Respond  of your colleagues who were assigned to a different case than you. Explain how you might apply knowledge gained from your colleagues’ case studies to you own practice in clinical settings.

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                                  Sleep/Wake Disorders

The patient is an obese 70-year-old female with a chief complaint of “being sad.” Her husband passed away several years ago due to coronary artery disease (CAD). She lives at home alone and has a home health aide help her. Her son comes to visit her often. She was feeling well until her hearing began to diminish in both ears. Her mobility has declined, so she has not been able to get out as much. She is often lonely at home. She has daily crying spells, is often very tired, has good insight to her illness, and wants to get better. 

Three Questions to Ask the Patient and Why            

The case study mentioned that the patient is a candidate for cochlear implants, but it is a long way off. Thus, my first question to ask the patient is what is preventing her from getting cochlear implants?  

She began experiencing sadness when she began to lose her hearing and mobility. Therefore, regaining her hearing may help decrease the depression. If its financial reasons, maybe there are resources that can help her. Finding out the reason the patient isn’t getting the implants can help the provider and patient find solutions.             

The patient also mentioned that her sleep was “awful”, stating her legs “ache and jump”, she takes frequent naps during the day, and admits to snoring frequently. Thus, the second question I would ask is what are her sleeping habits like? 

Individuals who have good sleep habits sleep better. Getting better sleep can be obtained by being consistent by going to bed at the same time each night and waking up the same time each day (Centers for Disease Control and Prevention, [CDC], 2016).  Individuals can make sure the room is dark, quiet, and cool (CDC, 2016). Additionally, remove electronic devices, avoid large meals, caffeine, and alcohol can help with getting better sleep (CDC, 2016).              My third question would be what do you do when you are sad? Individuals who are depressed often have a negative view of the world and often think of themselves as worthless (This Way Up, n.d.). They often blame themselves when something bad happens and feel like they are unlucky (This Way Up, n.d.). Thus, helping individuals identify negative thinking and reframe the way they think about life can help improve depressive symptoms (This Way Up, n.d.). 

People to Speak to with Specific Questions to Ask 

The first person I would want to speak to is the patient’s son. The case study states the son visits her often so he should know the patient’s habits. First, I would ask him the same questions I asked the patient such as what is preventing the patient from getting cochlear implants, what are her sleep habits, and what does she do when she is sad? By asking the son the same questions, insight can be shown on how the son views things and how the patient views things. I would also him when he began to notice her depressive symptoms because that will help provide a timeline as to when it all began.             

The second person I would talk to is her home health aide because she is familiar with the patient. I would ask her what the patient’s home life is like such as how is she maintaining her house? Is she able to clean up after herself? How is she doing with activities of daily living? 

These questions can provide insight on the severity of the patient’s depressive symptoms. 

Physical Exams and Diagnostic Tests and How Results Would Be Used            

The first diagnostic test I would want to perform on the patient is the 9-item Patient Health Questionnaire (PHQ-9). The PHQ-9 is a screening tool for major depression (Na et al., 2018). The test is a reliable and valid measurement of depressive symptoms that also asks about the individual’s thoughts of death or self-injury within the last two weeks (Na et al., 2018). The results would be used to determine the severity of her depression. Another diagnostic test that can be performed on this patient is a polysomnography. A polysomnography is a sleep study that helps providers diagnose sleep apnea, periodic limb movement disorder, restless leg syndrome (RLS), insomnia, and nighttime behaviors (National Sleep Foundation, n.d.). The results would be used to can help determine the cause of her daytime sleepiness such as sleep apnea or RLS. I would also want to run a complete blood count (CBC) with differential on the patient. I would specifically want to obtain a red blood cell count (RBC) and white blood cell count (WBC). Thus, a CBC with differential would help determine if the patient is fatigued due to anemia or an underlying infection.

