Bipolar Disorder Depressed 2

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Bipolar Disorder Depressed

Depression in people with bipolar illness (BD) poses significant clinical difficulties. Depression, the most common psychopathology even in BD that has been treated, is linked to excess morbidity, mortality from co-occurring general medical illnesses, and a high risk of suicide. Risks for cardiovascular disease, metabolic syndrome, diabetes, and other medical conditions, as well as the accompanying mortality rates, are many times higher in BD than in the general population or those with other psychiatric conditions (Baldessarini et al., 2020). The likelihood of suicide among people with BD is 20 times higher than the rate for the general population and is higher than the rate for those with other severe psychiatric conditions. In BD, hospitalization, time spent depressed, and mixed and depressive phases are all highly linked to suicide. (Bipolar Disorder Depressed 2)

Bipolar Disorder Depressed 2

Signs And Symptoms

Patients with BD frequently fear, try to avoid, report, and seek therapeutic assistance for depression. On the other hand, they might not regard little improvements in mood, vigor, activity, or libido as clinically significant hypomanic symptoms and might even enjoy such states (Barney, 2022). Diagnostic ambiguity is pervasive early in the illness and the absence of corroborating information from a family member or close friend. Initially undiagnosed, bipolar disorder (BD) is characterized by recurrent bouts of mania or hypomania that alternate with depressive episodes (Barney, 2022). Bipolar disorder’s depression phase can cause people to feel down, anxious, or empty, have little to no energy, feel like they cannot enjoy anything, sleep too little or too much, struggle to get out of bed, eat too little or too much, struggle to concentrate or remember things, struggle to make decisions, and even consider suicide or death. People may experience some or all of these symptoms. Bipolar disorder patients can experience extreme sadness and high energy levels (Barney, 2022). Those who experience depression for an extended period, often at least two weeks, are more likely to be in the depressive phase of BD. Patients may experience these episodes infrequently or frequently each year. (Bipolar Disorder Depressed 2)

Pharmacological Treatments

Pharmacological treatment for bipolar disorder depressed includes FDA-approved drugs such as olanzapine and fluoxetine (OFC), quetiapine, lurasidone, cariprazine, and lumateperone. Other common BD-D treatments include classic mood stabilizers and antipsychotics (Yalin & Young, 2020). The first medication that the US FDA expressly approved to treat BD-D was OFC. While treating BD-D, lurasidone is taken alone or in conjunction with lithium or valproate. Cariprazine lessens the symptoms of depression. Recently, lumateperone was licensed for treating depression in either BD-I or BD-II disorder as a monotherapy or as an additional therapy with lithium or valproate. Lithium is beneficial in the short-term management of mood and prevention of mania, and it may be especially effective in a subset of patients (Yalin & Young, 2020). Asenapine, risperidone, clozapine, aripiprazole, and ziprasidone have not received FDA approval. (Bipolar Disorder Depressed 2)

Nonpharmacological Treatments

Common nonpharmacological treatments for BD-D are electroconvulsive therapy and cognitive-behavioral therapy. Electroconvulsive therapy (ECT) delivers a rapid clinical reaction and can be utilized in urgent clinical conditions, including suicidal behaviors, severe psychosis or catatonia (Levenberg & Cordner, 2022). Patients with BD-D typically notice improvement after seven ECT sessions, while the number of sessions required varies considerably. There is a relatively minimal probability of negative side effects with psychotherapy. Pharmaceutical therapy is supplemented by cognitive behavioral therapy (CBT). CBT has been linked to decreased BD-D relapse rates and improved depressive symptoms. (Bipolar Disorder Depressed 2)

Appropriate Community Resources and Referrals

NAMI and NAMI Affiliates provide people with information about various community resources and support on an individual and family level. For questions concerning bipolar disorder and available resources, contact the NAMI HelpLine at 1-800-950-NAMI (6264) or info@nami.org. The Depression and Bipolar Support Alliance (DBSA) is a national nonprofit that assists people with depression and bipolar mood disorders. The group also provides a support system for parents of kids who have pediatric mood disorders. Assistance is provided through local chapter meetings and online tools like educational videos, discussion forums, and support groups. The American Academy of Child and Adolescent Psychiatry (AACAP) is a prestigious nonprofit group of doctors and other mental health specialists committed to assisting kids, teenagers, and families experiencing mental, behavioral, or developmental issues. The AACAP offers information for parents on its website, including a link to a local pediatric and adolescent psychiatrist. (Bipolar Disorder Depressed 2)

References

Baldessarini, R. J., Vázquez, G. H., & Tondo, L. (2020). Bipolar depression: a major unsolved challenge. International journal of bipolar disorders, 8(1), 1. https://doi.org/10.1186/s40345-019-0160-1

Barney, A. (2022). Depression in Bipolar Disorder: What You Can Do.https://www.webmd.com/bipolar-disorder/guide/depression-symptoms

Levenberg, K., & Cordner, Z. A. (2022). Bipolar depression: a review of treatment options. General Psychiatry, 35(4).

Yalin, N., & Young, A. H. (2020). Pharmacological Treatment of Bipolar Depression: What are the Current and Emerging Options?. Neuropsychiatric disease and treatment, 16, 1459–1472. https://doi.org/10.2147/NDT.S245166

 
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Letter of Analysis 2

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Letter of Analysis 2

(Letter of Analysis 2)

Dear Student,

I went through your classical argument and identified the following:

Reflection

You have written a paper on the importance of communication in clinical practice, the consequences of poor communication, and strategies that can be adopted to enhance communication among interdisciplinary teams. Communication is critical in care coordination and general healthcare delivery and is integral to accomplishing patient care objectives. There is a direct link between communication and healthcare outcomes, increasing the need to adopt evidence-based strategies, including a standardized checklist, participating in simulation-based training, and providing education on the communication process you shared to improve the effectiveness of interdisciplinary teams. (Letter of Analysis 2)

Letter of Analysis 2

Praise

Thesis

Your thesis is focused and well developed throughout the paper. The essay focuses on the importance of communication in the clinical environment and the consequence of communication failure. The thesis highlights the problem statement indicating that not all members are involved in communication currently, the interventions to enhance communication, including using a standardized checklist, participating in simulation-based training, and providing education on the communication process to every member, and the outcome, which is improved communication among interdisciplinary team members. These thesis elements are sustained throughout the paper, with supported information from current, peer-reviewed studies. You did well in this section, and you achieved your stated purpose. (Letter of Analysis 2)

Idea Development

I was also impressed with your idea development corresponding to the thesis. Your reasoning is clear and logical, and every statement and point developed or argument brought forward is well-thought and convincing. Regarding idea development, I am convinced you did a proper job, which helped sustain the thesis elements throughout the paper and deliver a compelling argument. (Letter of Analysis 2)

Recommendations

However, I have concerns about some elements of writing that you need to improve to become a better academic writer. You have a proper idea development, but your rhetorical arrangement, paragraph organization, and transitions within the paragraphs need improvement. (Letter of Analysis 2)

Organization/Rhetoric Arrangement

Although the ideas are well developed, the organization is flawed and sometimes fails to support the focus and unify the ideas in your essay. The organization contains gaps that, if addressed, would make the essay more aesthetic and free-flowing. Notably, the heading levels do not follow the APA style. The level one headings in a classical argument are the introduction, background, body (argument), opposition, refutation, and conclusion. I am more interested in the body section of the paper. Based on your thesis and main ideas, the interventions shared are subtopics within the body section and should be developed as level two headings rather than level one. Also, it is vital to use heading levels provided in word to specify level one and level two headers. (Letter of Analysis 2)

Paragraph Organization and Transition

Additionally, your paragraph organization and transition within the paragraphs are a major concern. Often, a paragraph has a topic sentence, evidence, critical thinking, and a transition, meaning that a paragraph requires at least four sentences. Some paragraphs have less than four sentences and do not follow the basic paragraph model. For instance, paragraphs one and two have three sentences. Paragraph four has two sentences, while paragraph nine has three sentences. Your paragraphs should follow the basic model to be more convincing and make your essay more robust. Also, you mention research studies in some paragraphs without in-text citations, such as in paragraphs one, three, and five. Your refutation paragraph is not evidence supported. Notably, most of your citations are indicated at the end of the paragraph instead of within the paragraph and at the end of the evidence sentence (s). Proper citations would make your work more credible and reliable. (Letter of Analysis 2)

Strategies for Improvement

Based on these concerns, I would advise that your review essay structuring or rhetoric organization and paragraph structuring and transition notes provided by the instructors.

