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 as a Psychiatric Nurse Practitioner.

NOTE: Positive comment

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The three questions this writer would as the patient are: 

Did your depressive symptoms worsen after the death of your husband? 

How many hours per night do you sleep on average? 

Do you sleep throughout those hours of sleep or do you wake constantly? 

Do you ingest any stimulants like coffee or chocolate before bed? 

Do you sleep during the daytime? 

The rationale behind question one is to gauge the timeline of the  patient’s depression. She appears to have been suffering with untreated  depression for a long time, however the additional symptoms of insomnia  and tearfulness seemed to worsen after his death. With this information  the nurse practitioner will know if her depression is in an acute state  and the severity of her illness.The patient is reporting sleeplessness;  however the nurse practitioner needs to gauge if the patient is  participating in restful sleep. Sleep of two hours or less may only  consist of REM sleep (Boland et al., 2020). If the patient is not  getting restful sleep, she is not benefiting from the bodily repair that  takes place during sleep (Fitzgerald et al., 2017).  This can place her  at an increased risk for other illnesses and heighten depressive  symptoms (Uchmanowicz et al., 2019).Knowing if the patient sleeps  consistently throughout those hours of sleep will provide information to  the nurse about the kind and amount of sleep the patient is getting.  Ingesting certain stimulants like caffeinated drinks, coffee or  chocolate can affects the client’s sleep by providing wakefulness (Ulke  et al., 2017).  If the patient is sleeping during the daytime, her  circadian rhythm could have been reversed where she will need less sleep  during the night time hours (Fitzgerald et al., 2017).

The people this writer would interview are:

The patient’s aide 

The patient’s son 

The patient aide may be able to provide more information about  observed sleepiness during the daytime. In addition, she will be able to  provide information on the patient’s dietary patterns and physical  activity. The questions to the aide would be:    

Does she easily nod off during the daytime? 

Does she easily become fatigued? 

Does she consume a well-balanced diet? 

Question one would illicit answers about her getting sleep. 

It appears that she in fact getting sleep but because of a revered  circadian rhythm she is not able to get the sleep at the night which is  the desired time.  Question two will help the nurse practitioner gauge  the extent of the effects that non sleep has taken on the patient’s  life. The patient, if constantly fatigued throughout the day has a life  that has been highly impacted by the lack of sleep. The aide would be  able to provide a clear, picture of the patient’s diet. The aide would  be able to reveal if the patient consumes a vast amount of sugar or  caffeine which could interrupt sleep.

Questions to the son would surround the family’s psychiatric history.   These questions will help the nurse practitioner construct the family  history of the patient and rule out or consider familial history as a  cause for her symptoms.

Can you recall any maternal family members with psychiatric disorders including depression and insomnia? 

Did the symptoms start after the death of the client’s husband?  

This would help the nurse practitioner rule out depressive symptoms as the cause of her insomnia.

Physical Examinations and Tests

Sleep Study:

Polysomnogram – The sleep study or polysomnogram  measures the brain waves, blood oxygen, leg movements and breathing  during sleep (Meghdadi et al., 2019). The Nurse Practitioner would be  able to rule out physiological reason’s ad the cause for the patient’s  insomnia.

Actigraphy: This is where a small device is worn on  the wrist and it measures the person’s sleep wake cycle for a specified  period (Meghdadi et al., 2019). This is convenient for this client and  the Nurse Practitioner would be able to monitor the client’s sleep  health and gauge the severity of the disruption of her sleep.The nurse  practitioner could also physically examine the patient’s nares for  septal occlusion.

Septal occlusion or deviation could lead to problems  with sleeping even during sleep, this would be important for the nurse  practitioner to evaluate as this could be interfering with the patient’s  sleep.

Epworth sleepiness scale – assesses the patient’s  tendency to nod off in various situations (Meghdadi et al., 2019).  For  this client it would be necessary for the nurse practitioner to assess  the severity of her nodding off during the day time especially at  unexpected times like during eating and other activities that would put  her safety at risk. 

Differential Diagnosis

G47.00 Unspecified Insomnia Disorder- The patient is  experiencing insomnia at nighttime that could be related to several  factors. She reports staying up late to watch T.V., depressive symptoms,  restless leg syndrome, sleep apnea and sleeping during the daytime.  Some of these factors have not been ruled out yet as the cause of her  anxiety. 

G47.23 Persistent Irregular Sleep Wake type severe 

F32.9 Unspecified Depressive Disorder 

G25.81 Restless legs syndrome 

Medications:

Trazodone 50 mg – This medication would be the first choice as it  offers antidepressant properties as well as promotes sleep in those  diagnoses with insomnia. It is generally safe for the elderly population  at low doses (Pagel et al., 2018). The Nurse Practitioner should  monitor the patient and evaluate the needs to slowly increase or in some  cases decrease the dose. 

