WHAT I NEED IS 1 REPLY COMMENT PER POST, EACH COMMENT NEEDS TWO HAVE TWO APA REFERENCE ABOVE 2013 WITH CITATION.

POST1

The selected case for this discussion is case number five which involves sleepy woman with anxiety.

The three questions to ask the patient

a.  Does anxiety interfere with your ability to concentrate?

The choice for this question is based on the fact that anxiety can send one into a true tailspin of disruptive and irrational thinking which interferes with the ability to focus

b.  Which medication did you use for narcolepsy?

The question will help in determining if the drugs used to treat past narcolepsy was effective to avoid possible onset.

c.  Do you experience headache, dizziness, nausea, vomiting, constipation or dry mouth?

The question will help determine if the patient is responding positively to bupropion. These are some of the side effects of bupropion and therefore, persistent of these symptoms would mean the patient is not responding well to bupropion

The people in the patient’s life to speak to or get feedback from for further assessment of the patient’s situation

a.  The husband: How do you describe the sleeping pattern of your wife?

The question will help in determining if the patient is having sleeping disorder, that is, excessive sleep.

b.  Former class teacher: How do you describe the concentration of the patient while in class?

Lack of concentration is one of symptoms of sleep apnea and therefore, the question will determine if the patient has recurring sleep apnea.

The physical exams and diagnostic tests that would be appropriate for the patient and the use of the results

I will perform physical exam to look for signs and symptoms of anxiety such as nervousness, restlessness, panics, rapid heartrate and weakness and lethargy. The result will be used to determine severity of the anxiety disorder and consequently helps in selecting the most effective medication. I will also use the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). I will also use polysomnography to monitors heart, lung and brain activity, breathing pattern to help in ruling the presence of absence of sleep apnea (Mokhlesi  & Cifu, 2017).

The three differential diagnoses for the patient

The first differential diagnosis is anxiety disorder. The patient presents symptoms of anxiety such as excessive sleep during the day.

The second differential diagnosis could be sleep apnea. This order can make one to feel tired and unrefreshed. During the day, one may feel fatigued and experiencing difficulty concentrating or unintentionally fall asleep.  Further, obstructive sleep apnea   is the most likely differential diagnosis for this patient. This is because obstructive sleep apnea   is associated with excessive daytime sleep just like evidenced in the patient.

The third differential diagnosis is narcolepsy. The past medical history of the patients showed that she had been diagnosed with narcolepsy and therefore, it is possible that the patient has another onset of narcolepsy.

Hypersomnia is another possible condition of the patient because she is having or excessive sleepiness. The patient has trouble staying awake during the day.  Insomnia is another possible condition as the patient has daytime impairment related daytime sleepiness (Ardani  et al. 2016).

Two pharmacologic agents and their dosing appropriate for the patient’s sleep/wake therapy

The first pharmacologic agent that would be appropriate for the patient’s sleep/wake therapy by considering that the patient has narcolepsy is to start initial dosage of amphetamines at 10 mg orally per day in divided doses.  The medication will be used induce daytime alertness because the patient is experiencing excessive sleep which is a symptom of obstructive sleep apnea.   The second pharmacologic agent that would be appropriate for the patient’s sleep/wake therapy is gabapentin. The medication is useful in patients with restless leg syndrome and insomnia just like the patient in the case study. The dosage for gabapentin would be 600 mg orally once daily together with food (Schroeck et al. 2016).

Therapeutic changes and check point

The following for this client based on amphetamines dosage, the   daily dose will be raised in 10 mg increments at weekly intervals up to the point when the optimal response is achieved.

The “lessons learned” from the case study

One of the challenges in the case is to use effective drug to treat resistant anxious depression while taking into consideration excessive sleep symptoms. A comprehension of the electrophysiologic, as well as, neurochemical that correlates with the stages of sleep is necessary in defining sleep disorders. Just like evidenced in the patient, excessive daytime sleepiness is normally associated with disorders such as obstructive sleep apnea and depression.

References

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

Ardani, A. R., Saghebi, S. A., Nahidi, M., & Zeynalian, F. (2016). Does abstinence resolve poor sleep quality in former methamphetamine dependents?. Sleep Science (sao Paulo, Brazil), 9, 3.

Schroeck, J. L., Ford, J., Conway, E. L., Kurtzhalts, K. E., Gee, M. E., Vollmer, K. A., & Mergenhagen, K. A. (November 01, 2016). Review of Safety and Efficacy of Sleep Medicines in Older Adults. Clinical Therapeutics, 38, 11, 2340-2372.

Mokhlesi, B., & Cifu, A. S. (2017). Diagnostic Testing for Obstructive Sleep Apnea in Adults. Jama, 318, 20, 2035.

