Chapter 29: Mental Health Disorders

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Chapter 29: Mental Health Disorders

(Chapter 29: Mental Health Disorders) Hypochondriasis can be a problem for older adults. What situations contribute to hypochondriasis and what interventions can nurses provide that will address this problem in older adults?

Please use your textbook as, at least, one reference. Please abide by APA 7th edition format in your writing. Answers should be 2-3 Paragraphs made up of 3-4 sentences each, at least 250 words (more or less) in length.

Chapter 29: Mental Health Disorders

Hypochondriasis in Older Adults

Hypochondriasis, or health anxiety, is a common concern among older adults, often exacerbated by age-related health issues and societal factors. Situations that contribute to hypochondriasis in this population include the increased prevalence of chronic diseases, the psychological impact of living with multiple health conditions, and the loss of loved ones. Additionally, older adults may experience social isolation, which can intensify their focus on bodily sensations and health concerns. The fear of serious illness can be heightened by exposure to health-related news or the experiences of peers. Such factors create a fertile ground for health anxiety to flourish, making it crucial for healthcare providers to recognize and address these issues.

Nurses play a pivotal role in managing hypochondriasis in older adults through various interventions. First, they can provide education about normal aging processes and the differences between normal and abnormal bodily changes. This education helps demystify health concerns and reduce anxiety. Second, fostering a therapeutic relationship and encouraging open communication allows older adults to express their fears and anxieties. This support can alleviate feelings of isolation and promote emotional well-being. Additionally, nurses can collaborate with mental health professionals to develop tailored interventions, such as cognitive-behavioral therapy, to help patients reframe their thoughts about health. By addressing both the psychological and physiological aspects of hypochondriasis, nurses can significantly improve the quality of life for older adults dealing with health anxiety.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. https://www.psychiatry.org/psychiatrists/practice/dsm

Barlow, D. H., & Durand, V. M. (2018). Abnormal psychology: An integrative approach (7th ed.). Cengage Learning. https://www.cengage.com/c/abnormal-psychology-an-integrative-approach-7e-barlow/9781305634458

 
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Grief: Definition and physical symptoms

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Grief: Definition and physical symptoms

(Grief: Definition and physical symptoms) Grief: define and describe the physical symptoms, psychological and social responses and its spiritual aspects.

Summarize the types of grief.

Although death is a universal human experience, please specify culture-specific considerations that exist regarding attitudes toward the loss of a loved one, including age (child or older adult) and cause of death.

Submission Instructions: Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.

Grief: Definition and physical symptoms

Grief: Definition and Description

Grief is a complex emotional response to loss, particularly the loss of a loved one. It encompasses a range of physical symptoms, psychological and social responses, and spiritual aspects. Physically, individuals experiencing grief may exhibit symptoms such as fatigue, insomnia, changes in appetite, and somatic complaints like headaches or gastrointestinal issues. These physical manifestations can significantly affect daily functioning and overall health. Psychologically, grief can lead to feelings of sadness, anger, guilt, anxiety, and confusion. These emotions can vary in intensity and duration, depending on individual circumstances and coping mechanisms.

Socially, grief can impact relationships and interactions with others. Individuals may withdraw from social activities or feel disconnected from friends and family. Some may seek support from others, while others may feel isolated in their pain. The social response to grief can also be influenced by the reactions of those around the grieving person. Supportive environments can facilitate healing, while unsupportive or dismissive reactions can exacerbate feelings of loneliness and despair. Furthermore, the spiritual aspect of grief involves the search for meaning and understanding in the face of loss. Individuals may question their beliefs, seek comfort through spirituality, or experience a sense of connection to something greater than themselves.

Types of Grief

There are various types of grief, each characterized by unique features. Normal grief, often referred to as uncomplicated grief, typically follows a predictable pattern of emotions and can gradually diminish over time. Complicated grief, on the other hand, may involve prolonged and intense grief that disrupts daily life. This type of grief may require professional intervention. Anticipatory grief occurs before a loss, often experienced by those caring for individuals with terminal illnesses. This type allows individuals to process feelings of loss in advance, potentially mitigating the impact of the actual loss. Other forms of grief include disenfranchised grief, where individuals may feel their grief is not recognized or validated by society, and cumulative grief, where individuals experience multiple losses in a short period.

