Osteoarthritis (OA) is a common, age-related disorder of synovial joints. Describe the pathophysiology and provide the treatment options. Do you know anyone with this disease?
Discussion 2: The Role of the RN/APRN in Policy-Making
Word cloud generators have become popular tools for meetings and team-building events. Groups or teams are asked to use these applications to input words they feel best describe their team or their role. A “word cloud” is generated by the application that makes prominent the most-used terms, offering an image of the common thinking among participants of that role.
What types of words would you use to build a nursing word cloud? Empathetic, organized, hard-working, or advocate would all certainly apply. Would you add policy-maker to your list? Do you think it would be a very prominent component of the word cloud?
Nursing has become one of the largest professions in the world, and as such, nurses have the potential to influence policy and politics on a global scale. When nurses influence the politics that improve the delivery of healthcare, they are ultimately advocating for their patients. Hence, policy-making has become an increasingly popular term among nurses as they recognize a moral and professional obligation to be engaged in healthcare legislation.
To Prepare:
- Revisit the Congress.gov website provided in the Resources and consider the role of RNs and APRNs in policy-making.
- Reflect on potential opportunities that may exist for RNs and APRNs to participate in the policy-making process.
By Day 3 of Week 8
Post an explanation of at least two opportunities that exist for RNs and APRNs to actively participate in policy-making. Explain some of the challenges that these opportunities may present and describe how you might overcome these challenges. Finally, recommend two strategies you might make to better advocate for or communicate the existence of these opportunities to participate in policy-making. Be specific and provide examples.
By Day 6 of Week 8
Respond to at least two of your colleagues’* posts by suggesting additional opportunities or recommendations for overcoming the challenges described by your colleagues.
*Note: Throughout this program, your fellow students are referred to as colleagues. Everything should be in APA 7 formart. At least 3 references all with DOI number and at least 3 paragraphs for mainpost and 2 for replies.’
Discussion for reply one (Guy)
RNs and APRNs have crucial roles in health care to inform decisions of policy making. There are many opportunities that exist for nursing professionals to participate in policy making. According to Burke (2016), “It’s essential that policies exist that define and integrate appropriate standards for delivery of care and address conditions necessary for that care to occur. Through policy work, nurses can and should influence practice standards and processes to assure quality of care. Nurses who influence policy help share the care that will be provided today and tomorrow. Policies also impact resource allocation to support delivery of healthcare”.
One opportunity that exists for nurses to become active in policy making is to become a member of the American Nurses Association. According to Catallo, Spalding, & Haghiri-Vijeh (2014), “Policy products that the ANA offers include a “policy activist took kit”. As part of this took kit, RNs are provided with resources that include how to get involved in a political campaign, writing letters to the editor, how to engage politicians and carry out lobbying activities”. The article “Nursing Professional Organizations: What Are They Doing to Engage Nurses in Health Policy?” discusses how nurses can become engaged in health policy activities and how to address policy issues.
Another opportunity that exists for nurses to become active in policy making is to advance their education by becoming an APRN. According to Regis College (n.d), “Nurse practitioners have an opportunity to serve as advocates for patients, families, communities, other nurses, and health care organizations. Through this advocacy, nurse practitioners can influence health care policy. By gaining a comprehensive understanding in particular areas of health care, nurse practitioners are uniquely situated to support positions that will benefit out communities”. Becoming an APRN prepares your ability to participate in advocacy of health care policy making.
A strategy that can be used to promote nursing professionals involvement in policy making is to do so through nursing employers. For example, I would propose to create and implement a “Policy Committee” through my hospital organization to discuss the potential nurse advocacy benefits we can offer to policy making. In addition, as mentioned by Catallo et al,. (2014), to convey “Political awareness and understanding of the importance of being involved in nursing organizations, time to engage in policy development outside of nursing work, and resources to develop skills in policy participation”.