POST2

Case 1: Volume 2, Case #16: The woman who liked late-night TV

List three questions you might ask the patient if he or she were in your office. Provide a rationale for why you might ask these questions.

I would ask the following questions from the patient

1. How has your life changed after the death of your husband?

The case reveals that patient’s husband died many years ago. This is an open ended question to ask about changes in patient’s life after the death of her husband. May be she feels lonely, maybe she does not have someone to listen to her views. Spending such a life for years might have resulted in symptoms of depression. Social isolation affects behavioral health in elderly people. It contributes to depression and sleep disturbance (Choi, et al., 2015).

1. Do you feel stressful in your life?

Depression and sleep problems are often associated with stress. Sleep disturbances often occur during high-stress periods (Schlarb, et al., 2017). This question access if patient’s sadness and sleep issues are due to stress in her life. May be feels stressful about something in her life. May be to deal with stress she prefer to watch TC until late at night.

1. What do you feel about your cochlear implant?

The case reveal that patient has a chief complaint of being sad. She is also expected to have a cochlear implant in future. This question access if her sadness issue is related to her hearing issue. The answer to this question would reveal if patient’s hearing problem is the reason behind her sadness or there is something else.

Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.

I would ask specific questions and would take specific feedback from patient’s son. The case reveal that patient has a son who visits him often but does not live with her. Patient is 70-year-old, is elderly and has hearing issues. Asking the following questions from her son would be helpful to understand her problem in detail

1. Other than your father’s death, has anything tragic happened in your mother’s life?
2. Have you notices anything notable in your mother’s behavior over the past six months?
3. Do you think your mother hearing and sadness problems are interrelated?
4. Why you do not keep your mother with yourself?
5. Does your mother ever insist to take her with you?

The above mentioned questions would provide useful insight to evaluate the health condition, past life condition and social life of the patient. I would indicate when the patient’s problem started.

Patient is an elderly and wants support from her love one still her son does not live with him. The other person caring for patient is her aide and I would also ask from questions from her to access patient’s condition and underlying problems more accurately.

1. Since when you have been caring for the patient?
2. How does the patient behaves with you?
3. Have you noticed any changes in patient’s behavior over the past few months?
4. What do you think might be the cause of her sleeping and sadness issues?

These questions would help analyze the relationship between patient and her aide. Patient is taken care by her aide. At this point we do not know the behavior of her aide. These questions are important to access if aide is caring for her in the right manner or she is not taking care of the patient.

Explain what physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.

A complete physical exam would be performed for the patient. Patient has depression, sleeping problems and leg ache. Physical exam would help determine if physical problems or weakness are the underlying cause of these problems. An eye exam would also be performed during physical exam to access why the patient is having the issue of tears in her eyes. Her eye problem would be accessed and appropriate eye drops would be prescribed. Thyroid test would be important to access the level of thyroid hormone in the body. This is because thyroid hormonal level is found to have a relationship with depression (Dayan & Panicker, 2013). Iron level test would also be needed to identify if inadequate levels of iron in the body are causing of restless leg syndrome (Cochrane, 2016). DSM-5 criteria would be used to determine the patient’s mental health problem and diagnosis.

List three differential diagnoses for the patient. Identify the one that you think is most likely and explain why.

Based upon the signs and symptoms and patient’s condition revealed in the given case, following are the three differential diagnosis for the patient

Restless Legs Syndrome (RLS):

This condition also called Willis-Ekbom Disease causes unpleasant or uncomfortable sensations in the legs and an irresistible urge to move them. Symptoms commonly occur in the late afternoon or in evening hours, and are often most severe at night when a person is resting such as lying or sitting (Guo, et al., 2017). Symptoms may also occur when someone remains in an inactive position for a long period of time for instance when sitting in an airplane for long hour or watching a movie. The intensity of symptoms in increased during night time and therefore it is often difficult to sleep at night or return to sleep after waking up.

Restless leg syndrome is the most likely diagnosis for the patient. This is because patient has complaints of ‘ache and jump’ and due to this condition she is unable to fall asleep at night.

Insomnia:

Insomnia is the most common sleep complaint. This condition occur when someone has trouble falling asleep or staying asleep even though he has the opportunity to get a full night of sleep. The symptoms, causes and severity of insomnia vary from person to person. Symptoms of the condition may include difficulty falling asleep; waking up too early in the morning; difficulty staying asleep throughout the night (Singh, 2016). In the current case, patient reports problem with sleeping, she has difficulty falling asleep at night. Therefore, the differential diagnosis for insomnia is included.

Obstructive Sleep Apnea (OSA):

This is a potentially serious sleep disorder. It causes breathing to repeatedly stop and start during sleep. There are several types of sleep apnea, but the most common type is obstructive sleep apnea. This condition occurs when the throat muscles intermittently relax and block the airway during sleep. A noticeable sign of obstructive sleep apnea is snoring (Foroughi, et al., 2016).