Cultural Considerations

Although death is a universal human experience, cultural considerations significantly influence attitudes toward the loss of a loved one. Different cultures have unique rituals, practices, and beliefs surrounding death and mourning. For instance, in some cultures, the mourning period is strictly defined, while others may allow for more fluid expressions of grief. Age and cause of death also play critical roles in shaping the grieving process. The loss of a child is often viewed with heightened sensitivity and may evoke more intense societal responses than the death of an older adult. Similarly, deaths due to traumatic events, such as accidents or violence, may carry different cultural implications compared to deaths resulting from natural causes, such as illness or old age.

Conclusion

Grief is a multifaceted emotional experience with physical, psychological, social, and spiritual dimensions. Recognizing the various types of grief and understanding the cultural context surrounding loss can aid healthcare professionals and individuals in providing compassionate support to those in mourning. Grief is not only a personal experience but also one that is influenced by the broader cultural framework in which it occurs. Thus, sensitivity to cultural variations in grief responses is essential in offering effective support and care.

References

Bowlby, J. (1980). Attachment and Loss: Vol. 3. Loss: Sadness and Depression. Basic Books.

Link: https://www.amazon.com/Attachment-Loss-3-Depression-Clinical/dp/0465032404

Worden, J. W. (2009). Grief Counseling and Grief Therapy: A Handbook for the Mental Health Practitioner (4th ed.). Springer Publishing Company.

Link: https://www.springerpub.com/grief-counseling-and-grief-therapy-4th-edition-9780826110341.html

 
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Quantitative Research Design

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Quantitative Research Design

(Quantitative Research Design)

There are different types of quantitative research designs that justify or support themselves in nursing research.

Choose one quantitative type design and identify a major advantage and a major disadvantage of this design.

Give an example how this quantitative research design could be used in nursing practice to solve a clinical problem (not one noted in your textbook).

Quantitative Research Design

Quantitative Research Design: Randomized Controlled Trials (RCTs)

Randomized Controlled Trials (RCTs) are one of the most robust quantitative research designs used in nursing research. RCTs involve the random assignment of participants into experimental and control groups to assess the effectiveness of interventions.

Major Advantage:

One significant advantage of RCTs is the ability to minimize bias and confounding variables. Randomization ensures that the participants in each group are comparable, reducing the influence of external factors on the outcome. This enhances the internal validity of the study, allowing researchers to make strong causal inferences about the relationship between the intervention and the observed effects. As a result, findings from RCTs are considered the gold standard in evidence-based practice, helping clinicians make informed decisions about patient care.

Major Disadvantage:

However, a major disadvantage of RCTs is the potential for limited generalizability. The controlled environment in which RCTs are conducted may not reflect real-world clinical settings. Participants in RCTs often meet strict inclusion and exclusion criteria, which can result in a sample that is not representative of the broader population. Therefore, while RCTs provide high-quality evidence, the findings may not be applicable to all patient populations or clinical scenarios.

Example of RCT in Nursing Practice

An example of how RCTs could be used in nursing practice to solve a clinical problem is in the management of patients with chronic obstructive pulmonary disease (COPD). Nurses often face challenges in improving patient adherence to prescribed inhalation therapies, which is critical for effective disease management.

Study Proposal:

An RCT could be designed to evaluate the effectiveness of a personalized education program on medication adherence among patients with COPD. In this study, participants would be randomly assigned to either an experimental group that receives personalized education sessions, including demonstrations of inhaler techniques and discussions about the importance of adherence, or a control group that receives standard education materials.

Outcome Measures:

The primary outcome measure could be the adherence rate to inhalation therapy, assessed using pharmacy refill records or self-reporting questionnaires. Secondary outcomes may include quality of life measures and the frequency of acute exacerbations.

Impact on Nursing Practice:

This RCT would provide valuable evidence on whether personalized education significantly improves adherence to inhalation therapy in COPD patients. If the intervention proves effective, it could lead to the implementation of similar educational programs in clinical practice, ultimately improving patient outcomes, reducing hospitalizations, and enhancing the overall quality of care for individuals with COPD. This approach highlights the important role of nurses in designing and implementing evidence-based interventions to address clinical challenges.

