Considering your role specialization (nurse educator, nurse informatics, nurse administrator, and family or adult-gerontology NP), identify the top three current trends or issues that you believe to be most important with regard to your chosen role and the impact the role has on patient outcomes. Synthesize knowledge from values theory, ethics and legal regulatory statutes, and develop your personal philosophy for a career as an advanced practice nurse. Be sure to incorporate the content of Week 5 (audio-visuals).

Guidelines: Support your responses with scholarly academic references using APA style format. Assigned course readings and online library resources are preferred. Weekly lecture notes are designed as overviews to the topic for the respective week and should not serve as a citation or reference.

In your discussion question response, provide a substantive response that illustrates a well-reasoned and thoughtful response; is factually correct with relevant scholarly citations, references, and examples that demonstrate a clear connection to the readings.

BACKGROUND

Mrs. Maria Perez is a 53 year old Puerto Rican female who presents to your office today due to a rather “embarrassing problem.”

SUBJECTIVE

Mrs. Perez admits that she has had “problems” with alcohol since her father died in her late teens. She reports that she has struggled with alcohol since her 20’s and has been involved with Alcoholics Anonymous “on and off” for the past 25 years. She states that for the past two years, she has been having more and more difficulty maintaining her sobriety since they opened the new “Rising Sun” casino near her home. Mrs. Perez states that she and a friend went to visit the new casino during their grand opening at which point she was “hooked.” She states that she gets “such a high” when she is gambling. While gambling, she “enjoys a drink or two” to help calm her during high-stakes games. She states that this often gives way to more drinking and more reckless gambling. She also reports that her cigarette smoking has increased over the past two years and she is concerned about the negative effects of the cigarette smoking on her health.

She states that she attempts to abstain from drinking but that she gets such a “high” from the act of gambling that she needs a few drinks to “even out.” She also notices that when she drinks, she doesn’t smoke “as much” but enjoys smoking when she is playing at the slot machines. She also reports that she has gained weight from drinking so much- she currently weights 122 lbs., which represents a 7 lb. weight gain from her usual 115 lb. weight.

Mrs. Perez is quite concerned today because she has borrowed over $50,000 from her retirement account to pay off her gambling debts. She is very concerned because her husband does not know that she has spent this much money.

MENTAL STATUS EXAM

The client is a 53 year old Puerto Rican female who is alert, oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. Her speech is clear, coherent, and goal directed. Her eye contact is somewhat avoidant during the clinical interview. As you make eye contact with her, she looks away or looks down. She demonstrates no noteworthy mannerisms, gestures, or tics. Her self-reported mood is “sad.” Affect is appropriate to content of conversation & self-reported mood. She visual or auditory hallucinations, no delusional or paranoid thought processes are readily appreciated. Insight and judgment are grossly intact, however, impulse control is impaired. She is currently denying suicidal or homicidal ideation.

Diagnosis: Gambling disorder, alcohol use disorder

Co-morbid Addiction (ETOH and Gambling) 53-year-old Puerto Rican Female

Puerto Rican female

Decision Point One

Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the Naltrexone (Vivitrol) Injection, 380mg intramuscularly in gluteal region every 4 weeks

n every 4 weeks

RESULTS OF DECISION POINT ONE

· Client returns to clinic in four weeks

· Mrs. Perez said that she felt “wonderful” as she has not “touched a drop” to drink since receiving the injection

· Client reports that she has not been going to the casino, as frequently, but when she does go she “drops a bundle” (meaning, spends a lot of money gambling)

· Client She is also still smoking, which has her concerned. She is also reporting some problems with anxiety, which also have her concerned

Decision Point Two

Refer to a counselor to address gambling issues address gambling issues

RESULTS OF DECISION POINT TWO

· Client returns to clinic in four weeks

· Client reports that the anxiety that she had been experiencing is gone

· Client reports that she has met with the counselor, but did not really like her. She did start going to a local meeting gamblers anonymous. She stated that last week, for the first time, she spoke during the meeting. She reports feeling supported in this group

Decision Point Three

Explore the issue that Mrs. Perez is having with her counselor, and encourage her to continue attending the Gambler’s Anonymous meetings

Guidance to Student Although controversy exists in the literature regarding how long to maintain a client on Vivitrol, four weeks is probably too soon to consider discontinuation. The psychiatric mental health nurse practitioner should explore the issues that Mrs. Perez is having with her counselor. As you will learn in future courses, ruptures and the therapeutic alliance can result in clients stopping therapy. Clearly, if the client does not continue with therapy, the likelihood of the gambling problem spontaneously remitting is lower (than had the client continued to receive therapy). Recall that there are no FDA approved treatments for gambling addiction, and the mainstay of treatment for this disorder is counseling. Since Mrs. Perez reports good perceived support from the gamblers anonymous meetings, she should be encouraged to continue her participation with this group.

The PMHNP needs to discuss smoking cessation options with Mrs. Perez in order to address the totality of addictions, and to enhance her overall health.

Examine Case Study: A Puerto Rican Woman With Comorbid Addiction. 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?