In the current case, patient might also be suffering from this disorder because she reported snoring during sleep.

At this point, it can be inferred that patient is having comorbid medical conditions including restless leg syndrome and obstructive sleep apnea. These two conditions are affecting her sleep pattern and due to lack of quality sleep she might be having depressive symptoms. Sleep problems often result in depressive problems (Luca et al., 2013)

List two pharmacologic agents and their dosing that would be appropriate for the patient’s sleep/wake therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.

The two pharmacologic agents that would be appropriate for the patient include:

1. modafinil
2. Mirapex

Modafinil is a wake-promoting agent approved for the treatment of excessive sleepiness associated with shift work disorder, obstructive sleep apnea (OSA) and narcolepsy (Stahl, 2014). This drug would be helpful for patient in controlling her problem of obstructive sleep apnea (OSA) that is causing her issues of snoring. The current dose of modafinil prescribed to the patient is 400 mg/day. This dose is the full dose. However, I would not prescribe full dose to the patient considering her age and possible side effects of the medicine at full dose.

Mirapex is prescribed for treatment of restless legs syndrome and Parkinson’s disease. The medicine can improve symptoms of restless legs syndrome and Parkinson’s disease and can improve sleep (Stahl, 2014). The medicine should be started at lowest dose (0.125 mg) and increased necessary every 5 to 7 days until symptoms are controlled (Stahl, 2014). Therefore, for the treatment of RLS, Mirapex would be prescribed to the patient.

If your assigned case includes “check points” (i.e., follow-up data at week 4, 8, 12, etc.), indicate any therapeutic changes that you might make based on the data provided.

A potential mistake or medical prescription error I noted in the case was that at second interim follow up Celexa was increased to 30 mg/day. However, maximum dose of Celexa for elderly is 20 mg/day (Stahl, 2014). Considering the age of patient, I would have not increased the dose to 30 mg/day. Another issue that I noted in the case was that patient did not agree for CPAP in repeated visits. I would have researched for new generation CPAP equipment and would have motivated the patient for CPAP treatment.

Explain “lessons learned” from this case study, including how you might apply this case to your own practice when providing care to patients with similar clinical presentations.

Through the case study I learnt how the symptoms of multiple conditions overlap and create difficulty for patient’s to cope up with the symptoms. This case also though to how to use polypharmacy for patients suffering from a number of sleep problems. In the current case, patient has suffering from restless leg syndrome and obsessive sleep apnea. For OSB, CPAP treatment was recommended for the patient which she denied. If I would be in a similar situation in my clinical practice, I would try to convince my patient for CPAP treatment. If however, patient would not agree then I would consider other treatment options.

                                                                                                            References

Choi, H., Irwin, M. R., & Cho, H. J. (2015). Impact of social isolation on behavioral health in elderly: Systematic review. World Journal of Psychiatry, 5(4), 432-436. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4694557/

Cochrane. (2016). Iron for restless legs syndrome. Retrieved from https://www.cochrane.org/CD007834/MOVEMENT_iron-for-restless-legs-syndrome

Dayan, C. M., & Panicker, V. (2013). Hypothyroidism and depression. European Thyroid Journal, 2(3), 168-179. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017747/

Foroughi, M., Razavi, H., Malekmohammad, M., Naghan, P. A., & Jamaati, H. (2016). Diagnosis of Obstructive sleep apnea syndrome in adults: A brief review of existing data for practice in Iran. Tanaffos, 15(2), 70-80. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5127617/

Guo, S., Huang, J., Jiang, H., Han, C., Li, J., Xu, X., & Wang, T. (2017). Restless Legs Syndrome: From pathophysiology to clinical diagnosis and management. Frontiers in Aging Neuroscience, 9(1), 171-182. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5454050/

Luca, A., Luca, M., & Calandra, C. (2013). Sleep disorders and depression: Brief review of the literature, case report, and nonpharmacologic interventions for depression. Clinical Interventions in Aging, 8(1), 1033-1042. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3760296/

Schlarb, A. A., Claßen, M., Grünwald, J., & Vögele, C. (2017). Sleep disturbances and mental strain in university students: Results from an online survey in Luxembourg and Germany. International journal of mental health systems, 11(1), 24-29. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372247/

Singh, P. (2016). Insomnia: A sleep disorder: Its causes, symptoms and treatments. International Journal of Medical and Health Research, 2(10), 37-41.

Stahl, S. M. (2014). The prescriber’s guide. New York, NY: Cambridge University Press. Retrieved from https://stahlonline-cambridge-org.ezp.waldenulibrary.org/prescribers_drug.jsf?page=9781316618134c114.html.therapeutics&name=SERTRALINE&title=Therapeutics

Prepare a 10-minute presentation (10-15 slides, not including title or reference slide) on organizational culture and values.