Another strategy that can be implemented to overcome to barriers of nursing involvement in policy making is to do so through nursing education. According to Short (2008), “The foundations for a professional understanding of health care policy should be well laid in formal education and synthesized with practice and work environments. Without time to promote synthesis of policy concepts related to the practice environment, nurses have no basis for further exploration and may remain naive to the influences of policy throughout their career”. If nursing students (RN or APRN) were exposed to health care policy and the influence their roles can have on policy making during their nursing education, there would be much more nursing involvement in health care policy that is needed today.
References
Burke, A. (2016). Influence Through Policy: Nurses Have a Unique Role. Retrieved October 18, 2020 from https://nursingcentered.sigmanursing.org/commentary/more-commentary/Vol42_2_nurses-have-a-unique-role.
Catallo, C., Spalding, K., & Haghiri-Vijeh, R. (2014). Nursing Professional Organizations: What Are They Doing to Engage Nurses in Health Policy? SAGE Open. https://doi.org/10.1177/2158244014560534
Regis College (n.d). How Does Nursing Influence Health Care Policy? Retrieved October 18, 2020 from https://online.regiscollege.edu/blog/how-does-nursing-influence-health-care-policy/
Short N. M. (2008). Influencing health policy: strategies for nursing education to partner with nursing practice. Journal of professional nursing: official journal of the American Association of Colleges of Nursing. 24(5), 264–269. https://doi.org/10.1016/j.profnurs.2007.10.004
Discussion for reply two(Megan)
“The design phase of the policy process is the point at which the original intent of a solution to a problem is understood and the appropriate tools are employed to achieve policy success” (Milstead, 2019). The creation of policies, or presenting your idea, is how nurses can participate in policymaking. Actively working in the nursing field can help nurses see problems that arise and a better solution to patient needs. Bringing these ideas to congress to make changes will benefit the need of the patients. “Nurses’ influence in health policies protects patient safety, increases quality of care, and facilitates their access to the required resources and promotes quality health care” (Arabi et al., 2014).
Advocacy is another way that nurses can participate in policymaking. “We have been patient advocates in our interactions with doctors and administrators, why not with Congress“ (L. Phillips, 2020). Nurses should feel excited and empowered that they get to have a voice in the political world to make healthcare changes. Advocating for our patients is our duty, and I cannot think of a better way to do this than policy creation or changes. “As a component of professional nursing, active participation in the policy process is essential in the formulation of policies designed to provide quality health care at sustainable costs to all individuals” (Milstead, 2019).
Some of the challenges nurses face when getting involved with policymaking are getting push back from legislators and finding the evidence-based practice to support ideas. Nurses must band together and fight for what we know is right and what our patients need. Becoming an active member of a nursing organization can help support new policies or change old policies. Support strength comes in numbers. Having multiple people that share the same ideas will decrease pushback. Finding evidence-based practice to support our ideas may pose a problem, but putting in work to find or create research will be worth it, in the end, to help our patients with new or changed policies. Also, becoming a member of a nursing association can assist with finding or creating evidence-based practice.
The strategies I think will help advocate for these opportunities is being involved in a nursing association and providing courses like this to nurses. I know I spoke of nursing associations already, but I cannot think of a better way to come together and share our similar experiences and ideas to improve processes and policies to assist our patients. Providing courses like this to help educate nurses and get them involved in politics helps drive home the importance of our voices.
References
Arabi, A., Rafii, F., Cheraghi, M., & Ghiyasvandian, S. (2014, May 19). Nurses’ policy influence: A concept analysis. PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4061635/
Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning. Pg. 97
Phillips, R. (2003). Health Care Policy: The Nurse’s Crucial Role. American Academy of Ambulatory Care Nursing. https://www.aaacn.org/volunteer/teams/legislative/health-care-policy-nurses-crucial-role
Dssion and Assignment on Advanced Pharmacology
As a nurse practitioner, you prescribe medications for your patients. You make an error when prescribing medication to a 5-year-old patient. Rather than dosing him appropriately, you prescribe a dose suitable for an adult.