Decision Point One

Select what you should do:

Vivitrol (naltrexone) injection, 380 mg intramuscularly in the gluteal region every 4 weeks

Antabuse (disulfiram) 250 mg orally daily

Campral (acamprosate) 666 mg orally three times/day

Decision Point Two

Select what you should do next:

Add on Valium (diazepam) 5 mg orally TID/PRN/anxiety

Refer to a counselor to address gambling issues

Add on Chantix (varenicline) 1 mg orally BID

Decision Point Three

Select what you should do next:

Explore the issue that Mrs. Perez is having with her counselor, and encourage her to continue attending the Gamblers Anonymous meetings

Encourage Mrs. Perez to continue seeing her current counselor as well as continuing with the Gamblers Anonymous group

Discontinue Vivitrol. Encourage Mrs. Perez to continue seeing her counselor and to continue participating in the Gamblers Anonymous group

Overview/Description: The final written assignment will synthesize what you have discovered about the different advanced practice roles and scope of practice found in the master of nursing curriculum: APRNs, nurse educator, nurse informaticist, and nurse administrator/executive. (the area I choose and want to focus on is ARNP or family nurse practitioner).You will review all roles and then examine the specialty for which you were admitted, focusing on the scope of practice, core competencies, certification requirements, and legal aspects of practice for that specific role. You will also identify the practice environment and population you will be working with, as well as peers and colleagues. In addition, you will discuss your future leadership role and participation in professional organizations.Your paper is to be based on current literature, standards of practice, core competencies, and certification bodies for your chosen role. The paper should be 8-10 pages excluding the title and reference pages, and APA format is required.Category of Roles:

• Advanced Practice Roles in Nursing:
  • Briefly define advance nursing practice and the roles in advanced practice nursing pertaining to clinical practice, primary care, education, administration, and health information. Distinguish between ANP and the APN.
  • Describe the advance nursing practice role you aspire and briefly share the experiences and/or qualities you have that have influenced your decision. Include your personal philosophy.
• Selected Advanced Practice Role:
  • Identify the AP you interviewed and summarize the interview, which should/may include (if not in the interview, please address):
  • Examine regulatory and legal requirements for the state in which you plan to practice/work.
  • Describe the professional organizations available for membership based on your selected role.
  • Identify required competencies (domains), including certification requirements for your selected role.
  • Describe the organization and setting, population, and colleagues with whom you plan to work.
• Leadership Attributes of the Advanced Practice Role:
  • Determine your leadership style
  • Define Transformational Leadership and as it relates to your identified leadership attributes that you possess or need to develop
  • Apply the leadership style you will embrace in AP to one of the domains
• Health Policy and the Advanced Practice Role:
  • Based on your program of study, review the literature and address the following:
    • FNP/AGNP: Medicare reimbursement for NPs is 85%for the same health care that MDs receive at 100% reimbursement? Please address questions below and state your position on this mandate.
    • FNP/AGNP: What states have NP Full Practice Authority and which states have limitations or restrictions? How does this apply to your state? Please address questions below and state your position on this regulation.
    • Nurse Executive: What is value based care and how will it impact decisions made at the executive level relative to nursing and AP nursing? Please address and state your position on the regulation.
    • Nurse Informaticists: What law(s) was enacted to regulate health information? Please address questions below and state your position on this regulation. 
    • Nurse Educator: What agency regulates nursing education?  Explain in detail.
• For the above category chosen, address the following:
• Describe the current policy or trends and determine if it needs to change; if opposed to change state why
• Provide the process required to make the change with key players and parties of interest; support opposition
• Explain how you could lead the effort to make or influence the change in policy or keep the policy the same and the impact in healthcare quality.
• Conclusion-Summarize your role paper by highlighting key points made in your paper.

Submission Details:

• Support your responses with examples.
• Cite any sources in APA format.

Please start with the pathophysiology of Alzheimer’s disease, conduct a literature review and discuss the latest developments.

Please include a discussion section about new developments in diagnostic tests and technologies.

In the conclusion section, please share your experience (if you have any) and include some tips for your NP colleagues.

Research Paper Instructions – You will write an original research paper about clinical applications of pathophysiology. I simply want you to choose a topic that will be helpful in your future career path. 

1) You can focus on the relationship between pathophysiology and evidence-based medicine and prepare a case study/literature review. As you know, “literature review” means the process of reading, analyzing, evaluating, and summarizing scholarly materials about a specific topic. In other words, you don’t have to design a study and/or collect data. 

2) You can choose any topic related to pathophysiology depending on your career plans and research interests.

– This paper will make up 20% of your final grade. 

– This will be a literature review. You will NOT collect and analyze any patient data because this requires IRB approval from both institutions. – Please use Adelphi University’s electronic library, you will find several full-text articles. 

– Your paper should be MINIMUM 3000 words long, not counting citations or pictures. This is the minimum number and please keep in mind that the more is better.

– Please follow APA style and include at least 10 peer-reviewed references 

– You don’t need to have “Abstract”, “Keywords”, and “Methodology” sections. Again, this will be a literature review, not an experimental trial. 

– Please do not forget to include a “Conclusion/Discussion” section at the end. This is the most important part where I want to see your own perspective about possible future applications/implementations. Do not worry about being subjective for this assignment, you don’t have to be objective in discussion section. I especially want to encourage our students to make some predictions about possible future (when possible). Even Steve Jobs and Bill Gates made several wrong predictions in the past, so I will not judge your conclusions, only grade the originality. 

– Studies, projects, experiences and findings that are contradicting each other could be a good start to make your own comments. 

– Here is a descriptive title example: “Comparison of Two Clinical Decision Support Tools for Diagnosis: XYZ and WZY”. – If you are not familiar with literature reviews, you can use the following link as a starting point: 

Literature Review Basics: What is a Literature Review? 

https://laverne.libguides.com/litreviews