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Nursing Paper Example on Gastrointestinal Disease: Gastroesophageal Reflux Disease (GORD)

Nursing Paper Example on Gastrointestinal Disease: Gastroesophageal Reflux Disease (GORD)

Introduction

Gastroesophageal Reflux Disease (GORD) is a prevalent gastrointestinal ailment affecting millions worldwide. Characterized by the backward flow of stomach acid into the esophagus, GORD poses significant discomfort and potential health risks if left untreated. The lower esophageal sphincter’s weakened state allows gastric contents to regurgitate, causing symptoms like heartburn, chest pain, and regurgitation. While the exact prevalence varies across demographics, GORD is commonly associated with factors such as obesity, smoking, and certain medications. Understanding the underlying mechanisms of GORD is crucial for effective management and prevention of complications. This essay explores the causes, symptoms, etiology, pathophysiology, diagnosis, treatment regimens, and patient education strategies related to GORD, shedding light on its impact on individuals’ daily lives and the importance of comprehensive management approaches. (Nursing Paper Example on Gastrointestinal Disease: Gastroesophageal Reflux Disease (GORD))

Nursing Paper Example on Gastrointestinal Disease: Gastroesophageal Reflux Disease (GORD)

Causes

Gastroesophageal Reflux Disease (GORD) stems from various factors, primarily centered around the malfunctioning of the lower esophageal sphincter (LES), a muscular ring separating the esophagus from the stomach. This weakening or relaxation of the LES allows stomach acid and partially digested food to flow backward into the esophagus, leading to the characteristic symptoms of GORD.

One of the significant causes of LES dysfunction is obesity. Excess weight puts pressure on the abdomen, which can force stomach contents upward into the esophagus, particularly when lying down or bending over. Additionally, adipose tissue produces hormones and substances that may contribute to LES relaxation, exacerbating reflux symptoms in obese individuals.

Smoking is another prominent risk factor for GORD. The chemicals in cigarette smoke can weaken the LES and impair its ability to prevent acid reflux. Moreover, smoking reduces saliva production, which normally helps neutralize stomach acid in the esophagus. Consequently, smokers are more prone to experiencing severe and prolonged reflux symptoms.

Certain medications are known to exacerbate GORD symptoms or weaken the LES. These include nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and aspirin, which can irritate the esophageal lining and increase acid production, aggravating reflux symptoms. Other medications, such as calcium channel blockers used to treat hypertension and some sedatives, may relax the LES, facilitating acid reflux.

Dietary factors play a crucial role in triggering GORD symptoms. Spicy, acidic, and fatty foods can irritate the esophagus and stimulate acid production, exacerbating reflux. Citrus fruits, tomatoes, chocolate, caffeine, and alcohol are common culprits known to worsen symptoms in susceptible individuals. Moreover, large meals and lying down shortly after eating can increase intra-abdominal pressure, promoting acid reflux.

Pregnancy is also associated with an increased risk of GORD due to hormonal changes and elevated intra-abdominal pressure as the uterus expands. Hormones like progesterone relax the LES, contributing to reflux symptoms during pregnancy. Additionally, the growing fetus can exert pressure on the stomach, forcing acid into the esophagus.

In summary, GORD is caused by a combination of factors, including obesity, smoking, certain medications, dietary habits, and pregnancy. Understanding these underlying causes is essential for developing effective management strategies tailored to individual patients and addressing modifiable risk factors to alleviate symptoms and improve quality of life. (Nursing Paper Example on Gastrointestinal Disease: Gastroesophageal Reflux Disease (GORD)

Signs and Symptoms

Heartburn:
Heartburn is the hallmark symptom of Gastroesophageal Reflux Disease (GORD), characterized by a burning sensation in the chest or throat. It typically occurs after eating or when lying down and is caused by stomach acid refluxing into the esophagus. Heartburn can range from mild discomfort to severe pain and is often exacerbated by certain foods, beverages, or lying flat.

Regurgitation:
Regurgitation is the involuntary return of partially digested food or stomach contents into the mouth or throat. Individuals with GORD may experience a sour or bitter taste in their mouth as stomach acid regurgitates into the esophagus. Regurgitation can occur shortly after eating or when bending over and is often accompanied by a sensation of fluid moving up the chest.

Chest Pain:
Chest pain, also known as acid indigestion, is a common symptom of GORD that can mimic heart-related conditions such as angina or a heart attack. The pain may be sharp or burning and is typically located behind the breastbone. It may worsen when lying down or after consuming acidic or fatty foods. While chest pain in GORD is usually non-cardiac in nature, it should be evaluated by a healthcare professional to rule out serious cardiac conditions.

Difficulty Swallowing:
Some individuals with GORD may experience dysphagia, or difficulty swallowing, due to inflammation and irritation of the esophagus caused by acid reflux. Dysphagia can manifest as a sensation of food sticking in the throat or chest, discomfort or pain while swallowing, or the need to swallow repeatedly to move food down. Severe dysphagia may indicate complications such as esophageal strictures or narrowing.

Persistent Cough:
A chronic cough that persists despite treatment for other respiratory conditions may be a symptom of GORD. The reflux of stomach acid into the esophagus can irritate the throat and trigger coughing. This cough is often dry and persistent, particularly at night or after eating. While coughing is a common symptom of GORD, it can also be indicative of other respiratory or gastrointestinal disorders, necessitating proper evaluation by a healthcare provider.

In conclusion, GORD manifests through various signs and symptoms, including heartburn, regurgitation, chest pain, difficulty swallowing, and persistent cough. These symptoms can significantly impact an individual’s quality of life and may vary in severity depending on the frequency and extent of acid reflux. Recognizing these manifestations is crucial for timely diagnosis and management of GORD to alleviate discomfort and prevent complications. (Nursing Paper Example on Gastrointestinal Disease: Gastroesophageal Reflux Disease (GORD))

Nursing Paper Example on Gastrointestinal Disease: Gastroesophageal Reflux Disease (GORD)

Etiology

Genetic Predisposition: While the exact cause of Gastroesophageal Reflux Disease (GORD) remains multifactorial, genetic predisposition plays a significant role in its development. Studies have identified a familial aggregation of GORD, suggesting a genetic component to the condition. Specific genetic variations may influence the function of the lower esophageal sphincter (LES) or alter gastric motility, predisposing individuals to reflux symptoms.

Obesity: Obesity is a well-established risk factor for GORD, with excess body weight contributing to increased intra-abdominal pressure. This pressure can weaken the LES, allowing gastric contents to reflux into the esophagus more easily. Adipose tissue also produces inflammatory cytokines and hormones that may further disrupt esophageal function and exacerbate reflux symptoms in obese individuals.

Hiatal Hernia: A hiatal hernia occurs when a portion of the stomach protrudes through the diaphragm into the chest cavity, disrupting the normal anatomy of the gastroesophageal junction. This structural abnormality can impair the function of the LES, leading to GORD symptoms. While not all individuals with hiatal hernias develop GORD, the presence of a hiatal hernia increases the risk of reflux and complications.

Smoking: Cigarette smoking is associated with an increased risk of GORD due to its effects on LES function and gastric motility. The chemicals in tobacco smoke can relax the LES, making it more prone to reflux. Smoking also reduces saliva production, which normally helps neutralize stomach acid in the esophagus. Consequently, smokers are more likely to experience severe and prolonged reflux symptoms.

Dietary Factors: Certain dietary habits and food choices can exacerbate GORD symptoms. Spicy, acidic, and fatty foods can irritate the esophagus and stimulate acid production, leading to increased reflux. Common trigger foods include citrus fruits, tomatoes, chocolate, caffeine, and alcohol. Large meals and lying down shortly after eating can also promote acid reflux by increasing intra-abdominal pressure. Identifying and avoiding trigger foods is essential for managing GORD symptoms.

Medications: Several medications are known to exacerbate GORD symptoms or weaken the LES, increasing the risk of reflux. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and aspirin can irritate the esophageal lining and increase acid production, aggravating reflux symptoms. Additionally, calcium channel blockers used to treat hypertension and certain sedatives may relax the LES, facilitating acid reflux.

The etiology of Gastroesophageal Reflux Disease involves a complex interplay of genetic predisposition, obesity, hiatal hernias, smoking, dietary factors, and medications. Understanding these underlying contributors is essential for developing targeted management strategies and addressing modifiable risk factors to alleviate symptoms and improve quality of life. (Nursing Paper Example on Gastrointestinal Disease: Gastroesophageal Reflux Disease (GORD)

Pathophysiology

Lower Esophageal Sphincter Dysfunction: Gastroesophageal Reflux Disease (GORD) primarily involves dysfunction of the lower esophageal sphincter (LES), a muscular ring that acts as a barrier between the esophagus and the stomach. In individuals with GORD, the LES fails to close properly or relaxes inappropriately, allowing gastric contents, including stomach acid and partially digested food, to reflux into the esophagus. This malfunctioning of the LES is central to the pathophysiology of GORD and leads to the characteristic symptoms associated with the condition.

Impaired Esophageal Clearance: Another aspect of GORD’s pathophysiology involves impaired esophageal clearance mechanisms. Normally, the esophagus has efficient mechanisms, including peristalsis and salivary neutralization, to clear refluxed material back into the stomach and neutralize gastric acid. However, in individuals with GORD, these clearance mechanisms may be compromised, leading to prolonged exposure of the esophageal mucosa to acidic gastric contents. This prolonged exposure contributes to esophageal mucosal injury and inflammation, exacerbating symptoms and potentially leading to complications such as erosive esophagitis or Barrett’s esophagus.

Esophageal Mucosal Injury and Inflammation: Repeated exposure of the esophageal mucosa to gastric acid and other corrosive contents leads to mucosal injury and inflammation in individuals with GORD. The acidic nature of gastric contents irritates the esophageal epithelium, causing tissue damage and inflammation. This inflammatory response further compromises esophageal function and exacerbates symptoms such as heartburn, regurgitation, and chest pain. Over time, chronic inflammation may contribute to the development of complications such as esophageal strictures, Barrett’s esophagus, or even esophageal adenocarcinoma in severe cases.

Potential Complications: GORD can lead to various complications due to chronic esophageal mucosal injury and inflammation. These complications may include erosive esophagitis, characterized by erosions or ulcers in the esophageal mucosa, which can cause pain and bleeding. Long-term untreated GORD may also result in the development of Barrett’s esophagus, a condition characterized by changes in the esophageal lining that predispose individuals to esophageal adenocarcinoma, a type of cancer. Additionally, severe and recurrent reflux can lead to esophageal strictures, narrowing of the esophagus that can cause difficulty swallowing and food impaction.

The pathophysiology of Gastroesophageal Reflux Disease involves dysfunction of the lower esophageal sphincter, impaired esophageal clearance mechanisms, mucosal injury, and inflammation. Chronic inflammation and mucosal injury may lead to complications such as erosive esophagitis, Barrett’s esophagus, and esophageal strictures if left untreated. Understanding the underlying pathophysiological mechanisms is essential for the effective management and prevention of complications associated with GORD. (Nursing Paper Example on Gastrointestinal Disease: Gastroesophageal Reflux Disease (GORD)).

Nursing Paper Example on Gastrointestinal Disease: Gastroesophageal Reflux Disease (GORD)

DSM-5 Diagnosis

Clinical Evaluation: Diagnosing Gastroesophageal Reflux Disease (GORD) typically involves a comprehensive clinical evaluation based on the patient’s medical history, symptom presentation, and physical examination. Healthcare providers often rely on the presence of characteristic symptoms such as heartburn, regurgitation, chest pain, and difficulty swallowing to initiate further diagnostic investigations.

Diagnostic Criteria: While the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) does not provide specific diagnostic criteria for GORD, it emphasizes the importance of assessing symptom severity and functional impairment in making a diagnosis. Healthcare providers use standardized questionnaires or symptom scales to evaluate the frequency, intensity, and impact of reflux symptoms on the patient’s daily functioning and quality of life.

Objective Measures: In addition to clinical assessment, objective measures such as upper gastrointestinal endoscopy, esophageal pH monitoring, and esophageal manometry may be employed to confirm the diagnosis of GORD and assess the extent of esophageal mucosal injury and dysfunction. Upper gastrointestinal endoscopy allows direct visualization of the esophageal mucosa and the identification of erosions, ulcers, or other pathological changes indicative of GORD. Esophageal pH monitoring measures the frequency and duration of acid reflux episodes, providing valuable information about the severity and pattern of reflux. Esophageal manometry evaluates esophageal motility and LES function, helping to identify underlying motor disorders contributing to GORD symptoms.

Differential Diagnosis: Diagnosing GORD requires differentiation from other conditions that may present with similar symptoms, such as peptic ulcer disease, gastritis, esophageal motility disorders, and cardiac conditions like angina or myocardial infarction. Healthcare providers consider the patient’s medical history, risk factors, symptom pattern, and response to initial interventions to rule out alternative diagnoses and confirm GORD.

Multidisciplinary Approach: Diagnosing GORD often involves a multidisciplinary approach, with collaboration between primary care physicians, gastroenterologists, and other healthcare professionals. This collaborative effort ensures comprehensive evaluation, appropriate diagnostic testing, and tailored management strategies to address individual patient needs and optimize outcomes.

Diagnosing Gastroesophageal Reflux Disease relies on a comprehensive clinical evaluation, standardized symptom assessment, and objective measures to confirm the diagnosis and assess the severity and impact of symptoms. While the DSM-5 does not provide specific diagnostic criteria for GORD, it underscores the importance of evaluating symptom severity and functional impairment in making a diagnosis. Differential diagnosis and a multidisciplinary approach are essential to differentiate GORD from other conditions with similar presentations and ensure optimal management and outcomes for affected individuals. (Nursing Paper Example on Gastrointestinal Disease: Gastroesophageal Reflux Disease (GORD)

Treatment Regimens

Lifestyle Modifications: Effective management of Gastroesophageal Reflux Disease (GORD) often begins with lifestyle modifications aimed at reducing reflux symptoms and improving esophageal health. Patients are advised to avoid trigger foods and beverages known to exacerbate reflux, such as spicy, acidic, and fatty foods, caffeine, alcohol, and carbonated drinks. Additionally, consuming smaller, more frequent meals and avoiding lying down or bending over shortly after eating can help reduce intra-abdominal pressure and minimize reflux episodes.

Weight Management: Obesity is a significant risk factor for GORD, and weight management is an integral component of treatment. Patients are encouraged to achieve and maintain a healthy weight through a balanced diet and regular physical activity. Weight loss can alleviate pressure on the abdomen, reduce reflux symptoms, and improve overall esophageal health.

