All posts by : chebby

Describe your clinical experience for this week.

• Did you face any challenges, any success? If so, what were they?
• Describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and at least 3 possible differential diagnosis with rationales.
• Mention the health promotion intervention for this patient.
• What did you learn from this week’s clinical experience that can beneficial for you as an advanced practice nurse?
• Support your plan of care with the current peer-reviewed research guideline.

Please ensure that the Reply includes more than 200 words of scholarly articles and that the plagiarism level remains below 20%.

Using Telemedicine and Remote Monitoring Technologies in APRN Practice
Telemedicine platforms and remote monitoring technologies have significantly impacted the practice of APRNs, improving medication adherence, therapeutic responses, and adverse effects management. These digital health solutions allow APRNs to monitor patients remotely, offer timely interventions, and enhance pharmacological care at a higher quality.

Remote Access to Medication Compliance and Therapeutic Responses

Telemedicine platforms allow APRNs to evaluate adherence through electronic medication dispensers, mobile applications, and digital pill bottles that log patients’ medication ingestion in real time. These technologies provide valuable data that enables APRNs to intervene when a patient misses a dose or departs from the prescribed regimen. Researchers have found that electronic adherence monitoring may improve medication adherence, especially in chronic diseases like hypertension, diabetes, and heart failure. (Patel et al., 2021).

At-home monitoring devices like wearable sensors and diagnostic devices allow for assessing therapeutic responses. For example, continuous glucose monitors (CGMs) give real-time blood glucose levels, enabling APRNs to adjust insulin therapy quickly. Blood pressure monitors and pulse oximeters, in a comparable way, assist APRNs in monitoring cardiovascular and respiratory conditions, which can allow for changes in pharmacological interventions based on objective data (Morris et al., 2020). As a result, APRNs can offer individualized care, limiting hospitalizations through RPM.

Alerts for Possible Adverse Drug Effects

Remote monitoring helps catch adverse drug effects. Digital health technologies (e.g., wearable electrocardiograms [ECGs] and smartwatch-based arrhythmia detection) are also capable of passively detecting medication-induced cardiac abnormalities (e.g., QT prolongation). RPM devices can also alert APRNs when physiological changes suggest adverse effects, such as changes in blood pressure, oxygen saturation, or weight. For instance,  smart scales and hydration sensors were also used to monitor patients on diuretics for dehydration and electrolyte imbalances (Takahashi et al., 2022). The principle of these individuals being able to make early modifications to treatment to accommodate adverse reactions to medications ultimately ensures patient safety.

The Effect on pharmacological Interventions and APRN Practice

Telemedicine and RPM have made pharmacological treatment more efficient, including proactive treatment instead of merely reactive treatment. These technologies enable APRNs to perform virtual medication reconciliations with patients, mitigating risks associated with polypharmacy and drug interactions. In addition, telehealth meetings aid in teaching patients how to use their medication, enabling them to participate in their healthcare (Kruse et al., 2021).
Remote monitoring adds a layer of reach from an APRN practice perspective that helps us assess the complete picture of our patients from other settings. It enhances patient involvement and compliance, especially for those with physical restrictions or living in remote areas. However, we must address data security, patient privacy, and technology issues for equitable healthcare delivery (Morris et al., 2020).

Conclusion

Telemedicine and remote monitoring technologies have revolutionized APRN practice by improving medication adherence, therapeutic monitoring,  and detecting adverse drug effects (ADEs). These technologies significantly enhance the quality of pharmacological care, enabling APRNs to provide care in a timely and efficacious way while promoting patient-centered health care. As the digital health arena continues to unfold, APRNs should allow themselves to evolve towards a more well-evolved stance by advocating for integrating these technologies into routine care and continuing education opportunities to help shift toward contemporary care delivery models.

References

Kruse, C. S., Krowski, N., Rodriguez, B., Tran, L., Vela, J., & Brooks, M. (2021). Telehealth and patient satisfaction: A systematic review and narrative analysis. BMJ Open, 11(8), e045104. https://doi.org/10.1136/bmjopen-2020-045104

Morris, M. E., Adair, B., Miller, K., Ozanne, E., Hansen, R., Pearce, A. J., Santamaria, N., & Said, C. M. (2020). Smart technologies to enhance social connectedness in older people who live at home. Australasian Journal on Ageing, 39(1), e36-e42. https://doi.org/10.1111/ajag.12794

In  what ways can APRNs utilize telemedicine platforms and remote  monitoring technologies to remotely access patients’ medication  adherence, therapeutic responses, and potential adverse effects? How  does remote patient monitoring impact the delivery of pharmacological  interventions and APRN practice?

