CT 3-550

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Health care industry 

Research the access to essential health commodities. Medical innovations are failing many patients globally. Describe the issues, barriers, and challenges for the neglected populations. Discuss how access can be expanded for these populations, what policy changes are needed, and who needs to be participating in solving this problem.

Please use the following headings in your paper: Introduction Essential Health Commodities The Failure of Medical Innovations Issues, Barriers, and Challenges Recommended Policy Changes Conclusions References

Your paper should meet the following structural requirements: Be 3-4 pages in length, not including the cover or reference pages. Be formatted according APA writing guidelines. Provide support for your statements with in-text citations from a minimum of six scholarly articles. Two of these sources may be from the class readings, textbook, or lectures, but four must be external. Utilize headings to organize the content in your work. More citation through the text No plagiarism The references not more than 5 years back

The Impact of Ethnicity on Antidepressant Therapy

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The Impact of Ethnicity on Anti-depressant Therapy

The Case: The man whose antidepressant stopped working. 

Gathering information on physical assessment is essential in the management and treatment of the patient’s conditions like depression. The participation of a family is vital in the overall treatment of a person who has a mental disorder.

The three questions necessary to ask the patient with depression are: “How do you feel about being retired?” ; “Can you tell me about your family?”; and “ Are you having thoughts of harming yourself?” The first question will explore the extent of financial demand on the patient and will assess the feeling of guilt regarding financial constraints related to his chronic disease. The importance of financial challenge appeared as the primary stressor on the study on chronic disease and depression (Chan & Corvin, 2016). The second question determines how family relations affect the patient’s condition, whether he has a sound support system. The third question explores the patient’s plan for himself.

The patient’s wife in the scenario is his support person. Family and social interactions appeared crucial to coping strategy even without resolution on the problem (Chan & Corvin, 2016). The following questions are necessary to determine how supportive is the patient’s wife: “Do you keep track of your husband’s medication regimen?” ; “ What are the things that you and your husband like to do?”; and “How do you feel about your husband’s illness?”

The first question determines the wife’s involvement in patient care and whether the patient is compliant with his schedules of medication. The second question explore the things that both patient and wife enjoy. The third question assesses how the patient’s wife handles his husband’s illness. The wife can be a husband’s caregiver, and such a job involves managing the patient’s treatment, side effects, and symptoms, which providing such care can be emotionally difficult (Nik Jaafar et al., 2014). Greater caregiver burden is associated with older adults with long-standing depressive manifestations (Marshe et al., 2017).

Physical Examination and Diagnostic Tests

Physical assessment on the patient’s head, thyroid, and nervous system is an appropriate action to rule out other causes of depression. Current studies affirmed a significant correlation between thyroid hormone imbalance in patients with MDD (Shen et al., 2019). The result of a physical examination will enable the provider to treat any condition that might have contributed to the patient’s depression. The patient may also benefit from HAM-D6 or melancholia sub-scale. The HAM-D6 is a focused version of the Hamilton Depression Rating Scale (HAM-D), an outcome measure in MDD (Dunlop et al., 2019). The test result helps identify the effect of an antidepressant (Dunlop et al., 2019). The result is beneficial and helpful in medication decision management. 

Three Differential Diagnosis

The three differential diagnoses for the patients’ case is adjustment disorder with depressed mood, mood disorder due to another medical condition, and anxiety disorder. Although all the differential diagnosis applies to the patient, the most appropriate one is the adjustment disorder with depressed mood. It is an episode that happens in reply to a psychosocial stressor (American Psychiatric Association, 2013). Although the patient’s depression originated after an A-fib experience, based on the patient’s history, his condition improved, and his A-fib is well managed with medication. The second depression started at the beginning of the patient’s retirement life, improved when he went back to work, and again retired. This depression is linked to a psychosocial stressor.

Pharmacologic Agents

Venlafaxine and sertraline are anti-depressants with a different class that are appropriate for patient’s therapy. Either sertraline 200 mg or venlafaxine 150 mg can be given to the patient considering his history. Sertraline is an antidepressant medication that acts by preventing the serotonin transporter (SERT) in the presynaptic terminals and belongs to the family of selective serotonin reuptake inhibitors (SSRIs) (Saiz-Rodriguez et al., 2018). It prevents the reuptake of 5-HT (Rosenthal & Burchum, 2018). Sertraline (Zoloft) manage depression by elevating the serotonergic activity (Up To Date, Inc, 2019). It has a dopamine neurotransmission blocking ability that gives its therapeutic action (Potter, 2020).

Venlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI) use to treat late-life depression and is usually prescribed between 75 and 300 mg in a day, which dosage of 150 or higher is enough to generate noradrenergic activity (Marshe et al., 2017). In a study, there was no ethnicity correlation with patients’ remission status found (Marshe et al., 2017).

Sertraline and venlafaxine would both be appropriate choices for the treatment of depression in this patient. However, I would choose sertraline over venlafaxine because SSRI is commonly tolerated and has a decrease rate of treatment disruption (Bauer, Severus, & Moller, 2017). Venlafaxine has been known to raise blood pressure in patients (Up To Date Inc., 2020). This patient has hypertension. It would require frequent monitoring of the patient’s blood pressure, checking it on time, and knowing the reportable changes would increase the patient and family burden, which is already high in this case. Using sertraline would be effective and would be more comfortable with the family because it would not require frequent blood monitoring. In this case, the has a history of hypertension, but it does not say whether it is or it is not uncontrolled and may only infrequently check his blood pressure at physician appointments or other wellness checks. 

In addition to lesser side effects in sertraline, it has an anxiolytic action that elevates the mood, energy, and concentration (Stahl, 2013). Also, when used as a single therapy, the chance of serotonin syndrome is significantly low (Dwyer & Bloch, 2019). Moreover, it is seldom fatal in single therapy overdose, and long-term use is safe (Potter, 2019).

Regarding ethnic considerations, the older Hispanic population has been found to have a negative outlook regarding pharmacotherapy (Stephenson, Martin, Ortiz, & Mongomey, 2019). This potentially is attributed to other findings such as complaints concerning a lack of providers that are either Hispanic or are bilingual (Stephenson et al., 2019). This could make it harder for patients to understand directions for taking medicine, how to get refills, or understand the provider’s basic instructions (Stephenson et al., 2019).

Lesson Learned

Polypharmacy is not recommended in older adults. The patient initially responds well to sertraline. Since then, multiple changes have taken place, and various medications have been added. The patient is now older, and with that, comes a slower metabolism. A therapeutic effect may be achieved with a smaller dose because of slower metabolism. 

Evidence of depression recurrence signifies progression that may develop into treatment resistance. The learning I earned from the case study will impact my future practice by being pro-active in medical management and education in patients with similar clinical presentations. For example, I will reinforce learning and encourage patients with MDD to take maintenance medication on the third relapse of MDD to avoid relapses in the future and risking changes in the brain formation (Stahl online) development of treatment-resistant depression. According to Dwyer & Bloch (2019), the indefinite continuation of antidepressant is recommended for patients who had three depressive episodes or had high severity episode. 

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders  (5th ed.). Washington, DC: Author.

Bauer, M., Severus, E., Moller, H., & Young, A. (2017). Pharmacological treatment of unipolar  depressive disorders: summary of WFSBP guidelines. International Journal of Psychiatry  in Clinical Practice, 21(3), 166-176.

https://doi-org.ezp.waldenulibrary.org/10.1080/13651501.2017.1306082

Chan, I., & Corvin, J. (2016). Chronic disease and depression among Hispanic Americans:  Reconceptualizing the masculine self. American Journal of Men’s Health, 10(6), N11- N12. doi: 10.1177/1557988315595858

Dunlop, B., Parikh, S., Rothschild, A., Tase, M., De Battista, C., Conway, C., Forester, B.,  Mondimore, F., Shelton, R., Macaluso, M., Logan, J., Traxter, P., Li, J., Johnson, H., &  Greden, J. (2019). Comparing sensitivity to change using the 6-item versus the 17-item  Hamilton depression rating scale in the GUIDED randomized controlled trial. BMC  Psychiatry, 19(1), 1-10. 

https://doi-org.ezp.waldenulibrary.org/10.1186/s12888-019-2410-2

Dwyer, J. B., & Bloch, M. H. (2019). Antidepressants for pediatrics patients. Currentpsychiatry,  18(9), 26-42F

Marshe, V., Maciukiewicz, M., Rej, S., Tiwari, A., Sibille, E., Blumberger, D., Karp, J., Lenze,  E., Reynolds, C., Kennedy, J., Mulsant, B., Muller, D. (2017). Norepinephrine transporter  gene variants and remission from depression with venlafaxine treatment in older adults.  American Journal of Psychiatry, 5, 468.

https://doi-org.ezp.waldenulibrary.org/10.1176/appi.ajp.2016.16050617

Nik Jaafar, N. R., Selma Din, S. H., S. H., Mohamed Saini, S., Ahmad, S. N. A., Midin, M., Sidi,  H., Silim, U. A., & Baharudin, A. (2014). Clinical depression while caring for loved ones  with breast cancer. Comprehensive Psychiatry, 55(Supplement 1), S52-S59.

https://doi-org.ezp.waldenulibrary.org/10.1016/j.comppsych.2013.03.003

Potter, D. R. (2019). Major depression disorder in adults: A review of antidepressants.  International Journal of Caring Sciences, 12(3), 1936-1942.