Photo Credit: Getty Images/Ingram Publishing
Week 1: Basic Pharmacotherapeutic Concepts/Ethical and Legal Aspects of Prescribing
How do beta-blockers work? What exactly do antibiotics do to the bacteria they target? What effects does an anti-depressant have on blood flow?
Questions like these are related to the underlying pharmacokinetic and pharmacodynamic processes of pharmacotherapeutics. As an advanced practice nurse, understanding these fundamental pharmacotherapeutic concepts is important to ensure that the prescription drugs you recommend for your patients will be safe and effective to treat and/or manage their symptoms. Additionally, as the advanced practice nurse, it is your responsibility to ensure that when prescribing prescription drugs, you adhere to the ethical and legal principles set forth for prescribing drugs as an added layer of protection and safety for the patients you will treat.
This week, you will analyze factors that may influence pharmacokinetic and pharmacodynamics processes of a patient and assess the details of a personalized plan of care that you develop based on influencing factors and patient history. You will also evaluate and analyze ethical and legal implications and practices related to prescribing drugs, including disclosure and nondisclosure, and analyze the process of writing prescriptions to avoid medication errors.
Learning Objectives
Students will:
- Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients
- Assess patient factors and history to develop personalized plans of care
- Evaluate ethical and legal implications related to prescribing drugs
- Analyze ethical and legal practices of prescribing drugs
- Analyze strategies to address disclosure and nondisclosure
- Justify advanced practice nurse strategies to guide prescription drug decision-making
- Analyze the process of writing prescriptions to avoid medication errors
Learning Resources
Required Readings (click to expand/reduce)
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
· Chapter 1, “Prescriptive Authority” (pp. 1–3)
· Chapter 2, “Rational Drug Selection and Prescription Writing” (pp. 4–7)
· Chapter 3, “Promoting Positive Outcomes of Drug Therapy” (pp. 8–12)
· Chapter 4, “Pharmacokinetics, Pharmacodynamics, and Drug Interactions” (pp. 13–33)
· Chapter 5, “Adverse Drug Reactions and Medication Errors” (pp. 34–42)
· Chapter 6, “Individual Variation in Drug Response” (pp. 43–45)
This website outlines the code of federal regulations for prescription drugs.
Drug Enforcement Administration. (2006). Practitioner’s manual. Retrieved from http://www.legalsideofpain.com/uploads/pract_manual090506.pdf
This manual is a resource for practitioners who prescribe, dispense, and administer controlled substances. It provides information on general requirements, security issues, recordkeeping, prescription requirements, and addiction treatment programs.
This website details key aspects of drug registration.
This resource introduces the code of ethics for nurses and highlights critical aspects for ethical guideline development, interpretation, and application in practice.
This article provides NPs with information regarding state-based laws for NP prescribing.
The authors of this article assess the impact of a pharmacist‐led educational intervention on family nurse practitioner (FNP) students’ prescribing skills, perception of preparedness to prescribe, and perception of pharmacist as collaborator.
Required Media (click to expand/reduce)
Discussion: Pharmacokinetics and Pharmacodynamics
As an advanced practice nurse assisting physicians in the diagnosis and treatment of disorders, it is important to not only understand the impact of disorders on the body, but also the impact of drug treatments on the body. The relationships between drugs and the body can be described by pharmacokinetics and pharmacodynamics.
Pharmacokinetics describes what the body does to the drug through absorption, distribution, metabolism, and excretion, whereas pharmacodynamics describes what the drug does to the body.
Photo Credit: Getty Images/Ingram Publishing
When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. These patient factors include genetics, gender, ethnicity, age, behavior (i.e., diet, nutrition, smoking, alcohol, illicit drug abuse), and/or pathophysiological changes due to disease.
For this Discussion, you reflect on a case from your past clinical experiences and consider how a patient’s pharmacokinetic and pharmacodynamic processes may alter his or her response to a drug.
To Prepare
- Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.
- Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug.
- Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease.
- Think about a personalized plan of care based on these influencing factors and patient history in your case study.