Elevating the Head of the Bed: Elevating the head of the bed by 6 to 8 inches can help prevent acid reflux during sleep by utilizing gravity to keep stomach contents in the stomach. Patients can achieve this elevation by using bed risers or placing blocks under the bed frame’s legs. Sleeping on a wedge-shaped pillow can also provide similar benefits by elevating the upper body during sleep.

Smoking Cessation: Smoking is a modifiable risk factor for GORD, and smoking cessation is an essential aspect of treatment. Patients are encouraged to quit smoking to reduce LES relaxation, improve esophageal motility, and decrease reflux symptoms. Healthcare providers can offer support and resources to help patients quit smoking, such as counseling, nicotine replacement therapy, or prescription medications.

Medications: Pharmacological interventions are often employed to manage GORD symptoms and reduce esophageal mucosal injury. Proton pump inhibitors (PPIs), such as omeprazole, lansoprazole, and esomeprazole, are commonly prescribed to suppress gastric acid production and promote esophageal healing. H2 receptor antagonists, such as ranitidine and famotidine, can also be used to reduce acid secretion and alleviate reflux symptoms. Antacids may provide symptomatic relief by neutralizing stomach acid, although they are less effective at healing esophageal mucosal damage.

Surgical Intervention: In refractory cases or when complications arise, surgical intervention may be considered to improve LES function and prevent reflux. Fundoplication is a surgical procedure in which the upper part of the stomach is wrapped around the LES to strengthen its closure and reduce reflux. Endoscopic procedures, such as transoral incisionless fundoplication (TIF) or radiofrequency ablation (RFA), may also be performed to tighten the LES and improve reflux control. (Nursing Paper Example on Gastrointestinal Disease: Gastroesophageal Reflux Disease (GORD)

Patient Education: Patient education is essential for empowering individuals to actively participate in their GORD management and achieve optimal outcomes. Patients should be educated about the importance of adhering to lifestyle modifications, including dietary changes, weight management, and smoking cessation, to minimize reflux symptoms and prevent complications. Healthcare providers should discuss the rationale behind recommended interventions, potential side effects of medications, and expected outcomes to enhance patient understanding and adherence.

Monitoring and Follow-Up: Regular monitoring and follow-up are crucial components of GORD management to assess treatment efficacy, adjust interventions as needed, and address any emerging concerns or complications. Patients should be encouraged to report any persistent or worsening symptoms, side effects of medications, or difficulties adhering to recommended lifestyle modifications during follow-up visits.

The management of Gastroesophageal Reflux Disease involves a multifaceted approach encompassing lifestyle modifications, pharmacological interventions, surgical options, and patient education. Tailored treatment regimens should address individual patient needs and preferences while emphasizing the importance of adherence to lifestyle modifications and regular monitoring to achieve optimal symptom control and improve esophageal health.

Conclusion

Gastroesophageal Reflux Disease (GORD) is a complex gastrointestinal disorder with multifactorial etiology and diverse clinical manifestations. This essay has provided an overview of the causes, signs and symptoms, etiology, pathophysiology, DSM-5 diagnosis, treatment regimens, and patient education strategies related to GORD. By emphasizing the importance of simple yet formal language, concise paragraphs, and clear transitions, this essay has sought to enhance readability and comprehension while maintaining a formal tone. Effective management of GORD requires a comprehensive approach that encompasses lifestyle modifications, pharmacological interventions, surgical options, and patient education. By addressing modifiable risk factors, empowering patients through education, and individualizing treatment regimens, healthcare providers can improve symptom control, prevent complications, and enhance the quality of life for individuals living with GORD. (Nursing Paper Example on Gastrointestinal Disease: Gastroesophageal Reflux Disease (GORD).

References

http://Clarrett DM, Hachem C. Gastroesophageal Reflux Disease (GERD). Mo Med. 2018 May-Jun;115(3):214-218. PMID: 30228725; PMCID: PMC6140167.

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Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis

January 26, 2024/in Assignment Help, Assignment Help Nursing, BLOG, Homework Help, Nursing Exam Help, Nursing Paper Help, Solved Nursing Essays /by Aimee Grace

Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis

Introduction

Gastrointestinal (GI) diseases pose significant health challenges worldwide, impacting millions annually. Among these ailments, “Gastro,” formally termed gastroenteritis, stands out as a prevalent condition characterized by inflammation of the stomach and intestines. While its colloquial name suggests a focus on the stomach, Gastro affects the entire gastrointestinal tract, causing distressing symptoms and discomfort. Understanding the intricacies of Gastro is essential for effective management and prevention, given its widespread occurrence and potential for complications, especially in vulnerable populations such as children and the elderly. This exploration dives into various aspects of Gastro, including its causes, signs, and symptoms, etiology, pathophysiology, diagnosis according to the DSM-5, treatment regimens, and patient education. By exploring these facets, we aim to gain a comprehensive understanding of this gastrointestinal ailment and its impact on individuals and communities. (Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis)

Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis

Causes

Gastro, formally known as gastroenteritis, is primarily caused by viral or bacterial infections that affect the gastrointestinal tract. The most common viral pathogens responsible for Gastro include norovirus, rotavirus, and adenovirus. These viruses are highly contagious and can spread rapidly through contaminated food, water, or direct contact with an infected individual. Norovirus, for example, is notorious for causing outbreaks in crowded settings such as schools, cruise ships, and nursing homes, highlighting its contagious nature and the ease of transmission.

On the bacterial front, Escherichia coli (E. coli), Salmonella, and Campylobacter are among the leading culprits behind bacterial gastroenteritis. Contaminated food, especially undercooked meat, poultry, eggs, and unpasteurized dairy products, serves as a common source of bacterial infections. Improper food handling, inadequate sanitation practices, and cross-contamination during food preparation contribute to the spread of these bacteria, emphasizing the importance of food safety measures in preventing Gastro outbreaks. (Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis)

Apart from viral and bacterial infections, parasitic organisms such as Giardia lamblia and Cryptosporidium can also trigger gastroenteritis, albeit less frequently. These parasites typically contaminate water sources, leading to waterborne outbreaks of gastroenteritis, especially in regions with inadequate sanitation infrastructure.

In addition to infectious agents, certain non-infectious factors can contribute to the development of Gastro. These include consuming contaminated food or water while traveling to regions with poor sanitation, exposure to toxins or chemicals, and adverse reactions to certain medications or dietary supplements. Furthermore, individuals with compromised immune systems, such as those with HIV/AIDS or undergoing immunosuppressive therapy, are at increased risk of developing severe or prolonged episodes of gastroenteritis due to their reduced ability to fight off infections.

The causes of Gastro are multifaceted, involving a range of infectious agents, poor hygiene practices, contaminated food and water sources, and underlying health conditions. Understanding these various contributors is essential for implementing effective preventive measures and mitigating the impact of gastroenteritis on public health. (Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis)

Signs and Symptoms

Gastro, or gastroenteritis, manifests with a spectrum of signs and symptoms affecting the gastrointestinal tract. These manifestations typically arise suddenly and can vary in severity, ranging from mild discomfort to debilitating illness. Understanding the diverse array of signs and symptoms associated with Gastro is crucial for timely diagnosis and management.

Nausea: Nausea, often described as a queasy or uneasy sensation in the stomach, is a common early symptom of Gastro. It may precede other symptoms and is frequently accompanied by an urge to ’omit. Nausea can vary in intensity, ranging from mild discomfort to persistent feelings of unease.

Vomiting: Vomiting, the forceful expulsion of stomach contents through the mouth, is a hallmark symptom of Gastro. It often follows nausea and may provide temporary relief from gastrointestinal discomfort. Vomiting episodes can be frequent and may lead to dehydration if fluid intake is inadequate.

Diarrhea: Diarrhea, characterized by loose, watery stools, is a prevalent symptom of Gastro. It results from inflammation of the intestinal lining and increased fluid secretion into the bowel. Diarrhea episodes can be frequent and may be accompanied by abdominal cramping and urgency to defecate. (Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis)

Abdominal Pain: Abdominal pain, ranging from mild discomfort to severe cramping, is a common feature of Gastro. It typically arises due to inflammation of the stomach and intestines and may be localized or diffuse. The intensity and duration of abdominal pain can vary among individuals.

Fever: Fever, characterized by an elevated body temperature above the normal range, is a systemic response to infection commonly observed in Gastro. It indicates an immun’ system reaction to the underlying viral or bacterial pathogen. Fever accompanying Gastro is usually low-grade but may spike in severe cases.

Dehydration: Dehydration, resulting from fluid loss through vomiting and diarrhea, is a significant complication of Gastro. It can manifest with symptoms such as increased thirst, dry mouth, decreased urine output, and lethargy. Dehydration requires prompt intervention to prevent complications such as electrolyte imbalances and organ dysfunction. (Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis)

Loss of Appetite: Loss of appetite, or anorexia, is a common symptom of Gastro due to gastrointestinal discomfort and systemic illness. Individuals affected by Gastro may experience a decreased desire to eat, leading to reduced food intake and potential nutritional deficiencies.

Fatigue: Fatigue, characterized by excessive tiredness and lack of energy, is a prevalent symptom of Gastro. It results from the body’s response to infection, immune activation, and fluid loss. Fatigue accompanying Gastro can interfere with daily activities and may persist beyond the resolution of other symptoms.

Muscle Aches: Muscle aches, or myalgia, are often reported by individuals with Gastro. These aches and pains may result from systemic inflammation, dehydration, and the body’s immune response to infection. Muscle aches can contribute to overall discomfort and may worsen with movement.

Headache: Headache, characterized by pain or pressure in the head, is a common symptom associated with Gastro. It may result from dehydration, electrolyte imbalances, or the body’s inflammatory response to infection. Headaches accompanying Gastro can vary in intensity and duration.

Gastro presents with a constellation of signs and symptoms affecting the gastrointestinal tract and systemic health. Recognizing these indicators is essential for prompt diagnosis and appropriate management of this common gastrointestinal ailment. (Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis)

Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis

Etiology

The etiology of Gastro is multifactorial, encompassing various infectious and non-infectious factors that contribute to its development and transmission.

Infectious Agents: Viral and bacterial pathogens are the primary culprits behind infectious gastroenteritis. Norovirus, rotavirus, and adenovirus are among the most common viral pathogens responsible for Gastro. These viruses are highly contagious and can spread rapidly through fecal-oral transmission, contaminated food, water, or close contact with infected individuals. Bacterial gastroenteritis, on the other hand, can result from pathogens such as Escherichia coli (E. coli), Salmonella, and Campylobacter. These bacteria typically contaminate food, especially undercooked meat, poultry, eggs, and unpasteurized dairy products, leading to gastrointestinal illness upon ingestion.

Parasitic Infections: Parasitic organisms such as Giardia lamblia and Cryptosporidium can also cause gastroenteritis, albeit less frequently than viral and bacterial infections. These parasites typically contaminate water sources, leading to waterborne outbreaks of gastroenteritis, especially in areas with inadequate sanitation infrastructure.

Non-Infectious Factors: Non-infectious factors can also contribute to the development of Gastro. These include exposure to toxins or chemicals, adverse reactions to certain medications or dietary supplements, and underlying health conditions such as inflammatory bowel disease (IBD) or irritable bowel syndrome (IBS). Additionally, consuming contaminated food or water while traveling to regions with poor sanitation can predispose individuals to gastroenteritis. (Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis)

Immune Status: The immune status of an individual plays a crucial role in determining their susceptibility to gastroenteritis. Individuals with weakened immune systems, such as those with HIV/AIDS, undergoing immunosuppressive therapy, or elderly individuals, are at increased risk of developing severe or prolonged episodes of gastroenteritis due to their reduced ability to fight off infections.

Environmental Factors: Environmental factors, including poor hygiene practices, inadequate sanitation infrastructure, and crowded living conditions, contribute to the transmission and spread of gastroenteritis. Improving sanitation, promoting hand hygiene, and implementing food safety measures are essential for preventing gastroenteritis outbreaks in communities.

The etiology of Gastro encompasses a diverse range of infectious and non-infectious factors that contribute to its development and transmission. Understanding these underlying causes is crucial for implementing effective preventive measures and mitigating the impact of gastroenteritis on public health. (Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis)

Pathophysiology

Gastro involves a complex interplay of pathophysiological mechanisms that lead to inflammation and dysfunction of the gastrointestinal tract.

Infectious Agent Invasion: Gastroenteritis typically begins with the ingestion of infectious agents such as viruses, bacteria, or parasites. These pathogens invade the lining of the stomach and intestines, where they replicate and trigger an inflammatory response.

Inflammation and Tissue Damage: The presence of infectious agents in the gastrointestinal tract stimulates the release of pro-inflammatory cytokines and chemokines by immune cells. These signaling molecules activate inflammatory pathways and recruit immune cells to the site of infection. The resulting inflammation leads to tissue damage, disruption of the epithelial barrier, and increased permeability of the intestinal mucosa. (Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis)

Increased Fluid Secretion: In response to infection and inflammation, the intestinal epithelial cells secrete fluid into the lumen of the gastrointestinal tract. This increased fluid secretion, coupled with decreased absorption due to epithelial damage, results in diarrhea, a hallmark symptom of gastroenteritis. The loss of fluid and electrolytes through diarrhea contributes to dehydration and electrolyte imbalances in affected individuals.

Altered Gastrointestinal Motility: Gastrointestinal motility, the rhythmic contractions of the digestive tract muscles, is altered in individuals with gastroenteritis. Inflammation and infection disrupt normal peristalsis, leading to abdominal cramping, bloating, and discomfort. These alterations in motility contribute to the symptoms of nausea, vomiting, and abdominal pain commonly experienced in gastroenteritis.

Immune Response: The immune system plays a critical role in the pathophysiology of gastroenteritis. Innate immune cells such as macrophages, dendritic cells, and neutrophils respond rapidly to the presence of infectious agents, initiating the inflammatory cascade. Adaptive immune responses, including the production of antibodies and activation of T cells, also contribute to the clearance of pathogens and resolution of infection. (Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis)

Resolution and Recovery: In uncomplicated cases, the inflammatory response resolves within a few days, and the gastrointestinal tract undergoes repair and regeneration. However, in severe or prolonged cases of gastroenteritis, persistent inflammation and tissue damage can lead to complications such as malabsorption, nutrient deficiencies, and electrolyte imbalances, requiring medical intervention.

The pathophysiology of gastroenteritis involves a complex interplay of inflammatory responses, altered gastrointestinal motility, fluid secretion, and immune activation. Understanding these underlying mechanisms is crucial for elucidating the clinical manifestations and guiding the management of this common gastrointestinal ailment.

DSM-5 Diagnosis

Gastro is a common gastrointestinal ailment characterized by inflammation of the stomach and intestines. While the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), primarily focuses on mental health conditions, healthcare providers diagnose gastroenteritis based on clinical presentation and laboratory findings rather than specific DSM-5 criteria.