Please review the rubric before posting to ensure a maximum of  points. APA format is mandatory. At least two appropriate references  should be used. The usage of “IA” is not approved and violates academic  integrity.

I recommend at least 500 words (2 pages) for the initial post and a minimum of 150 words for every response. 

Choose a state and review the scope of practice for the advanced practice nurse. How does it compare to Florida?

Submission Instructions:

• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
• You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.) 
• All replies must be constructive and use literature where possible.

I need your expertise with an assignment 

My chosen condition is Major Depressive Disorder ; (MDD) is a complex mental health condition characterized by persistent sadness, anhedonia, and cognitive impairment. The pathophysiology of MDD is multifactorial, involving neurotransmitter imbalances, structural brain changes, and dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. Dysfunction in serotonin, norepinephrine, and dopamine pathways contributes to mood disturbances, while neuroimaging studies reveal structural abnormalities in the prefrontal cortex, hippocampus, and amygdala (Malhi & Mann, 2018). Additionally, chronic stress and inflammation play a role, as elevated levels of cortisol and inflammatory markers such as C-reactive protein (CRP) have been linked to depressive symptoms (Kennis et al., 2020). Genetic predisposition and environmental factors, such as adverse childhood experiences (ACEs), also contribute to MDD development.

       MDD presents with a range of symptoms, including persistent low mood, fatigue, sleep disturbances, appetite changes, psychomotor agitation or retardation, and suicidal ideation. The disorder can lead to severe complications, including an increased risk of suicide, social withdrawal, impaired occupational functioning, and co-occurring conditions such as anxiety disorders and substance abuse (American Psychiatric Association [APA], 2022). Risk factors for MDD include a family history of depression, exposure to chronic stress, low socioeconomic status, and coexisting medical conditions such as diabetes and cardiovascular disease (Cuijpers et al., 2021). Women are at a higher risk, particularly during pregnancy and postpartum, due to hormonal fluctuations and psychosocial stressors.

     Diagnosis of MDD relies on clinical criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which requires the presence of at least five depressive symptoms for a minimum of two weeks, with significant impairment in daily functioning (APA, 2022). Standardized tools such as the Patient Health Questionnaire-9 (PHQ-9)and Hamilton Depression Rating Scale (HAM-D) are commonly used to assess symptom severity. Laboratory tests, including thyroid function tests and vitamin B12 levels, help rule out medical conditions that may mimic depressive symptoms (Goldstein-Piekarski et al., 2022). In cases of treatment-resistant depression, neuroimaging studies, such as magnetic resonance imaging (MRI), can assess structural abnormalities or coexisting neurological conditions.

      MDD manifests differently across the lifespan, with variations in symptomatology and risk factors. In children and adolescents, irritability and behavioral issues may predominate over classic depressive symptoms, with increased academic difficulties and social withdrawal (Maughan et al., 2021). Among pregnant and postpartum women, MDD can contribute to negative maternal and fetal outcomes, including preterm birth and impaired mother-infant bonding (Woody et al., 2022). In older adults, MDD often presents with somatic symptoms, cognitive decline, and an increased risk of suicide, particularly in elderly men. Recognizing these variations is crucial for accurate diagnosis and appropriate treatment across different age groups.

Case Study: Major Depressive Disorder (MDD)

Patient Profile:

• Name: Maria Lopez
• Age: 42 years old
• Gender: Female
• Ethnicity: Hispanic
• Occupation: Elementary school teacher
• Marital Status: Divorced, single mother of two children (ages 10 and 13)
• Medical History: No major medical conditions, history of gestational diabetes.
• Family History: Mother had depression, father died by suicide at age 50.
• Social History: Limited social support, financial stress, recently lost her mother to cancer.

Presenting Symptoms:

• Maria reports persistent low mood and lack of interest in daily activities for the past six weeks.
• Fatigue and difficulty concentrating at work, affecting her ability to teach.
• Sleep disturbances: Wakes up early and cannot fall back asleep.
• Appetite changes: Decreased appetite with unintentional weight loss of 8 lbs.
• Feelings of guilt about being a “bad mother.”
• Passive suicidal thoughts but denies active intent or plan.