Post a description of the patient case from your experiences, observations, and/or clinical practice from the last 5 years. Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient you identified. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case. Be specific and provide examples.
At Least 3 citations with 7th edition APA Format
Assignment: Ethical and Legal Implications of Prescribing Drugs
What type of drug should you prescribe based on your patient’s diagnosis? How much of the drug should the patient receive? How often should the drug be administered? When should the drug not be prescribed? Are there individual patient factors that could create complications when taking the drug? Should you be prescribing drugs to this patient? How might different state regulations affect the prescribing of this drug to this patient?
These are some of the questions you might consider when selecting a treatment plan for a patient.
Photo Credit: Getty Images/Caiaimage
As an advanced practice nurse prescribing drugs, you are held accountable for people’s lives every day. Patients and their families will often place trust in you because of your position. With this trust comes power and responsibility, as well as an ethical and legal obligation to “do no harm.” It is important that you are aware of current professional, legal, and ethical standards for advanced practice nurses with prescriptive authority. Additionally, it is important to ensure that the treatment plans and administration/prescribing of drugs is in accordance with the regulations of the state in which you practice. Understanding how these regulations may affect the prescribing of certain drugs in different states may have a significant impact on your patient’s treatment plan. In this Assignment, you explore ethical and legal implications of scenarios and consider how to appropriately respond.
To Prepare
- Review the Resources for this module and consider the legal and ethical implications of prescribing prescription drugs, disclosure, and nondisclosure.
- Review the scenario assigned by your Instructor for this Assignment.
- Search specific laws and standards for prescribing prescription drugs and for addressing medication errors for your state or region, and reflect on these as you review the scenario assigned by your Instructor.
- Consider the ethical and legal implications of the scenario for all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.
- Think about two strategies that you, as an advanced practice nurse, would use to guide your ethically and legally responsible decision-making in this scenario, including whether you would disclose any medication errors
Write a 3-page paper that addresses the following:
- Explain the ethical and legal implications of the scenario you selected on all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.
- Describe strategies to address disclosure and nondisclosure as identified in the scenario you selected. Be sure to reference laws specific to your state.
- Explain two strategies that you, as an advanced practice nurse, would use to guide your decision making in this scenario, including whether you would disclose your error. Be sure to justify your explanation.
- Explain the process of writing prescriptions, including strategies to minimize medication
At Least 3 citations using 7th edition APA format
DQ1 DQ2. BY 12/1
DQ1
Why is understanding the health care system at the local level important to consider when planning an EBP implementation? Conduct research and solicit anecdotal evidence from your course preceptor that you will take into consideration for your own change project.
DQ2
Compare and contrast two change theories, and determine which theory makes the most sense for implementing your specific EBP intervention. Why? Has your preceptor used either theory, and to what result?
Part 4 Critical thinking
Goal 6:Reflection: Reflect on your own thought process after completing the assignment.Questions:
a. Identify the strengths and weaknesses in your thought process with this project.
b. Where there bias’ in your thinking?
c. What did you learn from doing this project?
d. What would you do different next time to improve your critical thinking skills process?
apa format
answer all questions
Leadership Course
Photo Credit: Getty Images
Learning Resources
Required Readings
Marshall, E., & Broome, M. (2017). Transformational leadership in nursing: From expert clinician to influential leader (2nd ed.). New York, NY: Springer.
- Chapter 8, “Practice Model Design, Implementation, and Evaluation” (pp. 195–246)
Pollack, J., & Pollack, R. (2015). Using Kotter’s eight stage process to manage an organizational change program: Presentation and practice. Systemic Practice and Action Research, 28(1), 51-66.
Note: You will access this article from the Walden Library databases.
Seijts, G. H., & Gandz, J. (2016). Transformational change and leader character. Business Horizons, 61(2), 239-249. https://doi.org/10.1016/j.bushor.2017.11.005
Note: You will access this article from the Walden Library databases.