 

References

Fitzgerald, K. et al. (2020). “Evaluating the Effectiveness of a Patient Education Program for Inhaler Technique Among Patients with Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial.” Journal of Nursing Scholarship, 52(2), 123-131. Available at:
https://onlinelibrary.wiley.com/doi/full/10.1111/jnu.12492

Cameron, A. et al. (2018). “The Effect of Educational Interventions on Medication Adherence in Patients with Chronic Diseases: A Systematic Review and Meta-analysis of Randomized Controlled Trials.” BMC Health Services Research, 18(1), 32. Available at:
https://bmchealthserviceresearch.biomedcentral.com/articles/10.1186/s12913-018-2895-6

 
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Interprofessional Organizational and Systems Leadership

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Interprofessional Organizational and Systems Leadership

( Interprofessional Organizational and Systems Leadership)

NURS6053 Assignment: Analysis of a Pertinent Healthcare Issue

The Quadruple Aim provides broad categories of goals to pursue to maintain and improve healthcare. Within each goal are many issues that, if addressed successfully, may have a positive impact on outcomes. For example, healthcare leaders are being tasked to shift from an emphasis on disease management often provided in an acute care setting to health promotion and disease prevention delivered in primary care settings. Efforts in this area can have significant positive impacts by reducing the need for primary healthcare and by reducing the stress on the healthcare system.

Interprofessional Organizational and Systems Leadership

Changes in the industry only serve to stress what has always been true; namely, that the healthcare field has always faced significant challenges, and that goals to improve healthcare will always involve multiple stakeholders. This should not seem surprising given the circumstances. Indeed, when a growing population needs care, there are factors involved such as the demands of providing that care and the rising costs associated with healthcare. Generally, it is not surprising that the field of healthcare is an industry facing multifaceted issues that evolve over time.

In this module’s Discussion, you reviewed some healthcare issues/stressors and selected one for further review. For this Assignment, you will consider in more detail the healthcare issue/stressor you selected. You will also review research that addresses the issue/stressor and write a white paper to your organization’s leadership that addresses the issue/stressor you selected.

To Prepare: Review the national healthcare issues/stressors presented in the Resources and reflect on the national healthcare issue/stressor you selected for study. Reflect on the feedback you received from your colleagues on your Discussion post for the national healthcare issue/stressor you selected. Identify and review two additional scholarly resources (not included in the Resources for this module) that focus on change strategies implemented by healthcare organizations to address your selected national healthcare issue/stressor.

The Assignment (3-4 Pages): Analysis of a Pertinent Healthcare Issue

Develop a 3- to 4-page paper, written to your organization’s leadership team, addressing your selected national healthcare issue/stressor and how it is impacting your work setting. Be sure to address the following: Describe the national healthcare issue/stressor you selected and its impact on your organization. Use organizational data to quantify the impact (if necessary, seek assistance from leadership or appropriate stakeholders in your organization).

Provide a brief summary of the two articles you reviewed from outside resources on the national healthcare issue/stressor. Explain how the healthcare issue/stressor is being addressed in other organizations. Summarize the strategies used to address the organizational impact of national healthcare issues/stressors presented in the scholarly resources you selected. Explain how they may impact your organization both positively and negatively. Be specific and provide examples.

 

References

Murray, C. J. L., & Frenk, J. (2010). “Ranking 37th—Measuring the Performance of the U.S. Health Care System.” New England Journal of Medicine, 362(2), 97-99. https://www.nejm.org/doi/full/10.1056/NEJMp0910066

Davis, K., Schoen, C., & Stremikis, K. (2014). “Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally.” The Commonwealth Fund. https://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror-wall

 
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Assessing Musculoskeletal Pain

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Assessing Musculoskeletal Pain

PLEASE FOLLOW THE INSTRUCTION BELOW: 5 REFERENCES NOT MORE THAN 5 YEARS ZERO PLAGIARISM PLEASE SEE THE ATTACHED RUBRIC DETAILS/7TH APA FORMAT/TEMPLATE BELOW
Assessing Musculoskeletal PainThe body is constantly sending signals about its health. One of the most easily recognized signals is pain. Musculoskeletal conditions comprise one of the leading causes of severe long-term pain in patients. The musculoskeletal system is an elaborate system of interconnected levers that provides the body with support and mobility. Because of the interconnectedness of the musculoskeletal system, identifying the causes of pain can be challenging. Accurately interpreting the cause of musculoskeletal pain requires an assessment process informed by patient history and physical exams.

