1.4 Participate in health care policy development to influence nursing practice and health care.

Research public health issues on the “Climate Change” or “Topics and Issues” pages of the American Public Health Association (APHA) website. Investigate a public health issue related to an environmental issue within the U.S. health care delivery system and examine its effect on a specific population.

Write a 750-1,000-word policy brief that summarizes the issue, explains the effect on the population, and proposes a solution to the issue.

Follow this outline when writing the policy brief:

1. Describe the policy health issue. Include the following information: (a) what population is affected, (b) at what level does it occur (local, state, or national), and (c) evidence about the issues supported by resources.
2. Create a problem statement.
3. Provide suggestions for addressing the health issue caused by the current policy. Describe what steps are required to initiate policy change. Include necessary stakeholders (government officials, administrator) and budget or funding considerations, if applicable.
4. Discuss the impact on the health care delivery system.

Include three peer-reviewed sources and two other sources to support the policy brief.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. 

BACKGROUND

Katie is an 8 year old Caucasian female who is brought to your office today by her mother & father. They report that they were referred to you by their primary care provider after seeking her advice because Katie’s teacher suggested that she may have ADHD. Katie’s parents reported that their PCP felt that she should be evaluated by psychiatry to determine whether or not she has this condition. 

The parents give you a copy of a form titled “Conner’s Teacher Rating Scale-Revised”. This scale was filled out by Katie’s teacher and sent home to the parents so that they could share it with their family primary care provider. According to the scoring provided by her teacher, Katie is inattentive, easily distracted, forgets things she already learned, is poor in spelling, reading, and arithmetic. Her attention span is short, and she is noted to only pay attention to things she is interested in. The teacher opined that she lacks interest in school work and is easily distracted. Katie is also noted to start things but never finish them, and seldom follows through on instructions and fails to finish her school work. 

Katie’s parents actively deny that Katie has ADHD. “She would be running around like a wild person if she had ADHD” reports her mother. “She is never defiant or has temper outburst” adds her father.

SUBJECTIVE

Katie reports that she doesn’t know what the “big deal” is. She states that school is “OK”- her favorite subjects are “art” and “recess.” She states that she finds her other subjects boring, and sometimes hard because she feels “lost”. She admits that her mind does wander during class to things that she thinks of as more fun. “Sometimes” Katie reports “I will just be thinking about nothing and the teacher will call my name and I don’t know what they were talking about.” 

Katie reports that her home life is just fine. She reports that she loves her parents and that they are very good and kind to her. Denies any abuse, denies bullying at school. Offers no other concerns at this time. 

MENTAL STATUS EXAM

The client is an 8 year old Caucasian female who appears appropriately developed for her age. Her speech is clear, coherent, and logical. She is appropriately oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Self-reported mood is euthymic. Affect is bright. Katie denies visual or auditory hallucinations, no delusional or paranoid thought processes readily appreciated. Attention and concentration are grossly intact based on Katie’s attending to the clinical interview and her ability to count backwards from 100 by serial 2’s and 5’s. Insight and judgment appear age appropriate. Katie denies any suicidal or homicidal ideation.

Diagnosis: Attention deficit hyperactivity disorder, predominantly inattentive presentation

 Decision Point One

Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING 

RESULTS OF DECISION POINT ONE

·   Client returns to clinic in four weeks

·   Katie’s parents report that they spoke with Katie’s teacher who notices that her symptoms are much better in the morning, which has resulted in improvement in her overall academic performance. However, by the afternoon, Katie is “staring off into space” and “daydreaming” again

·   Katie’s parents are very concerned, however, because Katie reported that her “heart felt funny.” You obtain a pulse rate and find that Katie’s heart is beating about 130 beats per minute

Decision Point Two

Change to Ritalin LA 20 mg orally daily in the MORNING 

RESULTS OF DECISION POINT TWO

·   Client returns to clinic in four weeks

·   Katie’s academic performance is still improved, and the switch to the LA preparation is lasting Katie throughout the school day

·   Katie’s reports of her heart feeling “funny” have gone away. Pulse was 92 during today’s office visit

Decision Point Three

Maintain current dose of Ritalin LA and reevaluate in 4 weeks

Guidance to Student

At this point, Katie’s symptoms are well controlled (her attention is sustained throughout the school day) and her side effects have gone away following change to a long-acting preparation. There is no indication at this point that the dose should be increased as it is always advisable to use the lowest effective dose of stimulant medication. Katie’s heart rate is appropriate for an 8 year old girl and an EKG would not be indicated based on her heart rate. 

 

The assignment should include each of the categories listed below. Refer to the assignment rubric for grading criteria and requirements for each section. Be sure to reach out to your professor if you have any questions.

1. Disease Introduction
2. Etiology & Risk Factors
3. Pathophysiologic Processes
4. Clinical Manifestations: Subjective and Objective Findings
5. Clinical Manifestations: Complications
6. Diagnostics & Pharmacological Recommendations

 

Category

Points

%

Description

Introduction of disease

The introduction statement should:

1. Be one paragraph (approximately 200 words)

2. Include the disease description

3. Include the disease epidemiology

4. Includes information that is supported by current scholarly literature or course textbook, as evidenced by in text citations

(4 required elements)

Etiology and Risk factors

The student includes:

1. Common causes of the disease or condition

2.Risk factors for the disease or condition

3. Impact of age on disease or condition

4. Prevalence of disease based on gender

5. Genetic basis of disease 

6. Lifestyle influences on disease

7. Information that is supported by current scholarly literature or course textbook, as evidenced by in text citations

8. If a listed factor is not a component of the disease the student must state so in this section

(8 required elements)

Pathophysiological processes

The student:

1. Describes changes occurring at the cellular, tissue, and/or organ level that contribute to the disease process 

2. Describes adaptation of the cells and body in response to the disease 

3. Relates disease processes to manifested signs and symptoms

4. Includes information that is supported by current scholarly literature or course textbook, as evidenced by in text citations

(4 Required Elements)

Clinical manifestations: subjective and objective findings

The student:

1. Identifies subjective complaints that contribute to diagnosis of the condition 

2. Identifies the body systems affected by the condition 

3. Identifies physical assessment findings that contribute to diagnosis of the condition 

4. Identifies pertinent laboratory tests necessary for diagnosis of condition  

5. Includes information that is supported by current scholarly literature or course textbook, as evidenced by in text citations

(5 Required Elements)

Complications & Diagnostics

The student:

1. Identifies a minimum of two (2) complications of the disease

2, Discusses the implications for the patient when complications are left untreated

3. All information is supported by current scholarly literature or course textbook as evidenced by in text citations

4. Explains the purpose of each listed laboratory and diagnostic test listed within the clinical manifestations section

5. Discusses the significance of test findings in relation to the disease process

6. Includes information that is supported by current scholarly literature or course textbook, as evidenced by in-text citations

(6 required elements)

Pharmacologic recommendations-(20%)

The student:

1. Lists each medication individually with rationale included

2. Includes dosage, route, dosage frequency and length of treatment for each medication

3. Includes the drug classification for each medication

4. Includes the side effects of each medication

5. Includes the potential drug interactions to consider when prescribing (medications to avoid)

6. Includes information that is supported by current scholarly literature or course textbook, as evidenced by in-text citations

(6 required elements)

Total CONTENT Points= 135 pts

ASSIGNMENT FORMAT

Category

Points

%

Description

Grammar, Syntax, APA 

APA format, grammar, spelling, and/or punctuation are accurate and all cited information is paraphrased (no quotes are included in the paper)

Organization

1.  Assignment is written in the exact sequence listed  in the requirements section

2.  All required sections are included within the assignment 

3.  At least two (2) scholarly, primary sources from the last 5 years, excluding the textbook and course lectures, are provided in the reference list

4. The paper length does not exceed 3 pages, excluding title page and references  

(4 Required elements)

ASSIGNMENT TOTAL=150

Diuretics

              The therapeutic effect of diuretics is based on their ability to promote increased elimination of water and sodium from the body. They are considered the first-line for treating hypertension. There are three main types of diuretics, which are thiazides, potassium-sparing diuretics, and loop diuretics. Thiazides act by inhibiting the absorption of sodium chloride in the distal convoluted tubule, loop diuretics work by selectively inhibiting the reabsorption of sodium chloride by acting on the sodium-potassium-chloride symporter in the loop of Henle, and potassium-sparing diuretics act on the collecting tubules to decrease reabsorption of sodium (Aronow, 2018).

ACE Inhibitors

             The therapeutic action of ACE inhibitors is based on preventing the conversion of inactive angiotensin I to the active angiotensin II, which promotes the ACE inhibitors blood pressure lowing effect. They promote vasodilation, which prevents the narrowing of the blood vessels. Additionally, AC inhibitors also increase bradykinins and prostaglandins, which promotes reduction of blood pressure (Aronow, 2018).

ARBs

         ARBs work by blocking angiotensin II from binding to its respective receptor, which, in turn, prevents it from promoting vasoconstriction and fluid retention. The receptors are found on the muscles surrounding the blood vessels. The effect of ARBs in blocking angiotensin II promotes vasodilation, which in turn reduces the pressure of the blood. The effect of ARBs also reduces the effort the heart has to put in pumping the blood (Aronow, 2018).

CCBs

         Calcium channel blockers lower the blood pressure by preventing the entrance of calcium into the vascular smooth muscles. The effect of CCBs promotes vasodilation by reducing the contractibility of the blood vessels. Two types of CCBs exist, those that act on the peripheral blood vessels and those that act on both the peripheral blood vessels and cardiac muscles. While both of them are effective in managing hypertension, the nondihydropyridines, which act on both the cardiac muscles and peripheral blood vessels, are also effective in treating cardiac arrhythmias. Both types can be used as monotherapies in managing hypertension (Aronow, 2018).

Sympathetic Nervous System Drugs

          These drugs function by activating the sympathetic nervous system as hypertension has been linked to different modifications of the functions of the SNS. The main drugs that have been proven effective in activating the SNS and modifying its functions include ACE inhibitors, CCBs, diuretics, and alpha-blockers.

Patient Education for Antihypertensive Medication

         Patient education is important when prescribing or administering antihypertensive medication. Some of the considerations that patients should be educated on include the importance of adhering to their prescribed medication to promote its effectiveness in helping them control their blood pressure, and avoiding taking an extra dosage after forgetting to take their medication. Taking a higher dosage than the prescribed number of tablets can lower the blood pressure to very low point and increase the patient’s risk of complications or death. Other teaching points should incaalude the importance of talking to a physician before introducing another drug or supplement to the regimen to avoid drug-drug interactions and the need to report any adverse reactions that the patient might experience after using the drugs (Burnier & Egan, 2019). Taking these precautions seriously can reduce the risks of complications and promote effective management of hypertension.  

References 

Aronow, W. S. (2018). Antihypertensive drug therapy. Annals of Translational Medicine, 6(7), 123. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6015954/.Burnier, M., & Egan, B. M. (2019). Adherence in Hypertension: A Review of Prevalence, Risk Factors, Impact, and Management. Circulation Research, 124. 1124-1140. https://www.ahajournals.org/doi/10.1161/CIRCRESAHA.118.313220.