Category: Health Care and Life Sciences : Nursing

1. Please see attachment for instructions
2. I have attached the “Outcomes Analysis & Evaluation of Outcomes” paper where you can find the info for the paper
3. I have attached a article of what is benchmarking
4. Reference must be within 5 years

I am just responsible for the Method portion and the topic is Quantitative and  qualitative Using 10 nurses and 50 patients. We will use an audit to track . The study is based on education of staff, turning the patient and using the Braden Scale.
Pressure Ulcer Preventions in Older Adults: A qualitative study

I want to let the reader get an idea of who I am and what nursing means to me.  So my main reason I choose nursing because I feel a great sense of pride working with families and patients through difficult times. I also like to know that I am making a difference in the lives of others. I want to become a Nurse so that I can help others in the time of their needs.

Respond to 2 posts
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. Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days.
Student- Yoandra Gallardo:
Additional History
“Can you describe how your sleep habits have changed since the passing of your husband?” – This question helps to gather more specific information about the patient’s insomnia, including the onset, duration, and nature of sleep disturbances. Insomnia can present in different forms and subtypes, with each subtype having a possibly varied effect on the patient (Levenson et al., 2015).
“How has the loss of your spouse affected your overall mood and daily functioning?” – This question explores the patient’s emotional response to her husband’s death and assesses the impact on her mental well-being. The answer can help provide context and a relationship between the patient’s loss of husband, depression, and insomnia.
“Are you currently experiencing any social support or engaging in activities that bring you comfort or joy?” – This question aims to assess the patient’s social support system and coping mechanisms after the loss of her spouse. It helps determine if she has adequate emotional support and if she is participating in activities that can potentially improve her mood and overall well-being. Top of Form
Bottom of Form
Additional History from the Patient Circle
 Adult Children:
How has your mother been coping with the loss of her spouse since his passing? This question helps gather insights into the patient’s emotional well-being and adjustment.
Have you noticed any changes in her sleep patterns or insomnia symptoms? The child can provide context in the onset and patterns of insomnia and depression if they are in constant contact with their mother.
Does she frequently discuss her feelings or concerns about her emotional health with you? This question helps gauge the patient’s level of communication regarding her mental well-being.
 Siblings:
Have you observed any changes in her behavior, mood, or daily activities? Such input can help provide more details on the patient’s depressive symptoms.
Does she engage in any activities or seek support from family or friends? This question helps assess the patient’s social engagement and support network within the family.
 Neighbors:
How often do you interact with the patient, and have you noticed any changes in her behavior or mood since her husband’s passing? Positive answers can lead to whether the neighbor can be included as part of the patient’s support system.
Has she mentioned any difficulties with sleep or expressed concerns about her emotional well-being? This question aims to gather information about the patient’s self-disclosure of her symptoms to her neighbors.

