Week 3 Project

Your “Personal Philosophy and Theoretical Concepts” Paper is due this week. Your paper should contain the following sections:

• Nursing Autobiography: A brief (1 page) discussion of your background in nursing. This does not include future goals.
• The Four Metaparadigms: Describe what the literature says about the basic four metaparadigms/concepts of patient, nurse, health, and environment. Do not relate the metaparadigms to the theory you have chosen.
• Briefly describe the theory you have chosen.
• Two Practice-Specific Concepts: in separate subsections discuss each of your two concepts:
  • What is the definition of the concept (outside of the theory)?
  • How does your theorist define your concept?
  • How does this concept apply to your clinical setting? Give an example of how nurses in your area provide care that correlates with the theorist’s definition of the concept.

You MUST use the attached template here to complete your paper.

The paper is to be thoroughly researched and well documented, with relevant material from the nursing theorists presented incorporated into the paper. Use the current edition of the APA Manual throughout the paper. Sources should focus on references from nursing theory but may also include conceptual and theoretical material from other professional domains. The paper, excluding references or appendices, is to be limited to 3-5 pages. Writing should be succinct and well organized, as it is impossible for the facilitator to evaluate form and content separately

topics- Select one of the community nursing diagnosis (Health promotion needs for specific population )

Develop at least one program goal and two related outcomes. Discuss the rationale for your selection of the priority problem.

100-word minimum/200-word maximum without the references.

Minimum of two references (the course textbook can be one of the references) in APA format, articles chosen must have been published within last 3-5 years.

APA Style 

CASE STUDY Week 7 Conservation Model

Yolanda is a 55-year-old married African American mother of two adult children who has a history of breast cancer. She was diagnosed with fibromyalgia 2 years ago, after years of unexplained muscle aches and what she thought was arthritis. The diagnosis was a relief for her; she was able to read about it and learn how to care for herself. Over the past 2 months, Yolanda stopped taking all of her medicine, because she was seeing a new primary care provider and wanted to start her care at “ground zero.” In addition to her family responsibilities, she is completing her degree as an English major. At the time of her clinic appointment, she told the nurse practitioner that she was having the worst pain possible.

Using Levine’s conservation model, the nurse practitioner completes a comprehensive assessment in preparation for developing a plan of care. A thorough assessment of characteristics of the internal and external environments is performed, with assessment of the adequacy of the adaptive fit that Yolanda has achieved in response to the changing environmental conditions produced by this health challenge. Nursing care is planned using the conservation principles. Yolanda’s diagnosis of fibromyalgia was based on the cluster of presenting symptoms (pain, fatigue, and sleeplessness) and the exclusion of other illnesses.

The assessment of the internal environment (physiological and pathophysiological processes) was performed by a thorough physical examination and various laboratory and diagnostic tests. Yolanda’s tests results were within normal limits.

The external environment includes perceptual, operational, and conceptual factors. Perceptual factors are perceived through sensory input. Yolanda reported a history of unexplained fatigue and sensations of pain for years. She recently stopped her medications “to clean my body out.” However, she reported that the pain became unbearable and was making it difficult for her to sleep. She noted that when she sleeps at least 6 hours a night, her pain is less intense. With the current insomnia, her pain is very intense.

Operational factors are threats within the environment that the patient cannot perceive through the senses. Yolanda reported severe pain in response to both the cold weather and changes in barometric pressure.

The conceptual environment includes cultural and personal values about health care, the meaning of health and illness, knowledge about health care, education, language use, and spiritual beliefs. In response to breast cancer, Yolanda developed her spirituality through prayer and reading the Bible. She believes this is how she is getting through the painful moments of her current illness.

Conservation of energy focuses on the balance of energy input and output to prevent excessive fatigue. Yolanda complains of a fatigue that just “comes over me.” She has difficulty doing housework. A day of work usually means 1 day in bed because of extreme fatigue. Her hemoglobin level and hematocrit are normal; her oxygen saturation is also within normal limits. These normal physiological assessments are typical in patients with fibromyalgia.

Conservation of structural integrity involves maintaining the structure of the body to promote normal functioning. Fibromyalgia treatment focuses on reducing symptoms. Yolanda’s symptoms could not be traced to any physical or structural alteration, yet she reports severe pain and fatigue. It is important to acknowledge the reality of the symptoms and work with the patient to determine whether activities of daily living result in changes in the pattern of illness. In addition, Yolanda thinks she is going through menopause (a normal physiological change in body structure), and she is having trouble determining whether her symptoms are menopause or fibromyalgia.