Clinical Presentation: The diagnosis of gastroenteritis typically relies on the recognition of characteristic signs and symptoms, including nausea, vomiting, diarrhea, abdominal pain, and sometimes fever. Healthcare providers evaluate the duration, severity, and progression of symptoms to differentiate gastroenteritis from other gastrointestinal disorders. (Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis)

Laboratory Findings: Laboratory tests may be performed to support the diagnosis of gastroenteritis and identify the causative agent. Stool samples may be analyzed for the presence of infectious pathogens such as viruses, bacteria, or parasites. Additionally, blood tests may reveal markers of inflammation and electrolyte imbalances associated with gastroenteritis.

Exclusion of Other Conditions: Healthcare providers use the DSM-5 diagnostic process to rule out other medical conditions that may present with similar gastrointestinal symptoms. Conditions such as inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), food poisoning, and gastrointestinal malignancies must be considered and excluded based on clinical evaluation and diagnostic tests.

Diagnostic Considerations: The DSM-5 provides a framework for assessing and diagnosing mental health disorders, but it does not specifically address gastroenteritis. However, healthcare providers consider the Impact of gastroenteritis on mental health and well-being, particularly in cases of severe or prolonged illness leading to dehydration, malnutrition, and psychological distress. (Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis)

Comorbidity and Psychosocial Factors: While gastroenteritis itself is not listed in the DSM-5, healthcare providers consider comorbid mental health conditions and psychosocial factors that may influence the presentation and management of gastroenteritis. Patients with pre-existing mental health disorders or psychosocial stressors may experience exacerbation of symptoms and require additional support and interventions.

The DSM-5 diagnostic process is not directly applicable to gastroenteritis. Healthcare providers diagnose gastroenteritis based on clinical presentation, laboratory findings, and the exclusion of other gastrointestinal conditions. Understanding the diagnostic criteria and considerations for gastroenteritis is essential for accurate diagnosis and appropriate management of this common gastrointestinal ailment.

Treatment Regimens

The management of gastroenteritis focuses on relieving symptoms, preventing complications, and supporting the body’s recovery from the infection. Treatment regimens for gastroenteritis vary depending on the severity of symptoms, the underlying cause, and the individual’s overall health status. (Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis)

Hydration: Rehydration is a cornerstone of gastroenteritis management, especially in cases of vomiting and diarrhea leading to fluid loss. Oral rehydration solutions containing electrolytes and glucose are recommended to replace lost fluids and maintain electrolyte balance. In severe cases of dehydration, intravenous fluids may be necessary to restore hydration status.

Symptom Management: Medications may be prescribed to alleviate symptoms such as nausea, vomiting, and abdominal pain. Antiemetics, such as ondansetron, can help control nausea and vomiting, while antidiarrheal medications like loperamide may be used to reduce diarrhea frequency. Analgesics such as acetaminophen or ibuprofen may be recommended for abdominal pain and discomfort.

Antiviral and Antibiotic Therapy: In cases of viral gastroenteritis, antiviral medications are not typically prescribed, as the infection is self-limiting and resolves on its own. However, in certain situations, such as severe or prolonged illness or immunocompromised individuals, antiviral medications may be considered. Antibiotics are not routinely recommended for viral gastroenteritis but may be prescribed for bacterial gastroenteritis caused by specific pathogens such as Salmonella or Campylobacter. (Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis)

Dietary Modifications: Dietary modifications play a crucial role in gastroenteritis management. A bland diet consisting of easily digestible foods such as bananas, rice, applesauce, and toast (BRAT diet) may help alleviate gastrointestinal symptoms. Avoiding spicy, fatty, and dairy-rich foods can reduce gastrointestinal irritation and discomfort. Gradually reintroducing a regular diet as tolerated is recommended as symptoms improve.

Probiotics: Probiotics, beneficial bacteria that promote gut health, may help shorten the duration of diarrhea and reduce the risk of recurrent gastroenteritis episodes. Probiotic supplements or probiotic-rich foods such as yogurt and kefir can be incorporated into the diet during and after gastroenteritis treatment. (Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis)

Patient Education: Patient education is an integral part of gastroenteritis management. Patients should be advised on proper hydration techniques, dietary modifications, and medication adherence. They should also be educated on hand hygiene practices to prevent the spread of gastroenteritis to others.

Patients should also be educated about the importance of follow-up care in gastroenteritis management. Encouraging individuals to schedule follow-up appointments with their healthcare provider ensures ongoing monitoring of symptoms, treatment effectiveness, and resolution of gastroenteritis. Providing guidance on when to seek medical attention for persistent or worsening symptoms beyond the expected duration of gastroenteritis is essential for timely intervention and prevention of complications.

Conclusion

Gastroenteritis, commonly known as “Gastro,” presents as a significant gastrointestinal ailment characterized by inflammation of the stomach and intestines. Through an exploration of its causes, signs and symptoms, etiology, pathophysiology, diagnosis according to clinical presentation and laboratory findings, treatment regimens, and patient education, we have gained a comprehensive understanding of this condition. By emphasizing the importance of hydration, dietary modifications, medication adherence, hand hygiene practices, and follow-up care in gastroenteritis management, individuals can effectively navigate the condition and promote optimal health outcomes. Empowering patients with knowledge about gastroenteritis and its management is essential for mitigating its impact, preventing complications, and facilitating timely intervention when necessary, ultimately enhancing the quality of life for affected individuals. (Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis)

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7173482/

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Nursing Paper Example on Antisocial Personality Disorder (ASPD)

January 24, 2024/in Assignment Help, Assignment Help Nursing, BLOG, Nursing Exam Help, Nursing Paper Help, Solved Nursing Essays /by Daniel Jennings

Nursing Paper Example on Antisocial Personality Disorder (ASPD)

Introduction

Nursing Paper Example on Antisocial Personality Disorder (ASPD)

Antisocial Personality Disorder (ASPD), like all personality disorders represents a stable, pervasive pattern of behavior that is present for an individual’s entire life. In ASPD generally, the configuration is primarily one of a disregard for, and a violation of, the rights of others. This manifests itself in the individual fundamentally not caring about the wants, needs, and desires of others. The result of this core belief that others do not matter is behavior that mostly leads to arrest for petty offenses like theft. Though these crimes are not personality traits, the record that they create is reliable and traceable, making a good diagnostic tool. Another similar diagnostic tool is the individual’s work and school record. ASPD traits make listening to authority figures nearly impossible so most of these individuals have spotty educational and work histories.

These behavioral markers are the result of several personality traits. One of these chief characteristics is impulsiveness. Individuals with ASPD do not stop to carefully consider the consequences of their activity, rather they simply do what they want for themselves in the moment. This impulsivity can lead to reckless and dangerous activity both for their own safety and for the safety of others. They may drive with excessive speed or push others near a traffic filled intersection. If they desire the property of others and they can take it, they will. This same attitude that is used toward property is used toward other people. They will lie or con others in order to fulfill their personal desires. (Nursing Paper Example on Antisocial Personality Disorder (ASPD))

If the individual with ASPD is not able to meet their desires through theft or con, they will not stop trying to fulfill their needs. They are prone to get very irritable and often get very aggressive towards others. Fighting with others will likely be prevalent in their personal history. At the end of their theft, maltreatment, and aggressiveness they will not feel sorry for their actions. They will either not care that they have caused harm or rationalize the situation.

In order to qualify for a diagnosis three other criteria must be met:

The individual must be at least 18 years old. Individuals who are growing up and going through puberty do not have the stable personality required to be diagnosed with a personality disorder.

There must also be proof in their developmental history that the individual had antisocial traits as a child. This is demonstrated by fulfilling criteria for Conduct Disorder before age 15. Diagnosticians want to know that the individual’s personality has been set. They would like to know that the individual was like this before puberty and will be like this long after puberty before diagnosing a personality disorder.

The antisocial behavior must not be exclusively during schizophrenia or a manic episode. The behavior should not be because of an Axis I condition. (Nursing Paper Example on Antisocial Personality Disorder (ASPD))

Psychopathy & Sociopathy

In the literature there is a much greater emphasis on studying psychopathy and sociopathy than there is antisocial personality disorder. These three are related but are not identical. Antisocial personality disorder is the only one of these three terms that exists in the DSM-IV-TR. Psychopathy is defined by characteristics such as a lack of empathy and remorse, criminality, antisocial behavior, egocentricity, manipulativeness, irresponsibility and a parasitic lifestyle. It is commonly conceptualized that psychopathy is a more severe form of APD and this thinking is reasonably accurate. Almost all individuals who fulfill the requirements to receive the label of psychopathy fulfill the requirements for ASPD but most of the individuals who fulfill the requirements of ASPD do not also get the label of psychopath. The term sociopath is an attempt to demystify the term psychopath since many generalize the term psycho in psychopath to apply to other terms like psychotic. Sociopathy is also an attempt by some clinicians to explain the etiology of the condition as characterized by early socialization experiences. (Nursing Paper Example on Antisocial Personality Disorder (ASPD))

Nursing Paper Example on Antisocial Personality Disorder (ASPD)

Still Human

Subtypes

One of the diagnostic challenges with any personality diorder is that there is typically significant overlap between the personality disorders. This is due both to the diagnostic overlap in the definition of each of the personality disorders and the fact that individuals typically display many different traits throughout their lifetime. In order to get a better understanding of the common personality trait overlaps, Theodore Miller created a series of 5 subtypes of ASPD:

Coveteus—this type is purely made up of ASPD traits. This individual feels intentionally denied and deprived and seeks to get the things s/he covets but gets little satisfaction from ownership.

Nomadic—this type is ASPD with schizoid, schizotypal and avoidant features. This individual feels cast aside and is typically a drifter and societal dropout. When this individual acts out it is against that impulse.

Malevolent—this type is a mix of ASPD with paranoid personality features. This individual is typically more violent than the other personality disorder types. He expects betrayal and punishment and attempts to get revenge in a pre-emptive manner.

Risk-taking—this type is a mix of ASPD and histrionic features. This individual has the risk taking features of ASPD amplified heavily. They are very audacious and bold to the point of recklessness and they continuously pursue perilous adventures.

Reputation-defending—this type is a mix between ASPD and narcissistic features. This individual has a need to be thought of as unflawed and formidable and will react extremely negatively to perceived slights to status. (Nursing Paper Example on Antisocial Personality Disorder (ASPD))

Differences

Two of the most problematic differences for ASPD are Narcissistic and Histrionic personality disorder. Narcissistic Personality Disorder shows similar distorted thinking about others. They care little for the wants and needs of others and have limited empathy. Individuals with Narcissistic PD can be manipulative as well. However, Narcissistic individuals rarely show evidence of conduct disorder in youth or antisocial aggression. The underlying thought process behind their rules and norms breaking behavior is different as well. With ASPD the individual feels that they are entitled and special and that they can break the rules because of this fact. The ASPD individual does not need the rationalization, typically they do what they want because they want to do it. (Nursing Paper Example on Antisocial Personality Disorder (ASPD))

Individuals with Histrionic PD are often impulsive, show very little depth in their empathy and understanding of others. Their dramatic flair can be seen as impulsivity and can do things like maintaining affairs that can be characterized as violating social norms. However, histrionic individuals are not aggressive and will not show evidence of Conduct Disorder in typical presentation.

Symptom Overlap Between Antisocial and Narcissistic/Histrionic

Etiology

The nature of personality disorders makes their etiology more difficult to pin down than other disorders. ASPD requires even more evidence of prolonged atypical functioning than other personality disorders because it requires evidence of maladaptive functioning before age 18. This requirement muddies the already murky waters that are the interplay of genetics and environment and their expression in both brain anatamy and psychological activity. (Nursing Paper Example on Antisocial Personality Disorder (ASPD))

Irregularities of the serotonin network in the brain responsible for the release, use, and reuptake of the neurotransmitter are linked to individuals with ASPD. This network has been linked separately both to individuals diagnosed with ASPD and to highly impulsive behavior. The theory is that this deficit can lead either to arousal thresholds being too low in individuals who show impulsivity or the arousal threshold is too high in individuals who are cold or callous.

Psychological and family systems factors have also been shown to have an effect on the expression of ASPD. The researchers used national epidemiological survey and found individuals from a data set of alcohol users who also were antisocial, finding 1200 individuals on which to base their results. They found that significant childhood experiences of abuse and neglect significantly predict eventual display of ASPD. These early experiences of violence or abandonment have significant effects on attachment and relationship formation. (Nursing Paper Example on Antisocial Personality Disorder (ASPD))

Duggan (Duggan, et al. 2012) showed a positive relationship between early onset of alcohol use and the transition of conduct disorder to ASPD. Those who used alcohol and other substances at an earlier age more often wound up being diagnosed with ASPD than those who did not. This effect can easily by hypothesized to have an etiological function in either biological or social bases. Perhaps the drug use affected neurological pathways to make the individuals more susceptible. Perhaps early onset drug use was indicative of a social network that was more conducive to reinforcing antisocial behavior.

Gender Gap

There is a very wide diparity between the number of men and women who meet the criteria for diagnosis with ASPD. Epidemiological research suggests that as many as 3% of men have ASPD while less than 1% of women do. Some theorists, like Miller, have argued that the disparity in men and women in ASPD is mirrored by the same disparity with the diagnosis of Borderline Personality Disorder. Women are proportionately more likely to receive that diagnosis than men are to receive a diagnosis of ASPD. This may be due to the fact that the criteria for APD are heavily gender biased. Where men will use naked aggression in a way that leads to multiple arrests (criteria A-1 and criterion A-4) women tend to use relational aggression which has very different outcomes. The same underlying etiology and pathology lead to very different behaviors because these behaviors are mediated by cultural norms. The masculine ideal in the United States contains many antisocial traits. Men are encouraged to be self-reliant, independent, and to use physical force when necessary. They are taught to be stoic and unemotional. This antisocial personality is an overextension of that ideal. Women, on the other hand, are not taught to be unemotional or physically violent, so they manifest that same aggression in different ways. Alegria (Alegria, et al. 2013) found that women have to have a significantly higher lifetime loading of abuse and neglect to show antisocial traits than men do. (Nursing Paper Example on Antisocial Personality Disorder (ASPD))

The top theoretical explanations for antisocial personality traits unfortunately leave little for individual agency. The difficulty is that the diagnosis of ASPD requires that the individual gain their personality traits when they are least able to defend against them – during or before their teen years. The biological explanation leaves basically no room for personal agency. It is impossible to willfully change your brain chemistry. Other theoretical standpoints argue that childhood maltreatment and neglect are to blame. A neglected or abused child has little ability to even avoid their maltreatment, let alone recover from their own psychological load. One simple step that is clear from the literature is to delay the onset of alcohol and substance use. Using substances at an early age is a significant loading factor for ASPD. Avoiding early alcohol use can positively affect brain chemistry and alter future habitual activity for the better.