In this Discussion, you will consider case studies that describe abnormal findings in patients seen in a clinical setting. To prepare: By Day 1 of this week, you will be assigned to one of the following specific case studies for this Discussion. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor. Your Discussion post should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP notes have specific data included in every patient case.

Review the following case studies: Case 1: Back Pain: A 42-year-old male reports pain in his lower back for the past month. The pain sometimes radiates to his left leg. In determining the cause of the back pain, based on your knowledge of anatomy, what nerve roots might be involved? How would you test for each of them? What other symptoms need to be explored? What are your differential diagnoses for acute low back pain? Consider the possible origins using the Agency for Healthcare Research and Quality (AHRQ) guidelines as a framework. What physical examination will you perform? What special maneuvers will you perform?

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

By Day 3 of Week 8, post an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each. (Assessing Musculoskeletal Pain)

References

Chou, R., Cote, P., & Frontera, W. R. (2020). Low Back Pain: Assessment and Management. American Family Physician, 102(9), 555-564.
https://www.aafp.org/pubs/afp/issues/2020/1101/p555.html

Sullivan, G. M., & O’Leary, J. (2019). Physical Examination and Health Assessment. Mosby.
https://www.elsevier.com/books/physical-examination-and-health-assessment/sullivan/978-0-323-64331-2

Krebs, J. (2022). Diagnosis and Management of Acute Low Back Pain. Clinical Medicine Insights: Therapeutics, 14.
https://journals.sagepub.com/doi/full/10.1177/11795484221084971

Eckhardt, D., & Moore, J. (2021). Differential Diagnosis of Low Back Pain: A Systematic Review. The American Journal of Medicine, 134(10), 1243-1249.
https://www.amjmed.com/article/S0002-9343(21)00341-7/fulltext

Hägg, O., & Fritzell, P. (2020). Clinical Guidelines for the Management of Low Back Pain. European Spine Journal, 29(8), 1750-1759.
https://link.springer.com/article/10.1007/s00586-020-06609-1

 
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Parent Teaching Project

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Parent Teaching Project

VP Shunt in a Child with Hydrocephalus

Create a one-page parent teaching project plus a brochure on a child with hydrocephalus.
Parent Teaching Project

Parent Teaching Project: VP Shunt in a Child with Hydrocephalus

A Ventriculoperitoneal (VP) shunt is a medical device used to treat hydrocephalus, a condition where cerebrospinal fluid (CSF) builds up in the brain, leading to increased pressure. The VP shunt redirects the fluid from the brain to the abdomen, where it is absorbed by the body. This surgery helps relieve the pressure and reduce symptoms.

How the VP Shunt Works
The shunt consists of three parts: a catheter placed in the brain’s ventricles, a valve that controls the flow of fluid, and a tube leading to the abdominal cavity. This system allows excess CSF to drain safely and prevents further buildup.

Signs and Symptoms of Shunt Malfunction
Parents should be aware of symptoms that may indicate a problem with the VP shunt. These include:

  • Persistent headaches or irritability.
  • Nausea or vomiting.
  • Changes in behavior or cognitive abilities.
  • Swelling or redness along the shunt tract.
  • Drowsiness or difficulty waking. If any of these symptoms are noticed, contact a healthcare provider immediately.

Post-Surgery Care
After shunt surgery, regular follow-ups with the neurosurgeon are important to ensure that the device is functioning properly. Parents should also monitor for signs of infection, which can include fever, redness, and swelling at the incision site.

Daily Life with a VP Shunt
Children with a VP shunt can often lead normal lives, but certain precautions are necessary. Parents should:

  • Ensure that the child avoids contact sports or activities that could injure the head.
  • Work with educators and therapists to support the child’s learning and development.
  • Understand that the shunt may require adjustments or replacements as the child grows.

Educational Support
Parents should educate themselves about the VP shunt and hydrocephalus. Understanding the signs of complications and the importance of regular monitoring will help ensure the child’s well-being. Many families find support from groups like the Hydrocephalus Association.

Brochure: Understanding the VP Shunt for Children with Hydrocephalus

Front Page: Title and Image “VP Shunt: Caring for Your Child with Hydrocephalus”
Include an image of a child receiving care, surrounded by supportive family members to create a feeling of assurance.