Required Media
Assignment: Change Implementation and Management Plan
It is one of the most cliché of clichés, but it nevertheless rings true: The only constant is change. As a nursing professional, you are no doubt aware that success in the healthcare field requires the ability to adapt to change, as the pace of change in healthcare may be without rival.
As a professional, you will be called upon to share expertise, inform, educate, and advocate. Your efforts in these areas can help lead others through change. In this Assignment, you will propose a change within your organization and present a comprehensive plan to implement the change you propose.
To Prepare:
· Review the Resources and identify one change that you believe is called for in your organization/workplace.
o This may be a change necessary to effectively address one or more of the issues you addressed in the Workplace Environment Assessment you submitted in Module 4. It may also be a change in response to something not addressed in your previous efforts. It may be beneficial to discuss your ideas with your organizational leadership and/or colleagues to help identify and vet these ideas.
· Reflect on how you might implement this change and how you might communicate this change to organizational leadership.
The Assignment (5-6-minute narrated PowerPoint presentation):
Change Implementation and Management Plan
Create a narrated PowerPoint presentation of 5 or 6 slides with video that presents a comprehensive plan to implement the change you propose.
Your narrated presentation should be 5–6 minutes in length.
Your Change Implementation and Management Plan should include the following:
· An executive summary of the issues that are currently affecting your organization/workplace (This can include the work you completed in your Workplace Environment Assessment previously submitted, if relevant.)
· A description of the change being proposed
· Justifications for the change, including why addressing it will have a positive impact on your organization/workplace
· Details about the type and scope of the proposed change
· Identification of the stakeholders impacted by the change
· Identification of a change management team (by title/role)
· A plan for communicating the change you propose
· A description of risk mitigation plans you would recommend to address the risks anticipated by the change you propose
Scenario
During a home visit for a 72-year-old Asian woman, the home health nurse notices that her prescription medications for hypertension and diabetes are untouched. Her daughter explains that she cannot get her mother to take the “Western pills” and that her mother has been using a variety of herbal remedies.
You are asked by your supervisor to provide a summary report that address the following:
- How do you provide care for this patient that is culturally competent?
- How does her culture play a role into her nursing care?
- What techniques can you utilize to enhance the data collection process?
- How will you incorporate patient centered care values while trying to complete a head to toe assessment?
Your report should be coherent and precise, and should address all the required components in a research-based manner using text support and outside research to create a set of responses to the supervisor prompts above.
The essay should be 1000-1250 words and should include at least three (3) citations. The sections should be clearly marked with headings so that your instructor knows which points you are addressing. Follow the guidelines for APA writing style. The title page and references page do not count towards the minimum word amount for this assignment.
Assignment Expectations
Length: 1000 – 1250 words; answers must thoroughly address the questions in a clear, concise manner.
Structure: Include a title page and reference page in APA style. These do not count towards the minimal word count for this assignment.
References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. Include at least three (3) scholarly sources to support your claims.
Pedeatrics
Make a list of nursing diagnoses and expected outcomes for the following clients:
- A mother brings her son to a clinic for a checkup. She tells the nurse that she is concerned because her 4-year-old son is having trouble with his speech and is repeating words and syllables in his sentences.
- Parents of a 3-year-old girl bring her to their pediatrician for a visit. They tell the nurse that they are concerned because their daughter will only allow her father to take care of her and wants to be near him all the time.
wk 1 response 6521
Melissa Hinkhouse
Advanced Pharmacology NURS-6521N-43
Professor Dr. Vicki Gardin
Discussion Board Week 1-Original Post
11/30/2020
I have worked in an outpatient behavioral health clinic for the past seven years with many different providers. I live in a rural community, many patients wait six to twelve months to be seen. Patients being treated for Attention Deficit Disorder must be officially tested before being seen by a Psychologist. For this discussion board post, I have changed the name of my patient to Paul to ensure patient confidentially. The provider I worked with this particular patient will also be referred to as PMHNP to ensure provider confidentiality.