Hypothetical Conceptualization

Psychodynamic

Psychodynamic theorists conceptualize ASPD begins in the early childhood phase of trust vs. mistrust. Children who will later show evidence of conduct disorder and then ASPD do not have adequate social relationships as children. These inadequate relationships center on a lack of parental love. A lack of parental love can lead a child in many different pathological directions and is not necessarily indicative of ASPD in and of itself. Some subset of these children respond to the lack of love demonstrated by their parents by becoming emotionally aloof. They begin to develop the relational style that they are taught at home by bonding with others through overt power dynamics instead of a shared emotional bond. Psychodynamic theorists can point to the evidence of pervasive early childhood trauma in individuals who eventually develop ASPD as proof of their conceptual framework. (Nursing Paper Example on Antisocial Personality Disorder (ASPD))

Unfortunately, psychodynamic theoretical framework is largely ineffective. There are a number of hypothesized reasons for this therapeutic failure. The first is that almost no one with ASPD is in treatment voluntarily. In addition to this difficulty, individuals with ASPD also have no conscience and little motivation to change who they are naturally which further compounds treatment difficulty. Antisocial individuals also tend to have a very low frustration tolerance which makes seeing treatment through to its conclusion very difficult. (Nursing Paper Example on Antisocial Personality Disorder (ASPD))

Cognitive-Behavioral

Cognitive-Behavioral therapists conceptualize antisocial activity as a modeled behavior. Children may be reenacting the violent behavior that they experience in a far too personal manner. Theorists also believe that the negative acting out and violent behaviors may be reinforced by the attention that they receive. Parents may give in to violent outbursts simply to restore the peace once individuals have acted out.

Cognitive-behavioral therapists do not attempt to repair the causes of ASPD, consistent with their treatment modalities. They target problem behavior. Therapists attempt to give APD individuals skills to understand moral issues and conceptualize the needs of others. Some prisons and hospitals have tried to put ASPD individuals in group settings to teach responsibility. This approach does not seem to have any effect in most cases. (Arntz, Cima and Lobbestael 2013). (Nursing Paper Example on Antisocial Personality Disorder (ASPD))

Biological Theories

Biological theorists have begun using psychotropic medications on individuals with ASPD. Atypical Antipsychotic drugs have been used to treat ASPD. These newer antipsychotic medications bind to multiple dopamine receptor but also have an effect on serotonin. These therapies have not been evaluated in large scale trials to date. (Brook and Kosson 2013)

Biological models have many findings pertinent to individuals with ASPD. First, as was stated in depth earlier, serotonin deficits may be responsible for ASPD traits, especially in individuals who display highly impulsive behavior. Another area of research is the frontal lobes. Many individuals with ASPD have smaller or deficient frontal lobes. Lastly, it appears that many individuals with ASPD have very low resting levels of anxiety. Low levels of anxiety explain why it is difficult for individuals to learn from past negative experiences. (Boccaccini, et al. 2012)The biological model theorizes multiple etiologies for these deficiencies. They may come from genetic factors that cause malformation as children, nutritional deficiencies at key periods in development, the effect of viruses, or from physical harm such as brain lesions. (Nursing Paper Example on Antisocial Personality Disorder (ASPD))

Conclusion

Antisocial Personality Disorder is a difficult but influential disorder. It is an important problem both for the psychological community and for society. The psychological community has not been able to offer any meaningful therapeutic approaches. Part of the reason that this is the case has to do with the very recalcitrant nature of the disorder itself. Another significant part of that reason is that the psychological community cannot decide where to focus its research. Many very distinguished individuals have been trying to dissect a tiny subset of the APD population because they are very scary and are good for getting grant money. Society at large has a vested interest in ASPD because it makes up such a significant portion of the prison population. These individuals are likely to recidivate and likely to commit violent crimes. Understanding this population better is vital for long term meaningful prison reform. (Lewis, Olver and Wong 2013)

In addition to failing individuals with ASPD in terms of treatment, it is relevant to note that society is failing individuals with ASPD in their formative years. Recurrent episodes of neglect and abuse are run-of-the-mill for individuals with ASPD. Society at large needs to do a better job of policing this kind of abuse and neglect and provide safe, rehabilitative experiences for those who are victims of it. (Nursing Paper Example on Antisocial Personality Disorder (ASPD))

References

https://pubmed.ncbi.nlm.nih.gov/31536279/

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Ethical Conduct

November 16, 2023/in Assignment Help, Assignment Help Nursing, BLOG, Homework Help, Nursing Exam Help, Nursing Paper Help, Psychology assignment help, Solved Nursing Essays /by Aimee Grace

Ethical Conduct

(Ethical Conduct) Discuss nursing ethics based on the case study.

Ethical Conduct

Nursing Ethics in the Context of a Case Study

Nursing ethics is crucial in ensuring that patient care aligns with moral principles. A recent case study highlights the importance of ethical considerations in nursing. In this case, a nurse faced a dilemma when a terminally ill patient requested assistance in ending their life. This situation presents various ethical challenges, requiring a thorough understanding of nursing ethics to navigate effectively.

Respect for Autonomy

Firstly, respect for autonomy is a fundamental ethical principle in nursing. Autonomy refers to the patient’s right to make decisions about their own health care. In the case study, the patient expressed a clear desire to end their suffering through euthanasia. Therefore, the nurse must respect this wish while considering legal and professional boundaries. To support the patient’s autonomy, the nurse should ensure the patient fully understands their options and the potential consequences of their decision. (Ethical Conduct)

Beneficence and Non-Maleficence

Beneficence and non-maleficence are also critical in nursing ethics. Beneficence involves promoting the patient’s well-being, while non-maleficence means avoiding harm. In the case study, the nurse faces a conflict between these principles. Assisting the patient in ending their life may be seen as promoting well-being by alleviating suffering. However, it also involves causing harm. The nurse must carefully weigh these principles to determine the best course of action.

Legal and Professional Considerations

Legal and professional considerations also play a significant role in nursing ethics. The nurse must adhere to the laws and regulations governing their practice. In many jurisdictions, euthanasia is illegal, and assisting a patient in ending their life could result in severe legal consequences. Moreover, professional codes of ethics, such as the American Nurses Association’s Code of Ethics, provide guidelines for nurses. These codes often emphasize the importance of preserving life and prohibit actions that intentionally cause death. Thus, the nurse must balance ethical principles with legal and professional obligations. (Ethical Conduct)

Communication and Compassion

Effective communication and compassion are essential in addressing ethical dilemmas. The nurse should engage in open, honest conversations with the patient and their family. This approach helps to understand their perspectives and provide emotional support. By listening to the patient’s concerns and explaining the ethical and legal constraints, the nurse can build trust and provide compassionate care. Additionally, involving other healthcare professionals, such as physicians and ethicists, can offer valuable insights and support in decision-making.

Ethical Decision-Making Frameworks

Applying ethical decision-making frameworks can guide nurses in resolving complex ethical dilemmas. One such framework is the Four-Box Method, which considers medical indications, patient preferences, quality of life, and contextual features. By systematically evaluating these factors, the nurse can make a well-informed decision. In the case study, this approach could help balance the patient’s desire for euthanasia with the ethical, legal, and professional considerations involved.

Conclusion

Nursing ethics require a careful balance of respecting patient autonomy, promoting well-being, avoiding harm, and adhering to legal and professional standards. In the presented case study, the nurse faces a challenging ethical dilemma when a terminally ill patient requests assistance in ending their life. By applying ethical principles, effective communication, and decision-making frameworks, the nurse can navigate this complex situation. This approach ensures that patient care remains compassionate, ethical, and legally compliant.

References

https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/

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NURS6630 Final Exam (2018): Walden University

November 11, 2023/in Assignment Help Nursing, Nursing Exam Help, Nursing Paper Help, Uncategorized /by Daniel Jennings

NURS6630 Final Exam (2018): Walden University

QUESTION 1

What will the PMHNP most likely prescribe to a patient with psychotic aggression who needs to manage the top-down cortical control and the excessive drive from striatal hyperactivity? (NURS6630 Final Exam (2018): Walden University)

A. Stimulants B. Antidepressants C. Antipsychotics D. SSRIs

QUESTION 2

The PMHNP is selecting a medication treatment option for a patient who is exhibiting psychotic behaviors with poor impulse control and aggression. Of the available treatments, which can help temper some of the adverse effects or symptoms that are normally caused by D2 antagonism?

A. First-generation, conventional antipsychotics B. First-generation, atypical antipsychotics C. Second-generation, conventional antipsychotics D. Second-generation, atypical antipsychotics

QUESTION 3

The PMHNP is discussing dopamine D2 receptor occupancy and its association with aggressive behaviors in patients with the student. Why does the PMHNP prescribe a standard dose of atypical antipsychotics? (NURS6630 Final Exam (2018): Walden University)

A. The doses are based on achieving 100% D2 receptor occupancy. B. The doses are based on achieving a minimum of 80% D2 receptor occupancy. C. The doses are based on achieving 60% D2 receptor occupancy. D. None of the above.

QUESTION 4

Why does the PMHNP avoid prescribing clozapine (Clozaril) as a first-line treatment to the patient with psychosis and aggression?

A. There is too high a risk of serious adverse side effects. B. It can exaggerate the psychotic symptoms. C. Clozapine (Clozaril) should not be used as high-dose monotherapy. D. There is no documentation that clozapine (Clozaril) is effective for patients who are violent.

QUESTION 5

The PMHNP is caring for a patient on risperidone (Risperdal). Which action made by the PMHNP exhibits proper care for this patient?

A. Explaining to the patient that there are no risks of EPS B. Prescribing the patient 12 mg/dail C. Titrating the dose by increasing it every 5–7 days D. Writing a prescription for a higher dose of oral risperidone (Risperdal) to achieve high D2 receptor occupancy

QUESTION 6

The PMHNP wants to prescribe Mr. Barber a mood stabilizer that will target aggressive and impulsive symptoms by decreasing dopaminergic neurotransmission. Which mood stabilizer will the PMHNP select? A. Lithium (Lithane) B. Phenytoin (Dilantin) C. Valproate (Depakote) D. Topiramate (Topamax)

QUESTION 7

The parents of a 7-year-old patient with ADHD are concerned about the effects of stimulants on their child. The parents prefer to start pharmacological treatment with a non-stimulant. Which medication will the PMHNP will most likely prescribe?

A. Strattera B. Concerta C. Daytrana D. Adderall

QUESTION 8

8 The PMHNP understands that slow-dose extended release stimulants are most appropriate for which patient with ADHD? (NURS6630 Final Exam (2018): Walden University)

A. 8-year-old patient B. 24-year-old patient C. 55-year-old patient D. 82-year-old patient

QUESTION 9

A patient is prescribed D-methylphenidate, 10-mg extended-release capsules. What should the PMHNP include when discussing the side effects with the patient?

A. The formulation can have delayed actions when taken with food. B. Sedation can be a common side effect of the drug. C. The medication can affect your blood pressure. D. This drug does not cause any dependency.

QUESTION 10

The PMHNP is teaching parents about their child’s new prescription for Ritalin. What will the PMHNP include in the teaching? (NURS6630 Final Exam (2018): Walden University)

A. The second dose should be taken at lunch. B. There are no risks for insomnia. C. There is only one daily dose, to be taken in the morning. D. There will be continued effects into the evening.

QUESTION 11

A young patient is prescribed Vyvanse. During the follow-up appointment, which comment made by the patient makes the PMHNP think that the dosing is being done incorrectly?

A. “I take my pill at breakfast.” B. “I am unable to fall asleep at night.” C. “I feel okay all day long.” D. “I am not taking my pill at lunch.”

QUESTION 12

A 14-year-old patient is prescribed Strattera and asks when the medicine should be taken. What does the PMHNP understand regarding the drug’s dosing profile?

A. The patient should take the medication at lunch. B. The patient will have one or two doses a day. C. The patient will take a pill every 17 hours. D. The dosing should be done in the morning and at night.

QUESTION 13

The PMHNP is meeting with the parents of an 8-year-old patient who is receiving an initial prescription for D-amphetamine. The PMHNP demonstrates appropriate prescribing practices when she prescribes the following dose:

A. The child will be prescribed 2.5 mg. B. The child will be prescribed a 10-mg tablet. C. The child’s dose will increase by 2.5 mg every other week. D. The child will take 10–40 mg, daily. (NURS6630 Final Exam (2018): Walden University)

QUESTION 14

A patient is being prescribed bupropion and is concerned about the side effects. What will the PMHNP tell the patient regarding bupropion?

A. Weight gain is not unusual. B. Sedation may be common. C. It can cause cardiac arrhythmias. D. It may amplify fatigue.

QUESTION 15

Which patient will receive a lower dose of guanfacine?

A. Patient who has congestive heart failure B. Patient who has cerebrovascular disease C. Patient who is pregnant D. Patient with kidney disease

QUESTION 16

An 18-year-old female with a history of frequent headaches and a mood disorder is prescribed topiramate (Topamax), 25 mg by mouth daily. The PMHNP understands that this medication is effective in treating which condition(s) in this patient?

A. Migraines B. Bipolar disorder and depression C. Pregnancy-induced depression D. Upper back pain

QUESTION 17

The PMHNP is treating a patient for fibromyalgia and is considering prescribing milnacipran (Savella). When prescribing this medication, which action is the PMHNP likely to choose? (NURS6630 Final Exam (2018): Walden University)

A. Monitor liver function every 6 months for a year and then yearly thereafter. B. Monitor monthly weight. C. Split the daily dose into two doses after the first day. D. Monitor for occult blood in the stool.

QUESTION 18

The PMHNP is assessing a patient she has been treating with the diagnosis of chronic pain. During the assessment, the patient states that he has recently been having trouble getting to sleep and staying asleep. Based on this information, what action is the PMHNP most likely to take? (NURS6630 Final Exam (2018): Walden University)

A. Order hydroxyzine (Vistaril), 50 mg PRN or as needed B. Order zolpidem (Ambien), 5mg at bedtime C. Order melatonin, 5mg at bedtime D. Order quetiapine (Seroquel), 150 mg at bedtime

QUESTION 19

The PMHNP is assessing a female patient who has been taking lamotrigine (Lamictal) for migraine prophylaxis. After discovering that the patient has reached the maximum dose of this medication, the PMHNP decides to change the patient’s medication to zonisamide (Zonegran). In addition to evaluating this patient’s day-to-day activities, what should the PMHNP ensure that this patient understands?