Physical Exams
Vital signs: Assessing blood pressure, heart rate, and temperature would inform general health and the possible impact of insomnia and depression on the patient’s general health.
Assessment of Depression Severity: Utilize validated depression assessment scales such as the PHQ-9 (Patient Health Questionnaire-9) to evaluate the severity of depression symptoms and monitor changes over time (Levis et al., 2019).
Diagnostic Tests
Thyroid panel: Depressive symptoms can result from psychological and pathological causes. One of the notable causes is hypothyroidism. Hypothyroidism can contribute to depressive symptoms and sleep disturbances (Boland et al., 2022). This diagnostic test will be used to rule out any thyroid disorder as an underlying cause of depression.
Differential Diagnosis
Adjustment Disorder with Depressed Mood: This diagnosis involves a maladaptive reaction to a significant life stressor, such as the loss of a loved one, resulting in depressive symptoms (American Psychiatric Association, 2022). The patient’s history of no previous episodes of depression before her husband’s death supports this possibility.
Bereavement-Related Sleep Disorder: While this is not a typical diagnosis in the DSM-V manual, severe and persistent grief can cause insomnia and sleep disorder (Lancel et al., 2020). The patient’s chief complaint of insomnia following her husband’s death aligns with this diagnosis.
Possible working diagnosis
Major Depressive Disorder (MDD): The patient’s persistent depressive symptoms, lack of improvement over time, and the absence of previous depressive episodes may suggest MDD (American Psychiatric Association, 2022).
Pharmacologic Agents
Sertraline:
Dosing: The typical starting dose for sertraline in the treatment of depression is 50 mg orally once daily, which can be increased gradually as needed and tolerated, up to a maximum of 200 mg/day.
Mechanism of Action: Sertraline selectively inhibits the reuptake of serotonin (5-HT) in the brain, thereby increasing the availability of serotonin neurotransmitters (Stahl, 2021).
Venlafaxine:
Dosing: Venlafaxine’s immediate-release formulation is typically initiated at 37.5 mg orally twice daily (Stahl, 2021).
Mechanism of Action: Venlafaxine inhibits the reuptake of both serotonin and norepinephrine, resulting in increased levels of these neurotransmitters in the brain.
Most possible choice
Sertraline: According to Funk et al. (2020) Sertraline has the best cardiovascular outcomes and is not significantly associated with QT abnormalities. Furthermore, the therapeutic potency of Sertraline is better than Venlafaxine (American Psychological Association, 2019).
Contraindications
Sertraline should not be used among patients with seizures or bipolar disorder (Stahl, 2021). The drug is associated with serotonergic syndrome and hence might exacerbate seizures.
Check Points and Therapeutic Changes
Sertraline takes 2-4 weeks to begin its therapeutic effect (Stahl, 2021). Following the patient after four weeks is rational to monitor symptoms and adverse effects.
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association.
American Psychological Association. (2019). Guideline development panel for the treatment of depressive disorders, clinical practice guideline for the treatment of depression across three age cohorts. https://www.apa.org/depression-guideline
Boland, R., Verdiun, M., & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Lippincott Williams & Wilkins.
Funk, M. C., Beach, S. R., & Bostwick, J. R. (2020). Resource document on QTc prolongation and psychotropic medications. American Psychiatric Association. https://www.psychiatry.org/File%20Library/Psychiatrists/Directories/Library-and-Archive/resource_documents/Resource-Document-2018-QTc-Prolongation-and-Psychotropic-Med.pdf
Lancel, M., Stroebe, M., & Eisma, M. C. (2020). Sleep disturbances in bereavement: A systematic review. Sleep Medicine Reviews 53, 101331. https://doi.org/10.1016/j.smrv.2020.101331
Levenson, J. C., Kay, D. B., & Buysse, D. J. (2015). The pathophysiology of insomnia. Chest, 147(4), 1179-1192. https://doi.org/10.1378%2Fchest.14-1617
Levis, B., Benedetti, A., & Thombs, B. D. (2019). Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis. BMJ, 365, l1476. https://doi.org/10.1136/bmj.l1476
Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (5th ed.). Cambridge University Press.
Post 2 to respond to
Marisela Marisela Reyes
Yesterday Jul 12 at 8:18pm
Marisela Reyes
Main Discussion Post
List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.
I could question the client, “What brought you in this morning?” as one of my queries. This open-ended question helps build the patient-physician rapport to encourage them to speak freely about her feelings. “What is your daily caffeine consumption rate?” would be my second inquiry in the discussion. Consuming caffeine right before sleep time considerably increases the risk of sleeplessness. The final question would be, “Is there any history of (GERD) Gastro esophageal reflux disease?” In senior adults, GERD causes sleeplessness. Thus ruling out environmental factors while evaluating the patient’s condition.
Identify people in the patient’s life you would need to speak to or get feedback from to assess the patient’s situation further. Include specific questions you might ask these people and why.
Her caregivers and children are the people in the patient’s life who could offer further details and assistance. Questions like “Does she depict any recent decrease in interests, appetite, mood, or energy?” are suitable because of their constant touch before admission to the facility. The queries make it easier to obtain outside data along with further patient evaluations of anything untold.
Explain what, if any, physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.
A physical examination or self-reports could follow blood tests to rule out thyroid issues, as insomnia is frequently caused by hyperthyroidism, which causes uneasiness due to this hormone’s excessive activity (Cook et al., 2018). The Hamilton Anxiety Rating Scale would gauge the patient’s level of anxiety-related insomnia, and the HAM-A scores could assist with future treatment.
List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.
Depression was earlier confirmed for the patient as Generalized anxiety disorder (GAD), brought on by the husband’s demise. The multiple potential shifts in life dynamics include worry over money, solitude fear, the anxiety of passing away, and unexpectedly falling asleep unattended (Farazdaq et al., 2018). Persistent and excessive worry about different issues causes GAD to leave the patients. Struggle to keep their worries under control. The Patient in the scenario meets this differential diagnosis, as the observed insomnia could be due to routine changes.
List two pharmacologic agents and thier dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, explain why you might choose one agent over the other.
Temazepam and trazodone are the two suitable pharmaceuticals for the patient’s antidepressant therapy.                                                                     
For insomnia, trazodone has FDA approval for serious depression treatment and is additionally administered off-label to treat anxiety and sleeplessness (Cook et al., 2018). on the other side, Temazepam is an effective option for insomnia and is thus used off-label for catatonia, anxiety disorders, psychosis, and acute mania (Dell’Osso et al., 2015).
For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on ethical prescribing or decision-making. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals based on ethical prescribing guidelines or decision-making?
Temazepam would work best for this patient considering its shorter half-life, no active metabolites, and no pharmacological interactions, making it an ideal medicine for elderly patients (Farazdaq et al., 2018). Based on the patient’s current drug regimen, with metformin, Losartan, Januvia, Sertraline, and HCTZ, for depression, diabetes mellitus, and hypertension. Temazepam would not make other prescriptions poisonous when added to the pharmaceutical regimen since numerous genes influence sleep.
                                                                                                              References
Cook, B., Creedon, T., Wang, Y., Lu, C., Carson, N., Jules, P., Lee, E., & Alegría, M. (2018). Examining racial/ethnic differences in patterns of benzodiazepine prescription and misuse. Drug and Alcohol Dependence, 187, 29-34. https://doi.org/10.1016/j.drugalcdep.2018.02.011 Links to an external site.
Dell’Osso, B., Albert, U., Atti, A. R., Carmassi, C., Carrà, G., Cosci, F., … & Fiorillo, A. (2015). Bridging the gap between education and appropriate use of benzodiazepines in psychiatric clinical practice. Neuropsychiatric Disease and Treatment, 1885-1909.
Farazdaq, H., Andrades, M., & Nanji, K. (2018). Insomnia and its correlates among elderly patients presenting to family medicine clinics at an academic center. Malaysian Family Physician : The Official Journal of the Academy of Family Physicians of Malaysia, 13(3), 12-19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6382090/ Links to an external site.