Rozerem 8 mg- Is a nonbenzodiazepine hypnotic that promotes sleep.  The patient would benefit from his, but an added benefit would be that  she would be at a diminished risk of falls as this is a concern  following the use of hypnotics in the elderly. This drug is reported as  one that would prevent less falls from over sedation (Pagel et al.,  2018).

Lessons Learned            

This writer has learned that it is important to conduct a complete  evaluation of the patient and not just focus on the presenting symptoms.  There are additional environmental and physiological symptoms that  could be attributed to the patient’s insomnia. In this case the patient  had several factors that could be contributing her insomnia and they  needed to be ruled out. The cause of her insomnia could have been  physiological from the sleep apnea or from her habits of staying up tool  late at nights and sleeping during the daytime. It is also important to  evaluate medications, social and economic factors before the resorting  to pharmacological interventions. 

References

Boland, E. M., Vittengl, J. R., Clark, L. A., Thase, M. E., &  Jarrett, R. B. (2020). Is sleep disturbance linked to short- and  long-term outcomes following treatments for recurrent depression? Journal of Affective Disorders, 262, 323–332. 

FitzGerald, J. M., O’Regan, N., Adamis, D., Timmons, S., Dunne, C. P., Trzepacz, P. T., & 

Meagher, D. J. (2017). Sleep-wake cycle disturbances in elderly acute  general medical inpatients: Longitudinal relationship to delirium and  dementia. Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring, 7, 61–68. 

Meghdadi, A. H., Popovic, D., Rupp, G., Smith, S., Berka, C., &  Verma, A. (2019). Transcranial Impedance Changes during Sleep: A  Rheoencephalography Study. IEEE Journal of Translational Engineering  in Health and Medicine, Translational Engineering in Health and  Medicine, IEEE Journal of, IEEE J. Transl. Eng. Health Med, 7, 1–7.  

Pagel, T., Seithikurippu R. Pandi-Perumal, & Jaime M. Monti. (2018). Treating insomnia with medications. Sleep Science and Practice, (1), 1. Uchmanowicz I, Markiewicz K, 

Uchmanowicz B, Kołtuniuk A, & Rosińczuk J. (2019). The  relationship between sleep disturbances and quality of life in elderly  patients with hypertension. Clinical Interventions in Aging, 155. 

Ulke, C., Sander, C., Jawinski, P., Mauche, N., Huang, J., Spada, J.,  Hegerl, U. (2017). Sleep disturbances and upregulation of brain arousal  during daytime in depressed versus non-depressed elderly subjects. World Journal of Biological Psychiatry, 18(8), 633–640.    

 

Competency Describe different quality methods within healthcare. Explain the basic models of quality improvement in healthcare. Evaluate the role and importance of patient satisfaction. Evaluate the role and importance of the patient experience. Apply statistics to different quality methods in healthcare. Apply quality improvement methods.

Course Scenario

Chaparral Regional Hospital is a small, urban hospital of approximately 60 beds, and offers the following:
Emergency room services  Intensive care Surgical care Obstetrics Diagnostic services Some rehabilitation therapies Inpatient pharmacy services Geriatric services Consumer physician referral services 

Recently, the CEO has been hearing complaints from both patients and staff, varying from long wait times to rude physicians. You have been hired to design and implement a Quality Improvement Plan to help uncover quality problems and to satisfactorily resolve them.

Scenario Continued

You have been asked to present a narrated visual report for the CEO and Board of Directors on a video conference call to share your major findings and to discuss recommendations.

Competencies: Describe different quality methods within healthcare. Explain the basic models of quality improvement in healthcare. Evaluate the role and importance of patient satisfaction. Evaluate the role and importance of the patient experience. Apply statistics to different quality methods in healthcare.  Apply quality improvement methods.

Instructions

Your narrated visual report should include the following: Types of measurements that will be used. Overall design of the survey. Identifies who will lead the QI task force. Identifies who should be on the task force. Suggestions for implementing the results of the survey.

Your narrated visual report should be done using Microsoft PowerPoint, or any other presentation software of your choosing that also allows for narration to be added.

APA formatting for the References slide, and proper grammar, punctuation, and form are required.

  

Assignment:
Asthma and Stepwise Management 

Asthma is a respiratory disorder that affects children and adults. Advanced practice nurses often provide treatment to patients with these disorders. Sometimes patients require immediate treatment making it essential that you recognize and distinguish minor asthma symptoms from serious, life-threatening symptoms. Since symptoms and attacks are often induced by a trigger, advanced practice nurses must also help patients identify their triggers and recommend appropriate management options. Like many other disorders, there are various approaches to treating and managing care for asthmatic patients depending on individual patient factors. One method that supports the clinical decision-making of drug therapy plans for asthmatic patients is the stepwise approach, which you explore in this Assignment.