A. Monthly blood levels must be drawn. B. ECG monitoring must be done once every 3 months. C. White blood cell count must be monitored weekly. D. This medication has unwanted side effects such as sedation, lack of coordination, and drowsiness.

QUESTION 20

A patient recovering from shingles presents with tenderness and sensitivity to the upper back. He states it is bothersome to put a shirt on most days. This patient has end stage renal disease (ESRD) and is scheduled to have hemodialysis tomorrow but states that he does not know how he can lie in a recliner for 3 hours feeling this uncomfortable. What will be the PMHNP’s priority? (NURS6630 Final Exam (2018): Walden University)

A. Order herpes simplex virus (HSV) antibody testing B. Order a blood urea nitrogen (BUN) and creatinine STAT C. Prescribe lidocaine 5% D. Prescribe hydromorphone (Dilaudid) 2mg

QUESTION 21

The PMHNP prescribed a patient lamotrigine (Lamictal), 25 mg by mouth daily, for nerve pain 6 months ago. The patient suddenly presents to the office with the complaint that the medication is no longer working and complains of increased pain. What action will the PMHNP most likely take?

A. Increase the dose of lamotrigine (Lamictal) to 25 mg twice daily. B. Ask if the patient has been taking the medication as prescribed. C. Order gabapentin (Neurontin), 100 mg three times a day, because lamotrigine (Lamictal) is no longer working for this patient. D. Order a complete blood count (CBC) to assess for an infection.

QUESTION 22

An elderly woman with a history of Alzheimer’s disease, coronary artery disease, and myocardial infarction had a fall at home 3 months ago that resulted in her receiving an open reduction internal fixation. While assessing this patient, the PMHNP is made aware that the patient continues to experience mild to moderate pain. What is the PMHNP most likely to do? (NURS6630 Final Exam (2018): Walden University)

A. Order an X-ray because it is possible that she dislocated her hip. B. Order ibuprofen (Motrin) because she may need long-term treatment and chronic pain is not uncommon. C. Order naproxen (Naprosyn) because she may have arthritis and chronic pain is not uncommon. D. Order Morphine and physical therapy.

QUESTION 23

The PMHNP is assessing a 49-year-old male with a history of depression, post-traumatic stress disorder (PTSD), alcoholism with malnutrition, diabetes mellitus type 2, and hypertension. His physical assessment is unremarkable with the exception of peripheral edema bilaterally to his lower extremities and a chief complaint of pain with numbness and tingling to each leg 5/10. The PMHNP starts this patient on a low dose of doxepin (Sinequan). What is the next action that must be taken by the PMHNP? (NURS6630 Final Exam (2018): Walden University)

A. Orders liver function tests. B. Educate the patient on avoiding grapefruits when taking this medication. C. Encourage this patient to keep fluids to 1500 ml/day until the swelling subsides. D. Order a BUN/Creatinine test.

QUESTION 24

The PMHNP is evaluating a 30-year-old female patient who states that she notices pain and a drastic change in mood before the start of her menstrual cycle. The patient states that she has tried diet and lifestyle changes but nothing has worked. What will the PMHNP most likely do? A. Prescribe Estrin FE 24 birth control B. Prescribe ibuprofen (Motrin), 800 mg every 8 hours as needed for pain C. Prescribe desvenlafaxine (Pristiq), 50 mg daily D. Prescribe risperidone (Risperdal), 2 mg TID (NURS6630 Final Exam (2018): Walden University)

QUESTION 25

A patient with chronic back pain has been prescribed a serotonin-norepinephrine reuptake inhibitor (SNRI). How does the PMHNP describe the action of SNRIs on the inhibition of pain to the patient?

A. “The SNRI can increase noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn.” B. “The SNRI can decrease noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn.” C. “The SNRI can reduce brain atrophy by slowing the gray matter loss in the dorsolateral prefrontal cortex.” D. “The SNRI can increase neurotransmission to descending neurons.” (NURS6630 Final Exam (2018): Walden University)

QUESTION 26

A patient with fibromyalgia and major depression needs to be treated for symptoms of pain. Which is the PMHNP most likely to prescribe for this patient?

Venlafaxine (Effexor)

Duloxetine (Cymbalta)

Clozapine (Clozaril)

Phenytoin (Dilantin)

QUESTION 27

The PMHNP prescribes gabapentin (Neurontin) for a patient’s chronic pain. How does the PMHNP anticipate the drug to work?

A. It will bind to the alpha-2-delta ligand subunit of voltage-sensitive calcium channels. B. It will induce synaptic changes, including sprouting. C. It will act on the presynaptic neuron to trigger sodium influx. D. It will inhibit activity of dorsal horn neurons to suppress body input from reaching the brain.

QUESTION 28

Mrs. Rosen is a 49-year-old patient who is experiencing fibro-fog. What does the PMHNP prescribe for Mrs. Rosen to improve this condition? A. Venlafaxine (Effexor) B. Armodafinil (Nuvigil) C. Bupropion (Wellbutrin) D. All of the above

QUESTION 29

The PMHNP is caring for a patient with fibromyalgia. Which second-line treatment does the PMHNP select that may be effective for managing this patient’s pain? (NURS6630 Final Exam (2018): Walden University)

A. Methylphenidate (Ritalin) B. Viloxazine (Vivalan) C. Imipramine (Tofranil) D. Bupropion (Wellbutrin

QUESTION 30

The PMHNP is attempting to treat a patient’s chronic pain by having the agent bind the open channel conformation of VSCCs to block those channels with a “use-dependent” form of inhibition. Which agent will the PMHNP most likely select?

A. Pregabalin (Lyrica) B. Duloxetine (Cymbalta) C. Modafinil (Provigil) D. Atomoxetine (Strattera)

QUESTION 31

A patient with irritable bowel syndrome reports chronic stomach pain. The PMHNP wants to prescribe the patient an agent that will cause irrelevant nociceptive inputs from the pain to be ignored and no longer perceived as painful. Which drug will the PMHNP prescribe? (NURS6630 Final Exam (2018): Walden University)

A. Pregabalin (Lyrica) B. Gabapentin (Neurontin) C. Duloxetine (Cymbalta) D. B and C

QUESTION 32

The PMHNP wants to use a symptom-based approach to treating a patient with fibromyalgia. How does the PMHNP go about treating this patient?

A. Prescribing the patient an agent that ignores the painful symptoms by initiating a reaction known as “fibro-fog” B. Targeting the patient’s symptoms with anticonvulsants that inhibit gray matter loss in the dorsolateral prefrontal cortex C. Matching the patient’s symptoms with the malfunctioning brain circuits and neurotransmitters that might mediate those symptoms D. None of the above (NURS6630 Final Exam (2018): Walden University)

QUESTION 33

The PMHNP is working with the student to care for a patient with diabetic peripheral neuropathic pain. The student asks the PMHNP why SSRIs are not consistently useful in treating this particular patient’s pain. What is the best response by the PMHNP?

A. “SSRIs only increase norepinephrine levels.” B. “SSRIs only increase serotonin levels.” C. “SSRIs increase serotonin and norepinephrine levels.” D. “SSRIs do not increase serotonin or norepinephrine levels.”

QUESTION 34

A patient with gambling disorder and no other psychiatric comorbidities is being treated with pharmacological agents. Which drug is the PMHNP most likely to prescribe?

A. Antipsychotics B. Lithium C. SSRI D. Naltrexone

QUESTION 35

Kevin is an adolescent who has been diagnosed with kleptomania. His parents are interested in seeking pharmacological treatment. What does the PMHNP tell the parents regarding his treatment options?

A. “Naltrexone may be an appropriate option to discuss.” B. “There are many medicine options that treat kleptomania.” C. “Kevin may need to be prescribed antipsychotics to treat this illness.” D. “Lithium has proven effective for treating kleptomania.” (NURS6630 Final Exam (2018): Walden University)

QUESTION 36

Which statement best describes a pharmacological approach to treating patients for impulsive aggression?

A. Anticonvulsant mood stabilizers can eradicate limbic irritability. B. Atypical antipsychotics can increase subcortical dopaminergic stimulation. C. Stimulants can be used to decrease frontal inhibition. D. Opioid antagonists can be used to reduce drive.

QUESTION 37

A patient with hypersexual disorder is being assessed for possible pharmacologic treatment. Why does the PMHNP prescribe an antiandrogen for this patient?

A. It will prevent feelings of euphoria. B. It will amplify impulse control. C. It will block testosterone. D. It will redirect the patient to think about other things.

QUESTION 38

Mrs. Kenner is concerned that her teenage daughter spends too much time on the Internet. She inquires about possible treatments for her daughter’s addiction. Which response by the PMHNP demonstrates understanding of pharmacologic approaches for compulsive disorders?

A. “Compulsive Internet use can be treated similarly to how we treat people with substance use disorders.” B. “Internet addiction is treated with drugs that help block the tension/arousal state your daughter experiences.” C. “When it comes to Internet addiction, we prefer to treat patients with pharmaceuticals rather than psychosocial methods.” D. “There are no evidence-based treatments for Internet addiction, but there are behavioral therapies your daughter can try.”

QUESTION 39

Mr. Peterson is meeting with the PMHNP to discuss healthier dietary habits. With a BMI of 33, Mr. Peterson is obese and needs to modify his food intake. “Sometimes I think I’m addicted to food the way some people are addicted to drugs,” he says. Which statement best describes the neurobiological parallels between food and drug addiction?

A. There is decreased activation of the prefrontal cortex. B. There is increased sensation of the reactive reward system. C. There is reduced activation of regions that process palatability. D. There are amplified reward circuits that activate upon consumption.

QUESTION 40

The PMHNP is caring for a patient who reports excessive arousal at nighttime. What could the PMHNP use for a time-limited duration to shift the patient’s brain from a hyperactive state to a sleep state?

A. Histamine 2 receptor antagonist B. Benzodiazepines C. Stimulants D. Caffeine

QUESTION 41

The PMHNP is caring for a patient who experiences too much overstimulation and anxiety during daytime hours. The patient agrees to a pharmacological treatment but states, “I don’t want to feel sedated or drowsy from the medicine.” Which decision made by the PMHNP demonstrates proper knowledge of this patient’s symptoms and appropriate treatment options?

A. Avoiding prescribing the patient a drug that blocks H1 receptors B. Prescribing the patient a drug that acts on H2 receptors C. Stopping the patient from taking medicine that unblocks H1 receptors D.None of the above

QUESTION 42

The PMHNP is performing a quality assurance peer review of the chart of another PMHNP. Upon review, the PMHNP reviews the chart of an older adult patient in long-term care facility who has chronic insomnia. The chart indicates that the patient has been receiving hypnotics on a nightly basis. What does the PMHNP find problematic about this documentation?

A. Older adult patients are contraindicated to take hypnotics. B. Hypnotics have prolonged half-lives that can cause drug accumulation in the elderly. C. Hypnotics have short half-lives that render themselves ineffective for older adults. D. Hypnotics are not effective for “symptomatically masking” chronic insomnia in the elderly.

QUESTION 43

The PMHNP is caring for a patient with chronic insomnia who is worried about pharmacological treatment because the patient does not want to experience dependence. Which pharmacological treatment approach will the PMHNP likely select for this patient for a limited duration, while searching and correcting the underlying pathology associated with the insomnia?

A. Serotonergic hypnotics B. Antihistamines C. Benzodiazepine hypnotics D. Non-benzodiazepine hypnotics

QUESTION 44

The PMHNP is caring for a patient with chronic insomnia who would benefit from taking hypnotics. The PMHNP wants to prescribe the patient a drug with an ultra-short half-life (1–3 hours). Which drug will the PMHNP prescribe?

A. Flurazepam (Dalmane) B. Estazolam (ProSom) C. Triazolam (Halcion) D. Zolpidem CR (Ambien)

QUESTION 45

The PMHNP is attempting to treat a patient’s chronic insomnia and wishes to start with an initial prescription that has a half-life of approximately 1–2 hours. What is the most appropriate prescription for the PMHNP to make?

A. Triazolam (Halcion) B. Quazepam (Doral) C. Temazepam (Restoril) D. Flurazepam (Dalmane)

QUESTION 46

A patient with chronic insomnia asks the PMHNP if they can first try an over-the-counter (OTC) medication before one that needs to be prescribed to help the patient sleep. Which is the best response by the PMHNP?

A. “There are no over-the-counter medications that will help you sleep.” B. “You can choose from one of the five benzo hypnotics that are approved in the United States.” C. “You will need to ask the pharmacist for a non-benzodiazepine medicine.” D. “You can get melatonin over the counter, which will help with sleep onset.”

QUESTION 47

A patient with chronic insomnia and depression is taking trazodone (Oleptro) but complains of feeling drowsy during the day. What can the PMHNP do to reduce the drug’s daytime sedating effects?

A. Prescribe the patient an antihistamine to reverse the sedating effects B. Increasing the patient’s dose and administer it first thing in the morning C. Give the medicine at night and lower the dose D. None of the above

QUESTION 48

The PMHNP is teaching a patient with a sleep disorder about taking diphenhydramine (Benadryl). The patient is concerned about the side effects of the drug. What can the PMHNP teach the patient about this treatment approach?

A. “It can cause diarrhea.” B. “It can cause blurred vision.” C. “It can cause increased salivation.” D. “It can cause heightened cognitive effects.”

QUESTION 49

Parents of a 12-year-old boy want to consider attention deficit hyperactivity disorder (ADHD) medication for their son. Which medication would the PMHNP start?

Methylphenidate Amphetamine salts Atomoxetine All of the above could potentially treat their son’s symptoms.

QUESTION 50

An adult patient presents with a history of alcohol addiction and attention deficit hyperactivity disorder (ADHD). Given these comorbidities, the PMHNP determines which of the following medications may be the best treatment option?

A. Methylphenidate (Ritalin, Concerta) B. Amphetamine C. Atomoxetine (Strattera) D. Fluoxetine (Prozac)

QUESTION 51

An 8-year-old patient presents with severe hyperactivity, described as “ants in his pants.” Based on self-report from the patient, his parents, and his teacher; attention deficit hyperactivity disorder (ADHD) is suspected. What medication is the PMNHP most likely to prescribe?

A. Methylphenidate (Ritalin, Concerta) B. Clonidine (Catapres) C. Bupropion (Wellbutrin) D. Desipramine (Norpramin)

QUESTION 52

A 9-year-old female patient presents with symptoms of both attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder. In evaluating her symptoms, the PMHNP determines that which of the following medications may be beneficial in augmenting stimulant medication?

A. Bupropion (Wellbutrin) B. Methylphenidate (Ritalin, Concerta) C. Guanfacine ER (Intuniv) D. Atomoxetine (Strattera)

QUESTION 53

A PMHNP supervisor is discussing with a nursing student how stimulants and noradrenergic agents assist with ADHD symptoms. What is the appropriate response?