With continued questioning, Yolanda revealed that she was diagnosed with irritable bowel syndrome several years earlier. This condition presents further risks to structural integrity. She is not worried about constipation but is concerned about sudden diarrhea. She is afraid to go to school, fearing embarrassment because she might have an “accident.” Interventions to conserve structural integrity include interventions to promote normal bowel function and optimize Yolanda’s nutritional status.

Personal integrity involves the maintenance of one’s sense of personal worth and self-esteem. Yolanda reported that she “lost control” when she was diagnosed with breast cancer. A dear friend convinced her to go to church and encouraged her to use prayer. When feeling sorry for herself, she would go into her bedroom and read her Bible, cry by herself, and pray. She believes that prayer and Bible reading helped her heal. She continues to pray and read her Bible to gain the strength she needs to live with her illness. She also believes that she needs to be able to laugh at aspects of her situation; humor helps her feel better. She actively seeks health information, as indicated by her quest to learn about her diagnosis of fibromyalgia. She is most upset about not being able to walk as she used to walk. One of her favorite pastimes was shopping for shoes at the mall, which now is difficult for her.

Social integrity acknowledges that the patient is a social being. Yolanda is a married mother of two grown children. She conceals many of her feelings from her children but does share with her husband, who is supportive. Among the ways that he cares for her are to take her places she needs to go (such as grocery shopping) and to make sure she gets to her health care appointments on time.

An initial plan of care for Yolanda includes interventions based on the four conservation principles:

• Conservation of energy: (1) Discuss strategies to balance rest and activity; (2) discuss strategies to help her achieve restful sleep; (3) discuss both nonpharmacological and pharmacological approaches to manage pain; and (4) assess her nutritional intake to ensure adequate energy stores.

• Conservation of structural integrity: (1) Discuss any needed modifications of activities to prevent injury; (2) assess diet to identify whether any foods exacerbate gastrointestinal symptoms; (3) discuss the normal physiological process of menopause, including associated symptoms; and (4) consider additional laboratory work or referrals to evaluate hormone levels and assess whether additional treatment is indicated to relieve menopause symptoms.

• Conservation of personal integrity: (1) Validate the illness experience; (2) encourage continued use of prayer, Bible reading, and humor to help her feel better; and (3) discuss strategies to help her manage her anxiety related to the irritable bowel syndrome, including both nonpharmacological and pharmacological approaches.

• Conservation of social integrity: (1) Praise Yolanda for the strong family relationships that she has built and encourage her to continue to work together with her family to optimize her health; (2) with Yolanda’s permission, talk with her husband to answer his questions about her condition and discuss how they can continue to work together to improve her health; and (3) praise Yolanda for continuing to seek achievement of her goal of completing her English degree and discuss strategies to manage the irritable bowel syndrome and manage problems to help her feel more confident about going to school.

In Yolanda’s follow-up care, these outcomes suggest effective adaptation that is conserving wholeness and integrity:

• Feels rested, with 6 hours of uninterrupted sleep

• Reduction in pain and fatigue

• Distinguishes symptoms of menopause from symptoms of fibromyalgia

• Collaborates with health care providers to manage symptoms of menopause

• Reports comfort as a result of prayer, Bible reading, and humor

• Minimal adverse bowel symptoms and adequate nutritional intake

• Healthy relationships with family and friends.

• Attends school and participates in other social activities with minimal limitations.

*This case study was developed from a fibromyalgia study (Schaefer, 2005). A fictitious name was used to protect privacy and anonymity.

Critical thinking questions

1. Are there any aspects of Yolanda’s care that you would add to the plan as you consider nursing care with the conservation principles?

2. Keep a reflective journal about a personal health or illness experience and apply the conservation model to that experience.

3. As you consider application of the conservation principles in question 2, what aspects of care are assessed that previously were not included in your plans of care?

4. Use the perspective of the conservation model to identify what may be missed in simulation experiences of nursing practice. What does it capture that other perspectives miss?

5. Suggest how you might begin to develop your style of nursing practice using the conservation model.

  

Discussion: Foundational Neuroscience

As a psychiatric nurse practitioner, it is essential for you to have a strong background in foundational neuroscience. In order to diagnose and treat patients, you must not only understand the pathophysiology of psychiatric disorders but also how medications for these disorders impact the central nervous system. These concepts of foundational neuroscience can be challenging to understand. Therefore, this Discussion is designed to encourage you to think through these concepts, develop a rationale for your thinking, and deepen your understanding by interacting with your colleagues.

