as the article provided.

· Do NOT simply saying “pain level was decreased,” “adherence was increased” 

Do NOT include contents from Discussion and/or Conclusion in the article. 

Bipolar Therapy
Client of Korean Descent/Ancestry

BACKGROUND INFORMATION

The client is a 26-year-old woman of Korean descent who presents to her first appointment following a 21-day hospitalization for onset of acute mania. She was diagnosed with bipolar I disorder. 

Upon arrival in your office, she is quite “busy,” playing with things on your desk and shifting from side to side in her chair. She informs you that “they said I was bipolar, I don’t believe that, do you? I just like to talk, and dance, and sing. Did I tell you that I liked to cook?”

She weights 110 lbs. and is 5’ 5” 

SUBJECTIVE

Patient reports “fantastic” mood. Reports that she sleeps about 5 hours/night to which she adds “I hate sleep, it’s no fun.” 

You reviewed her hospital records and find that she has been medically worked up by a physician who reported her to be in overall good health. Lab studies were all within normal limits. You find that the patient had genetic testing in the hospital (specifically GeneSight testing) as none of the medications that they were treating her with seemed to work. 

Genetic testing reveals that she is positive for CYP2D6*10 allele. 

Patient confesses that she stopped taking her lithium (which was prescribed in the hospital) since she was discharged two weeks ago. 

MENTAL STATUS EXAM

The patient is alert, oriented to person, place, time, and event. She is dressed quite oddly- wearing what appears to be an evening gown to her appointment. Speech is rapid, pressured, tangential. Self-reported mood is euthymic. Affect broad. Patient denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment is grossly intact, but insight is clearly impaired. She is currently denying suicidal or homicidal ideation.

The Young Mania Rating Scale (YMRS) score is 22

RESOURCES

§ Chen, R., Wang, H., Shi, J., Shen, K., & Hu, P. (2015). Cytochrome P450 2D6 genotype affects the pharmacokinetics of controlled-release paroxetine in healthy Chinese subjects: comparison of traditional phenotype and activity score systems. European Journal of Clinical Pharmacology, 71(7), 835-841. doi:10.1007/s00228-015-1855-6

Decision Point One

Select what the PMHNP should do:

Begin Lithium 300 mg orally BID

Begin Risperdal 1 mg orally BID

Begin Seroquel XR 100 mg orally at HS

Examine Case Study: An Asian American Woman With Bipolar Disorder. 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
  • Which decision did you select?
  • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
  • Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
• Decision #2
  • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
  • Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
• Decision #3
  • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
  • Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

Also include how ethical considerations might impact your treatment plan and communication with clients.

Choice one: I choose to start Seroquel

Decision Point One

Begin Seroquel XR 100 mg orally at HS

RESULTS OF DECISION POINT ONE

• Client returns to clinic in four weeks
• Client is reporting that she sleeps a bit more at bedtime
• Client states that she has gained about 2 or 3 pounds, which she does not like
• Client also reports that she has been constipated since starting this medication
• Client is also complaining of dry mouth which she does not like.
• Client’s score on the Young Mania Rating Scale has decreased from a 22 to an 18
• Client is reporting really good mood, but is asking for a different medication because of the weight gain

Decision Point Two

Select what the PMHNP should do next:

Increase Seroquel XR to 300 mg orally daily 

Discontinue Seroquel and start Geodon 40 mg orally BID. Administer with 500 calorie meal 

Continue same dose of Seroquel and counsel client regarding ways to prevent constipation

I choose to discontinue Seroquel and start Geodon 40 mg orally BID. ADminister with 500 calorie meal

Discontinue Seroquel and start Geodon 40 mg orally BID. Administer with 500 calorie meal 

RESULTS OF DECISION POINT TWO

• Client returns to clinic in four weeks
• Client demonstrates a 50% decrease in score on the Young Mania Rating Scale (from 22 to 11)
• Client denies any additional weight gain and denies any additional side effects