A. They both increase signal strength output dopamine (DA) and norepinephrine (NE). B. Dopamine (DA) and norepinephrine (NE) are increased in the prefrontal cortex. C. Noradrenergic agents correct reductions in dopamine (DA) in the reward pathway leading to increased ability to maintain attention to repetitive or boring tasks and resist distractions. D. All of the above.

QUESTION 54

A 43-year-old male patient is seeking clarification about treating attention deficit hyperactivity disorder (ADHD) in adults and how it differs from treating children, since his son is on medication to treat ADHD. The PMHNP conveys a major difference is which of the following?

A. Stimulant prescription is more common in adults. B. Comorbid conditions are more common in children, impacting the use of stimulants in children. C. Atomoxetine (Strattera) use is not advised in children. D. Comorbidities are more common in adults, impacting the prescription of additional agents.

QUESTION 55

A 26-year-old female patient with nicotine dependence and a history of anxiety presents with symptoms of attention deficit hyperactivity disorder (ADHD). Based on the assessment, what does the PMHNP consider?

A. ADHD is often not the focus of treatment in adults with comorbid conditions. B. ADHD should always be treated first when comorbid conditions exist. C. Nicotine has no reported impact on ADHD symptoms. D. Symptoms are often easy to treat with stimulants, given the lack of comorbidity with other conditions.

QUESTION 56

Which of the following is a true statement regarding the use of stimulants to treat attention deficit hyperactivity disorder (ADHD)?

A. In adults with both ADHD and anxiety, treating the anxiety with selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or benzodiazepines and the ADHD with stimulants is most effective in treating both conditions. B. Signal strength output is increased by dialing up the release of dopamine (DA) and norepinephrine (NE). C. In conditions where excessive DA activation is present, such as psychosis or mania, comorbid ADHD should never be treated with stimulants. D. High dose and pulsatile delivery of stimulants that are short acting are preferred to treat ADHD.

QUESTION 57

The PMHNP is providing a workshop for pediatric nurses, and a question is posed about noradrenergic agents to treat ADHD. Which of the following noradrenergic agents have norepinephrine reuptake inhibitor (NRI) properties that can treat ADHD?

A. Desipramine (Norpramin) B. Methylphenidate (Ritalin, Concerta) C. Atomoxetine (Strattera) D. Both “A” & “C” E. “C” only

QUESTION 58

A 71-year-old male patient comes to an appointment with his 65-year-old wife. They are both having concerns related to her memory and ability to recognize faces. The PMNHP is considering prescribing memantine (Namenda) based on the following symptoms:

A. Amnesia, aphasia, apnea B. Aphasia, apraxia, diplopia C. Amnesia, apraxia, agnosia D. Aphasia, agnosia, arthralgia

QUESTION 59

The PMHNP evaluates a patient presenting with symptoms of dementia. Before the PMHNP considers treatment options, the patient must be assessed for other possible causes of dementia. Which of the following answers addresses both possible other causes of dementia and a rational treatment option for Dementia?

A. Possible other causes: hypothyroidism, Cushing’s syndrome, multiple sclerosis Possible treatment option: memantine B. Possible other causes: hypothyroidism, adrenal insufficiency, hyperparathyroidism Possible treatment option: donepezil C. Possible other causes: hypothyroidism, adrenal insufficiency, niacin deficiency Possible treatment option: risperidone D. Possible other causes: hypothyroidism, Cushing’s syndrome, lupus erythematosus Possible treatment option: donepezil

QUESTION 60

A group of nursing students seeks further clarification from the PMHNP on how cholinesterase inhibitors are beneficial for Alzheimer’s disease patients. What is the appropriate response?

A. Acetylcholine (ACh) destruction is inhibited by blocking the enzyme acetylcholinesterase. B. Effectiveness of these agents occurs in all stages of Alzheimer’s disease. C. By increasing acetylcholine, the decline in some patients may be less rapid. D. Both “A” & “C.”

QUESTION 61

The PMHNP is assessing a patient who presents with elevated levels of brain amyloid as noted by positron emission tomography (PET). What other factors will the PMHNP consider before prescribing medication for this patient, and what medication would the PMHNP want to avoid given these other factors?

A. ApoE4 genotype and avoid antihistamines if possible B. Type 2 diabetes and avoid olanzapine C. Anxiety and avoid methylphenidate D. Both “A” & “B”

QUESTION 62

A 72-year-old male patient is in the early stages of Alzheimer’s disease. The PMHNP determines that improving memory is a key consideration in selecting a medication. Which of the following would be an appropriate choice?

A. Rivastigmine (Exelon) B. Donepezil (Aricept) C. Galantamine (Razadyne) D. All of the above

QUESTION 63

A 63-year-old patient presents with the following symptoms. The PMHNP determines which set of symptoms warrant prescribing a medication? Select the answer that is matched with an appropriate treatment.

A. Reduced ability to remember names is most problematic, and an appropriate treatment option is memantine. B. Impairment in the ability to learn and retain new information is most problematic, and an appropriate treatment option would be donepezil. C. Reduced ability to find the correct word is most problematic, and an appropriate treatment option would be memantine. D. Reduced ability to remember where objects are most problematic, and an appropriate treatment option would be donepezil.

QUESTION 64

A 75-year-old male patient diagnosed with Alzheimer’s disease presents with agitation and aggressive behavior. The PMHNP determines which of the following to be the best treatment option?

A. Immunotherapy B. Donepezil (Aricept) C. Haloperidol (Haldol) D. Citalopram (Celexa) or Escitalopram (Lexapro)

QUESTION 65

The PMHNP has been asked to provide an in-service training to include attention to the use of antipsychotics to treat Alzheimer’s. What does the PMHNP convey to staff?

A. The use of antipsychotics may cause increased cardiovascular events and mortality. B. A good option in treating agitation and psychosis in Alzheimer’s patients is haloperidol (Haldol). C. Antipsychotics are often used as “chemical straightjackets” to over-tranquilize patients. D. Both “A” & “C.”

QUESTION 66

An 80-year-old female patient diagnosed with Stage II Alzheimer’s has a history of irritable bowel syndrome. Which cholinergic drug may be the best choice for treatment given the patient’s gastrointestinal problems?

A. Donepezil (Aricept) B. Rivastigmine (Exelon) C. Memantine (Namenda) D. All of the above

QUESTION 67

The PMHNP understands that bupropion (Wellbutrin) is an effective way to assist patients with smoking cessation. Why is this medication effective for these patients?

A. Bupropion (Wellbutrin) releases the dopamine that the patient would normally receive through smoking. B. Bupropion (Wellbutrin) assists patients with their cravings by changing the way that tobacco tastes. C. Bupropion (Wellbutrin) blocks dopamine reuptake, enabling more availability of dopamine. D. Bupropion (Wellbutrin) works on the mesolimbic neurons to increase the availability of dopamine.

QUESTION 68

Naltrexone (Revia), an opioid antagonist, is a medication that is used for which of the following conditions?

A. Alcoholism B. Chronic pain C. Abuse of inhalants D. Mild to moderate heroin withdrawal

QUESTION 69

A patient addicted to heroin is receiving treatment for detoxification. He begins to experience tachycardia, tremors, and diaphoresis. What medication will the PMHNP prescribe for this patient?

A. Phenobarbital (Luminal) B. Methadone (Dolophine) C. Naloxone (Narcan) D. Clonidine (Catapres)

QUESTION 70

A patient diagnosed with obsessive compulsive disorder has been taking a high-dose SSRI and is participating in therapy twice a week. He reports an inability to carry out responsibilities due to consistent interferences of his obsessions and compulsions. The PMHNP knows that the next step would be which of the following?

A. Decrease his SSRI and add buspirone (Buspar). B. Decrease his SSRI and add an MAOI. C. Decrease his SSRI steadily until it can be discontinued then try an antipsychotic to manage his symptoms. D. Keep his SSRI dosage the same and add a low-dose TCA.

QUESTION 71

The PMHNP is assessing a patient who will be receiving phentermine (Adipex-P)/topiramate (Topamax) (Qsymia). Which of the following conditions/diseases will require further evaluation before this medication can be prescribed?

A. Kidney disease stage II B. Obesity C. Cardiovascular disease D. Diabetes type II

QUESTION 72

The PMHNP prescribes an obese patient phentermine (Adipex-p)/topiramate ER (Topamax) (Qsymia), Why is topiramate (Topamax) often prescribed with phentermine (Adipex-P)?

A. Phentermine (Adipex-P) dose can be increased safely when taken with an anticonvulsant. B. Phentermine (Adipex-P) works by suppressing appetite while topiramate (Topamax) acts by inhibiting appetite. C. Topiramate (Topamax) potentiates appetite suppression achieved by phentermine (Adipex-P). D. Topiramate (Topamax) helps prevent the unwanted side effects of phentermine (Adipex-P).

QUESTION 73

The PMHNP is assessing a patient who has expressed suicidal intent and is now stating that he is hearing voices and sees people chasing him. The PMHNP identifies these symptoms to be associated with which of the following?

A. Barbiturate intoxication B. Marijuana intoxication C. “Bath salt” intoxication D. Cocaine intoxication

QUESTION 74

The PMHNP is caring for a patient who openly admitted to drinking a quart of vodka daily. Prior to prescribing this patient disulfiram (Antabuse), it is important for the PMHNP to:

A. Evaluate the patient’s willingness to abstain from alcohol B. Counsel the patient on dietary restrictions C. Obtain liver function tests D. Assess for addiction to opioids

QUESTION 75 An opioid-naive patient is taking MS Contin (morphine sulfate) to treat his pain that is secondary to cancer. Under what circumstances would the PMHNP order naloxone (Narcan) IM/SQ?

A. The patient’s speech is slurred, and he is in and out of sleep. B. The patient’s appetite has decreased from eating 100% of his meal to 50% of his meal. C. The patient complains of not having a bowel movement for 4 days. D. The patient’s vital signs are 98.4F temp, 88 pulse, 104/62 blood pressure, and 8 respirations.

QUESTION 76

When completing this exam, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity?

Yes No

NURS 6630 Midterm Exam (2018): Walden University

QUESTION 1

1. A noncompliant patient states, “Why do you want me to put this poison in my body?” Identify the best response made by the psychiatric-mental health nurse practitioner (PMHNP).

“You have to take your medication to become stable.”

“Most medications will increase the number of neurotransmitters that you already have in the brain.”

“Most medications used in treatment are either increasing or decreasing neurotransmitters that your body already has.”

“Why do you believe that your medication is poison?”

QUESTION 2

1. Which statement about neurotransmitters and medications is true?

Natural neurotransmitters such as endorphins have been discovered after the development of medications.

Some medications were developed after the discovery and known action of the neurotransmitters in the brain.

Neurotransmitters receive messages from most medications.

The neurotransmitter serotonin is directly linked to depression. Following this discovery, the antidepressant Prozac was developed.

1 points

QUESTION 3

1. When an unstable patient asks why it is necessary to add medications to his current regimen, the PMHNP’s best response would be:

“In an extreme case such as yours, more than one medication is often needed.”

“Due to the ineffectiveness of your current medication, we need to try something else that can possibly potentiate its effects.

“Medications are often specific to the neurotransmitter(s) they are affecting and, due to more than one neurotransmitter involvement, it is often necessary to use more than one medication to improve symptoms.”

“I understand your concern. We can discontinue your current medication and switch to a different one that may better manage your symptoms.”

1 points

QUESTION 4 ?

1. During gene expression, what must occur prior to a gene being expressed?

Transcription factor must bind to the regulatory region within the cell’s nucleus.

RNA must be converted to mRNA.

The coding region must separate from the regulatory region. This is wrong

RNA polymerase must inhibit the process of changing RNA to mRNA.

1 points

QUESTION 5

1. While genes have potential to modify behavior, behavior can also modify genes. How do genes impact this process?

Genes impact neuron functioning directly.

Changes made to proteins lead to changes in behavior.

Neurons are able to impact protein synthesis.

Genes impact the DNA of a cell, leading to changes in behavior.

1 points

QUESTION 6

1. Though medications have the ability to target neurotransmitters in the synapse, it is not always necessary. The PMHNP understands that this is because:

Neurotransmission that occurs via the axon allows for transport of a neurotransmitter.

Active transport is a different type of energy that allows the transport of certain neurotransmitters.

Neurotransmitters can spread by diffusion.

The postsynaptic neuron can release the neurotransmitter.

1 points

QUESTION 7

1. Why is the cytochrome P450 enzyme system of significance to the PMHNP?

The kidneys play a role with excretion of the medication, and if a patient has kidney damage, the dose must be increased to be effective.

The bioavailability of the medication after it passes through the stomach and liver can be altered. Correct answer

The medication’s chemical composition changes when it comes in contact with the acid in the stomach.

The CYP enzyme system is a steady and predictable process that prescribers must understand to treat conditions effectively.

1 points

QUESTION 8

1. It is important for the PMHNP to recognize differences in pharmacokinetics to safely prescribe and monitor medications. Which of the following statements does the competent PMHNP identify as true?

About 1 out of 5 Asians requires lower-than-normal doses of some antidepressants and antipsychotics.

The term polymorphic refers to the body’s ability to break a medication down several ways, and this patient may require higher doses of certain antidepressants and antipsychotics.

About 1 out of 30 Caucasians requires lower doses of some antidepressants and antipsychotics.

Most enzyme pathways do not have interactions between the newer medications.

1 points

QUESTION 9

1. As it relates to G-protein linked receptors, what does the PMHNP understand about medications that are used in practice?

Most medications that act on G-protein linked receptors have antagonistic traits.

The majority of medications used in practice are full agonists and are used to stimulate the body’s natural neurotransmitters.

Most medications act as partial agonists because they allow the body to use only what is needed.

Medications used in practice may act as inverse agonists if the dosage is too high.

1 points

QUESTION 10

1. The PMHNP is considering prescribing a 49-year-old male clozapine (Clozaril) to treat his schizophrenia and suicidal ideations. The PMHNP is aware that which factor may impact the dose needed to effectively treat his condition:

The patient smokes cigarettes.

The patient has hypertension.

The patient has chronic kidney disease, stage 2.

The patient drinks a cup of coffee a day.

1 points

QUESTION 11

1. A patient is diagnosed with bipolar disorder and is currently taking carbamazepine (Tegretol), aripiprazole (Abilify), and melatonin. The PMHNP has just written an order to discontinue the carbamazepine (Tegretol) for drug-induced thrombocytopenia. The PMHNP is aware that his next best action is to:

Alert staff to possible seizures

Write an order for a different moodstabilizer

Decrease the amount prescribed for aripiprazole (Abilify)

Explain to the patient that it will be more difficult to control his temper

1 points

QUESTION 12

1. A patient recently transferred following a suicide attempt has a history of schizophrenia, depression, and fibromyalgia. He is currently taking Amitriptyline (Elavil), Lisinopril, aspirin, and fluoxetine (Prozac). Which is the best action for the PMHNP to take for this patient?