Assessment Findings:

• Appearance: Unkempt, minimal eye contact.
• Affect: Flat.
• Speech: Soft, slow response.
• Thought Process: Logical but preoccupied with feelings of worthlessness.

Diagnostic Workup:

• PHQ-9 Score: 19 (indicative of moderate-to-severe depression).
• TSH, T3, T4: Normal (rules out hypothyroidism).
• CBC: Mild anemia.
• Vitamin B12/Folate: Normal.
• Urine Toxicology: Negative for substance use.

Diagnosis:

Major Depressive Disorder (MDD), Moderate to Severe

Treatment Plan:

1. Pharmacological Management:
   • Initiate Selective Serotonin Reuptake Inhibitor (SSRI) (e.g., Sertraline 50 mg daily).
2. Psychotherapy:
   • Cognitive Behavioral Therapy (CBT) for cognitive restructuring.
   • Supportive therapy for grief processing.
3. Lifestyle Modifications:
   • Encourage structured daily routines and social engagement.
   • Recommend mild exercise (walking, yoga).
4. Follow-up and Monitoring:
   • Weekly follow-ups for the first month.
   • Safety plan for suicidal ideation.

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.).American Psychiatric Publishing.

Cuijpers, P., Karyotaki, E., Weitz, E., Andersson, G., Hollon, S. D., & van Straten, A. (2021). The effects of psychotherapies for major depression in adults on remission, recovery, and improvement: A meta-analysis. JAMA Psychiatry, 78(3), 294-302. https://doi.org/10.1001/jamapsychiatry.2020.3673

Goldstein-Piekarski, A. N., Williams, L. M., Humphreys, K. L., & Gotlib, I. H. (2022). Neurobiological markers of depression: Insights from neuroimaging and genetics. Molecular Psychiatry, 27(3), 1378-1394. https://doi.org/10.1038/s41380-021-01255-7

Kennis, M., Gerritsen, L., van Dalen, M., Williams, A., & Cuijpers, P. (2020). Prospective biomarkers of major depressive disorder: A systematic review and meta-analysis. Molecular Psychiatry, 25(2), 321-338. https://doi.org/10.1038/s41380-019-0585-z

Maughan, B., Collishaw, S., & Stringaris, A. (2021). Depression in childhood and adolescence. Journal of Child Psychology and Psychiatry, 62(5), 447-468. https://doi.org/10.1111/jcpp.13299

Woody, C. A., Ferrari, A. J., Siskind, D. J., Whiteford, H. A., & Harris, M. G. (2022). A systematic review and meta-regression of the prevalence and incidence of perinatal depression. Journal of Affective Disorders, 314, 1-11. https://doi.org/10.1016/j.jad.2022.02.075Links to an external site.

 https://www.nso.com/Learning/Artifacts/Legal-Cases/nurse-and-medical-malpractice-case-study-with-risk 

1. Did the nurse follow hospital policies?  Why or why not?  Please explain. 
2. Do you think the nurse is the only one who should be responsible for the patients’ fall? Please explain. 
3. Is there anything else the nurse could have done, to prevent the patients fall? Please explain. 
4. We know that nurses are advocates for patients and for their safety.  Could the nurse have escalated her concerns about her assignment?  How would the nurse do this? Please explain. 
5.  How do you feel about the nurse being reported to the National Practitioner Data Bank?  need apa style with 2 refernces

Reflective Journal

Objectives:

1. Reflect on thoughts, ideas, ex­periences, and insights related to the course.
2. Examine personal skills, frames of reference, and assumptions about the provision of care.
3. Gain insight on how student views themselves in relationship to others when engaged in therapeutic and professional communication.
4. Identify areas for students to further develop their abilities and understanding related to bedside practice.

Directions: (Professional Identity and Spirit of Inquiry)

Respond to at all four of the questions below using the same bullet points. Responses must be double-spaced in a Word document. Entry should be a minimum of 1500 words and NOT more than 2000 words.