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice  providers. St. Louis, MO: Elsevier.

Saiz-Rodriguez, M., Belmonte, C., Roman, M., Ochoa, D., Koller, D., Talegon, M., … Abad- Santos, F. (2018). Effects of polymorphisms on the pharmacokinetics,  pharmacodynamics, and safety of sertraline in healthy volunteers. Basics & Clinical  Pharmacology & Toxicology, 122(5), 501-511.

Shen, Y., Wu, F., Zhou, Y., Ma, Y., Huang, X., Ning, Y., Lang, X., Lou, X., & Zhang, X. (2019).  Association of thyroid dysfunction with suicide attempts in first-episode and drug  naive patients with major depressive disorder. Journal of Affective Disorders, 259,  180-185

https://doi-org.ezp.waldenulibrary.org/10.1016/j.jad.2019.08.067

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical  applications (4th ed.). New York, NY: Cambridge University Press.

Stephenson, J., Distelberg, B., Mortin, K., Ortiz, L., & Montgomery, S. (2019). Different  depression treatment recommendations and adherence for Spanish and English-speaking  patients. JAFBM, 32(6), 904-912

Retrieved from https://www.jabfm.org/content/jabfp/32/6/904.full.pdf

Up To Date Inc. (2020). Sertraline drug information. Retrieved from https://www.uptodate.com/contents/sertraline-drug-information?  search=sertraline%20adult&usage_type=panel&kp_tab=drug_general&source=panel_search_result&selectedTitle=1~149

&usage_type=default&display_rank=1

Up To Date Inc. (2020). Venlafaxine drug information. Retrieved from https:// www.uptodate.com/contents/venlafaxine-drug-information?search=effexor&source=panel_search_result&selectedTitle=1~149&usage_type=panel&kp

_tab=drug_general&display_rank=1.

I NEED  A RESPONSE FROM THIS ASSIGNMENT

1 PAGE

2 REFERENCES

dis 5 resp

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In your responses to your peers, describe some factors you think are most important for the clinical nurse to know in treating these patients. Would one of these factors contribute more than the others in making the chosen patient-care technology transition easier?

Peers Response attached below.

 Please respond individually to both peers.

health care finance and economic

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Professional Development Considering the five stakeholders in health care: consumers, providers, payers, suppliers, and regulators – what role can each play in health care quality, and cost containment?
  In your opinion, what health policy has had the greatest impact on health care in the United States? Why?
  Frame some arguments for or against the policy of mandated minimum staffing ratios in the positive versus normative economic dichotomy.
 

This APA essay will have 1200-1500 words with 4 supporting references. Make certain to include an introduction and conclusion paragraph, along a title and reference page.

Consider a single nursing care issue at your facility where quality has already been improved by implementation of evidence.

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this discussion post can be done by today at 11pm in 12 hrs plz

Customer service module 5 discussion

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Working in healthcare can be stressful at times, especially when you are trying to maintain multiple practitioners’ schedules and patient visits. Many times, schedules get delayed, which causes some frustration for the practitioner, staff, and patients. Effectively working with your coworkers will help to alleviate these issues.

Utilizing the content from your assigned readings and online lectures, explain how you would manage an upset physician who wants to know why her schedule is behind and each department (Administrative Assistants, Nurses, Medical Assistants) are blaming one another for the delay. What can individuals and an organization do to prevent these types of issues and conflict from occurring?

Module 7 case study discussion

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MODULE 07 CASE STUDY

S.is a 48-year-old divorced woman with one adult daughter and three grandchildren. She is currently working as an LPN part-time in a nursing home and also works at a convenience store one or two days per week. She has had many jobs over the last 22 years, usually changing every one or two years. S notes that she has been called less often to work in the convenience store and worries that they don’t like her anymore. She reports being written up several times for arguing with customers. She also reports that her supervisor at the nursing home “is a bitch”; although she really liked her supervisor at first, she says “Now I hate her; she’s trying to get me fired.” S. reports that she has tried to get fulltime jobs five times in the last four years, was hired for three, but only lasted one or two weeks at each one. 

S. reports that she is currently not talking to her daughter because “she is horribly mean to me and she needs to apologize or I won’t talk to her again”. She is upset that she hasn’t seen her three small grandchildren in about a year. She sends them presents and cards frequently that says “I still love you! Grandma”, but hasn’t called them since she stopped talking to her daughter. She is considering reporting to the county that her daughter is keeping her grandchildren from her. 