Organization and Rhetoric Arrangement

To improve essay structure:

  1. The Paragraph Shuffle: Create a set of index cards, with one card for each paragraph in your essay. Write one idea per index card. If you have multiple ideas in each paragraph, write the second (and third, etc.) idea on a separate card. Now, shuffle the cards. Inspect the order. Try rearranging the cards to deliver your focus, ideas, and overall message more effectively.
  2. Color the Categories: Use a highlighter to separate your ideas into categories. Use one color highlighter to mark all your sentences within one category in your essay. Use a different color to code the second category, etc. Now organize your essay into matching colors/categories (Letter of Analysis 2)

Paragraph Organization and Transition

To improve paragraph structuring and transition within paragraphs, I recommend:

  1. Basic Paragraph Model: Use this paragraph model to ensure your body paragraphs are developed and organized so that readers can clearly understand the relationship between your ideas and the progression of your thoughts.
    1. Topic Sentence: States the main idea of this paragraph and shows how it supports the thesis
    2. Evidence: Expert opinion, example, fact, statistical, or logical argument
    3. Critical Thinking: Analyzes, synthesizes, and/or evaluates the evidence
    4. Transition: Make a connection between the main idea of this paragraph, the paper’s thesis statement, and the next paragraph’s main point.
  2. Transition Test: Q & A
    1. Look at the last sentence of your body paragraph.
    2. Write three questions about your main idea. Begin each question with how, why, or what.
    3. Now look at the first sentence of the following paragraph–does it answer or respond to any of those implied questions? If not…
    4. Write the answer to the question…
    5. That answer may fit the first sentence of your paragraph that already exists.
    6. OR! You may need to create another new paragraph.

Generally, the argument is thought-provoking and encouraging and puts forward a genuine concern in the healthcare environment, impacting the effectiveness of interdisciplinary teams and patient health outcomes. Your essay/academic writing level is recommendable in terms of thesis development, sustaining the thesis throughout the paper, and idea development.  (Letter of Analysis 2)

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3990376/#:~:text=Good%20communication%20between%20nurses%20and,demonstrating%20courtesy%2C%20kindness%20and%20sincerity.

 
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Letter of Analysis 3

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Letter of Analysis 3

Letter of Analysis 3

Dear Student, (Letter of Analysis 3)

I went through your classical argument and identified the following:

Praise

Your thesis or focus of the paper is clear and well developed, and sustained throughout the paper. The essay focuses on the importance of communication in the clinical environment and the consequence of communication failure. The thesis highlights the problem statement indicating that not all members are involved in communication currently, the interventions to enhance communication, including using a standardized checklist, participating in simulation-based training, and providing education on the communication process to every member, and the outcome, which is improved communication among interdisciplinary team members. These thesis elements are sustained throughout the paper, with supported information from current, peer-reviewed studies. You did well in this section, and you achieved your stated purpose. I was also impressed with your idea development corresponding to the thesis. Your reasoning is clear and logical, and every statement and point developed or argument brought forward is well-thought and convincing. Regarding idea development, I am convinced you did a proper job, which helped sustain the thesis elements throughout the paper and deliver a compelling argument. (Letter of Analysis 3)

Recommendations

However, I have concerns about some elements of writing that you need to improve to become a better academic writer. Your thesis and idea development is proper, but your organization or rhetorical arrangement, paragraph organization, and transitions within the paragraphs need improvement. Although the ideas are well developed, the organization is flawed and sometimes fails to support the focus and unify the ideas in your essay. The organization contains gaps that, if addressed, would make the essay more aesthetic and free-flowing. Notably, the organization does not attend to the APA style regarding heading levels. The level one headings in a classical argument are the introduction, background, body (argument), opposition, refutation, and conclusion. I am more interested in the body section of the paper. Based on your thesis and main ideas, the interventions shared are subtopics within the body section and should be developed as level two headings rather than level one. Also, it is vital to use heading levels provided in word to specify level one and level two headers. (Letter of Analysis 3)

Your paragraph organization and transition within the paragraphs are a major concern. Often, a paragraph has a topic sentence, evidence, critical thinking, and a transition, meaning that a paragraph requires at least four sentences. Some paragraphs have less than four sentences and do not follow the basic paragraph model. For instance, paragraphs one and two have three sentences. Paragraph four has two sentences. Paragraph nine has three sentences. Your paragraphs should follow the basic model to be more convincing and make your essay more robust. Also, you mention research studies in some paragraphs without in-text citations, for instance, in paragraphs one, three, and five. Your refutation paragraph is not evidence supported. Notably, most of your citations are indicated at the end of the paragraph instead of within the paragraph and at the end of the evidence sentence (s). Proper citations would make your work more credible and reliable. (Letter of Analysis 3)

Strategies for Improvement

Based on these concerns, I would advise that your review essay structuring or rhetoric organization and paragraph structuring and transition notes provided by the instructors. To improve essay structure:

  1. The Paragraph Shuffle: Create a set of index cards, with one card for each paragraph in your essay. Write one idea per index card.  If you have more than one idea in each paragraph, write the second (and third, etc.) idea on a separate card.  Now, shuffle the cards.  Inspect the order.  Try rearranging the cards to deliver your focus, ideas and overall message more effectively.
  2. Color The Categories: Use a highlighter to separate your ideas into categories. Use one color highlighter to mark all of your sentences dealing with one category in your essay. Use a different color to code the second category, etc. Now organize your essay into matching colors/categories (Letter of Analysis 3)

To improve paragraph structuring and transition within paragraphs, I recommend:

  1. Basic Paragraph Model: Use this paragraph model to make sure your body paragraphs are developed and organized so that readers can clearly understand the relationship between your ideas and the progression of your thoughts.
    1. Topic Sentence: states the main idea of this paragraph and shows how it supports the thesis
    2. Evidence: expert opinion, example, fact, statistical, or logical argument
    3. Critical Thinking: analyzes, synthesizes and/or evaluates the evidence
    4. Transition: makes a connection between the main idea of this paragraph, the thesis statement of the paper, and the main point of the next paragraph. (Letter of Analysis 3)
  2. Transition Test: or Q & A
    1. Look at the last sentence of your body paragraph.
    2. Write three questions about your main idea. Begin each question with how, why, or what.
    3. Now look at the first sentence of the following paragraph–does it answer or respond to any one of those implied questions? If not…
    4. Write the answer to the question…
    5. That answer may fit as the first sentence of your paragraph that already exists.
    6. OR! You may need to create another new paragraph. (Letter of Analysis 3)

References

https://www.academia.edu/6911544/THESIS_WRITING_GUIDE

 
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Communication is Key

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Communication is Key

Teamwork is an essential component of providing quality care for patients. Being a part of a team means using different tools to best interact with other members of the health care team. Members of the health care team often work in different departments, have different leadership, and receive different levels of education on how to interact as a team. A recent review of reports collected by the Joint Commission reveal the startling statistic that over 70 percent of sentinel events share a common root cause; communication failures of the team. (Communication is Key)

Currently, members of the health care team consist of many different people, with various roles, who receive various training on working together. If members of a very important team aren’t able to communicate with each other, the potential for poor patient outcomes rises.  Since communication education currently does not involve all members of the team, utilizing a standard checklist, participating in simulation based training, and providing education of communication processes to all team members can promote better communication amongst interdisciplinary members of the team. (Communication is Key)

Communication is Key

Background

Recently, the Institute for Safe Medication Practices (ISMP) published an article citing the most common reasons for medication errors.  In that list, communication failures surrounding verbal/oral orders was listed as the 4th highest reason for errors.  This article was posted in January of 2020, less than 3 years ago.  For many years, the existence of the electronic medical record and tools, such as checklists, have been available to use, yet not all members of the team utilize resources that could potentially entrance communication, thus leading to better care. (Communication is Key)

The growing number of literature available suggests that poor communication (especially between physician and primary nurse) is a significant contributor to negative patient outcomes. In one study, highlighting the ICU, poor collaborative communication between the nurse and physician boasted a 1.8 percent increase in length of stay (Zwarenstein & Reeves, 2002).

Standardized Checklist

Communication is Key

The use of a standardized checklist for communication amongst team members is one that is already utilized in both the field of aviation and health care. Checklists are often found in high stakes areas, where missing a step could be critical to the overall mission, or patient care goal. In one high stakes setting, post anesthesia care unit (PACU), a communication tool was implemented by the bedside nursing team. The PACU was experiencing a drop in information from the operating room to the PACU, leaving the nursing team with a feeling of lack of information. Bedside nurses were getting report from a member of the anesthesia team but, not the surgical team, again leaving the team responsible for assessing the patient with no communication of what to expect or even what they did. (Communication is Key)

The PACU nursing team enacted a simple bedside checklist to standardize information that would be useful for any patient visiting the PACU. This allowed for the information to be given in a quick, concise method. This checklist was adopted by the nursing team and then provided to the surgical and anesthesia teams to circulate. A copy of the checklist was laminated and kept in each bay, for quick reference. Although patient outcomes were not able to be quantified from this method, the PACU council conducted an audit after 30 days and reported a perceived better handoff from surgery. PACU nurses reported less distractions in report and felt that they obtained better assessment data about their patient (Sapikowski, et al 2022).