1. Journal prompt 1 (Human Flourishing, Professional Identity)
2. What are your feelings as you begin this clinical experience? Make sure you identify feelings, not thoughts. Complete the following statement: “l feel…”
3. What past experiences, perceptions, and thoughts might be contributing to the above feelings?
4. What personal qualities, strengths, and talents do you bring to this clinical experience?
5. Identify one goal for the semester related to your personal self-awareness and growth.
6. Journal prompt 2 (Human Flourishing, Professional Identity)

As you begin your clinical experience, it is important to be aware of how you communicate and how you respond to the communication styles of others. This awareness is essential to working with the healthcare team to provide care to residents that is personalized, evidence-based, and safe.

1. What is your communication style? Are you direct, passive, etc.?
2. How do you try to come across to others when communicating?
3. How do you think you are perceived by others when communicating?
4. Describe two strategies to improve your communication skills during this clinical experience.
5. Journal prompt 3 (Human Flourishing, Professional Identity)

Judgment is making opinions as to the value of someone or something. How we perceive others is influenced by our personal beliefs, assumptions, and values. Professional nurses operate within a Professional Code of Ethics and Standards.

1. Examine the values, assumptions, and beliefs (address all three) that shape your behavior. Provide specific examples.
2. Explore how your values, assumptions and beliefs influence your relationships with residents and families.
3. Journal prompt 4 (Spirit of Inquiry)

Locate on NTC library site one peer-reviewed journal article within the past five years that address healthcare needs of the geriatric population. Suggestions include health management, polypharmacy, safety, caregiver role strain, etc.

1. Briefly summarize the article including key points and conclusion.
2. Analysis: what is the role of the nurse in addressing this issue?
3. Use in-text citations to give credit to the author and provide a reference list APA citation for the article at the end of your journal entry. Faculty to assist as needed.
   1. In-text citation example:
      1. A recent study found that geriatric healthcare needs are growing (Smith, 2018).
   2. Reference list citation example:
      1. Last, F. M. (Year Published). Article title. Journal Name, Volume(Issue), pp. Page(s). doi:#

Reflective Journal Grading Rubric (10 points)

Level 5

Level 4

Level 3

Level 2

Level 1

Complete (5 points)

• Thoroughly addresses all 3 questions.
• Entry is at least 1500 words and not more than 2000 words long.
• Addresses all 3 questions with fair amount of depth.
• Entry is at least 1250 total words or exceeds the 2000 word limit.
• Somewhat addresses at least 2 of the 3 questions.
• Entry is at least 1000 total words.
• Somewhat addresses 1 question.
• Answers are not complete.
• Entry is at least 750 total words.
• Entry does not clearly address any of the questions provided.
• Entry is a recitation of significant experiences in clinical, OR
• Entry is less than 750 total words.

Reflection

(5 points)

• Reflection demonstrates insight and ability to connect personal experience with theory on all questions.
• Discussion on all questions draws upon self-knowledge, self-awareness and past experience to gain insight and create or discover ideas that are new and enhance professional growth.
• Reflection usually (2 of 3) demonstrates insight and ability to connect personal experience with theory.
• Discussion usually (2 of 3) draws upon self-knowledge, self-awareness and past experience to gain insight and create or discover ideas that are new and enhance professional growth.
• Reflection at times (1 question) demonstrates ability to connect personal experience with theory but 2 of 3 questions are superficially answered.
• Discussion at least once draws upon self-knowledge, self-awareness and past experience to gain insight and create or discover ideas that are new and enhance professional growth.
• Entry does not reflect application of theory or genuine insight on behavior.
• Objectively shares experience, but reflection is vague, lacks depth or insight.
• Does not draw upon self- knowledge, self-awareness, or experience to enhance professional growth.
• There is minimal evidence of reflection
• No evidence of ability to draw upon self-knowledge, self-awareness and past experience to gain insight.
• Entry merely recites what was done/ learned during clinical.

This activity will focus on:  Emotional and Intellectual Wellness

• Document: Risk Control Self-Assessment Checklist for Nurses (pg 36)Download Risk Control Self-Assessment Checklist for Nurses (pg 36)
  • Review the checklist from the NCSBN Welcomes You to the Nursing Profession booklet.
• Document:  Significant Practice Errors Case Study (pg 23)Download Significant Practice Errors Case Study (pg 23)
  • Read the case study from the NCSBN Welcomes You to the Nursing Profession booklet.
• Document:  Wellness Journal ActivityDownload Wellness Journal Activity
  • Complete this Legal Issues wellness journal Wth 2 references and APA style