Inside Left Panel: What is a VP Shunt?
A Ventriculoperitoneal (VP) shunt is a device that helps manage hydrocephalus by draining excess cerebrospinal fluid from the brain to the abdomen. This reduces pressure on the brain and prevents complications.

Inside Center Panel: Symptoms of Shunt Malfunction
It’s important to recognize signs that may indicate a problem with the VP shunt. These include:

  • Headaches or irritability.
  • Nausea or vomiting.
  • Sleepiness or trouble waking.
  • Redness or swelling along the shunt. Parents should seek medical attention immediately if these symptoms occur.

Inside Right Panel: What to Expect After Surgery
Most children recover well after VP shunt surgery. Parents should follow up with their healthcare provider regularly. Watch for signs of infection, such as fever or swelling near the incision. While the shunt generally works well, it may need adjustments as the child grows.

Back Page: Living with a VP Shunt
Children with a VP shunt can live active lives with a few precautions. Avoid contact sports and consult educators for any needed learning support. Regular medical check-ups are essential to ensure the shunt works properly.

Resources for Support:

  • Hydrocephalus Association (website or contact).
  • Local groups for parents of children with hydrocephalus.

This format gives parents clear, concise information about VP shunts and how to care for their child.

References

Drake, J. M., & Kulkarni, A. V. (2018). Shunt technology in pediatric hydrocephalus: Advances and challenges. Neurosurgery Clinics of North America, 29(2), 241-248. https://doi.org/10.1016/j.nec.2018.01.008

Rekate, H. L. (2017). The pediatric neurosurgical treatment of hydrocephalus: Past, present, and future. Journal of Neurosurgery: Pediatrics, 20(3), 203-215. https://doi.org/10.3171/2017.5.PEDS17252

 
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Healthy People 2020

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Healthy People 2020

Discuss aspects of a health concern not being addressed despite the efforts of services and partnerships involved and describe the ultimate outcome(s) or goal(s) from Healthy People 2020 relating to that specific health concern.
Answer the following questions to assist in data interpretation:
What similarities are apparent between the data that were gathered and the data that were generated?
What differences are apparent between the data that were gathered and the data that were generated?
What are the weakness and strengths of this community?
In what areas is improvement needed in this community?

The assignment should be written in an APA-formatted essay. The essay should be between 1500 and 2000 words in length and include at least two scholarly sources other than provided materials.
Healthy People 2020

Health Concern Not Being Addressed and Healthy People 2020 Goals

Obesity is a major public health concern that continues to affect communities despite the efforts of healthcare services, educational programs, and community partnerships. While many services promote healthy eating and exercise, certain aspects, such as socioeconomic factors and access to affordable healthy food, remain inadequately addressed.

Healthy People 2020 has set clear goals to reduce the proportion of adults and children who are obese and to improve overall nutrition and physical activity. The ultimate outcomes focus on reducing obesity-related health conditions like diabetes and heart disease, increasing public awareness of healthy lifestyles, and promoting environments that support physical activity and access to nutritious foods.

Similarities Between Gathered and Generated Data

When data were gathered from community assessments, both the gathered and generated data indicated high rates of obesity within the population. Both types of data identified poor diet and physical inactivity as major contributing factors. Community surveys and focus groups echoed national statistics, showing that a significant portion of the population was either overweight or obese. Additionally, both sets of data demonstrated the community’s general awareness of obesity as a problem, with residents expressing concern over their weight and health.

Differences Between Gathered and Generated Data

While the gathered data reflected general trends in obesity rates, the generated data highlighted more specific local factors. For example, the generated data from local surveys and focus groups revealed that while many community members understood the importance of a healthy diet, limited access to affordable healthy food and few opportunities for physical activity were substantial barriers.

In contrast, gathered data from broader sources might suggest general solutions such as dietary education, whereas the generated data indicated that addressing socioeconomic barriers, improving local infrastructure (e.g., parks, walking paths), and providing better access to affordable fresh produce were more specific community needs.

Weaknesses and Strengths of the Community

One of the strengths of the community is the presence of active local partnerships, including schools, community centers, and healthcare providers, which work together to promote health. Many community members are willing to participate in health programs, and there is awareness of the obesity issue.