 Three Differential Diagnosis and Why

The three potential differential diagnoses include:Major Depressive DisorderPersistent Insomnia Disorder Obstructive Sleep Apnea Hypopnea The most likely differential diagnosis is major depressive disorder (MDD). The diagnostic criteria for MDD is five or more symptoms during the same 2-week period and a change from previous functioning (American Psychiatric Association, 2013).  The symptoms include: depressed mood most of the day, marked diminished interest or pleasure in all or almost all activities most of the day, significant weight loss or weight gain, insomnia or hypersomnia neatly every day, psychomotor agitation or retardation nearly every day, fatigue or loss of energy nearly every day, feelings of worthlessness or excessive or inappropriate guilt nearly every day, diminished ability to concentrate, and recurrent thoughts of death (American Psychiatric Association, 2013). The patient fits this diagnosis as evidence by depressed mood, diminished interest in activities she used to enjoy, fatigue, diminished ability to concentrate, and psychomotor retardation.

Two Pharmacological Agents and Dosing and Why 

One pharmacologic agent that can be tried is doxepin 3 mg at bedtime for insomnia. Doxepin works by boosting serotonin and norepinephrine by blocking the serotonin reuptake pump and norepinephrine reuptake pump (Stahl, 2017). At hypnotic doses, doxepin blocks histamine-1 receptors, which promotes sleep (Stahl, 2017). Doxepin is a substrate for CYP450 2D6 and has a half-life of 8-24 hours (Stahl, 2017). In the elderly, the recommended dose for insomnia is 3 mg per day (Stahl, 2017).             Another pharmacologic agent that I would like to start the patient on is bupropion (extended release) XL 150 mg daily in the morning. Bupropion is used to treat MDD and works by boosting norepinephrine and dopamine by blocking the norepinephrine reuptake pump and dopamine reuptake pump (Stahl, 2017). Bupropion inhibits CYP450 2D6, has a parent half-life of 10-14 hours, and a metabolite half-life of 20-27 hours (Stahl, 2017). Thus, since bupropion blocks the dopamine reuptake pump and norepinephrine reuptake pump, this medication is beneficial in improving symptoms of loss of happiness, joy, interest, pleasure, energy, enthusiasm, alertness, and self-confidence (Stahl, 2013). Thus, because of bupropion’s mechanism of action and the patient’s symptoms, I would want this patient to try this medication. 

Lessons Learned  

Lessons learned during this case study is that geriatric depression can be difficult to treat. They often have multiple comorbidities with the possibility of more pronounced side-effects (Stahl, 2008). Additionally, medications can have contraindications that do not previously exist prior to the patient being put on medication. Thus, providers must be aware of new and old warnings on medications in the event there are changes made to medications. I will apply this information when I am in practice by paying close attention to dosages, side effects, and potential contraindications when providing medication to the geriatric population. 

                                                  References

American Psychiatric Association. (2013). Diagnostic and statistical manual od mental disorders (5th ed.). Washington, DC: Author. Centers for Disease Control and Prevention. (2016). Tips for better sleep. Retrieved from https://www.cdc.gov/sleep/about_sleep/sleep_hygiene.htmlNa, P. J., Yaramala, S. R., Kim, J. A., Kim, H., Goes, F. S., Zandi, P. P.,…Bobo, W. V. (2018). The PHQ-9 item 9 based screening for suicide risk: a validation study of the Patient Health Questionnaire (PHQ-9)-9 item 9 with the Columbia Suicide Severity Rating Scale (C-SSRS). Journal of Affective Disorders, 232, 34-40. doi: https://doi.org/10.1016/j.jad.2018.02.045National Sleep Foundation. (n.d.). Sleep apnea. Retrieved from https://www.sleepfoundation.org/sleep-apneaThis Way Up. (n.d.). How do you feel? Retrieved from https://thiswayup.org.au/how-do-you-feel/sad/Stahl, S. M. (2008). Essential psychopharmacology online. Retrieved from https://stahlonline-cambridge-org.ezp.waldenulibrary.org/viewPdf?page=csEP_16.pdf&vol=2Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical    applications (4th ed.). New York, NY: Cambridge University Press. Stahl, S. (2017). Stahl’s essential psychopharmacology: Prescriber’s guide (6th ed.). San Diego,  CA: Cambridge University Press. 

see attached

  Type of paperOther SubjectNursing Number of pages2 Format of citationAPA Number of cited resources1 Type of serviceWriting

Instructions will be uploaded later.