Review Amitriptyline (Elavil) level

Order a liver function test

Check the patient’s blood pressure and pulse

Order a stat platelet count

1 points

QUESTION 13

1. A patient with schizophrenia is given an inverse agonist that acts on the receptor 5HT and neurotransmitter serotonin. What is the rationale for prescribing a medication such as this?

To promote the availability of serotonin

To decrease serotonin

To indirectly increase the amount of dopamine in the body

To help decrease the amount of serotonin and dopamine

1 points

QUESTION 14

1. The PMHNP is caring for four patients. Which patient statement indicates that benzodiazepines would be beneficial?

“I have trouble staying asleep in the middle of the night.”

“My spouse told me that I seem to have trouble remembering things sometimes.”

“I really want to stop smoking, but the cravings are too strong.”

“I feel nervous to go outside and be in large crowds.”

1 points

QUESTION 15

1. Ms. Harlow is a 42-year-old patient who is prescribed a drug that acts on ionotropic receptors. She is curious about the effects of the drug and how it will act on her symptoms. Which statement made by the PMHNP demonstrates proper understanding of Ms. Harlow’s prescription?

“The drug will have an almost immediate effect.”

“The drug can take a while to build up in your system.”

“The drug is slow to release but lasts for a long time.”

“The drug will make a subtle difference in your symptoms.”

1 points

QUESTION 16

1. A patient is seeking pharmacological treatment for smoking cessation. Which drug class does the PMHNP prescribe to the patient?

Benzodiazepine

Mirtazapine (Remeron)

Ketamine

Varenicline (Chantix)

1 points

QUESTION 17

1. The PMHNP is caring for a new patient who has been transferred from another office. When meeting with the new patient, the patient reports, “I feel like I am improving with the stabilizers.” The PMHNP immediately recognizes that the patient is describing which kind of drug? (NURS6630 Final Exam (2018): Walden University)

Full agonists

Antagonists

Partial agonists

Inverse agonists

1 points

QUESTION 18

1. A patient presents with frequent episodes of mania. Which statement describes an appropriate treatment approach for this patient?

“The patient needs to have an inverse agonist.”

“The patient could benefit from an anticonvulsant.”

“The patient’s calcium, sodium, chloride, and potassium levels must be regulated.”

“The patient should have a drug that acts on ligand-gated ion channels.”

1 points

QUESTION 19

1. The PHMNP is caring for a patient who would benefit from nicotine cholinergic, serotonin 3, or glycine receptors. What kind of agent does the PHMNP want to prescribe for this patient?

Ligand-gated ion channels with a pentameric structure

Ligand-gated ion channels with a tetrameric structure

Voltage-sensitive ion channels

Anticonvulsants

1 points

QUESTION 20 ?

1. Which statement made by the patient suggests the patient will need to be treated with antipsychotics that target paranoid psychosis?

“It’s my fault that all of this is happening. I don’t think I could ever forgive myself.”

“I have to talk to the President because I’m the only one who can help him.”

“I’m not sure why that lady is wearing a red jacket since it’s the dogs who need food.”

“I don’t know that I even want to go to that meeting. It doesn’t seem worth it anymore.”

1 points

QUESTION 21

1. A patient has been treated with a number of novel psychotropic drugs. How is it theoretically possible to identify cognitive improvement in the patient using neuropsychological assessment batteries after the pharmacologic therapy? I did not have this question

Obtaining raw normative metrics and using them to assess functionality

Having the patient report on cognitive function based on personal experiences

Monitoring the patient in a controlled setting

Measuring symptoms of psychosis

1 points

QUESTION 22

1. Mr. McCullin is 64 years old with Parkinson’s disease. The PMHNP caring for Mr. McCullin wants to start him on a dopamine agonist to help manage and treat his condition. The PHMNP selects this agent because of which action it has on patients like Mr. McCullin?

Dopamine is terminated through multiple mechanisms.

The D2 autoreceptor regulates release of dopamine from the presynaptic neuron.

MAO-B presents in the mitochondria within the presynaptic neuron.

D2 receptors are the primary binding site for dopamine agonists.

1 points

QUESTION 23

1. Mrs. Trevor is a 44-year-old patient who does not have a diagnosis of schizophrenia but occasionally reports symptoms of psychosis, followed by severe fatigue. Mrs. Trevor inquires about the use of amphetamines to help with her energy levels. Which response made by the PMHNP is most appropriate?

“Amphetamines may help you, as they can alleviate psychotic conditions.”

“Amphetamines can inhibit negative symptoms of schizophrenia, so this might be a good choice for you.”

“Amphetamines can cause hallucinations, so I would advise against this type of prescription.”

“Amphetamines can lead to a dopamine deficiency, so I will not prescribe this for you.”

1 points

QUESTION 24

1. The PMHNP is caring for a patient with schizophrenia and is considering a variety of treatment approaches. The PHMNP selects a viable treatment that is consistent with the “dopamine hypothesis of schizophrenia.” What action does the PMHNP anticipate this treatment having on the patient?

Blocking the release of dopamine facilitates the onset of positive schizophrenia symptoms.

Hyperactivity in the mesolimbic dopamine pathway mediates the positive symptoms of schizophrenia.

Antipsychotic drugs that open D2 receptor pathways can treat schizophrenia.

The neuroanatomy of dopamine neuronal pathways can explain symptoms of schizophrenia.

1 points

QUESTION 25

1. A patient is diagnosed with schizophrenia. What increases the patient’s potential to mediate the cognitive symptoms of the disease?

Achieving underactivity of the mesocorticol projections to the prefrontal cortex

Achieving overactivity of the mesocorticol projections to the ventromedial prefrontal cortex

Achieving underactivity of the mesocortical projections to the ventromedial prefrontal cortex

Achieving overactivity of the mesocorticol projections to the prefrontal cortex

1 points

QUESTION 26

1. The PMNHP is assessing a 29-year-old patient who takes antipsychotics that block D2 receptors. What patient teaching should the PMHNP include related to the possible side effects of this type of drug?

Hypersexuality

Amenorrhea

Dystonia

Tardive dyskinesia

1 points

QUESTION 27

1. The PMHNP is caring for a patient who is taking antipsychotics heard the psychiatrist tell the patient that the patient would be placed on a different antipsychotic agent. Which of the following requires the longest transition time for therapeutic benefit?

Olanzapine to clozapine

Asenapine to Risperidone

Aripripazole to ziprasidone

Aripripazole to clozapine

1 points

QUESTION 28

1. The PMHNP is assessing a patient who has cirrhosis of the liver and anticipates that the patient will be prescribed an antipsychotic. Which medication does the PMHNP suspect will be ordered for this patient?

Quetiapine

Paliperidone

Lurasidone

Clozapine

1 points

QUESTION 29

1. Which statement made by the PMHNP exemplifies correct teaching of physiological effects in the body?

Muscarinic antagonists are more likely to cause decreased prolactin levels.

D2 antagonists decrease the likelihood of EPS symptoms.

D2 antagonism is linked to antidepressant properties.

D2 partial agonists are associated with increased efficacy in treating positive symptoms of schizophrenia.

1 points

QUESTION 30

1. Mrs. Schwartzman is a 52-year-old patient with schizophrenia and no established history of depression. When meeting with the PMHNP, she presents with apathy and withdrawn social behavior, and she reports a loss of joy from enjoyable activities. What does the PMHNP infer from this encounter with the patient?

An underlying depressive disorder

The recent change of a 2nd generation antipsychotic to a conventional one

The recent change of a 1st generation antipsychotic to a 2nd generation antipsychotic

All of the above

1 points

QUESTION 31

1. The PMHNP is taking a history on a patient who has been on antipsychotics for many years. Which risk factors are most likely to contribute to a person developing tardive dyskinesia (TD)?

Long-term use of antipsychotics

Genetic disposition

Age

A and C

All of the above

1 points

QUESTION 32

1. The student inquires about antipsychotic medications. Which response by the PMHNP describes nthe factors that contribute to reduced risk of extrapyramidal symptoms (EPS) for patients who take antipsychotics?

Those that are potent D2 antagonists

Those that are potent D2 antagonists with 5HT2A antagonism properties

D2 receptors that are blocked in the nigrostriatal pathway

Potent D2 antagonists that block the muscarinic anti-M1 cholinergic receptors

1 points

QUESTION 33

1. Mr. Gordon is a middle-aged patient who is taking antipsychotics. When meeting with the PMHNP, he reports positive responses to the medication, stating, “I really feel as though the effects of my depression are going away.” Which receptor action in antipsychotic medications is believed to be the most beneficial in producing the effects described by Mr. Gordon?

5HT2 antagonism

D2 antagonism

Alpha-2 antagonism

D2 partial agonist

1 points

QUESTION 34

1. A patient who was recently admitted to the psychiatric nursing unit is being treated for bipolar disorder. Which neurotransmitter is the PMHNP most likely to target with pharmaceuticals?

Norepinephrine

Dopamine

Serotonin

A and C

All of the above

1 points

QUESTION 35

1. Ms. Ryerson is a 28-year-old patient with a mood disorder. She recently requested to transfer to a new PMHNP, after not getting along well with her previous provider. The new PHMNP is reviewing Ms. Ryerson’s medical chart prior to their first appointment. Upon review, the PMHNP sees that the former provider last documented “patient had rapid poop out.” What does the PMHNP infer about the patient’s prescription based on this documentation?

The patient has an unsustained response to antidepressants.

The patient has antidepressant-induced hypomania.

The patient has a depletion of monoamine neurotransmitters.

The patient has an adverse effect to atypical antipsychotics.

1 points

QUESTION 36

1. The PMHNP recognizes that which patient would be contraindicated for antidepressant monotherapy? (NURS6630 Final Exam (2018): Walden University)

Patient with a bipolar I designation

Patient with a bipolar II designation

Patient with a bipolar III designation

None of the above

1 points

QUESTION 37

1. Why does the PMHNP avoid treating a patient with cyclothymia, and has major depressive episodes, with antidepressant monotherapy?

The patient may experience paranoid avoidant behavior.

The patient may experience severe depression.

The patient may experience auditory hallucinations.

The patient may experience increased mood cycling.

1 points

QUESTION 38

1. The PMHNP is caring for a patient with the s genotype of SERT. What does the PMHNP understand regarding this patient’s response to selective serotonin reuptake inhibitor (SSRI)/SNRI treatment?

The patient has a higher chance of tolerating SSRI/SNRI treatment.

The patient will have a positive response to SSRI/SNRI treatment.

The patient will develop severe mood cycling in response to treatment.

The patient may be less responsive or tolerant to the treatment.

1 points

QUESTION 39

1. Ms. Boeckh is a 42-year-old patient with major depression. The PMHNP understands that which action of norepinephrine will affect Ms. Boeckh’s serotonin levels?

Norepinephrine potentiates 5HT release through a2 postsynaptic receptors.

Norepinephrine inhibits 5HT release through a2 receptors.

Norepinephrine inhibits α2 receptors on axon terminals.

Norepinephrine potentiates 5HT release through a1 and a2 receptors.

1 points

QUESTION 40

1. Which statement made by the PMHNP correctly describes the relationship between NE neurons and pharmaceutical treatment?

“Drugs inhibit the release of NE.”

“Drugs can mimic the natural functioning of the NE neuron.”

“Drugs are unable to simulate the effects of NE neurons.”

“Drugs prevent the natural functioning of the NE neuron by stopping the presynaptic a2 neuron.”

1 points

QUESTION 41

1. The PMHNP is assessing a patient in the psychiatric emergency room. The patient tells the PMHNP that he does not understand why his depression has not lifted after being on four different antidepressants over the course of a year. Which of the following symptoms can be residual symptoms for patients who do not achieve remission with major depressive disorder?

Insomnia

Suicidal ideation

Problems concentrating

A and C

1 points

QUESTION 42

1. Fluoxetine (Prozac) has been prescribed for a patient. Which of the following statements is true regarding the action of this medication?

Neuronal firing rates are not dysregulated in depression.

Blocking the presynaptic SERT will immediately lead to a great deal of serotonin in many synapses.

Upon the acute administration of a SSRI, 5HT decreases.

The action at the somatodendritic end of the serotonin neuron may best explain the therapeutic action of SSRIs.

1 points

QUESTION 43

1. The nurse educator knows that teaching was effective when one of the students compares fluvoxamine to sertraline and notes which of the following similarities?

Both have a sedative-like, calming effect.

Both contribute to antipsychotic actions.

Both demonstrate favorable findings in treating depression in the elderly.

Both are known for causing severe withdrawal symptoms such as dizziness, restlessness, and akathisia.

1 points

QUESTION 44

1. A 45-year-old female patient with allergic rhinitis and normal blood pressure has had no reduction in depressive symptoms after trying bupropion, paroxetine, and venlafaxine. What precautions are needed in considering monoamine oxidase inhibitors (MAOI) in treating her depression?

Since all MAOIs require dietary restrictions, the patient will need to avoid all cheeses and aged, smoked, or fermented meats.

The patient cannot take any antihistamines.

The patient cannot have two wisdom teeth extracted while on a MAnOI.

The patient will need to minimize dietary intake of foods such as tap and unpasteurized beer, aged cheeses, and soy products/tofu.

1 points

QUESTION 45

1. After sitting in on an interdisciplinary treatment team meeting, the student nurse asks the instructor to explain a system-based approach to the treatment of depression. What is the appropriate response?

Symptoms help create a diagnosis, then symptoms are deconstructed into a list of specific symptoms experienced by a patient.

Symptoms are matched first with the brain circuits that hypothetically mediate them and then with the known neuropharmacological regulation of these circuits by neurotransmitters.

Treatment options that target neuropharmacological mechanisms are selected to eliminate symptoms one by one.

All of the above.

1 points

QUESTION 46

1. A 51-year-old female patient presents with symptoms of depression, including lack of motivation and difficulty sleeping. What risk factors would increase her vulnerability for a diagnosis of depression?

First onset in puberty or early adulthood

Late onset of menses

Premenstrual syndrome

A and C

1 points

QUESTION 47

1. A nurse overhears that a patient has failed single therapy with an SSRI and SNRI. She also learns that the patient has been on dual SSRI/SNRI therapy without adequate symptom control. She approaches the PMHNP and asks what the next treatment option could be in this seemingly treatment-resistant patient. The PMHNP tells the nurse she will treat the patient with the following regimen:

MAOI plus SNRI

SSRI/SNRI plus NDRI

NDRI/SNRI plus mirtazapine

NDRI plus modafinil

1 points

*Q/UESTION 48

1. Mrs. Radcliff is a 42-year-old patient who is considering stopping paroxetine. Why does her PMHNP advise against this abrupt discontinuation of the medicine?