Simulation Based Training

Currently, hospital staff are provided education in a traditional method.  Staff complete mandatory training, utilizing computer based, self paced/study modules. Providers and members alike all have to work together in real time yet, are trained in a siloed, isolated environment. In one recent study, a review of different education provided to all members of an intensive care team; perceived communcication improvement amongst the members was shown upon review of a simulation based training tool. Team members were able to role play difficult patient care scenarios and were instructed to provide feedback in real time. Members were given roles to play and a mediator led the training. (Communication is Key)

Evaluation of this was completed by utilizing a pre and post survey of perceived communication improvement.  Of note, this study involved not only nurses and physicians but, chaplains, social workers, and techs as well. Amongst nursing, perceived communication was improved surrounding nurse to nurse communication. No physicians returned the request for post survey information, leaving many questions to be unanswered (Fettig et all, 2022).

Education for All

Transitioning from the previous section, education provided for all members of the health care team could be considered to improve communication amongst the health care team. Members of the team work in a variety or roles, yet don’t all receive training or even know what type of training the other party has. One study done in the ICU setting revealed that current interventions surrounding collaborative communication are not being provided or encouraged (Boyle & Koshinda, 2004). This is a stepping stone to start the conversation with senior leadership on how improvements surrounding interdisciplinary collaboration and collaborative education can lead to better patient outcomes. (Communication is Key)

Barriers

Barriers cited have included logistical challenges to getting an interdisciplinary team together.  Scheduling challenges and location of departments were cited by both the nursing and ancillary teams that participated in the simulation based training mentioned previously. Costs associated with enacting sweeping changes to the current education program is a factor to implementation.

Refutation

Logistical challenges will always be a factor that provides limitations on gathering a large team together in one location. However, simulation based training or training in general doesn’t have to be in person. We learned over the course of the pandemic that almost anything can be done virtually. There is opportunity to think outside of traditional educational offerings and get creative. Costs associated is also a factor that could be calculated with a return on investment over time, seeing the date (or numbers) may help influence key stakeholders of the value of their investment. (Communication is Key)

Conclusion

            Working as a team means communicating, sharing, and providing all the members with all the information needed to be set for success. In the health care setting, high stakes can mean high tensions, leading to an environment of lack of communication and collaboration.  As evidenced by the studies cited, having a standard checklist, providing simiulation based training, and ensuring all team members have access to education, perceived communication enhancement amongst team members has been shown.  All leading towards the goal of providing the best patient care we can. (Communication is Key)

References

Hospital: 2023 national patient safety goals. The Joint Commission. (n.d.). Retrieved March 19, 2023, from https://www.jointcommission.org/standards/national-patient-safety-goals/hospital-national-patient-safety-goals/

Fettig, L., Tang, Q., Newton, E., Rosario, R., Matthias, M. S., & Torke, A. M. (2022). A Communication Skills Training Workshop to Improve ICU Team Relational Coordination about Goals of Care: A Pilot Study. The American journal of hospice & palliative care, 39(10), 1157–1164. https://doi.org/10.1177/10499091211069994

Sapikowski, L., Bullock, K., Walsh, J., & Alexander, C. (2022). Implementation of a PACU pause in a Pediatric Post Anesthesia Care Unit. Journal of PeriAnesthesia Nursing, 37(4). https://doi.org/10.1016/j.jopan.2022.05.032

ISMP publishes top 10 list of medication errors and hazards covered in newsletter. Institute For

Safe Medication Practices. (2020, January 17). Retrieved March 19, 2023, from

https://www.ismp.org/news/ismp-publishes-top-10-list-medication-errors-and-hazards-

covered-newsletter

 
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Consumer Health Information Website Analysis Paper

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Consumer Health Information Website Analysis Paper

(Consumer Health Information Website Analysis Paper)

The world is in an information age as consumers seek more information to understand products, including health products. Concurrently, more information is available about health on multiple online sources, readily available to everyone with internet access. However, the credibility of the information varies because most people present as health experts on their websites, providing health information and advice without supporting evidence or authority (NIH, 2023). Most websites are for sale, and only a few provide authentic and evidence-based information for educational purposes. This paper addresses diabetes mellitus and analyzes a website offering information on diabetes mellitus, including its authority, credibility, and adequacy.

Consumer Health Information Website Analysis Paper

Diabetes Mellitus

Diabetes mellitus is a metabolic illness that involves abnormally high glucose levels. It is a chronic disease occurring due to impaired insulin secretion, resistance to insulin peripheral actions, or both (Xu et al., 2018). Diabetes mellitus significantly impacts the quality of life and can damage other body organs and systems, making individuals disabled and living with multiple health complications like retinopathy, nephropathy, and neuropathy (Liu et al., 2020). Diabetes increases the risk of macrovascular complications two to four times, making an individual more susceptible to cardiovascular diseases. (Consumer Health Information Website Analysis Paper)

Diabetes mellitus is classified into type 1 diabetes, type 2 diabetes mellitus, and gestational diabetes. Type 1 diabetes is marked by autoimmune damage of insulin-producing beta cells in the pancreas, resulting in insulin deficiency (Sapra & Bhandari, 2022). It can develop at any stage of life but is more common among children and adolescents. Type 2 diabetes mellitus accounts for 90% of all diabetes mellitus cases, and its etiology is linked to insulin resistance (Sapra & Bhandari, 2022). Type 2 diabetes mellitus is more common among adults, particularly those above 45 years old, although cases are increasing among children and young adults due to sedentary lifestyles and calorie-dense foods. Gestational diabetes occurs during pregnancy due to hyperglycemia (Sapra & Bhandari, 2022). Risk factors include age, ethnicity, family history of diabetes, physical inactivity, obesity, and smoking. (Consumer Health Information Website Analysis Paper)

Consumer Health Information Website Analysis Paper

Website Description and Analysis

The American Diabetes Association (ADA) website provides information, services, and support to ensure a life free of diabetes and associated burdens or consequences. The organization’s mission is to prevent and cure diabetes and enhance people’s lives (ADA, n.d.). The organization owning the website fund research towards diabetes prevention, cure, and management, delivers associated services to American communities, offers objective and credible information, and gives voice to those facing denied rights due to diabetes.

Overall, the web pages are well arranged with working buttons to navigate the website from one page to another. The pages are visible at the top of the websites, and the reader can easily go to the webpage they are interested in. It is easy to find information. The website provides previews for the various elements and a “Learn More” or “Get Started” button that directs the reader to more information about a particular topic. The website is not text-dense and easy to read. If the reader requires more information, they can click the “Learn More” or “Get Started” button. The colors contrast perfectly, and the fonts are large enough, making reading easy. The website looks professional. The only issue is the pop-ups about donating that come up every time the website is refreshed or opened again. (Consumer Health Information Website Analysis Paper)

The American Diabetes Association sponsors the websites. It has memberships who donate to the websites, but anyone is open to donating. The website is updated annually, but it can be more frequent when new information, evidence, or regulatory changes are made, and it has to incorporate them (ADA, n.d.). The website was created in 1995. It was last updated as recently as December last year. The website does not state whether the content is medical advice or not. All Americans comprise the intended audience because it provides information to prevent, treat, cure, and manage diabetes. It also specifically targets medical professionals, community groups, and students with the latest diabetes research and treatment and general information to enhance awareness, knowledge, and attitudes regarding diabetes prevention, cure, and management (ADA, n.d.). The information presented is appropriate for the general public and people of all ages and ethnicities. (Consumer Health Information Website Analysis Paper)

Information Credibility

Authority

Behind the American Diabetes Association, which sponsors the website, is a network of over 565,000 volunteers, including their families and caregivers and a professional society of over 12,000 healthcare professionals and 250 staff members (ADA, n.d.). Professionals working with ADA have the expertise and authority to publish information on the websites in various forms, including panel discussions and research. ADA network of professionals offers exclusive education, career development, engagement resources, and other information and education materials for the diverse audience of the general public and healthcare professionals (ADA, n.d.). The website publishes journals providing necessary research information related to diabetes. Readers can access multiple abstracts, which also include the authors’ information and the various institutions they are affiliated with. Many are affiliated with universities and medical institutions, and some are members of the ADA research community, giving them credibility to conduct research and publish information on the website. The website does not offer a place to contact the authors, but it has a center for information where readers can leave or post their inquiries. (Consumer Health Information Website Analysis Paper)

Bias

The website’s authors are multiple, and most publications are new updates on diabetes and research journals. There are publications on general health information, including food and nutrition, weight loss criteria, health and wellness, and diabetes care products, without mentioned authors, only the date when they were last updated (ADA, n.d.). The website is professional and does not indicate any form of bias in the information published. The publications are not promoting any products but offer information to help people prevent, cure, and manage diabetes, including information on lifestyle choices that enhance the quality of life.