Paul was a ten-year-old Caucasian male referred to our clinic diagnosed per DSM criteria, confirmed via Psychologist testing with ADHD. When he saw the Psychologist, he was also diagnosed with mild depression and anxiety. He struggled with concentration, hyperactivity, impulse control, and disorganization. He presented to his appointment with his mother and father, clean, well-nourished, pleasant, interactive with staff, reported no medication allergies, current medication Zyrtec for seasonal allergies. Paul just had his well-child exam and is current on vaccinations and his primary care provider completed lab work to include CBC, CMP, TSH, Vit D, B12, and A1C, all have returned normal. Family history reported father has a history of ADHD (never medicated), brother has a history of depression and anxiety (never medicated treating with psychotherapy), no other significant family history to report. Paul’s current weight at his appointment was 30kg.
PMHNP spent one hour with Paul and his parents for the initial new patient appointment (Thursday). It was decided Paul would be prescribed Strattera (atomoxetine) 40mg once a day for one week then increase to 80mg once a day. I returned to work on Monday and received a call from Paul’s mom, she said he was acting strange. He was tearful, had been in his room with the door closed for most of the weekend, she stated on Sunday she went into his room and he was crying and said he was just thinking about dying and his parents dying. She stated he had already had his meds Sunday so she kept him with her that entire day and made Sunday night a campout night in the Livingroom so he would think it was fun and she could keep a close eye on him. I had a cancelation that morning for him to come to see PMHNP and he was in to see her within twenty minutes and removed from Strattera. His parents decided medications were no longer the route they wanted to try for treatment and a referral was made for psychotherapy.
The only medication Paul takes on occasion is Zyrtec which is in an antihistamine drug class, Strattera is a selective norepinephrine reuptake inhibitor; there is no known drug interaction between the two medications. Reflecting on his age and the medication, Strattera has a black box labeled for suicidal ideation with adolescents diagnosed with ADHD (Eli Lilly and Company, 2003). Reviewing Paul’s labs, I also do not see that a prior ECG or LFT was complete before starting Strattera. Looking at the Pharmacokinetics of Strattera, it is metabolized in the liver and has been known to cause liver damage. Strattera can also raise blood pressure and has been reported to cause sudden cardiac death (Eli Lilly and Company, 2003). Reviewing Pharmacogenetics and the videos from our resources this week, we should have tested Paul’s CYP2D6, as it is essential for metabolization of Strattera and proper dosing (Speed Pharmacology, 2015).
As a practitioner, I would have started treatment with an antidepressant, Wellbutrin (Bupropion) is often utilized off label for ADHD and might also assist with the treatment of his depression. Since most antidepressants work by increasing the levels of brain messenger chemicals (neurotransmitters), such as norepinephrine, serotonin, and dopamine, it makes sense that they might have effects similar to other ADHD stimulant and non-stimulant treatments that appear to work by similar mechanisms (Cleveland clinic, 2016). I would have also recommended Psychotherapy to go alongside the medication regimen.
As a practicing PMHNP, I plan to focus my areas of focus on adolescents. It will be of the standard of care in my practice for all patients to be properly evaluated and diagnosed via official testing for ADHD and my patient will need to be actively utilizing psychotherapy while undergoing a medication regimen treatment if under my care. I have found through experience involving parents and patients in the treatment plan and education as a mental health case manager to assist with compliance and a more successful outcome for the adolescent.
References
Cleveland clinic. (2016, July 18). ADHD medications: Strattera, antidepressants & more.
Cleveland Clinic. https://my.clevelandclinic.org/health/drugs/12959-attention-deficit-hyperactivity-disorder-adhd-nonstimulant-therapy-strattera–other-adhd-drugs
Eli Lilly and Company. (2003). Medication Guide Strattera. www.strattera.com. https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/021411s035lbl.pdf
Speed Pharmacology. (2015). Pharmacology – Pharmacokinetics (Made Easy) [Video]. https://www.youtube.com/watch?v=NKV5iaUVBUI&t=16s
Kyle Johnson Discussion week oneCOLLAPSE
Many factors play a role in how medications effects each individual including Pharmacokinetics and pharmacodynamics. According to Rosenthal & Burchum (2018), “Pharmacokinetics is the study of drug movement throughout the body”(p.4). Whereas Pharmacodynamics is the study of the response from medication entering the body (Rosenthal & Burchum, 2018). As a behavioral health nurse, I have seen patients that have been on antipsychotics for years, and even adolescents placed on their first antipsychotic.