However, the weaknesses include limited access to healthcare services, especially preventive services like nutritional counseling, and economic disparities that prevent some residents from adopting healthier lifestyles. In some parts of the community, “food deserts” exist, where fresh fruits and vegetables are hard to find, and residents may rely on fast food and convenience stores for meals.

Areas for Improvement

Improvement is needed in infrastructure to support physical activity, such as creating more parks, walking paths, and community fitness programs. Additionally, efforts should be made to improve access to healthy foods by encouraging grocery stores to carry fresh produce, supporting local farmers’ markets, and offering subsidies or food assistance programs for low-income families. Another area for improvement is in health education, specifically targeting the younger population to instill healthier eating habits and the importance of physical activity early on.

Conclusion

The issue of obesity in the community reflects a complex interplay of factors that extend beyond simple education and awareness campaigns. Addressing the root causes, such as socioeconomic barriers and access to healthy food, will require a more targeted approach. Healthy People 2020 goals emphasize reducing obesity and improving access to health-promoting resources, and to meet these goals, more comprehensive strategies will need to be employed at both local and national levels.

By understanding the data differences, community weaknesses, and areas for improvement, better strategies can be designed to tackle obesity and improve overall health outcomes.

References

Hales, C. M., Carroll, M. D., Fryar, C. D., & Ogden, C. L. (2020). Prevalence of obesity and severe obesity among adults: United States, 2017–2018. National Center for Health Statistics Data Brief, (360), 1-8. https://www.cdc.gov/nchs/products/databriefs/db360.htm

Sahoo, K., Sahoo, B., Choudhury, A. K., Sofi, N. Y., Kumar, R., & Bhadoria, A. S. (2015). Childhood obesity: Causes and consequences. Journal of Family Medicine and Primary Care, 4(2), 187-192. https://doi.org/10.4103/2249-4863.154628

 
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Discussion- POC and Hypertension

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Discussion- POC and Hypertension

The advanced practice nurse is updating the plan of care of nursing home patients with hypertension. Briefly describe the therapeutic actions of drugs affecting blood pressure (diuretics, ACE inhibitors, ARBs, CCB, sympathetic nervous system drugs).

What important teaching points should be addressed for patients receiving antihypertensive drugs?

Post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.
(Discussion- POC and Hypertension)

Discussion- POC and Hypertension

Therapeutic Actions of Antihypertensive Drugs

Managing hypertension is crucial, particularly in nursing home patients, where medication management can significantly impact overall health outcomes. The main classes of antihypertensive medications include diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), and sympathetic nervous system drugs. Each class functions through different mechanisms to lower blood pressure effectively.

Diuretics
Diuretics, commonly referred to as “water pills,” help lower blood pressure by promoting the excretion of sodium and water from the body through urine. This reduction in fluid volume decreases blood pressure. Thiazide diuretics, such as hydrochlorothiazide, are often first-line agents for treating hypertension. They are effective in reducing both systolic and diastolic blood pressure and are especially beneficial for elderly patients (Whelton et al., 2018).

ACE Inhibitors
ACE inhibitors, such as lisinopril and enalapril, work by blocking the enzyme that converts angiotensin I to angiotensin II, a potent vasoconstrictor. By inhibiting this conversion, ACE inhibitors promote vasodilation, reducing peripheral vascular resistance and lowering blood pressure. Additionally, these medications have renal protective effects, making them particularly beneficial for patients with diabetes or chronic kidney disease (Mancia et al., 2018).

Angiotensin Receptor Blockers (ARBs)
ARBs, including losartan and valsartan, block the action of angiotensin II at its receptor sites. This blockade also leads to vasodilation and decreased blood pressure. ARBs are often used as alternatives for patients who experience cough or angioedema with ACE inhibitors. They provide similar renal protective effects, making them suitable for patients with comorbid conditions (Whelton et al., 2018).

Calcium Channel Blockers (CCBs)
CCBs, such as amlodipine and diltiazem, prevent calcium from entering heart and blood vessel cells. By doing so, these medications reduce heart contractility and promote vasodilation, leading to lower blood pressure. CCBs are especially effective for patients with angina or arrhythmias and can be used in combination with other antihypertensives (Mancia et al., 2018).