Supporting Evidence

ADA website is a professional one with various types of publications. Some publications provide general information on various topics without reference lists indicating supporting evidence. On the other hand, there are journals or research publications available as abstracts for the general public, but full articles can be accessed only by members (ADA, n.d.). The journals have a complete list of works cited, referencing credible and authoritative sources. The information presented as research publications is valid and supported by evidence. The website is committed to providing objective information, and its purpose is clear. The information posted on the website includes peer-reviewed and scholarly articles which are credible, reliable, and valid sources of information in terms of accuracy. The publications providing general information are consistent with the wide knowledge of diabetes. Readers can click on multiple links directing them to additional, valuable resources with minimum effort, although it is easier for members who can access full publications. (Consumer Health Information Website Analysis Paper)

Adequacy

The website is educative, providing informative publications in different forms, including statistics, research publications, education guides on healthy living, and additional tools, products, and resources the audience can access to learn more about diabetes prevention, treatment, and management (ADA, n.d.). The educational information is adequate, and the audience does not have to go elsewhere to get answers about topics presented on the websites. The consumer can access general information on the various web pages and gain more information by accessing multiple research journals published on the website. The information targets every individual, and the level of information sophistication, especially on publications providing general information on diabetes, is elementary to ease understanding and provide uncomplicated data. More technical and advanced information is provided in the research journals. The website communicates its clear purpose through its mission and vision statements, and the information published on it corresponds with its purpose. The website is intended to educate the general public on diabetes. (Consumer Health Information Website Analysis Paper)

References

American Diabetes Association (ADA). (n.d.). Diabetes. https://diabetes.org/

Liu, J., Ren, Z. H., Qiang, H., Wu, J., Shen, M., Zhang, L., & Lyu, J. (2020). Trends in the incidence of diabetes mellitus: results from the Global Burden of Disease Study 2017 and implications for diabetes mellitus prevention. BMC public health, 20(1), 1415. https://doi.org/10.1186/s12889-020-09502-x

National Institute on Aging (NIH). (2023, January 12). How To Find Reliable Health Information Online. https://www.nia.nih.gov/health/how-find-reliable-health-information-online

Sapra, A., & Bhandari, P. (2022). Diabetes mellitus. In: StatPearls [Internet]. StatPearls Publishing.

Xu, G., Liu, B., Sun, Y., Du, Y., Snetselaar, L. G., Hu, F. B., & Bao, W. (2018). Prevalence of diagnosed type 1 and type 2 diabetes among US adults in 2016 and 2017: population based study. BMJ (Clinical research ed.), 362, k1497. https://doi.org/10.1136/bmj.k1497

 
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Analyzing Liability

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Analyzing Liability

The purpose of this analysis is to examine a complaint letter from CapraTek employee Thomas Lee. It will identify potential legal liabilities based on U.S. laws relevant to the complaint letter. It will discuss the potential harm to the company, employees, and workplace culture if the complaint goes unattended. Furthermore, this analysis will identify preventative measures to avoid legal liability for the company and suggest viable legal defenses if the company is required to defend this complaint, including the specifics of this complaint letter. Finally, this analysis will address the ethical principles and implications of the complaint letter. (Analyzing Liability)

Summary of the Complaint

The complaint letter is by Mr. Thomas Lee about his disappointment with the company for failing to ensure a secure workplace for individuals from all backgrounds and nationalities. Mr. Lee is an American of Chinese origin who complains of racial discrimination at the workplace following the accusation that he brought COVID-19 to the workplace because he is Chinese. The employee presented a verbal complaint to the supervisor, who failed to listen to him and questioned Mr. Lee’s customs and beliefs. Mr. Lee says the workplace is hostile and intimidating, and he has received threats from other employees who have singled him out for allegations of spreading the virus on the basis of his origin and ethnicity, sending him negative messages through texts, emails, social media and telephone. Mr. Lee continues to point out that several people have died after exposure to Covid-19, insisting the company’s judgment and preparedness was the primary reason.

Furthermore, another letter by Karen Small, a security guard, confirms the allegation. She points out that she probably acquired the virus from Mr. Lee, who the company allowed into the premise, hence the disease spread. Mr. Lee is an American Citizen who has lived in Alabama and cannot contemplate why he is being singled out for spreading the virus merely because he is Chinese. Mr. Lee says the company has done nothing to address the situation and lacks leadership, which encourages the behavior. He is considering a lawsuit if the issue is not dealt with. (Analyzing Liability)

Associated U.S. laws or regulations and how they are relevant to the identified liability

First Mr. Lee complains of racial discrimination at the workplace, which Title VII of the Civil Rights Act of 1964 addresses. This Act makes it illegal to discriminate against people on the mere basis of their color, race, religion, national origin, or sex. For example, Hahn et al. (2018) provide that this Act is fundamental in ensuring racial and ethnic equity and eliminating discriminatory behavior, implying the Act corresponds to the identified liability of preventing racial discrimination based on color, race, gender, or nationality. The law protects all employees from retaliation if they decide to forward a claim on discrimination at the workplace. (Analyzing Liability)

Mr. Lee also points out that most people acquired and were exposed to the virus because of the company’s lapse in judgment and preparedness, addressed by the Occupational Safety and Health Act of 1970. The Act requires employers to keep the workplace free from hazardous conditions, stressing employees’ rights to information regarding the dangers in their job. For example, in Michaels & Wagner (2020), employers are legally required to offer an environment that protects employees from COVID-19 per OSHA provisions. Michaels & Wagner (2020) argue that only employers can make the workplace safe by enforcing OSHA guidelines, and a failure to do so is considered a non-adherence and non-compliance. This scenario implies that the OSHA is relevant to the identified liability of keeping employees safe from Covid-19 at the workplace. The law also protects employees from being punished if they decide to exercise their rights per OSHA.

The potential harm to the company, its employees, and its workplace culture that could result from a lawsuit emanating from the selected complaint

Suppose the company is found liable for non-compliance with Title VII. In that case, it could face penalties for intentional discrimination, enforced as either compensatory or punitive damage up to a maximum provided by the Title VII of the Civil Rights Act of 1964 according to the number of employees in the company. The company would have to pay either back pay, compensatory damages, or punitive damages. For instance, in Lund (2020), the case, titled Bostock v. Claton County, involves the Supreme Court upholding non-discrimination based on race and sex, against which an employer is liable and faces paying compensatory damages. This case implies that if the company is found liable under the interpretation of Title VII of the Civil Rights Act, it would have to pay compensatory damages to Mr. Lee. (Analyzing Liability)

Analyzing Liability

Confirming liability would affect other employees, especially those of other nationalities, who have experienced the same and may also choose to forward their case. This liability would label the workplace as toxic, discriminatory, and lacking diversity. Suppose the company is found liable under OSHA for failing to protect its employees from Covid-19 exposure. In that case, it could face penalties based on the type of violation, ranging between $15,625 and $156,259 per violation. In this case, dealing with litigations for OSHA non-compliance will be costly for the company. For instance, Sadeh et al. (2022) address the cost impact of Covid-19 OSHA citations and specify that fines for non-compliance and regulatory violations significantly impact a company. If the company is found liable, it means that the company would also be liable for all other Covid-19-related cases, amounting to millions of dollars in fines and compensatory damages that would be detrimental to the company’s finances. It would also mean the work environment is unsafe, and the company cannot protect its most valuable resource, leading to a demoralized workforce. (Analyzing Liability)

Realistic preventative measures that could have avoided legal liability

The company must promote workplace diversity by developing and enforcing anti-harassment and anti-discrimination policies that condemn discrimination based on race, color, gender, ability or disability, sexual orientation, and other identifiers to protect employees from bullying and harassment. Cross-cultural or cultural sensitivity training and education would be necessary to ensure a discrimination-free environment. For example, Shepherd (2019) offers evidence supporting cross-cultural training, including diversity training, anti-racism raining, and micro-aggression training, effectiveness in enhancing cultural competence, safety, humility, and intelligence, which are integral in ensuring a workplace free from discrimination, harassment, and intimidation.

The training would include all employees because there are allegations of lapse in conduct and professionalism among low-level employees and supervisors. It would ensure that all employees respect cultural and racial differences, act professionally in conduct and speech, refuse to instigate, participate, or condone discrimination and harassment, and avoid race-based or culturally offensive acts, including humor and pranks (Shepherd, 2019). Systematic factors contribute to discrimination, harassment, and retaliation in the workplace. Therefore, the company should develop an effective internal complaints procedure and address such issues internally to avoid legal liability. These procedures, coupled with dispute resolution systems, can help prevent discrimination and harassment, as provided by Dobbin and Kalev (2020), who offer guidelines for making discrimination and harassment systems better. (Analyzing Liability)

Individuals and departments that would need to be involved in the proposed measures

Mr. Lee complained of harassment daily, from a fellow security guard to the supervisor. This case implies a lack of cultural sensitivity and awareness across employees of all levels. Therefore, all employees, including supervisors and managers, will be involved in the proposed measures, particularly the cross-cultural or cultural sensitivity training, and education. The Human Resources Department will be involved because it is responsible for outlining disciplinary action policies and procedures to respond to actions or behavior that violate the company’s policies. It will help formulate and enforce anti-harassment and anti-discrimination policies and formalize the internal complaints procedure to orient all employees on the code of discipline.