Photo Credit: Getty Images/Cultura RF

For this Discussion, review the Learning Resources and reflect on the concepts of foundational neuroscience as they might apply to your role as the psychiatric mental health nurse practitioner in prescribing medications for patients. 

By Day 3 of Week 2

Post a response to each of the following:

1. Explain the agonist-to-antagonist spectrum of action of psychopharmacologic agents, including how partial and inverse agonist functionality may impact the efficacy of psychopharmacologic treatments.
2. Compare and contrast the actions of g couple proteins and ion gated channels.
3. Explain how the role of epigenetics may contribute to pharmacologic action.
4. Explain how this information may impact the way you prescribe medications to patients. Include a specific example of a situation or case with a patient in which the psychiatric mental health nurse practitioner must be aware of the medication’s action.

Read a selection of your colleagues’ responses.

By Day 6 of Week 2

Respond to at least two of your colleagues on two different days in one of the following ways:

• If your colleagues’ posts influenced your understanding of these concepts, be sure to share how and why. Include additional insights you gained.
• If you think your colleagues might have misunderstood these concepts, offer your alternative perspective and be sure to provide an explanation for them. Include resources to support your perspective.

Discussion 1 R

1.  Explain the agonist-to-antagonist spectrum of action of psychopharmacologic agents, including how partial and inverse agonist functionality may impact the efficacy of psychopharmacologic treatments.

Psychopharmacologic agents can demonstrate their therapeutic effects by regulating the action of neurotransmitters at post-synaptic receptor sites. Agonists increase the effects of neurotransmitters by binding to and activating specific receptor sites (Kowalski et al., 2017). They can be used to treat disorders with low levels of a neurotransmitter. Antagonists decrease or block the effects of neurotransmitters by binding to specific receptor sites without activating them. They can be used to treat disorders characterized by too much of a neurotransmitter. Partial agonists produce partial or submaximal effects at receptor sites, which can be therapeutic when a reduced response is desired. Many receptors retain a baseline effect even when they are not bound with a neurotransmitter, which is known as constitutive activity. Inverse agonists can be therapeutic when bound to receptor sites by causing an opposite effect of the agonist and removing the constitutive activity at the receptor site (Kowalski et al., 2017).

2.  Compare and contrast the actions of g couple proteins and ion gated channels.

G protein-coupled receptors (GPCRs) and ion gated channels are both transmembrane signaling systems that have ligand receptor sites. GPCRs are the most numerous receptors in eukaryotes, having many diverse functions and being involved in many biological and pathological processes (Alexander et al., 2017). Consequently, they are the target of almost half of all pharmaceutical drugs. They are activated by numerous signaling molecules, or ligands, that allow it to activate a second messenger system or directly trigger a response inside the cell. Ion gated channels are present in the cellular membrane and allow ions (i.e. sodium and potassium) to pass in and out of the cell via a “gated” mechanism. Activation of its receptor site opens the channel, allowing ions to influence the cellular action potential (Alexander et al., 2017).

3.  Explain how the role of epigenetics may contribute to pharmacologic action.

Epigenetics refers to variations in gene expression—without changes to the DNA code—that typically form in response to environmental stimuli (Kular & Kular, 2018). The cellular alterations, including DNA methylation and histone acetylation, are perpetuated as they are retained following cell division. This subsequently leads to the alteration or silencing of specific genes that can disrupt various biological pathways and influence the development of disease. Research to identify biomarkers, such as DNA methylation on specific genes, aims to improve the diagnosis and treatment of disease by allowing pharmacologic therapy to target specific alterations for potential correction, as well as make predictions about treatment response (Kular & Kular, 2018).

4.  Explain how this information may impact the way you prescribe medications to patients. Include a specific example of a situation or case with a patient in which the psychiatric mental health nurse practitioner must be aware of the medication’s action.

Prescribers must consider the above-mentioned concepts in order to formulate a safe and effective treatment strategy. An understanding of neurotransmitters’ actions at receptor sites, as well as how they can be manipulated for therapeutic effect, can help prescribers choose more targeted drug therapy and better understand associated side effects of specific drug therapy (Camprodon & Roffman, 2016). For example, a psychiatric mental health nurse practitioner (PMHNP) has prescribed a Haldol, a first-generation antipsychotic drug to treat psychotic symptoms. Therapeutic outcome is achieved by producing an antagonistic effect on dopamine receptors in the mesolimbic pathway (Solmi et al., 2017). The PMHNP must understand and anticipate the potential for a wide range of side effects due to the blockage of dopaminergic activity at numerous receptor sites. Subsequently, the patient should be monitored for impaired cognitive function, exacerbated negative symptoms, and neuromotor dysfunction (Solmi et al., 2017).