To prepare:

· Consider drugs used to treat asthmatic patients including long-term control and quick relief treatment options for patients. Think about the impact these drugs might have on patients including adults and children.

· Review Chapter 25 of the Arcangelo and Peterson text. Reflect on using the stepwise approach to asthma treatment and management.

· Consider how stepwise management assists health care providers and patients in gaining and maintaining control of the disease.

Write a 2- to 3- page paper that addresses the following:

· Describe long-term control and quick relief treatment options for asthma patients, as well as the impact these drugs might have on patients.

· Explain the stepwise approach to asthma treatment and management.

· Explain how stepwise management assists health care providers and patients in gaining and maintaining control of the disease.

 

reply to  other students and include a reference that justifies your post.  Your reply must be at least 3 paragraphs. 

Below is the DQ answer from another student to wish i have to react. 

 

Safety and Quality Improvement in Healthcare Setting

1)  The link between quality and safety in the healthcare setting

In most reports, quality and safety are often cited together, bringing out the link between the two concepts in a healthcare setting. Quality, defined as the degree to which individuals’ and population health services increases the likelihood of desired health outcomes, has a link with safety, in that for quality to be improved, there must be the safety of patients; thus safety is considered a significant component of quality ( Masters, 2018). Among the key attributes to the effective quality healthcare system is safety; hence the two are linked.

Safety is described as a risk reduction of unnecessary harm associated with healthcare providers to an acceptable minimum. The practices that are placed by healthcare facilities to improve the safety of patients in the healthcare setting improves the overall quality of healthcare. Therefore, safety and quality are terms used together. Adequate and proper safety offered to the patient’s results to improved the quality of healthcare services.

The safety of the patient is a cornerstone of quality health care. Most works are defining patient practices and safety that prevent harm focus on adverse outcomes of care like morbidity and mortality. Nurses are thus critical to the coordination that reduce such adverse outcomes. Increased patient safety should be a significant concern in health settings since it’s a crucial element in quality healthcare.

2)  Role of Nurse in Quality Improvement

The role of a nurse in quality improvement relies on the ability of the nurse to analyze and collect the patient’s data. Nurses both on training and the experience have a significant role in participating in quality improvement initiatives (Masters, 2018). A novice nurse, in quality improvement, is involved in data collection and assisting with the improvement interventions. Conversely, the experienced nurse can take the lead in quality improvement initiatives in promoting quality improvement in healthcare settings.

The role of the nurse in quality improvement is more important in those hospitals which try to promote patient safety culture. Nurses who are registered often employ the techniques of quality improvement that were at one point used by quality assurance personnel. Nurses should always monitor the outcome of patients care processes using flow diagrams, spreadsheets, and computer programs to monitor and record data when they analyze clinical situations and problems.

Besides the process of data analysis, change, and monitoring that occurs in quality improvement routine cycle, nurses, are commonly involved in problem identification outside the ordinary data monitoring system routine (American Nurses Association, 2015). The nurses can initiate the quality improvement process based on clinical issues observations in daily practice. The view of the clinical issues may lead to the conduct of health record audits to make a comparison of care provided to evidence-based clinical practice guidelines. The outcomes of such a health records audit can lead to the development of a quality improvement plan. Nursing Sensitive Measures and their Importance in Nursing Care Delivery

Nursing sensitive measures are identified as a patient-related process or structured variables that function as proxies to the process and outcomes that reflect the nurse-quality relationship (Masters, 2018). The nurse-sensitive measures are compiles through a consensus development process. The measures are identified in three domains; nursing centered measures, patient-centered measures, and system-centered systems.

The nursing-sensitive measures are essential in nursing care delivery since they are suitable to reflect nursing care quality (Mangold & Pearson, 2017). They help the registered nurse inpatient quality improvement and safety by providing research-based comparative data on nursing care and the relationship to the outcomes of the patients.

Sensitive nursing measures are a reliable and valuable way of determining if nursing quality-improvement projects are effective and efficient. The nursing-sensitive measures additionally promote continual improvement in nursing safety and quality.  It as well provides scientific evidence for detecting implementation efficacy and setting an implementation plan in nursing care.

References

American Nurses Association. (2015). Nursing: Scope and Standards of Practice (3rd ed.). Silver Spring, MD: Author.

Mangold, K., & Pearson, J. (2017). Making Sense of Nursing-Sensitive Quality Indicators. Journal for nurses in professional development, 33(3), 159-160.

Masters, K. (2018). Role development in professional nursing practice. Jones & Bartlett Learning.