Viable legal defenses the company could assert in a litigation context to defeat the complainant’s claims

The complainant must prove that he experienced racial discrimination at the workplace. It appears to be a serious case because the allegations are confirmed by other complaints, implying that employees think Mr. Lee spread the virus under the company’s watch. The company would also have to prove beyond doubt that Mr. Lee did not experience racial discrimination or that if he did, it was unintentional because only intentional racial discrimination is ruled as non-compliance. The company can also counter the claim by stating a lack of substantial evidence indicating that Mr. Lee experienced racial discrimination. The company has to show current policies that protect employees from racial discrimination and how it enforces these policies to respond to complaints. If the company proves that Mr. Lee indeed brought the virus to the workplace, it can avoid legal liability. In the interview transcript, interviewees provide that the company developed safety rules and measures per CDC to protect employees from Covid-19 exposure. It has to prove this claim with substantial evidence to avoid legal liability, given that other complaint letters point to the lapse of judgment and preparedness as the primary cause of over 70% of infections and several wrongful deaths. Lastly, the company has to convince the jury that employees acquired the virus outside the workplace, which is beyond the employer’s control, to avoid legal liability. (Analyzing Liability)

Ethical implications of the scenario and measures that address ethical issues

Harassment and discrimination are among the most significant ethical issues companies like Capra Tek face today, especially due to the increased workforce diversities and individual differences. Harassment and discrimination occurring at the workplace can be catastrophic to companies like Capra Tek financially and reputationally. Racial discrimination and harassment in the workplace are perceived as ethical failures due to cultures or practices of disrespect, unfairness, and harm (Elias & Paradies, 2021). It violates human rights due to an unjustified distinction created by the nature of the work environment or policy failures. Racial discrimination negatively impacts the work environment and the company at large. Employees harassed and singled out by other employees, including managers and supervisors, feel unheard and unprotected by the company. As a result, it creates a toxic environment, forming divides between employees that are detrimental to the company. Employees of other racial and ethnic minorities or nationalities fear engaging or collaborating meaningfully when the company does not protect them from harassment and discrimination. It would mean increased absenteeism, turnover, poor performance, loss of income and litigation, and damaged relationships with other companies that employ an anti-racist or anti-discrimination approach. If the case is forwarded to the US Equal Employment Opportunity Commission (EEOC), it would have legal ramifications for the company, which is undesirable and harmful to the company’s reputation.

It is paramount companies like Capra Tek consider robust measures to curb ethical issues like racial discrimination and harassment. The company should be aware of the primary ethical principles that guide professional conduct, including justice and fairness, respect of persons, responsibility, and protection from harm. The company should also be aware of the anti-discrimination laws and regulations like Title VII of the Civil Rights Act of 1964 that protect employee from unjust treatment in the workplace. Additionally, companies like Capra Tek can adopt the ILPA Industry Code of Conduct Guidelines that provides all individuals to be treated equally in an organization, and a company should not tolerate discrimination based on age, gender, race, religion, sexual orientation, family status, disability, marital status, or political beliefs (Institutional Limited Partners Association, 2018).

The company is faced with enforcing these ethical principles, anti-harassment and discrimination laws, and the code of conduct guidelines as measures to ensure ethical practice in the workplace. To curb discrimination and racism, protect employees from bullying and harassment, and promote a diverse and inclusive environment where employees respect each other’s differences, the company should apply ethical decision-making or preventive measure framework. The Ethical Work Climate 2.0 theory by Weber and Opoku-Dakwa (2022) presents an ethical framework for Capra Tek. Adopting this model would help establish an ethical workplace, setting up the company to successfully address employee complaints, assess legal liability, and promote ethical decision-making (Weber & Opoku-Dakwa, 2022). The model sets the antecedents that shape the expectations for ethical behavior within the company and fosters employees’ ability to implement benevolent and principled climates, which help foster organizational commitment, job satisfaction, performance, well-being, and ethical behavior.  (Analyzing Liability)

References

Dobbin, F., & Kalev, A. (2020). Making discrimination and harassment complaint systems better. WHAT WORKS? 24.

Elias, A., & Paradies, Y. (2021). The Costs of Institutional Racism and its Ethical Implications for Healthcare. Journal of bioethical inquiry, 18(1), 45–58. https://doi.org/10.1007/s11673-020-10073-0

Hahn, R. A., Truman, B. I., & Williams, D. R. (2018). Civil rights as determinants of public health and racial and ethnic health equity: health care, education, employment, and housing in the United States. SSM-population health, 4, 17-24.

Institutional Limited Partners Association. (2018). Code of conduct: harassment, discrimination and workplace violence: Guidelines for the private equity ecosystem.

Lund, N. (2020). Unleashed and Unbound: Living Textualism in Bostock v. Clayton County. Clayton County (July 14, 2020). Federalist Society Review, 21, 20-15.

Michaels, D., & Wagner, G. R. (2020). Occupational Safety and Health Administration (OSHA) and worker safety during the COVID-19 pandemic. Jama, 324(14), 1389-1390.

Sadeh, H., Mirarchi, C., Shahbodaghlou, F., & Pavan, A. (2022). Predicting the trends and cost impact of COVID-19 OSHA citations on US construction contractors using machine learning and simulation. Engineering, Construction, and Architectural Management (ahead-of-print).

Shepherd, S. M. (2019). Cultural awareness workshops: limitations and practical consequences. BMC Medical Education, 19(1), 1-10.

Weber, J., & Opoku-Dakwa, A. (2022). Ethical Work Climate 2.0: A Normative Reformulation of Victor and Cullen’s 1988 Framework. Journal of Business Ethics, 1-18.

 
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Skin Comprehensive SOAP Note 

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Skin Comprehensive SOAP Note 

(Skin Comprehensive SOAP Note)

Skin Comprehensive SOAP Note

Patient Initials: D.W.              Age: 32                                   Gender: Female

SUBJECTIVE DATA:

Chief Complaint (CC) (Graphic 2): “I feel less confident around people, including my husband, and I cannot go out to swim or wear bikini or crop tops.”

History of Present Illness (HPI): D.W. is a 32-year-old single African American woman who is 29 weeks pregnant and presenting at the clinic with complaints of increasing stretch marks in the past one and a half months. D.W. claims that due to the stretch marks, she has lost confidence and self-esteem. She denies feeling any pain in places of the abdomen but explains that the area might be “itchy” and that the lines are continuing to darken. She claims that since she cannot wear a bikini, crop top, or swimsuit, she would like anything to reduce the stretch marks. She indicates 0/10 for reported pain on the pain scale and denies fever. Over-the-counter cocoa butter was ineffective in eliminating or reducing stretch marks. She also thinks her stretch marks are related to weight gain. (Week 4 – Skin Comprehensive SOAP Note)

Medications:

  1. Prenatal Rx: 1 tablet daily
  2. Amlodipine for HTN: 10 mg daily
  3. Albuterol 90mcg for Asthma
  4. Cortisone OTC for itching skin: Applies at least 6 times daily

Allergies: Patient reports she is allergic to dust, mold, pollen, and metronidazole

Past Medical History (PMH): The patient developed HTN when she was 24, asthma at 4 years, although controlled, and allergic rhinitis at age 7. She also has past medical history of bacterial vaginosis, controlled with medication, and anxiety, which was managed without medication.

Past Surgical History (PSH): The patient underwent a surgical report of the umbilical hernia in 2006.

Sexual/Reproductive History: D.W. reports that she is married with one child, which she conceived at 26 years. This is her second pregnancy. She is sexually active and not on using condoms. She has one sexual partner, and together they go for regular testing for STIs, every four months.

Personal/Social History: She is married and currently lives with her husband. She has an extended family comprising of her mother and father and two brothers. (Week 4 – Skin Comprehensive SOAP Note)

Health Maintenance:

  • She does not smoke
  • She maintains one sexual partner
  • Maintains a healthy diet, although she has experienced weight gain during pregnancy.
  • She maintains a healthy, supportive relationships with members of the extended family and friends.

Immunization History:

  1. Covid vaccination
  2. Influenza vaccine: 09/10/2019
  3. Tdap: 07/4/2020
  4. Measles and Rubella

Significant Family History: She has an extended family comprising of the mother, father and two brothers. Her grandparents are dead. The mother, 60, has a history of asthma and depression. The father, 63, has a history of diabetes. The brothers are 35 and 27 years and have no medical history.

Review of Systems:

General: The patient reports fatigue over the last two months. She denies fever, syncope, lightheadedness with standing or ambulation, or chills. She reports sleeping 7-10 hours a day. She reports pervasive weight gain over the course of her pregnancy, gaining about 10 pounds. (Week 4 – Skin Comprehensive SOAP Note)

            HEENT

Respiratory: Patient reports a history of asthma. Denies history of pneumonia, dyspnea or hemoptysis. Reports dyspnea during vigorous physical activities like running or walking fast.

Cardiovascular/Peripheral Vascular: Denies chest pain, chest pressure, or chest discomfort. No palpitations or edema.