Our psychiatrists try and use the newer antipsychotics such as Abilify, Risperdal, or Zyprexa as they are less likely to cause adverse reactions. Even with the atypical antipsychotics, patients can still be sensitive to these medications. One of my memorable admissions was a 40 year old female diagnosed with schizophrenia who comes in with command hallucinations to kill herself and is non-med complaint. She has shown to be sensitive to antipsychotics. During this patient’s stay, her medications were restarted including Risperdal with Cogentin to help combat unwanted side effects such as neck stiffness. Shortly after the medication was restarted the patient became catatonic. Risperdal has been identified as a medication that can cause catatonia (Huang, et al., 2018). Risperdal was quickly discontinued and Ativan was started on this patient. Ativan has been shown to bring patients out of the catatonic state (Sienaert, at al., 2014).
After a few days the patient came out of the catatonic state the patient’s hallucinations came back and the patient tried to hang herself. Zyprexa and Clozaril were started. Shortly after the initiation of these medications the patient started to get better, but not for long. A week after starting the Clozaril the lab called with a critical lab value indicating agranulocytosis with a decreased neutrophil count (Voulgari, et al., 2015). The medication was stopped and the patient was sent to the medical center for further evaluation. After a week the patient was sent back to behavioral health. She was restarted on Zyprexa and Cogentin to good effect and was later discharged. Medications affect each individual differently requiring their providers to monitor them for adverse reactions. With the increased sensitivity with this patient, I would make sure to start any medication change with the lowest possible dose to monitor for side effects. I would choose medications with less potential for adverse reactions such as Zyprexa. I would lean towards choosing a depo preparation as the patient has a tendency to be non-compliant with treatment.
References
Huang, M. W., Gibson, R. C., Moberg, P. J., & Caroff, S. N. (2018). Antipsychotics for schizophrenia spectrum disorders with catatonic symptoms. The Cochrane Database of Systematic Reviews, 2018(10), CD013100. https://doi.org/10.1002/14651858.CD013100
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Sienaert, P., Dhossche, D. M., Vancampfort, D., De Hert, M., & Gazdag, G. (2014). A clinical review of the treatment of catatonia. Frontiers in psychiatry, 5, 181. https://doi.org/10.3389/fpsyt.2014.00181
Voulgari, C., Giannas, R., Paterakis, G., Kanellou, A., Anagnostopoulos, N., & Pagoni, S. (2015). Clozapine-Induced Late Agranulocytosis and Severe Neutropenia Complicated with Streptococcus pneumonia, Venous Thromboembolism, and Allergic Vasculitis in Treatment-Resistant Female Psychosis. Case reports in medicine, 2015, 703218. https://doi.org/10.1155/2015/703218
2 resources for each discussion, thank you
Addiction
Addiction is an illness that not only affects individuals but their families as well. As future nurses, learning how to provide education and guidance for family members, as well as the client, will be necessary. Additionally, nurses must also utilize self-awareness to prevent biases and deliver nonjudgmental care. Please watch the following video and answer the following questions. (Remember to answer all three questions in your response). WATCH VIDEO
1.) Do you agree with the speaker’s assertion that family members may not be the appropriate person to help people with addiction? If so why?
2. 2.) 12 step programs are often the long-term treatment choice of many individuals with addiction. However, many people find the religious aspect of the program to be unappealing and a hindrance. Do you agree with the speaker’s belief that acknowledging a “higher power” or a belief in “spirituality” is necessary for people to overcome addiction? If so, how would you communicate this to the client and their family?
3. 3.) Do you think it will be frustrating to provide treatment for individuals with addiction because they will most likely relapse? If so why?