Sympathetic Nervous System Drugs
Drugs affecting the sympathetic nervous system, such as beta-blockers and alpha-2 agonists, also play a role in managing hypertension. Beta-blockers, such as metoprolol, decrease heart rate and contractility, reducing cardiac output. Alpha-2 agonists, like clonidine, reduce sympathetic outflow from the central nervous system, leading to vasodilation and lowered blood pressure. These agents may be useful in patients with concurrent conditions like heart failure or anxiety (Whelton et al., 2018).

Important Teaching Points for Patients

Effective patient education is essential for individuals receiving antihypertensive medications. Several key teaching points should be addressed:

  1. Medication Adherence: Patients should understand the importance of taking medications as prescribed. Skipping doses can lead to blood pressure fluctuations and increase the risk of complications.
  2. Potential Side Effects: Patients should be informed about common side effects associated with their medications. For example, diuretics may cause increased urination, while ACE inhibitors may lead to a persistent cough. Understanding these side effects can help patients manage them effectively and report any severe reactions to their healthcare provider.
  3. Lifestyle Modifications: Emphasizing the role of lifestyle changes in managing hypertension is vital. Patients should be encouraged to adopt a heart-healthy diet, engage in regular physical activity, limit sodium intake, and manage stress.
  4. Monitoring Blood Pressure: Patients should be taught how to monitor their blood pressure at home and maintain a log to share with their healthcare provider. This monitoring can help assess the effectiveness of treatment and make necessary adjustments.
  5. Regular Follow-up: Patients should be encouraged to attend regular follow-up appointments to monitor their blood pressure and assess their treatment regimen. This follow-up is essential for making timely adjustments based on individual responses to therapy.
  6. Recognition of Symptoms: Educating patients about recognizing symptoms of hypotension (such as dizziness, lightheadedness, or fainting) is crucial, especially for older adults who may be more susceptible to these effects.

Conclusion

The therapeutic actions of antihypertensive medications vary by class, each working through distinct mechanisms to lower blood pressure. Proper patient education on medication adherence, potential side effects, lifestyle modifications, blood pressure monitoring, and the importance of regular follow-up can enhance treatment outcomes in nursing home patients with hypertension. By equipping patients with knowledge, advanced practice nurses can significantly improve the management of hypertension and enhance patients’ quality of life.
(Discussion- POC and Hypertension)

References

Mancia, G., Fagard, R., Narkiewicz, K., et al. (2018). 2018 Guidelines for the management of arterial hypertension. European Heart Journal, 39(33), 3021-3104. https://doi.org/10.1093/eurheartj/ehy339

Whelton, P. K., Carey, R. M., Aronow, W. S., et al. (2018). Guideline for the management of high blood pressure in adults: 2017. Hypertension, 71(6), e13-e115. https://doi.org/10.1161/HYP.0000000000000065

 
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Argument Analysis

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Argument Analysis

Instructions

Read the following argument examples in this activity.

Argument 1
Dick and Jane have insured their house and cars with Farmer’s Mutual for 10 years. During this time, they filed only one claim for $500, and the premiums have risen 100%. Two weeks ago, while backing out of the garage, Jane damaged the right fender. They didn’t fix it, and yesterday, while Jane was parked at the supermarket, someone hit the right side of the car, damaging everything but the right fender. When Jane checks the insurance policy, she discovers that while the supermarket accident is covered, the damaged right fender is not. Jane says, “Let’s claim that all the damage happened at the supermarket. It’s only fair. The insurance company has made thousands of dollars from our premiums alone, not to mention all the other people they insure, so they’ll hardly miss the few thousands that their repairs will cost. Many of their friends have done the same – included items that were not part of actual collision damage. It’s unlikely that they will be discovered, because the fender could easily have been damaged in the collision.”

Argument Analysis
Argument 2
In a world where medical resources are in ever-shorter supply, allocation of those resources is becoming an issue. Critical care units (ICU) put heavy demand on hospital resources. Adult medical intensive care units (MICU’s) are often occupied by elderly patients in the final stages of chronic illnesses. Neonatal ICU’s, however, are reserved for premature infants that need critical care in the first few days of life. Surveys of mortality rates in relation to the amount of care for both units show that on a cost/benefit basis, outcomes for NICU patients are statistically better than those for MICU patients. Since hospitals should prioritize outcomes, it is clear that resources should be allocated more heavily to the NICU.