S. is very unhappy that she isn’t in a relationship. She was abused by her ex-husband and has a pattern of meeting and dating men who eventually abuse her. She states that her last relationship was very good, however; the man was not abusive and “I loved him very much”. The relationship ended for reasons that S. doesn’t understand, although she does report many arguments that ended in “scenes” such as her throwing chairs, stomping out of the house, making crank phone calls to his family, and calling the police with false reports. But S. also reports that she “couldn’t have loved him more and I showed it”. She gives examples of going to her boyfriend’s place of work with flowers, buying him expensive presents, surprising him with tickets to Mexico at the last minute – she was very upset that he wasn’t willing to drop everything and go with her. S. reports asking him why he didn’t love her and what she was doing wrong on a regular basis. When the boyfriend asked to break up, S. reports sitting outside his house for weeks, crying; she called his mother, called his boss, and called and texted him until he filed a restraining order. This occurred about 4 months ago.

S. admitted herself to the mental health unit when she felt suicidal. She reports that she had stopped her individual psychotherapy 3 months ago and stopped going to DBT. She also stopped her anti-depressant at that time, as she felt it wasn’t working, and missed her last two psychiatrist appointments.

Questions:

Read the case study about Borderline Personality Disorder and answer the following questions in your initial posting:

1. How would you use therapeutic communication and the principles of cognitive-behavioral therapy with the client?

2. Describe your assessment process. What are some likely co-morbid conditions? List one nursing diagnosis and appropriate nursing intervention.

3. What interdisciplinary referrals might be appropriate?

Week 5 Discussion Prompt 2

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Evidence-based practice is extremely important in nursing. Throughout your master’s program, you will complete research on various topics. Knowing how to construct a strong problem statement and complete a critical analysis of the available information to write a literature review is essential. Follow the instructions in the bullets below to direct you where to find resources on problem statements and literature reviews.

This week, you will write a problem statement and perform a literature review in preparation for your ethical issues debate presentation. Share your problem statement in this discussion so that you can review each other’s work and provide peer-to-peer feedback. Also, describe what you think are the most important learning takeaways from the literature review resources you reviewed.

Nursing role in health assesment

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Please answer the following question in your initial post:

Describe how you apply the first step (assessment) of the nursing process in your current practice setting. If you are not currently practicing as an RN, you may use an example from a prior clinical or work experience. Include the following information: Briefly describe your practice setting and the typical patient population. Provide examples of key subjective and objective data points you collect. Describe how you document your findings. Is there technology involved? Describe your process of data analysis. What is the end result of this process? (i.e., Do you formulate nursing diagnoses and care plans, collaborate with others and/or make referrals?)

Remember to use and credit the textbook or lesson, as well as an outside scholarly source, for full credit.

NR534 week 1 SR

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Respond 

 

Part 1:

Leadership to me is a person who possesses the ability to be inspiring, impactful, and influential. A good leader is trustworthy, follows through, listens well, and is supportive. My philosophy of leadership is, a leader possesses the ability to practice self-awareness, transparency, be truthful, and able to coach or help develop other. In order to create trust with their team, the leader must be genuine and truthful through the good, the bad, and the ugly. If not, the leader runs the risks of losing their team members trust. Coaching and mentoring are desirable to team members, everyone desires to grow and learn. It is the leader job to provide their team with the tools and training to become experts in their respective fields (Speranza, & Pierce, 2019). At Wellstar these traits are relatable to my leadership role and align with our values, mission, and vision. Our values are the following: we honor every voice, we pursue excellence, and we serve with compassion. Our vision is to deliver world-class healthcare to every person, every time. By honoring our team members voices, we allow the nurses to better care for their patients. The nurses are more likely to speak up and advocate if they are working in an environment where the feel heard.

Part 2:

 The definition of a leader varies depending on the audience. Some may argue that a leader is influential, another may think of the person who is managing them. My personal values align with Wellstar, as I desire to honor every voice, be transparent, listen well, mentor others, and serve with compassion. I became a nurse because I enjoyed caring for people. Serving with compassion and pursuing excellence, is the heart of what I do. As a leader, I try and lead by example, be the person who inspires others. Also, I try to honor every voice- the patient, the patient’s family, and team members. It is imperative that our staff and consumers feel as if we are listening and that their concerns are heard. Otherwise, what we are doing is in vain, we lose trust, which can result in the loss of an employee or patients. At Wellstar, we practice person-centred care, one way is the incorporation of IDR’s- the entire team is focusing on that one patient and their needs. This has proven to great catches, and improved patient outcomes.