 

Research a healthcare organization within Saudi Arabia in which you are currently employed or choose one with which you are familiar. 

Respond to the following questions: What specific steps does the chosen healthcare organization take to identify risk, manage risk, reduce risk, or prevent risk? Do they employ a dedicated risk manager? If so, what are the key responsibilities of that person (training staff, on boarding, auditing, etc.)? If they do not have a specific risk manager, who is responsible for managing risk? How do they manage risk for both the employees and the patients? Are there separate programs or do they overlap? Lastly, in your opinion, are they doing enough to address risk?

Your paper should meet the following structural requirements: The paper should be 5 pages in length, not including the cover sheet and reference page. Format the paper according to APA writing standards. Provide support for your statements with in-text citations from a minimum of four scholarly articles. Two of these sources may be from the class readings, textbook, or lectures, but two must be external.  The reference not older than 5 years back.

Topic 4 DQ 2

Nutrition is an essential component of health promotion, because without proper nutrition the risk for non-communicable illness increases. Four of the leading causes of death in the United States are linked to poor nutrition. However, this problem is directly linked to over consumption of foods high in fat and calories. This is coupled with an inadequate intake of fruits and vegetables (Falkner, 2018).  

Some of the nutritional challenges present in emerging populations are related directly to their genetic predisposition. However, many of the challenges are due to food preferences. For instance, some cultures prohibit certain food items. Additional consideration must be made for ceremonial or religious food, as well as food preparation methods. The problem is exacerbated by the quantity of high fat, high sugar, processed foods that are readily available at low cost. Healthier food choices often cost more. This creates even more of a problem for a lower-income family (Falkner, 2018).

Both nutritional deficits and nutritional excesses have a role in disease processes. For instance, certain disease processes, such as hypertension and type 2 diabetes occur more frequently in obese populations. In fact, dietary modifications greatly reduce the risk of poor outcomes related to obesity (Falkner, 2018). In addition, nutritional deficits can also lead to illness. A recent study concluded that 58% of women with polycystic ovary disease were also vitamin D deficient (Hanif,Qamar,Aslam,Omar, Mustafa,& Masood, 2019). Another case study showed that a B12 deficiency can cause neuropathy and hyperpigmentation of the lower extremities (Turnquist & Holt, 2020). A balanced diet with the proper intake of vitamins and minerals is essential for health in all three stages of health promotion. When implemented in primary health promotion, proper nutrition may significantly reduce the risks of illness or disease. 

Falkner, A., (2018). Cultural Awareness. In Grand Canyon University (Eds.), Health promotion: health and wellness across the continuum. Retrieved from https://lc.gcumedia.com/nrs429vn/health-promotion-health-and-wellness-across-the-continuum/v1.1/#/chapter/3

Hanif, Q., Qamar, S., Aslam, P., Omar, H., Mustafa, N., & Masood, S. (2019). Association of vitamin D deficiency with polycystic ovarian syndrome. Pakistan Armed Forces Medical Journal, 69(2), 241–244. Retrieved from https://eds-b-ebscohost-com.lopes.idm.oclc.org/eds/pdfviewer/pdfviewer?vid=4&sid=63e3b836-df2d-4857-a070-d16c4fd4bfaa%40pdc-v-sessmgr05

Turnquist, M. & Holt, C., (2020) Fresh fruits and vegetables really do keep the doctor away: symptomatic vitamin deficiency in a middle aged man, Journal of maine medical center 2(1), 1-3. Retrieved from https://knowledgeconnection.mainehealth.org/cgi/viewcontent.cgi?article=1018&context=jmmc

