Part A: In the paragraph below there are 3 direct quotes and/or paraphrases, rewrite the paragraph in correct APA format.

The day has come for the patient to see the nurse practitioner prior to his trip abroad. By having a “pretravel assessment at least 6 weeks before departure, the provider may assess the timing, duration, and circumstances of travel. Michelle Zappas Candice Whitely and Sarah Carter p. 548 2019.” When the patient is traveling abroad it depends on what country or countries the patient is visiting as to what if any vaccinations are required. It is necessary for the nurse practitioner to remain current with regards to the latest recommendation from the CDC and WHO for travel advisories. (JNP, 2019, p. 548). Primary care NP’s are uniquely positioned to protect the health and well-being of the patient and local community Zappas, Whitely, & Carter.

Part B: Write the following references in correct APA format:

1. Hosein Karimi and Negin Masoudi Alavi Nurse Midwifery Study June 2015 volume 4 issue 2 Doi: 10.17795/nmsjournal29475 Florence Nightingale: The Mother of Nursing
2. Jean Watson: Theory of Human Caring. Angelo Gonzalo, BSN, RN updated September 12, 2019. Retrieved March 20, 2020 from https://nurseslabs.com/jean-watsons-philosophy-theory-transpersonal-caring
3. Michael B. A. Oldstone. Viruses, Plagues, & History. Published 11/2/2009. Oxford University Press. revised and updated edition 2010. New York, New York. ISBN 978-0-19-532731-1
4. American journal of respiratory and critical care medicine. January 1, 2020. Volume 201 number 1. Clinical fingerprinting: a way to address the complexity and heterogeneity of bronchiectasis in practice. Miguel Angel Martinez-Garcia, Timothy R. Aksamit, and Alvar Agusti. Pages 14-19.
5. Taber’s Cyclopedic Medical Dictionary. Edition 17. F.A. Davis company. Philadelphia, PA. copyright 1993. Page 679.
6. Nurses and the use of computer technology. RNAO. No date. Retrieved November 19, 2019 from https://rnao.ca/sites/rnao-ca/files/Nurses_and_the_use_of_computer_technology.pdf
7. Arabi. F. Rafii. M. A. Cheraghi and Ghiyasvandian, S. (2014). Nurses’ policy influence: A concept analysis. Iranian journal of nursing and midwifery research, (issue 3) volume 19, pp 315–322.
8. Burke, S. (2016). Influence through policy: Nurses have a unique role. Reflections on Nursing Leadership. Retrieved from https://www.reflectionsonnursingleadership.org/commentary/more-commentary/Vol42_2_nurses-have-a-unique-role.
9. Davoodvand, S., Abbaszadeh, A., & Ahmadi, F. 2016 Journal of medical ethics and history of medicine Patient advocacy from the clinical nurses’ viewpoint: a qualitative study volume 5 number 9
10. Volume 6 issue3. Pages 1124-1132. Nsiah, C., Siakwa, M., & Ninnoni, J. P. 2019. Registered Nurses’ description of patient advocacy in the clinical setting. Nursing Open

 

New construction projects begin with a design phase, where architects blueprint the vision complete with design details. They work in collaboration with builders who use the designs to prepare the appropriate strategies, tools, and materials to bring the vision to reality. You are both architect and builder of your success. You have started to blueprint your vision in your Academic Success and Professional Development Plan. You have identified others with whom you will collaborate. Now you can begin to prepare the appropriate strategies, tools, and materials

How will you approach your studies? What types of resources are available to you, and how will you access and utilize them? Taking the opportunity to prepare these strategies, tools, and materials will help ensure you can “break ground” without incident and successfully move to the phase where you begin building your vision.

To Prepare:

• Consider your goals for academic accomplishments while a student of the MSN program.
• Reflect on the strategies presented in the Resources for this week.

The Assignment:

• Clearly identify and accurately describe in detail at least three academic resources or strategies that can be applied to the MSN program.
• Clearly identify and accurately describe in detail at least three professional resources that can be applied to success in the nursing practice in general or in a specialty.
• Clearly and thoroughly explain in detail how you intend to use these resources, and how they might benefit you academically and professionally.

Note:  Remember to include an introduction paragraph which contains a clear and comprehensive purpose statement which delineates all required criteria, and end the assignment Part with a conclusion paragraph. List at least five appropriate sources in APA Format. 

  DISCUSSION 1 

TO.

Disorder: Depression

I chose to complete the scenario on a 70-year-old male presenting with symptoms of depression.  

Background information: 

70-year-old Hispanic male 

Death of mother at a young age 

Occasional back pain & stiff shoulders 

Insomnia 

Poor concentration 

Montgomery Asberg Depression Rating Scale 51 I indicates (severe depression). 

I would not prescribe phenelzine 15mg TID because it’s an MAOI and could interact with common tyramine foods such as processed meats, cheese, & avocado commonly found in the diet of Hispanic people. 

Common barriers to treatment of depression in Hispanics include lack of information about mental health services, fewer linguistically & culturally trained providers representative of the Hispanic community (Camacho et al.,2018). 

SSRIs are the first-line treatment for major depression (McCance & Huether, 2019). 

I chose to treat the patient with an SNRI (Venlafaxine). I believe it would benefit the patient by treating his to major depression & chronic pain. Other benefits of Venlafaxine include it is deemed to have fewer side effects, is safe in older adults, and has fewer drug interactions. 

Venlafaxine (Effexor) can be used to treat major depression & chronic pain (McCance & Huether, 2019). 

I decided to start the patient on Effexor (Venlafaxine) 37.5mg 1 PO QD. 