Gastrointestinal: The patient reports diet changes, feelings of nausea and vomiting. Denies diarrhea. No abdominal pain or blood. Patient reports experiencing constipation.

Genitourinary: Denies burning on urination, urgency, hesitancy, odor, odd color.

Musculoskeletal: The patient reports occasional muscle pain and weakness. Denies back pain and muscle or joint stiffness.

Neurological: Denies headaches, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.

Psychiatric: Patient reports a history of anxiety, controlled nonmedically through meditation and physical exercise.

Skin/hair/nails: Patient indicates intermittent abdominal pruritus, scalp dandruff. Patient denies dermatitis on other body areas, spontaneous bruising, brittle hair, yellowing nails, or fungal infections. She reports itching, controlled using Cortisone OTC.  

OBJECTIVE DATA:

Physical Exam:

Vital signs: temp: 98.6F, B.P.: 100/65, P: 85, R.R.: 18, pain: 0/10 Ht: 5’5 feet, Wt.: 167 lbs., BMI: 27.8

General: Well-nourished and groomed AXOx4 32-year-old Black female, with appropriate mood, bright affect, and polite.

HEENT: Normocephalic and atraumatic. Sclera anicteric, No conjunctival erythema, PERRLA, oropharynx red, moist mucous membranes.

Neck: Supple. No JVD. Trachea midline. No pain, swelling, or palpable nodules.

Chest/Lungs: The patient’s heartbeat and rhythm are normal. The patient’s heart rate is within normal range, and capillaries refill within two seconds.

Heart/Peripheral Vascular: Regular rate and rhythm noted. No murmurs. No palpitation. No peripheral edema to palpation bilaterally.

Abdomen: Normal active bowel sounds x4. No rebound tenderness X 4. Soft abdomen. No organomegaly. Fundal distance 30cm

Genital/Rectal: D.W. decline, reporting seeing a gynecologist routinely.

Musculoskeletal: Normal range of motion. Low muscle mass for age. No signs of swelling or joint deformities. Muscle and back pain rated 0/10.

Neurological: Balance is stable, gait is normal, posture is erect, the tone is good, and speech is clear.

Skin: Multiple stretch marks visible on the abdomen; color nigrae and albae. Noted skin xerosis to the abdomen, linea nigra vertically from pubic bone to intermediary breast. No lymph nodes on palpation. Severe striae as indicated by TSS:> 18 (Week 4: Skin Comprehensive SOAP Note )

Diagnostic results:

  1. HCT – 36
  2. WBC 5.89
  3. Albumin – 3.7
  4. Sodium – 135
  5. Potassium – 3.7
  6. AIC – 4.6
  7. Fibrinogen – 215
  8. Rh negative

ASSESSMENT:

Primary diagnosis:

  1. Striae gravidarum and Linea Nigra:

Stretch marks, or striae gravidarum, develop in roughly 50 to 90% of pregnant women as the uterus grows inside the abdominal cavity and separates the connective tissue beneath (Oakley & Patel, 2022). Early stretch marks are reddish-purple and develop as skin collagen is damaged and blood vessels enlarge. White or brown mature stretch marks result from melanocytes or pigment-producing cells dying due to collagen remodeling. Stretch marks most frequently appear on the breasts, thighs, and abdomen (Dai et al., 2021). A woman’s skin type and family history affect the thickness of the striae. The weight gain D.W. experienced could explain the striae gravidarum, the first confirmed diagnosis, vividly noticeable to her abdomen.

Linea is a brown line visible on the abdomen, running from the umbilical to the symphysis pubis. Usually, around the second or third trimester of pregnancy, linea nigra symptoms manifest. Linea nigra hyperpigmentation is brought on by hormonal fluctuations in progesterone and estrogen during pregnancy, which lead the cells to stimulate melanocytes in the skin more (Barnawi et al., 2021). The skin’s increased melanocyte count is what makes the abdomen darker. Linea nigra is also vividly noticeable on D.W. abdomen, confirming it as the second diagnosis. (Week 4 – Skin Comprehensive SOAP Note)

Week 4: Skin Comprehensive SOAP Note

Differential Diagnosis

  1. Linear Focal Elastosis: Uncertain etiology characterizes linear focal elastosis (LFE), an unusual benign acquired elastotic disease. Clinically, it is distinguished by several asymptomatic, raised, yellowish striae-like lines or bands dispersed horizontally throughout the lower and middle portion of the posterior trunk (Florell et al., 2017). The dermis’s focused increase in elastic fibers is the histological sign of LFE. The most common differential for LFE is Striae distensae.

Week 4: Skin Comprehensive SOAP Note

  1. Steroid Induced Skin Atrophy: Topical steroids applied excessively on the skin might lead to steroid-induced skin atrophy. D.W.  exceeded the recommended dosage by using cortisone at least six times daily. Two to three times a day is recommended for using cortisone cream. When applied excessively, topical cortisone creams can lead to lipocortin production that blocks enzyme phospholipase A2, resulting in erythema and striae distensae (Niculet et al., 2020). Protein catabolism and increased mitotic activity caused the enzyme phospholipase to develop, which helps to reduce inflammation. As seen in striae distensae, the atrophy brought on by excessive topical steroid use can elevate the skin, create vasoconstriction, and cause itching.
  2. Week 4: Skin Comprehensive SOAP Note
  3. Cushing’s Syndrome: Cushing’s syndrome frequently presents as different skin disorders because of endogenous glucocorticoids and hypercortisolism. Although miscarriages are uncommon during pregnancy, they are highly likely when high blood pressure is present (Chaudhry & Singh, 2022). Striae distensae, a Cushing’s syndrome-related condition, results in dark, medium-sized to wide marks on the back, hips, thighs, and belly. Stretch marks are caused in patients with this illness by significant weight gain, high cortisol levels, and thin skin.

Week 4: Skin Comprehensive SOAP Note 

  1. Pruritic Urticarial and Plagues of Pregnancy (PUPPP): PUPPP can develop at the end of the second trimester and continue into the third trimester in places including the belly, legs, and forearms (Ishikawa-Nishimura et al., 2021). D.W.’s belly shows extensive striae, which she describes as itchy. Target lesions on the abdomen might appear in PUPPP patients as itchy, edematous eczema lesions resembling stretch marks or a combination of stretch marks and eczema. Owing to PUPPP’s pathophysiology, it frequently goes undetected and eludes treatment during pregnancy. In PUPPP, Th2 cytokines such as IL-9 and IL-33 are upregulated. These cytokines target body parts where there is an excess of cortisol and cause hyperpigmentation, skin eruptions, and patchy white lesions with stretch marks. (Week 4 – Skin Comprehensive SOAP Note)

Polymorphic Eruption of Pregnancy: Background, Epidemiology, Etiology

PLAN: This section is not required for the assignments in this course (NURS 6512), but will be required for future courses.

References

Barnawi, A. M., Barnawi, G. M., & Alamri, A. M. (2021). Women’s Health: Most Common Physiologic and Pathologic Cutaneous Manifestations During Pregnancy. Cureus, 13(7), e16539. https://doi.org/10.7759/cureus.16539

Chaudhry, H. S., & Singh, G. (2022). Cushing syndrome. In StatPearls [Internet]. StatPearls Publishing.

Dai, H., Liu, Y., Zhu, Y., Yu, Y., & Meng, L. (2021). Study on the methodology of striae gravidarum severity evaluation. Biomedical engineering online, 20(1), 109. https://doi.org/10.1186/s12938-021-00945-w

Florell, A. J., Wada, D. A., & Hawkes, J. E. (2017). Linear focal elastosis associated with exercise. JAAD case reports, 3(1), 39–41. https://doi.org/10.1016/j.jdcr.2016.10.012

Ishikawa-Nishimura, M., Kondo, M., Matsushima, Y., Habe, K., & Yamanaka, K. (2021). A Case of Pruritic Urticarial Papules and Plaques of Pregnancy: Pathophysiology and Serum Cytokine Profile. Case reports in dermatology, 13(1), 18-22. https://doi.org/10.1159/000511494

Niculet, E., Bobeica, C., & Tatu, A. L. (2020). Glucocorticoid-Induced Skin Atrophy: The Old and the New. Clinical, cosmetic and investigational dermatology, 13, 1041–1050. https://doi.org/10.2147/CCID.S224211

Oakley, A.M., & Patel, B.C. (2022). Stretch Marks. In: StatPearls [Internet]. StatPearls Publishing.