References

Alexander, S. P., Christopoulos, A., Davenport, A. P., Kelly, E., Marrion, N. V., Peters, J. A.,

Faccenda, E., Harding, S. D., Pawson, A. J., Sharman, J. L., Southan, C., Davies, J. A., & CGTP Collaborators. (2017). THE CONCISE GUIDE TO PHARMACOLOGY 2017/18: G protein-coupled receptors. British Journal of Pharmacology, 174, S17–S129. https://doi-org.ezp.waldenulibrary.org/10.1111/bph.13878

Alexander, S. P., Peters, J. A., Kelly, E., Marrion, N. V., Faccenda, E., Harding, S. D., Pawson,

A. J., Sharman, J. L., Southan, C., Davies, J. A., & CGTP Collaborators. (2017). THE CONCISE GUIDE TO PHARMACOLOGY 2017/18: Ligand-gated ion channels. British Journal of Pharmacology, 174, S130.

Camprodon, J. A., & Roffman, J. L. (2016). Psychiatric neuroscience: Incorporating

pathophysiology into clinical case formulation. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 1–19). Elsevier.

Kowalski, P. C., Dowben, J. S., & Keltner, N. L. (2017). My Dad Can Beat Your Dad: Agonists,

Antagonists, Partial Agonists, and Inverse Agonists. Perspectives in Psychiatric Care, 53(2), 76. https://doi-org.ezp.waldenulibrary.org/10.1111/ppc.12208

Kular, L., & Kular, S. (2018). Epigenetics applied to psychiatry: Clinical opportunities and

future challenges. Psychiatry & Clinical Neurosciences, 72(4), 195–211. https://doi-org.ezp.waldenulibrary.org/10.1111/pcn.12634

Solmi, M., Murru, A., Pacchiarotti, I., Undurraga, J., veronese, N., Fornaro, M., Stubbs, B.,

Monaco, F., Vieta, E., Seeman, M. V., Correll, C. U., & Carvalho, A. F. (2017). Safety, tolerability, and risks associated with first- and second-generation antipsychotics: a state-of-the-art clinical review. Therapeutics & Clinical Risk Management, 13, 757–777. https://doi-org.ezp.waldenulibrary.org/10.2147/TCRM.S117321

Response 2 S

 Agonist and antagonist play a key role in pharmacology and the human body by working against each other to establish a balance. When agonist is stimulating an action, the antagonist sits idle (Gordon, 2017). An agonist ties to the receptor site and causes the ion channel’s opening up to its full capacity and frequency, making the downstream signal transduction possible for utilization at the binding site. Compared to a full agonist, an additional receptor site allows the ion channel to open more frequently. Therefore, the agonist ties cause responses while the antagonist work against drugs by blocking the response (Staudt, et al., 2019). Agonist plays a role in binding and altering the receptors’ activity and functions while the antagonists help in biding receptors without altering its activities. The agonist, therefore, causes a response to the drug. Simultaneously, the antagonist works against the drug by blocking the response helping to cause stabilization in the receptor sites in resting phases, a mechanism similar to the lack of agonist at the receptor site (Staudt, et al., 2019).

When comparing partial agonist to full agonist, both causes changes in receptors by opening ion channels; however, the frequency is different. Partial agonist opens ion channels with a frequency greater than a resting state but less frequent when compared to the effect of full agonist (Alexander, et al., 2017). Antagonists act similarly when it comes to reversing both full agonists and partial agonists by playing a reversing role that returns the receptor site to its resting state. The rate of iron flow and downstream signal transduction depends on agonist nature. Partial flow has an effect greater than agonist at its resting state but with a lesser effect than a full agonist. Partial agonist plays a key role in stabilizing neurotransmissions within the brain by causing an even reaction between extreme action potential to stabilize the receptor output (Alexander, et al., 2017). 

Psychotropic drugs majorly target a class of receptors linked to G proteins. The G couple proteins consist of seven transmembrane regions that span the membrane seven-folds. Each membrane region has a central core acting as the binding core of neurotransmitters where drugs interact within the receptor. The interaction and binding results in modifications of the receptor actions by fully or partially coping or even blocking neurotransmitter functions at a specific receptor site (Alexander, et al., 2017). Drug actions change the downstream molecular processes activating or deactivating phosphoproteins making the neurotransmitter modify receptors, enzymes, and ion channels differently. The alterations at the G-protein-linked receptor site caused by drugs is possible to cause actions on the psychiatric disorders or symptoms as the drug action changes gene expression, protein synthesis, and the downstream communication between neurons linked to G-protein-linked receptor (Alexander, et al., 2017).