Topic 4 DQ 2

In order to provide holistic care to patients, health promotion becomes a necessity whereby patients are empowered with tools to practice and live healthy lives. Having said this, nutrition therefore becomes the first step to assisting patients live healthier lives. Due to the abundance of highly-processed, convenient and in-expensive sources of comfort food, the US along with other countries globally suffer a growing crisis of obesity and other co-morbidities such as hypertension, diabetes, heart diseases among others secondary to unhealthy feeding (Falkner, 2018). According to statistics, nearly 1 in 3 adults is considered obese and approximately 81.6% of adults fail to get the recommended amount of daily activity. Furthermore, the American society is noted to have moved from being a country of nutritional deficit-related diseases to one of noncommunicable diseases related to nutritional excess and overconsumption (ODPHP, n.d.). It is because of this shift that healthcare professionals and other government programs such as Healthy People 2020 have embarked on working closely with different community populations to promote and restore health through advocacy of healthy eating patterns.

Despite nutrition being considered rudimentary to all people regardless of culture; different cultures have varying customs, traditions, religions and routines that impact daily nutritional preferences. Given the cultural diversity and emerging population growth in the US, there are different challenges that may be a barrier to healthy nutrition. Firstly, being new in the US, these populations may have difficulties accessing their preferred food choices they are used to, and thus may resort to fast foods. Moreover, as they strive to settle in, most may be financially strained to afford healthy meals and thus would prefer highly-processed cheaper food which equally poses health concerns. Secondly, some of the emerging minority populations like LGTBQ face adversities and discrimination and they are mostly biased from accessing medical information including nutritional knowledge and so they end up marginalized (Landry, 2017). Thirdly, limited resources, unemployment and poverty has led to homeless populations whereby they not only exposed to violence and high stress levels but also lack of clean water and proper nutrition. Last but not least certain habits of different cultures like the Mexican-American involves frequent family meal sharing where their food is prepared with lard and served in large portions with less vegetables, something that is inconsistent with health nutrition (Falkner, 2018).

Some diseases such as obesity, hypertension, stroke, diabetes and cancer have a direct correlation to poor dietary intake that has consistency in nutritional excesses of salt, fat, calories and cholesterol (Patience, 2016). On the contrary, nutritional deficiency has also caused malnutrition a condition that predisposes patients to various communicable diseases such as respiratory problems for lack of adequate immunity. While most of the causative factors to nutritional excesses may be lifestyle-related and modifiable, other factors of nutritional deficiencies may be due to lack of access to resources and thus requiring an interdisciplinary team effort and collaboration with relevant stakeholders to eliminate barriers to balanced nutrition. Careful consideration of nutritional aspects therefore becomes paramount when doing health promotion as ignorance of it can lead to different diseases that can be avoided. Conclusively, nutritional health ultimately becomes relevant to health promotion and preservation, and if well mastered leads to family wellness and prevention of diseases.

References.

 Falkner, A. (2018). In GCU’s Health Promotion: Health and Wellness Across the Continuum. Retrieved from

https://www.gcumedia.com/digital-resources/grand-canyon-university/2018/health-promotion_health-and-wellness-across-the-continuum_1e.php

 Landry, J. (2017). Delivering culturally sensitive care to LGBTQI patients. The Journal for Nurse Practitioners, 13(5), 342-347. doi: 10.1016/j.nurpra.2016.12.015

Office of Disease Prevention and Health Promotion. (n.d.). Nutrition, physical activity, and obesity. Retrieved from https://www.healthypeople.gov/2020/leading-health-indicators/2020-lhi-topics/Nutrition-Physical-Activity-and-Obesity/data

Patience, S. (2016). Advising patients on nutrition and healthy eating. British Journal of Nursing, 25(21), 1182.