Decision Point Three

Select what the PMHNP should do next:

Continue same dose and reassess in 4 weeks 

Increase Geodon to 60 mg orally BID with a 500 calorie meal 

Augment with Lithium sustained release 300 mg orally BID

I now choose to continue same dose and reassess in 4 weeks

Decision Point Three

Continue same dose and reassess in 4 weeks 

Guidance to Student
The PMHNP should provide counseling to the client about this side effect and encourage increased fluids and fiber in the diet to combat constipation. Hard candies or gum can be used to prevent dry mouth. This is another issue as the drug can cause dental problems as a result of dry mouth.

Changing to Geodon clearly helped with symptoms and arrested weight gain in this client. The PMHNP could wait 4 weeks and see if any changes in Young Mania Rating Scale are noted, or increasing to 60 mg orally BID in an attempt to hasten symptom improvement. Increasing dose may be associated with side effects.

Augmentation with Lithium may be appropriate if the goal of therapy is to discontinue antipsychotic therapy and treat with Lithium monotherapy. Lithium was problematic for this client but changing formulation to the extended release may overcome the difficulties she was experiencing with side effects. The PMHNP would need to educate client regarding side effects of medication and need to maintain compliance. 

 

Nurses often become motivated to change aspects within the larger health care system based on their real-world experience. As such, many nurses take on an advocacy role to influence a change in regulations, policies, and laws that govern the larger health care system.

For this assignment, identify a problem or concern in your state, community, or organization that has the capacity for advocacy through legislation. Research the issue and use the “Advocacy Through Legislation” template to complete this assignment.

You are required to cite to a minimum of three sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice. 

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center. 

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. 

AttachmentsNRS-440VN-RS4-AdvocacyThroughLegislation.docx 

  

HCA320 Assignment Mod 1

Assignment:

Population Health Advocacy

Human trafficking, extreme poverty, preventable diseases, the opioid crisis and the lack of adequate low-income housing are a few current societal concerns worthy of social change. Nurses and healthcare leaders are in a good position to shape and influence health care policy.

Think of a cause you believe in strongly. Access the website of your elected officials either at the local, state, or federal level using the following link: https://www.usa.gov/elected-officials/ or use the website of your choice. Explore some of the issues and committees your legislators are involved in and select at least one that interest you or align with your beliefs. You may also contact your legislator’s office and speak to his or her legislative assistant by calling the U.S. Capitol switchboard operator at (202) 224-3121 for the Senate and (202) 225-3121 for the House. Legislator assistants are very knowledgeable about the legislator’s agenda and can provide a wealth of information. 

This assignment will be at least 1500 words or more. This week reflect on advocacy, collaborative partnerships with other health care practitioners and stakeholders, and the policy making process and write a paper that addresses the following:

• Describe      the policy issue, policy problem of interest or a particular bill that      your legislator has introduced
• Elaborate      on why the policy matters and what you can possibly do to strengthen the      policy? 
• Briefly      define the role you would play as an advocate for the healthcare consumer      and healthcare professionals.
• Explain      how the policy impacts the public at large or a particular      population. 
• What      stakeholders would you collaborate with to promote the cause? 

Assignment Expectations

Length: 1500-2000 words in length

Structure: Include a title page and reference page in APA format. These do not count towards the minimal word amount for this assignment.  Your essay must include an introduction and a conclusion.

References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. A minimum of two (2) scholarly sources are required for this assignment.

Digestive Disorder

1. For the digestive disorder that you have been assigned. 

1. You can review your Textbook and visit these links:  

https://www.niddk.nih.gov/health-information/digestive-diseases

http://www.webmd.com/

1. Describe the disorder of Hiatal Hernia (in 150-300 words). In your description include:
   1. Causes
   2. Risk factors
   3. Symptoms
   4. Treatments
   5. Risk reduction behaviors

 Feel free to include pictures or diagrams

As always, please check for grammar and spelling errors.