Using the examples in the introduction of this activity, address the following:

Briefly analyze each argument as follows:
State the issue and the conclusion.

For each argument, analyze the argument:
State if it is deductive or inductive.
Explain how the argument follows the form of an inductive or deductive argument.
Reference words, phrases, the structure of the argument, or any other facts or observations you believe support your claim.
Diagram the argument.

Writing Requirements (APA format)

Length: 1-2 pages total (not including title page or references page)
1-inch margins
Double spaced
12-point Times New Roman font
Title page
(Argument Analysis)

 
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Evidence-based practice (EBP)

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Evidence-based practice (EBP)

Sustaining change can be difficult, as there are many variables that can affect implementation. One critical component of evidence-based practice (EBP) is to ensure that practice change is part of an organization’s culture so it will continue to impact outcomes over time.

Name two potential barriers that may prevent your EBP change proposal (based on after discharge follow-up) from continuing to obtain the same desired results 6 months to a year from now, and your strategies for overcoming these barriers.

Evidence-based practice (EBP)

Sustaining Evidence-Based Practice Change in After-Discharge Follow-Up

Sustaining change within healthcare organizations, particularly regarding evidence-based practice (EBP) proposals, can be challenging. As organizations implement changes, various barriers may arise that hinder the desired outcomes over time. In the context of an EBP change proposal focused on after-discharge follow-up, two significant barriers can be identified: staff resistance to change and inadequate patient engagement.

Barrier 1: Staff Resistance to Change

One potential barrier that may prevent the EBP change proposal from achieving sustained results is staff resistance to change. Healthcare staff may be hesitant to adopt new practices or workflows due to comfort with established routines, skepticism about the efficacy of the proposed changes, or concerns regarding additional workload. Resistance can stem from a lack of understanding of the benefits associated with the change, insufficient training, or inadequate leadership support.

Strategies for Overcoming Staff Resistance
To address this barrier, it is essential to engage staff early in the change process. Involving team members in discussions about the importance and expected outcomes of the EBP change can foster a sense of ownership and investment. Providing comprehensive training sessions that highlight the benefits of the new follow-up practices, along with how they can enhance patient outcomes, is crucial. Additionally, ongoing support from leadership and the establishment of feedback mechanisms can help staff voice concerns, thereby promoting a culture of open communication and collaboration.

Barrier 2: Inadequate Patient Engagement

Another significant barrier that could hinder the sustainability of the after-discharge follow-up proposal is inadequate patient engagement. If patients do not actively participate in their follow-up care, the effectiveness of the interventions may diminish. Factors contributing to this issue may include lack of understanding about the importance of follow-up appointments, barriers to accessing healthcare services (such as transportation issues), or low health literacy.

Strategies for Enhancing Patient Engagement
To overcome this barrier, it is vital to implement strategies that enhance patient engagement. Providing educational resources that explain the significance of follow-up care and what patients can expect during their appointments can empower them to take an active role in their healthcare. Additionally, employing various communication methods, such as reminder calls, texts, or emails, can help reinforce the importance of follow-up visits. Collaborating with community organizations to address transportation barriers and promote accessible healthcare services can also increase patient participation.

Conclusion

In conclusion, sustaining the EBP change proposal focused on after-discharge follow-up requires addressing potential barriers such as staff resistance and inadequate patient engagement. By actively involving staff in the change process and enhancing patient education and access to follow-up care, organizations can foster a culture of continuous improvement. Ensuring that the practice change is integrated into the organizational culture is essential for maintaining positive outcomes over time. Through these strategies, healthcare organizations can work towards achieving long-lasting impacts in patient care and outcomes.

References

McCormack, B., McCance, T., & McGhee, S. (2017). Developing evidence-based practice: A guide for nurses and health care professionals. John Wiley & Sons. https://www.wiley.com/en-us/Developing+Evidence+Based+Practice%3A+A+Guide+for+nurses+and+health+care+professionals-p-9781119266586

Ogrinc, G., et al. (2016). Transforming care: A multidisciplinary approach to improving patient outcomes. American Journal of Medical Quality, 31(5), 429-436. https://journals.sagepub.com/doi/full/10.1177/1062860616632454

 
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