Insomnia is one of the most common medical conditions you will encounter as a PMHNP. Insomnia is a common symptom of many mental illnesses, including anxiety, depression, schizophrenia, and ADHD (Abbott, 2016). Various studies have demonstrated the bidirectional relationship between insomnia and mental illness. In fact, about 50% of adults with insomnia have a mental health problem, while up to 90% of adults with depression experience sleep problems (Abbott, 2016). Due to the interconnected psychopathology, it is important that you, as the PMHNP, understand the importance of the effects some psychopharmacologic treatments may have on a patient’s mental health illness and their sleep patterns. Therefore, it is important that you understand and reflect on the evidence-based research in developing treatment plans to recommend proper sleep practices to your patients as well as recommend appropriate psychopharmacologic treatments for optimal health and well-being.
Reference: Abbott, J. (2016). What’s the link between insomnia and mental illness? Health. https://www.sciencealert.com/what-exactly-is-the-link-between-insomnia-and-mental-illness#:~:text=Sleep%20problems%20such%20as%20insomnia%20are%20a%20common,bipolar%20disorder%2C%20and%20attention%20deficit%20hyperactivity%20disorder%20%28ADHD%29
For this Discussion, review the case Learning Resources and the case study excerpt presented. Reflect on the case study excerpt and consider the therapy approaches you might take to assess, diagnose, and treat the patient’s health needs. 
Case: An elderly widow who just lost her spouse.
Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications:
Metformin 500mg BID
Januvia 100mg daily
Losartan 100mg daily
HCTZ 25mg daily
Sertraline 100mg daily
Current weight: 88 kg
Current height: 64 inches
Temp: 98.6 degrees F
BP: 132/86
BY DAY 3 OF WEEK 7
Post a response to each of the following:
List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.
Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.
List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.
List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.
For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on ethical prescribing or decision-making. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals based on ethical prescribing guidelines or decision-making?
Include any “check points” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.