Ligand-gated ion channels are a type of receptor forming ion channels; they consist of long strings of amino acids forming subunits around ions channel; they act both as a ligand-gated ion channel as channel-linked receptors. Complex proteins contain sites that allow ions to pass through. This allows neurotransmitters, drugs, and other natural substances to bind to a site, either increasing or decreasing the channel opening’s sensitivity. The important ion channels in psychopharmacology include the channels controlling calcium, chloride, sodium, and potassium flow. The drug-induced modifications occurring with the inotropic receptors immediately changes the flow of ions, which in turn triggers clinical onset when medications are used, though other drugs acting at the G-protein-linked receptor sites may result in delayed response instigated by cellular functions activated by signal transduction cascade (Alexander, et al., 2017).

References

Alexander, S. P., Christopoulos, A., Davenport, A. P., Kelly, E., Marrion, N. V., Peters, J. A., …

& CGTP Collaborators. (2017). The Concise Guide to PHARMACOLOGY 2017/18: G protein‐coupled

Gordon, M. (Ed.). (2017). Psychopharmacological agents (Vol. 4). Elsevier.

Staudt, M. D., Herring, E. Z., Gao, K., Miller, J. P., & Sweet, J. A. (2019). Evolution in the

treatment of psychiatric disorders: from psychosurgery to psychopharmacology to neuromodulation. Frontiers in neuroscience, 13, 108.

 

Instructions: 

Read the following Case Study and Answer the questions that follow.

Mr. Munoz is a struggling young actor in Chicago who has battled alcoholism since approximately the age of 13 years.

“There was a lot of fighting in our house when I was growing up,” he says. “Entering my middle school years, it just got worse,” he says. Mr. Munoz’s parents had violent fights. Although they were both very supportive of him, he cannot remember when they ever really got along.

Still, Mr. Munoz was able to get through early adolescence as an honors student and starred on both the debate team and his school’s drama club. He even starred in an elaborate production of Shakespeare’s Richard III.

“In our school,” he says, “if you were a drama club kind of kid instead of an athlete, you really had to prove yourself to be a real man to avoid getting picked on. I did that by drinking. We had lots of ways to sneak booze into the places we met, and it was kind of exciting at first. You’re 15 years old, you’re outside on a starry night in a big city, you’re with your friends, and there’s plenty of alcohol. It makes you feel like a big man.”

Unfortunately, his parents never seemed to notice; therefore, Mr. Munoz never got help or encouragement to stop.

“After high school, my stress—and the reasons I gave myself for drinking—got worse. Those good grades got me partial scholarships to some local colleges—but mostly for drama awards, which suited me fine. But when my parents found out I wanted to be an actor, they freaked out.”

When Mr. Munoz refused to pursue prelaw, as his parents insisted, they withdrew all financial (and emotional) support, and they dissolved their marriage and household at the same time.

“It wasn’t all bad,” Mr. Munoz says. “I used the best partial scholarship, stayed local, living with friends, and we all went to school part time and worked part time—mostly in bars. The party just sort of—yeah—continued.”

Fourteen years later, Mr. Munoz is well known enough to “make a decent living” as an actor, teaching workshops on the side and waiting tables in the lean times. Half of his friends are now married and no longer trying to pursue acting.

“As the loneliness has increased, so has my drinking,” he says. “I mean, I have friends, but I never married, so those old days are just gone. I never made it to the New York stage as I’d dreamed, so all I have of those old party days is the alcohol. Only the alcohol has remained available. It tastes like nostalgia, you know?”

Because he started so young and because alcohol has played such a central role in his life, for the past 2 years, Mr. Munoz has already begun battling early stages of cirrhosis.

“I sort of didn’t expect this until old age,” he says with a sad smile. “Imagine my shock.”

He tells the nurse that he has not had a drink for 4 months.

1.      Mr. Munoz was initially treated with neomycin, followed by lactulose. “The lactulose has worked better for me,” he says, “but it has some side effects that aren’t any fun.” How should he be counseled nutritionally—taking into account both his condition and his drug therapy?

2.      Unfortunately, Mr. Munoz’s disorder progresses to end-stage liver disease, and he is awaiting a liver transplant. The good news is that he is an excellent candidate. What are likely his most crucial nutritional needs (a) at this time and (b) during the immediate posttransplant period?