 
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Discussion 3 (1)

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Discussion 3 (1)

(Discussion 3 (1))

Veziari et al. (2022) explore the barriers ad enablers to the conduct and application of research among complementary and alternative medicine stakeholders in Australia and New Zealand, adopting a qualitative descriptive research design. To ensure ethical conduct, the researchers obtained consent before conducting the interviews. The researchers did not use participant identifiers but assigned each participant a unique alpha-numerical identification pseudonym that ensured data could be used to identify the participants. Participants were selected from a contact list of a survey completed previously examining the barriers to the research conduct and application. A non-probability self-selection was used in choosing participants to ensure an individual had adequate experience in the study phenomena and could offer information-rich data. The researchers did not emphasize or focus on rigid distribution because they needed robust information to study the phenomenon in detail, so they used the contact list of a previous study with participants with already diverse experiences in the phenomena. However, this approach creates a selection bias that can impact the research findings’ generalizability and reliability. For instance, using a non-probability selection gives other willing participants no chance of being in the sample, increasing the risk of under coverage bias, which conflicts with the principle of justice and fairness (Barrow et al., 2022). Also, the selection is based on ease of access, which creates a sampling bias, according to Andrade (2021). (Discussion 3 (1))

Discussion 3 

The participants selected for the study do not fit the criteria of a vulnerable population because the study included only researchers and practitioners from a previous contact list. Researchers and practitioners have professional knowledge and understanding of the research phenomena and do not fall within groups considered vulnerable, including ethnic and racial minorities, children, the elderly, the disabled, the socioeconomically disadvantaged, and those with disabling medical conditions. The participants only shared their opinions and perspectives on the study phenomena and were not subjected to any physical harm or discomfort, not that is documented. The participants were interviewed via video-conferencing at a convenient date and time. The steps taken to ensure the privacy and confidentiality of participants include obtaining consent and avoiding the collection of personal identifiers, instead using a unique alpha-numerical identification pseudonym that ensured data could be used to identify the participants. (Discussion 3 (1))

References

Andrade C. (2021). The Inconvenient Truth About Convenience and Purposive Samples. Indian journal of psychological medicine, 43(1), 86–88. https://doi.org/10.1177/0253717620977000

Barrow, J. M., Brannan, G. D., & Khandhar, P. B. (2022). Research ethics. In StatPearls [Internet]. StatPearls Publishing.

Veziari, Y., Kumar, S., & Leach, M. J. (2022). An exploration of barriers and enablers to the conduct and application of research among complementary and alternative medicine stakeholders in Australia and New Zealand: A qualitative descriptive study. Plos one, 17(2), e0264221.

 
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Topic 6 DQ 1

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Topic 6 DQ 1

The literature evaluation table helps with the critical synthesis of empirical and theoretical research evidence for research support. The table includes various sections that help with adopting a proper reference for the article and evaluating the research questions, purpose, aim, hypothesis, research design, methodology, data analysis and interpretation, research findings, and limitations to the research. Other sections include future research recommendations and evaluating how the research study reviewed supports the research topic or question. For the DPI project, using the literature evaluation table is paramount to extract data effectively and conduct a rigorous synthesis and review. It helps develop a synopsis of each article, succinctly presenting all relevant information pertinent to the review and research support (Younas & Ali, 2021). Conducting a literature evaluation using the table helps me see the information at a glance, including frameworks and methods, strengths and limitations, the conceptual contribution of each article reviewed, and themes. (Topic 6 DQ 1)

Topic 6 DQ 1

The most crucial criterion is key research findings. The primary aim of every research is to generate outcomes that are useful scientifically, clinically, or in other ways desired by the researchers. The other sections or criteria help evaluate the reviewed article’s reliability, validity, authority, and robustness. However, the research findings are the primary target and help determine the study’s relevance and whether it supports the research topic and questions. Although the level of evidence does not always signify the quality of the research or evidence, it is vital in establishing the best available evidence for the research purpose. The “Levels of Evidence in Research” helps categorize the reviewed studies by evidence level, and level 1 evidence is often perceived as the best or appropriate evidence for the research question (Simmons University, 2022). It also helps determine the internal validity of the various studies. The “Criteria for Acceptance Research” helps understand the requirements for appropriate practice questions, literature searches, or primary research studies for inclusion in the DPI project. It guides what to consider and include during the literature search and review. (Topic 6 DQ 1)

References

Simmons University. (2022, March 3). Nursing – Systematic Reviews: Levels of Evidence. https://simmons.libguides.com/c.php?g=1023284&p=7412063

Younas, A., & Ali, P. (2021). Five tips for developing useful literature summary tables for writing review articles. Evidence-Based Nursing, 24(2), 32-34.

 
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 Medication Guide

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 Medication Guide

(Medication Guide)

Introduction

WHO ranked major depressive disorder (MDD) as the third leading cause of disease burden, projected to be the leading cause of disease burden by 2030. Depression, in general, is the first-ranking cause of disability worldwide. It affects individuals across all populations, ages, and ethnicities. Still, it is significant among vulnerable populations like the elderly, youth, and individuals with physical illnesses like obesity, diabetes, and other chronic conditions. Older adults are at an increased risk of developing MDD, a typical cause of geriatric psychiatric disorders and a significant risk factor for disability and mortality among older patients (Zenebe et al., 2021). Depression is the most common mental health issue among older adults despite being undiagnosed in half of the cases. The paper address major depressive disorder among older adults, including causes, symptoms, diagnosis, and medications. (Medication Guide)

 Medication Guide

Major Depressive Disorder Causes and Symptoms

MDD etiology is multifactorial, including environmental, biological, genetic, and psychosocial factors. MDD is mainly attributed to neurotransmitter abnormalities, particularly dopamine, norepinephrine, and serotonin. It is indicated by the use of various antidepressants like selective serotonin receptor inhibitors, serotonin-norepinephrine receptor inhibitors, and dopamine-norepinephrine receptor inhibitors in treating depression (Bains et al., 2022). MDD is highly prevalent among mental health conditions, with a lifetime prevalence of around 5 to 17% and an average of 125. The disease is more common among women than men, almost double, and among individuals without close interpersonal relationships, such as those who are divorced, separated, or widowed, which is the case among many older adults (Bains et al., 2022). Most people with MDD present with symptoms including pervasive low and depressed mood, decreased interest and enthusiasm in previously pleasured activities, guilt and worthlessness feelings, low energy, poor or impaired concentration, and changes in appetite (Bains et al., 2022). These individuals also experience psychomotor retardation, agitation, sleep disturbances, and suicidal thoughts. (Medication Guide)

 

Figure 1: MDD causes and symptoms

MDD Diagnosis for the Elderly

Older people are a valuable resource in society, but many age-related actors influence their health and well-being by exposing them to multiple physical and mental illnesses. The elderly population is growing, and it will be the case going into the future, which has extensive economic, social, and health consequences in the world and the United States. The increasing aging population is attributed to reduced mortality and fertility rates and improved quality of life over the past two decades, leading to increased life expectancy. In 2019, older people aged 60 years and over were 1 billion, and the number will rise to 1.4 million by 2030 and to over 2.1 billion by 2050, and by then, 80% will live in low- and middle-income countries (Zenebe et al., 2021). With the increasing aging population, the incidence of mental health problems is also expected to increase, with depression being the most prevalent disorder. This population is categorized as vulnerable because of the high disease encounter associated with aging and the likelihood of experiencing multiple conditions that impede their functioning, including mobility, which is a barrier to healthcare access. (Medication Guide)

Figure 2: Depression prevalence by age

MDD among older adults is diagnosed through comprehensive psychiatric evaluation of the individual and mental health examination. The practitioners conduct a history and physical assessment, including medical history, family history, social history, alcohol and substance use history, and psychiatric history (Bains et al., 2022). Among older adults, collateral information from family members or friends is immensely important in psychiatric evaluation because, in some cases, older adults experience cognitive decline and judgement impairment. A comprehensive physical examination, including a neurological examination, is conducted to help diagnose and rule out any root cause, organic or medical, of depressive symptoms. The diagnosis follows the ICD-10 or the DMS-5 criteria. According to the DMS-5 criteria, five of the following symptoms must be present for a diagnosis to be made: difficulty sleeping, loss of interest or pleasure, feelings of inadequacy or helplessness, fatigue or erratic energy, difficulties concentrating or listening intently, fluctuations in appetite or weight, psychomotor issues, suicidality, and depressed mood. (Medication Guide)

Medication Treatment Options

Various modalities, including pharmacological, psychotherapeutic, interventional, and lifestyle changes, are used to treat major depressive disorder. Medication treatment includes FDA-approved medications, including all antidepressants, which are equally effective but with varying side effects profiles. Selective serotonin reuptake inhibitors (SSRIs) are the first line of treatment and include fluoxetine, sertraline, citalopram, paroxetine, and fluvoxamine (Bains et al., 2022). However, SSRIs can increase agitation and anxiety and cause indigestion, diarrhea or constipation, appetite and weight loss, dizziness, dry mouth, or blurred vision. Serotonin-norepinephrine reuptake inhibitors (SNRIs) are often used among patients with comorbid pain disorders (Bains et al., 2022). SNRIs include venlafaxine, milnacipran, duloxetine, and levomilnacipran. However, these drugs can cause nausea, dry mouth, dizziness, headache, and excessive sweating. (Medication Guide)