Healthcare Spending and Services
Healthcare data at a community, county, or region level and state level determine healthcare spending and services allocated for individuals. Using the South University Online Library or the Internet, research about these data as it will help you build a reality of costs of care for the healthcare system and beyond.
Research your own geographic region (town, city, county, or state) for data that is commonly used in health services systems. This includes census data, vital statistics data (birth, deaths, marriages, and divorces), surveillance data, administrative data, and survey research data. Keep in mind that most of this data will come from federal, state, or local offices that are federally mandated, but don’t stop there. You may find data in other surprising places.
Based on your readings and research, answer the following:
Which office contains the health-related data identified above?
How do people go about enrolling for Medicare and Medicaid in your community? Describe the eligibility requirements and costs, if any, for each of these types of subsidized care.
Coverage for acute care, including hospitalization
Coverage for preventive care
Outpatient services
Specialty services, such as mental health, rehabilitation, etc.

Overview
When many laypeople think of mental health disorders, they tend to think of the most severe cases. As a nurse you need to be aware of the spectrum of mental disorders and the treatments available to your clients.
Tasks
Create a spectrum of ten (10) mental health disorders from least to most severe, including signs/symptoms, treatments, and your role as the nurse in client care.
You may use any format you wish in sharing your spectrum, whether it’s a table, PowerPoint slide, Word document, etc.

Overview
The nervous system is made up of the central and peripheral nervous system. As the nurse prepares to assess and care for clients with neurosensory disorders, the goal of this assignment is to facilitate learning about specific neurosensory diagnostics and procedures that are commonly used when evaluating clients presenting with neurosensory complaints.
Tasks
Complete the NUR 215 Neurosensory Disorders Chart with assessment data pertinent to each neurosensory disorder.
Include pertinent medical management and nursing care for each disorder (ie. medical management for seizure disorder- patient safety & medications/nursing care for seizures-set up suction at the bedside, maintain IV access, etc.)

Overview 
The older elderly, those age 80 and older, may be at higher risk for malnutrition due to physiologic changes.  These include but are not limited to poor oral health, dementia, and/or a repetitive or limited dietary intake due to lack of interest or inability to prepare variety in their meals. This is particularly a concern for elderly persons who live alone without a nearby support system. Persons at risk for malnutrition require a detailed assessment to identify the extent of their risk for problems associated with malnutrition.
The case study below has you conduct a nutritional assessment on an elderly person and make recommendations as well as identify appropriate resources.
Case Study
Irma is an 82-year-old widow who lives alone. She has a history of hypertension. At the age of 67 she had a mild stroke but recovered with no physical impairments. Lately she has been complaining of dizziness and fatigue.
Irma used to be an avid fan of all the cooking shows and took pride in fixing gourmet meals for friends and her husband. Her husband died 6 years ago and since his death she lost all interest in cooking. A year ago, her smoke alarm went off when she fell asleep and left the stove on.  Now Irma is afraid of using the stove for fear of starting a fire. Her meals consist of a boiled egg and toast with orange juice for breakfast and a cup of canned soup in the evening. She has no variety in her meals and eats little protein or vegetables.
Irma has no children and her younger siblings live in another state. She occasionally walks to the community center and participates in some of the activities for seniors.  Her physician reported that she is exhibiting signs of early dementia and may not be able to live alone much longer.
Tasks
Write a paper of 1500 words or less answering the following regarding Irma’s scenario.
What malnutrition indicators are prevalent with Irma?
How is Irma’s aging impacting her nutrition?
What are Irma’s nutritional needs as part of the older elderly population?
Citing evidence-based resources, what health problems can we expect Irma to have as a result of being malnourished?
What determinants of health are impacted in Irma’s malnutrition scenario?
If Irma were living in your community/state, what resources would be available to her?
Include a references page in your paper. Remember to conform to current APA standards for headings, citations and/or reference pages.

Hello, I’m trying to get a scholarship to become and lvn. They just want a 250 word essay on why I want to become a lvn.  Move up in healthcare, show my kids you can always go towards your goal even if it any steps. Help others and eventually become a RN.