1. Describe how alignment between the values of an organization and the values of the nurse impact nurse engagement and patient outcomes.
2. Discuss how an individual can use effective communication techniques to overcome workplace challenges, encourage collaboration across groups, and promote effective problem solving. Incorporate how system needs and the culture of health may influence the outcomes. How does this relate to health promotion and disease prevention in the larger picture?
3. Identify a specific instance from your own professional experience in which the values of the organization and the values of the individual nurses did or did not align. Describe the impact this had on nurse engagement and patient outcomes.

Solid academic writing is expected and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

Discussion 

There are many factors that affect chronic illness—chronic pain, stigma, social isolation, altered mobility, or fatigue. Utilizing your learning from your readings and the South University Online Library resources, respond to one the following questions:

• Based on the research, which of these factors have the greatest impact on a patient? Why? Contrast at least two ways the factors would affect a twelve-year-old with the way they would affect a seventy-five-year-old.
• Consider the twelve-year-old and the seventy-five-year-old have a chronic illness. How does the chronically ill patient’s illness trajectory influence the plan of care?
• Review Healthypeople.gov website. Discuss how you feel these goals will impact the health of the nation. Briefly discuss how you could incorporate these goals/objectives into your day-to-day nursing practice.

Citations should conform to APA guidelines. You may use this APA Citation Helper as a convenient reference for properly citing resources or connect to the APA Style website through the APA icon below.

 CASE STUDY 3: Focused Ear Exam Martha brings her 11-year old grandson, James, to your clinic to have his right ear checked. He has complained to her about a mild earache for the past 2 days. His grandmother believes that he feels warm but did not verify this with a thermometer. James states that the pain was worse while he was falling asleep and that it was harder for him to hear. When you begin basic assessments, you notice that James has a prominent tan. When you ask him how he’s been spending his summer, James responds that he’s been spending a lot of time in the pool

 

Nurses conducting assessments of the ears, nose, and throat must be able to identify the small differences between life-threatening conditions and benign ones. For instance, if a patient with a sore throat and a runny nose also has inflamed lymph nodes, the inflammation is probably due to the pathogen causing the sore throat rather than a case of throat cancer. With this knowledge and a sufficient patient health history, a nurse would not need to escalate the assessment to a biopsy or an MRI of the lymph nodes but would probably perform a simple strep test.

In this Case Study Assignment, you consider case studies of abnormal findings from patients in a clinical setting. You determine what history should be collected from the patients, what physical exams and diagnostic tests should be conducted, and formulate a differential diagnosis with several possible conditions.

To Prepare

• By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
• Also, your Case Study Assignment should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP Notes have specific data included in every patient case.

With regard to the case study you were assigned:

• Review this week’s Learning Resources and consider the insights they provide.
• Consider what history would be necessary to collect from the patient.
• Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
• Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

The Assignment

Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis and justify why you selected each.

5 references not more than 5 years

Zero plagiarism

 

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Chapter 11, “Head and Neck”

This chapter reviews the anatomy and physiology of the head and neck. The authors also describe the procedures for conducting a physical examination of the head and neck.
Chapter 12, “Eyes”

In this chapter, the authors describe the anatomy and function of the eyes. In addition, the authors explain the steps involved in conducting a physical examination of the eyes.
Chapter 13, “Ears, Nose, and Throat”

The authors of this chapter detail the proper procedures for conducting a physical exam of the ears, nose, and throat. The chapter also provides pictures and descriptions of common abnormalities in the ears, nose, and throat.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.

Allied health professionals are confronted with different death and dying practices. An effective allied health professional recognizes the importance of understanding different cultural practices, and learns how to evaluate the death, dying, and spiritual beliefs and practices across the cultures.

Read the two specified case histories and choose one for this assignment.

Chapter 4, “Stories of Abby: An Ojibwa Journey” and Chapter 14, “Stories of Shanti: Culture and Karma,” by Gelfland, Raspa, and Sherylyn, from End-of-Life Stories: Crossing Disciplinary Boundaries (2005), from the GCU Library.

Identify your role as a health care professional in supporting Abby’s or Shanti’s dying rituals, and in creating strategies for displaying respect while still providing quality care. Identify communication strategies necessary in caring for your select person. Integrate your strategies as you develop a care plan describing how you would approach the situation and care for the patient. Review the “Care Plan” template prior to beginning.

Include the following in your care plan:

1. Communication: family and patient
2. Treatment options that align with the specific culture
3. Education: family and patient
4. Family roles in the process
5. Spiritual beliefs
6. Barriers
7. Cultural responses
8. Any additional components that you feel would need to be addressed (from your perspective as a health care professional)

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

You are not required to submit this assignment to LopesWrite.