Patients can also be prescribed serotonin modulators like vilazodone, trazodone, and vortioxetine (Bains et al., 2022). Despite their high effectiveness, serotonin modulators can lead to gastrointestinal adverse reactions, central nervous system adverse reactions, bleeding, sexual dysfunction, and hyponatremia. Possible treatment also includes atypical antidepressants like bupropion and mirtazapine, often prescribed as augmenting agents when an individual develops sexual side effects after using SSRIs or SNRIs (Bains et al., 2022). Common side effects of atypical antidepressants include lightheadedness, dizziness, and dry mouth. Additionally, mood stabilizers and antipsychotics help improve antidepressant effects (Bains et al., 2022). However, the patient can experience blurred vision, dry mouth, drowsiness, muscle tremors, and weight gain after taking mood stabilizers and antipsychotic medications.  (Medication Guide)

Figure 3: Antidepressants commonly used to treat MDD

Medication Considerations of Medication Examples Prescribed

Older adults are vulnerable individuals, and most are experiencing multiple comorbidities and taking multiple drugs simultaneously. Therefore, optimizing drug therapy for older adults is crucial to ensure their safety and reduce the risk of medication-related complications. Prescribing medication among older adults is a complex process, and the practitioner has to consider the patient’s physiological status, drug effectiveness and toxicity, and potential side effects (Rochon & Schmader, 2019). Avoidable adverse drug events should always be evaluated when prescribing for older adults. The practitioner has to consider and review current drug therapy, discontinue ineffective therapy, review avoidable drug-drug interaction, and appropriate use of prescribed drugs or medication adherence. (Medication Guide)

SSRIs are commonly prescribed to treat MDD and used as first-line treatment. However, safety considerations for prescribing SSRIs are paramount to avoid complications like adverse drug events, drug-drug interactions, disabling side effects, and fatality. When prescribing SSRIs or selecting a specific SSRI, it is imperative to consider common possible complications like vascular events, which are life-threatening, patients at a higher risk of cardiovascular risk, and relevant comorbidity and co-medication (Mortensen & Andersen, 2022). Additional considerations include potential interaction with particular foods and drinks and the presence of diseases like diabetes, epilepsy, and kidney disease. The practitioner should evaluate current drug therapy because SSRIs can interact with some over-the-counter painkillers and herbal remedies.  (Medication Guide)

Monitoring Labs and Comorbid Medical Issues

To date, there are no diagnostic laboratory tests available to diagnose MDD. However, labs can be used to exclude other medical illnesses that present symptoms as MDD, including complete blood cell (CBC) count, thyroid tests, fasting blood glucose tests, and folate and vitamin B12 tests. These lab tests are a vital consideration, especially for individuals experiencing multiple comorbidities, to determine the presence of depressive symptoms by excluding potential links to other illnesses presenting as MDD (Wainberg et al., 2021). The comorbidity of MDD with chronic illnesses like diabetes, obesity, and eating disorders should be monitored to determine how the pathologic processes associated with the diseases interact (Almeida et al., 2020). Other comorbid medical issues with MDD include psychotic disorders, OCP, anxiety disorders, and substance use. Their association with MDD must be evaluated to develop a comprehensive patient treatment plan and education plan. Identifying comorbidities is vital for accurate diagnosis and developing treatment and management strategies.  (Medication Guide)

Special Considerations

When working with MDD patients, it is vital to consider laws like the Mental Healthcare Act of 2017 that explicitly describes the rights of individuals with mental illnesses, specifying ethical and legal responsibilities practitioners and the government have (Bipeta, 2019). The law corresponds with the fundamental rights of human beings and ethical principles, including autonomy, non-maleficence, beneficence, justice, confidentiality, informed consent, and boundary violations. Ethical issues and dilemmas associated with autonomy, respect of persons, informed consent, and beneficence can arise when working with MDD patients, hence the need for ethical imperatives like ensuring confidentiality and privacy, respecting autonomy and the law, demonstrating compassion, beneficence, and promoting justice, honesty, and fidelity (Bipeta, 2019). For instance, older people with cognitive decline need surrogates or caregivers to offer informed consent and address autonomy and confidentiality issues.

Cultural considerations are imperative in treating depression, especially for ethical or racial minorities. The epidemiology of depression varies across various racial and ethnic groups. This variability is due to contextual factors in the different groups, including cultural beliefs and practices, cultural adaptations, and intersectionality (Cardemil et al., 2020). Moreover, every culture looks at mental health differently, and practitioners should consider these differences in treating depression. Social determinants of health, including socio-economic status, family relationships, educational attainment, social isolation, and supportive relationships, should be considered when treating MDD because of their influence on development and progression of depression and healthcare access and service utilization for depression.   (Medication Guide)

Figure 4: Ethical issues in psychopharmacology

Resources to Follow Up for more information

Multiple resources available in the community can offer more information regarding depression, including the National Alliance on Mental Illness (NAMI), Anxiety and Depression Association of America (ADAA), National Suicide Prevention Lifeline, American Psychological Association (APA), National Institute of Mental Health (NIMH), and Centers for Disease Control and Prevention (CDC) Division of Mental Health. These resources or institutions publish information on their websites accessible to the general public in search of further information on depression. The institutions are on a mission to reduce mental health concerns’ impact on American communities, hence providing a wealth of information and services accessible to all. (Medication Guide)

Prescription Examples

The patient will initially be prescribed FDA approved SSRIs, including citalopram, escitalopram, and fluoxetine.

Prescription 1

Date of Issue: March 23, 2023

Patient Name: N.D.

Drug Name: Citalopram

Dosage Form: Tablet

Quantity Prescribed: 20 mg PO qDay, increasing to 40 mg/day after 1 week

Clinician Name: J.M.

Prescription 2

Date of Issue: March 23, 2023

Patient Name: N.D.

Drug Name: Escitalopram

Dosage Form: Tablet

Quantity Prescribed: 10 mg PO qDay; may increase to 20 mg/day after 1 week

Clinician Name: J.M.

Prescription 3

Date of Issue: March 23, 2023

Patient Name: N.D.

Drug Name: Fluoxetine

Dosage Form: Tablet

Quantity Prescribed: 20 mg PO qDay initial, and consider gradual increase after several weeks by 20mg/day, not exceeding 80 mg qDay

Clinician Name: J.M.

Conclusion

Major depressive disorder is a disabling illness among older adults and a significant contributor to the disease burden. MDD co-occurs with other illnesses, mostly age-related, including diabetes, psychotic disorders, anxiety disorders, and eating disorders, that make MDD treatment and management challenging. Pharmacological treatments effectively address MDD; SSRIs are prescribed as the first-line treatment modality. Considering that older people experience multiple comorbidities and are taking multiple drugs, it is vital to consider potential side effects, drug interactions, adverse events like complications, medication adherence, and drug effectiveness and appropriateness when prescribing medication for MDD. Legal, ethical, cultural, and social actors influence MDD development, progression and treatment perception, and these must be considered when working with MDD patients. More information on MDD can be obtained from CDC, ADAA, APA, NIMH, and NAMI websites and online publications. (Medication Guide)

References

Almeida, S. S., Zizzi, F. B., Cattaneo, A., Comandini, A., Di Dato, G., Lubrano, E., Pellicano, C., Spallone, V., Tongiani, S., & Torta, R. (2020). Management and Treatment of Patients With Major Depressive Disorder and Chronic Diseases: A Multidisciplinary Approach. Frontiers in psychology, 11, 542444. https://doi.org/10.3389/fpsyg.2020.542444

Bains, N., Abdijadid, S., & Miller, J. L. (2022). Major depressive disorder (nursing). In StatPearls [Internet]. StatPearls Publishing.

Bipeta R. (2019). Legal and Ethical Aspects of Mental Health Care. Indian journal of psychological medicine, 41(2), 108–112. https://doi.org/10.4103/IJPSYM.IJPSYM_59_19

Cardemil, E. V., Noyola, N., & He, E. (2020). Cultural Considerations in Treating Depression. Handbook of Cultural Factors in Behavioral Health: A Guide for the Helping Professional, 309-321.

Mortensen, J. K., & Andersen, G. (2022). Safety considerations for prescribing SSRI antidepressants to patients at increased cardiovascular risk. Expert opinion on drug safety, 21(4), 467–475. https://doi.org/10.1080/14740338.2022.1986001

Rochon, P. A., & Schmader, K. E. (2019). Drug prescribing for older adults. Dostpuno na https://www. uptodate. com/contents/drug-prescribing-for-older-adults. Pristupljeno.

Wainberg, M., Kloiber, S., Diniz, B., McIntyre, R. S., Felsky, D., & Tripathy, S. J. (2021). Clinical laboratory tests and five-year incidence of major depressive disorder: a prospective cohort study of 433,890 participants from the UK Biobank. Translational Psychiatry, 11(1), 380.

Zenebe, Y., Akele, B., W/Selassie, M., & Necho, M. (2021). Prevalence and determinants of depression among old age: a systematic review and meta-analysis. Annals of general psychiatry, 20(1), 55. https://doi.org/10.1186/s12991-021-00375-x

 
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