Discussion: Treatment for a Patient With a Common Condition
Insomnia is one of the most common medical conditions you will encounter as a PMHNP. Insomnia is a common symptom of many mental illnesses, including anxiety, depression, schizophrenia, and ADHD (Abbott, 2016). Various studies have demonstrated the bidirectional relationship between insomnia and mental illness. In fact, about 50% of adults with insomnia have a mental health problem, while up to 90% of adults with depression experience sleep problems (Abbott, 2016). Due to the interconnected psychopathology, it is important that you, as the PMHNP, understand the importance of the effects some psychopharmacologic treatments may have on a patient’s mental health illness and their sleep patterns. Therefore, it is important that you understand and reflect on the evidence-based research in developing treatment plans to recommend proper sleep practices to your patients as well as recommend appropriate psychopharmacologic treatments for optimal health and well-being.
Reference: Abbott, J. (2016). What’s the link between insomnia and mental illness? Health. https://www.sciencealert.com/what-exactly-is-the-link-between-insomnia-and-mental-illness#:~:text=Sleep%20problems%20such%20as%20insomnia%20are%20a%20common,bipolar%20disorder%2C%20and%20attention%20deficit%20hyperactivity%20disorder%20%28ADHD%29
For this Discussion, review the case Learning Resources and the case study excerpt presented. Reflect on the case study excerpt and consider the therapy approaches you might take to assess, diagnose, and treat the patient’s health needs.
Case: An elderly widow who just lost her spouse.
Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications: A patient has come into your primary care office today, and their primary complaint is that they are having trouble sleeping. Patient is 75 years old and has diabetes, high blood pressure, and major depressive disorder as part of their PMH. Her husband of 41 years and 10 months had passed away previously. She claims that her depression and her sleeping patterns have both been significantly worse since then. The patient has no history of depression prior to the passing of her husband, and this is the first time she has experienced it. She is conscious, aware, and oriented three times over. Patients often visit their primary care physicians once or twice each year. Patient denies any suicidal ideations. Patient traveled here in his own vehicle today and arrived at the clinic.
Metformin 500mg BID
Januvia 100mg daily
Losartan 100mg daily
HCTZ 25mg daily
Sertraline 100mg daily
Current weight: 88 kg
Current height: 64 inches
Temp: 98.6 degrees F
By Day 3 of Week 7
Post a response to each of the following:
List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.
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.
Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.
List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.
List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant 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.
For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on ethical prescribing or decision-making. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals based on ethical prescribing guidelines or decision-making?
Include any “check points” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen givbcien your treatment options chosen.
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Do not confuse this with evaluation plan.
Posted on October 12, 2022 | by Linus | Leave a Commenton Do not confuse this with evaluation plan.
Submit the following section to DNP project faculty advisor (Blackboard):
• Project Methods- (~ 4-6 paragraphs) Detailed discussion of the plan for conducting the project. Introduce the project with broad overview including the site and population. Must be in APA format and include reference listing.
• Project Site Include description of site/ facility, location of project. Consider setting and context.
• Target Population
• Design Indicate the design you plan to use (it could be pre-posttest design, posttest only) and the translational or management framework that will guide your project.
• Project Plan (A step-by-step plan of what the project will entail. Write in a way that the project could be replicated.)
• Inputs: The resources that go into a program (including community partners, budget, personnel, potential team members, other resources….). Keep in mind that budget costs should include direct, indirect, and in-kind costs for the project. This should include cost for your project time as the project director. Please include table for budget and summarize in the narrative.
• Outputs: The activities the program undertakes. What are the key project activities. Do not confuse this with evaluation plan. That is separate (see below).
• Timeline: (Recommend use of a figure/Gantt chart) to illustrate and then discuss briefly in narrative.
• Measures: Write about how you intend to evaluate each objective. Make sure measures align with the objectives. If you are using a survey, state the reliability (with Cronbach’s alpha) and validity of the instrument. Attach a copy of the instrument. (Make sure you obtain permission to use the instrument, if needed, and state this in the proposal). Be sure to note if using organization’s internal database, reports, or dashboard.
• Data Analysis/ Evaluation Plan
Write a paragraph about what statistical software program and statistical tests will be employed to examine for change (if applicable). Align this with your objectives/ measures- how will you evaluate each one.
• Outcomes: The changes or benefits that you expect. This should include specific program outputs, demographic information, and program evaluation components such as anticipated health outcomes expected as a result of the program. Be sure that each expected outcome reported aligns with the project objectives.
• Plan for Sustainability: Note how your project involves a sustainable practice change that will be sustained even when you leave. Describe how the system, policy or process is modified to facilitate the adoption of the practice improvement initiative.
• Contingency Plan: Describe your plan A, B, and C (backup plan) in case your initial plan is not feasible.
• Impact on Practice and Policy: Potential Practice & Policy Implications- Consider how might this project impact practice and policy decisions… how might it help/impact others? Consider implications from some of the following perspectives- unit-based, organization wide, system wide, other settings (e.g., institutions, global.,)
• Summary/Conclusion (~1 paragraph)- Summarize the essence of your project proposal supporting discussion with evidence to strengthen the discussion. Focus on how using this evidence-based approach to address the practice problem has the potential to solve/ address the practice issue in this particular setting.
• References in APA format
(See Purdue Owl website for APA sample paper examples, no abbreviating journal titles)
Attached is an outline I made. Also, here is an essay Please follow the example of how the charts should look. APA FORMAT Here is the first two sections of my paper. All articles are attachbcied to the two previous orders
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Chapters basbcied upon selected theorist/theory
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Chapters basbcied upon selected theorist/theory
Textbook link: https://b-ok.xyz/book/22782454/11b5cd