Pathophysiology of Venlafaxine: Venlafaxine was found to be effective in managing depression by blocking Norepinephrine and serotonin reuptake. It also has weak blocking of dopamine reuptake (McCance & Huether, 2019). 

As a result of this, the patient returns in 4wks with no change in depressive symptoms. I later decided to increase the dose to 75mg PO QD. A second Montgomery Depression screening was completed, the patient scored a 38. 

Next, the Client returns to the clinic in 4wks, 

reports improvement of depressive symptoms.  

Rosenthal & Burchum (2021) explain a clinician has the following options if the first dose is ineffective: increase the dose of the first drug, switch to another drug in the same class, switch to another drug in a different class, or add an atypical antidepressant as a second drug. 

To prevent a relapse, I would continue the therapy for 4 to 9 mos.  I would educate the patient on continuing therapy even if there are no symptoms. I would encourage the patient to attend Behavioral Health counseling and include his family members in his plan of care. Camacho et al. (2018) suggest recruiting a bilingual psychotherapist to help promote a welcoming & safe environment for a patient to express emotions. Frequent monitoring of the patient would be necessary, to observe for s/s of suicidal ideation. 

References: 

Camacho, D., Estrada, E., Lagomasino, I. T., Aranda, M. P., & Green, J. (2018). Descriptions of depression and depression treatment in older Hispanic immigrants in a geriatric collaborative care program. Aging & Mental Health, 22(8), 1056–1062. https://doi-org.ezp.waldenulibrary.org/10.1080/13607863.2017.1332159 

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier. 

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier. 

DISCUSSION 2

L.

The psychological disorder that was presented in my presentation was bipolar I disorder. A female of Korean decent presented with bipolar disorder in a manic state. She had been recently hospitalized and discharged on lithium for mania. Prior to her follow up in the clinic the patient had decided to discontinue the medication on her own which had exacerbated her condition. When presenting to the clinic, she was labile and euphoric. I had made the decision to start her on Risperdal 1 mg orally BID. After this decision point, she returned to the clinic accompanied by her mother and was very sedated and lethargic. The mother had stated that she had been like this for about a week after her left office visit. Though I was happy that she continued to take her medication and it was obviously controlling some of her symptoms, that obviously had been too strong of a dosage. This is most likely because of her CYP2D6*10 allele from her Korean descent, simply her genetics which led her course of treatment following differently. At the second office visit, I had decided to decrease the Risperdal to 1 mg at HS With another follow-up visit in four weeks again. When the client had returned, she was much less sedated, and showing symptoms of improvement. Her young mania rating scale had been priest from 22 for 16, which was a 25% decrease in her presenting symptoms. At this point I had advised the patient to continue the same dose of Risperdal and reassess again in another 4 weeks. I wanted to see how the patient would respond while on this same dose of Risperdal as the CYP2D6*10 allele gives her a slower clearance of Risperdal from her system which is most likely what had resulted in higher than normal levels of sedation. Puangpetch et. al. 2016 states that CYP2D6 is associated with plasma concentrations of risperidone as it is a poor metabolizer and showed more serious adverse events than those without this allele. This is why the patient’s symptoms while on this medication were of that extreme for a relatively low dose especially to start with. Vuppalaanchi also states that the metabolism of risperidone specifically is again by CYP2d6 and is also is responsible for up to 20% of drugs that undergo biotransformation and is a poor metabolizer. 

References

Bipolar Therapy. (2020). http://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_04/index.html

Puangpetch, A., Vanwong, N., Nuntamool, N., Hongkaew, Y., Chamnanphon, M., & Sukasem, C. (2016). CYP2D6 polymorphisms and their influence on risperidone treatment. Pharmacogenomics and personalized medicine, 9, 131–147. https://doi.org/10.2147/PGPM.S107772

Vuppalanchi, R. (2011). Metabolism of Drugs and Xenobiotics. Retrieved from https://doi.org/10.1016/B978-0-443-06803-4.00004-6

 

Describe how providing culturally appropriate care is a challenge for the advanced practice nurse. The phenomena of communication according to Giger and Davidhizar’s model can shape care.  

How Giger and Davidhizar’s model can shape care? Or how this theory applies to care?

Describe appropriate ways to communicate with patients from various cultures.

Mention strategies that you can use to communicate appropriately to patients.

How communication influences patient care?

Should be a minimum of 350 words, scholarly written, no older than 5 years, use APA 7 formatted, and referenced.  A minimum of 2 references is required.  

Discussion: Assessing Musculoskeletal Pain

Photo Credit: Getty Images/Fotosearch RF

The body is constantly sending signals about its health. One of the most easily recognized signals is pain. Musculoskeletal conditions comprise one of the leading causes of severe long-term pain in patients. The musculoskeletal system is an elaborate system of interconnected levers that provides the body with support and mobility. Because of the interconnectedness of the musculoskeletal system, identifying the causes of pain can be challenging. Accurately interpreting the cause of musculoskeletal pain requires an assessment process informed by patient history and physical exams.

In this Discussion, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.

Case 2: Ankle Pain

A 46-year-old female reports pain in both of her ankles, but she is more concerned about her right ankle. She was playing soccer over the weekend and heard a “pop.” She is able to bear weight, but it is uncomfortable. In determining the cause of the ankle pain, based on your knowledge of anatomy, what foot structures are likely involved? What other symptoms need to be explored? What are your differential diagnoses for ankle pain? What physical examination will you perform? What special maneuvers will you perform? Should you apply the Ottawa ankle rules to determine if you need additional testing?

With regard to the case study you were assigned:

·  Review this week’s Learning Resources, and consider the insights they provide about the case study.

·  Consider what history would be necessary to collect from the patient in the case study you were assigned.

·  Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?

·  Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.