She may experience withdrawal symptoms.

She may experience increased trauma.

Effects of abrupt cessation are unknown.

It can lead to difficulties with concentration.

1 points

QUESTION 49

1. A patient is prescribed fluoxetine but is concerned about the side effects. Which statement demonstrates accurate patient teaching when discussing the side effects associated with fluoxetine?

Weight gain can be problematic.

Sedation is very common.

Induction of mania is rare.

Seizures are not unusual.

1 points

QUESTION 50

1. The PMHNP is caring for a patient with anxiety who develops mild to moderate hepatic impairment. Which action does the PMHNP take regarding the use of venlafaxine?

Stop the venlafaxine

Lower the dose of venlafaxine by 50%

Lower the dose of venlafaxine by 25-40%

Increase the dose of venlafaxine by 50%

1 points

QUESTION 51

1. A 25-year-old female patient is being prescribed milnacipran to treat fibromyalgia, and expresses concern regarding “how she will feel and look” from taking the medicine. Which statement correctly describes the side effects as a result of taking this medication?

It can affect her menstruation.

Suicidality can be common among young adults.

Sedation may be problematic.

Weight gain is unusual.

1 points

QUESTION 52

1. Mr. Ruby is a 33-year-old single father who is requesting pharmacological intervention to treat his fibromyalgia. The PMHNP sees in the medical chart that he has a recent diagnosis of arrhythmia and a BMI of 29. During his assessment, the PMHNP learns that Mr. Ruby works 40-50 hours a week as a contractor and “manages his stress” by smoking 3-4 cigarettes a day and having 8-10 drinks of alcohol each week. Why would duloxetine be contraindicated for Mr. Ruby?

He has fibromyalgia.

He has arrhythmia.

He uses alcohol.

He is overweight.

1 points

QUESTION 53

1. A patient is prescribed sertraline to treat panic disorder. Knowing that sertraline can initially cause anxiety or insomnia, what should the PMHNP do?

Prescribe long-acting benzodiazepine for 2 weeks, then increase the dose.

Prescribe short-acting benzodiazepine for 2 weeks, then discontinue.

Prescribe long-acting benzodiazepine for 2 weeks, then discontinue.

Prescribe short-acting benzodiazepine for 2 weeks, then increase the dose.

1 points

QUESTION 54

1. A patient is prescribed 50 mg of desvenlafaxine to take every other day for major depressive disorder. What does the PMHNP understand about this patient?

The patient has hepatic impairment.

The patient has moderate renal impairment.

The patient has severe renal impairment.

The patient has cardiac impairment.

1 points

QUESTION 55

1. The PMHNP understands that which mechanism contributes to a worse tolerability profile for patients taking tricyclic antidepressants (TCAs)?

Histamine H1 receptor blockade can cause insomnia.

Muscarinic M1 receptor blockade causes blurred vision.

Alpha 1 adrenergic receptor blockade causes weight gain.

Muscarinic M3 receptor blockade causes sedation.

1 points

QUESTION 56

1. A patient who was prescribed an MAO inhibitor is learning about dietary modifications. Which statement made by the PMHNP demonstrates proper teaching of the food-drug interactions for MAO inhibitors?

“You must avoid soy products, such as tofu.”

“You should not consume processed meats.”

“You may consume fermented foods, like sauerkraut.”

“You may continue to drink beers on tap.”

1 points

QUESTION 57

1. A patient who is prescribed MAO inhibitors asks about whether he can continue taking pseudoephedrine to relieve his congestion. Which response by the PMHNP indicates proper understanding of drug-drug interactions?

“Decongestants are fine to continue taking with MAO inhibitors.”

“Decongestants are okay to take with MAO inhibitors in moderation.”

“Decongestants should be avoided due to risk of serotonin syndrome.”

“Decongestants should be avoided due to risk of hypertensive crisis.”

1 points

QUESTION 58

1. Ms. Skidmore presents for a follow-up appointment after being prescribed phenelzine (Nardil), and reports “I take my 45 mg pill, three times a day, just like I’m supposed to.” What does the PMHNP understand about this patient? (NURS6630 Final Exam (2018): Walden University)

Ms. Skidmore is taking the correct dose of phenelzine (Nardil).

Ms. Skidmore is not taking enough of the phenelzine (Nardil); she should be taking three times that amount.

Ms. Skidmore is taking too much of the phenelzine (Nardil); she should be taking the 45 mg in three doses.

Ms. Skidmore is taking too much of the phenelzine (Nardil); she is supposed to take 45 mg every 24 hours.

1 points

QUESTION 59

1. The PMHNP is caring for several patients who present with various symptoms and health issues. For which patient does the PMHNP prescribe pregabalin (Lyrica)?

Patient with PTSD

Patient with partial seizures

Patient with galactose intolerance

Patient with Lapp lactase deficiency

1 points

QUESTION 60

1. Mr. Gutier is 72 years old with anxiety and depressive symptoms. His PMHNP is prescribing lorazepam (Ativan). What does the PMHNP understand regarding this prescription?

The PMHNP will prescribe less than 2-6 mg for Mr. Gutier to take daily.

The PMHNP will require Mr. Gutier to take 2-4 doses of lorazepam (Ativan) per day.

The PMHNP will prescribe more than 2-6 mg for Mr. Gutier to take daily.

The PMHNP will have Mr. Gutier take 6 mg of lorazepam (Ativan) as a PRN.

1 points

QUESTION 61

1. A patient is being prescribed a sedating antidepressant, but is concerned about weight gain. Which medication is most likely to be prescribed to addresses the patient’s concerns?

mirtazapine (Remeron)

doxepin (Silenor)

alprazolam (Xanax)

trazadone (Oleptro)

1 points

QUESTION 62

1. A patient who was diagnosed with bipolar disorder without mania, asks the PMHNP why he is being prescribed a mood stabilizer. What is the appropriate response?

Mood stabilizers are only prescribed to treat manic phases of bipolar depression

Mood stabilizers can consistently treat both mania and bipolar depression

Mood stabilizers can target mania and mania relapse and also reduce symptoms of bipolar depression and relapse of bipolar depression symptoms but no drug has been proven to target all four therapeutic actions

Certain mood stabilizers, such as lithium, are able to consistently target mania and bipolar depression

1 points

QUESTION 63

1. The PMHNP is assessing a patient in the emergency room. The patient shares that he has been on lithium (Lithobid) for many years. What blood tests does the PMHMP order?

Thyroid Stimulating Hormone (TSH)

Complete Blood Count (CBC)

Erythrocyte Sedimentation Rate

Platelet Count

1 points

QUESTION 64

1. A 39-year old female patient presently on lithium would like to try a new medication to treat her bipolar disorder. She has had concerns about side effects from lithium and wants to learn more about Lamotrigine (Lamictal) as a treatment option. The PMHNP conveys some of the unique aspects of this agent, including which of the following? I don’t think I had this question

There is some indication lamotrigine can prevent progression from mild cognitive impairment to Alzheimer’s disease

Lamotrigine may cause rashes, including the life-threatening Stevens-Johnson syndrome

It was one of the first anticonvulsants approved by the FDA to treat bipolar depression

There is a risk for amenorrhea and polycystic ovarian disease in women of childbearing age

1 points

QUESTION 65

1. A nursing student is seeking clarification on the use of anticonvulsants to treat depression and is unclear about most effective outcomes. Which of the following agents does the PMHNP convey as having uncertain outcomes?

Carbamazepine (Tegretol)

Gabapentin (Neurontin)

Valporoic Acid (Depakene)

All of the above

1 points

QUESTION 66

1. A 46-year old male patient mentions several alternative treatments to Carbamazepine (Tegretol) as a way to manage symptoms of his bipolar depression. Which of the following does the PMHNP indicate would not be an agent to treat bipolar depression? (NURS6630 Final Exam (2018): Walden University)

Omega-3-fatty-acids

Soybean lecithin

Inositol

L-methylfolate

1 points

QUESTION 67

1. The PMHNP is meeting with a new mother who would like to begin taking medication again to treat her bipolar depression; she is breastfeeding her 2-month old daughter. The PMHNP recognizes that which of the following medications is contraindicated for this patient?

Valporic Acid (Depakene)

Carbamazepine (Tegretol)

Lithium (Lithobid)

Lamotrigine (Lamictal)

1 points

QUESTION 68

1. The PMHNP assesses a 10-year old male child in the ER and suspects mania. Which of the following symptoms and recommendations for follow-up evaluation are appropriate?

Irritability, euphoria, anger; the child should be evaluated further for conduct disorder.

Irritability, violent outbursts, hyperactivity; the child should also be evaluated further for ADHD

Irritability, lethargy, anger; the child should be evaluated further for ADHD.

Irritability, acute mania, hyperactivity; the child should be evaluated further for conduct disorder.

1 points

QUESTION 69

1. A patient was diagnosed with GAD 4 weeks ago and was placed on Clonazepam (klonopin) twice a day and citalopram (citalopram (celexa)) once daily. When he asks the PMHNP why it is necessary to wean him off of the Clonazepam (klonopin) the best response is:

Clonazepam (klonopin) may interfere with citalopram (celexa)s targeted areas in the brain

Clonazepam (klonopin) is not recommended for long term use due to possible sedation

Clonazepam (klonopin) was used as an aid to treat your condition while you were adjusting to citalopram (celexa)

Clonazepam (klonopin) and citalopram (celexa) target the same area in the brain and after long-term use they will begin to compete making one more or less effective than the other

1 points

QUESTION 70

1. During assessment a patient states “Why are you asking me about my heart, I am here for my head”, the PMHNP’s best response is:

“Some medications can cause heart issues so it is necessary to rule those out before you begin medication.”

“This is a part of our routine admission and it is important that you give me truthful answers.”

“Chronic conditions such as Lupus can cause an area in your brain to malfunction, specifically your hippocampus.”

“Anxiety can cause cortisol levels to increase and when this happens frequently it puts you at risk for comorbidities such as type 2 diabetes.”

1 points

QUESTION 71

1. The PMHNP understands that the potential of alcohol abuse in the anxious patient is higher for the following reason: A.

Alcohol is legal and is a common way that most people deal with their problems.

Alcohol works similar to benzodiazepines

Up to 30% of people with anxiety use alcohol to self-medicate

Alcohol increases serotonin at the synapse and the patient may temporarily feel happy

1 points

QUESTION 72

1. After ordering flumazenil (Rumazicon) the PMHNP cautions the staff to monitor for which possible effect?

Respiratory depression

Sedation and restlessness

Sweating and nausea (This question was marked wrong but I think the answers are different too)

Bradycardia and tachypnea

1 points

QUESTION 73

1. A patient is prescribed escitalopram (Lexapro) for his anxiety. When he asks why he was given an antidepressant the PMHNP’s best response is:

“SSRIs are used to treat anxiety because serotonin has been proven to help with feelings of fear and worry.”

“Even though you were diagnosed with anxiety there is a very high chance that you also have depression due to the similarities of both diseases.”

“Antidepressants are prescribed prophylactically to prevent symptoms of depression.”

“Escitalopram (Lexapro) is very effective with treating the panic attacks that can occur with anxiety.” (NURS6630 Final Exam (2018): Walden University)

1 points

QUESTION 74 ?

1. The PMHNP evaluates the patient for “fear conditioning” when he asks:

Have you ever experienced any type of trauma?

What do you do when you feel fear?

Does your mother or father have a history of fear and/or worrying?

What makes your fear better?

1 points

QUESTION 75

1. A patient diagnosed with PTSD is prescribed propranolol (Inderal) and the PMHNP understands that he was prescribed this medication for what purpose:

He has uncontrolled high blood pressure and this must be treated before focusing on his PTSD.

Beta blockers are linked to reconsolidation.

This medication will allow the patient to sleep throughout the night.

This medication is linked to the increase of serotonin in the brain.

See the link for Final Exam Only

https://www.homeworkmarket.com/questions/nurs6630-final-exam-2018-walden-university

See the link for Midterm Exam Only

https://www.homeworkmarket.com/questions/nurs-6630-midterm-exam-2018-walden-university-already-graded-a (NURS6630 Final Exam (2018): Walden University)

References

https://academics.waldenu.edu/catalog/courses/nurs/6630

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Tension headache in a 13 years old adolescent

November 3, 2023/in Assignment Help, Assignment Help Nursing, BLOG, Homework Help, Nursing Exam Help, Nursing Paper Help, Psychology assignment help, Solved Nursing Essays /by Stephen

Tension headache in a 13 years old adolescent

(Tension headache in a 13 years old adolescent) Discussion Topic: Pediatric Soap Note

Requirements

The discussion must address the topic

Rationale must be provided mainly in the differential diagnosis

Use at least 600 words (no included 1st page or references in the 600 words)

May use examples from your nursing practice

Formatted and cited in current APA 7

Use 3 academic sources, not older than 5 years. Not Websites are allowed.

Plagiarism is NOT permitted.

I have attached the SOAP note template, a SOAP note sample, and the rubric.

Tension headache in a 13 years old adolescent

Pediatric SOAP Note: Tension Headache in a 13-Year-Old Adolescent

Subjective:

Chief Complaint:
The patient, a 13-year-old male, presents with complaints of frequent headaches over the past month.

History of Present Illness:
The patient describes the headache as a dull, pressing sensation around the forehead and temples. The headaches occur 3-4 times per week and last for several hours. The intensity is moderate, rated 5-6 on a 10-point scale. The headaches are not associated with nausea, vomiting, or visual disturbances. The patient reports increased stress from schoolwork and poor sleep patterns.

Past Medical History:
No significant medical history. No history of head trauma or migraines.

Family History:
Father has a history of migraines. No other relevant family history.

Social History:
The patient is a middle school student. He denies alcohol, tobacco, or drug use. He reports an increased workload and upcoming exams contributing to stress.

Review of Systems:
Denies fever, chills, weight loss, vision changes, photophobia, phonophobia, dizziness, weakness, numbness, or any other neurological symptoms.

Objective:

Vital Signs:

Blood Pressure: 110/70 mmHg
Heart Rate: 75 bpm
Respiratory Rate: 18 breaths per minute
Temperature: 98.6°F
Oxygen Saturation: 98% on room air

General:
The patient appears well-nourished and in no acute distress.

Head:
Normocephalic, atraumatic.

Eyes:
Pupils equal, round, and reactive to light. Extraocular movements intact. No conjunctival injection or papilledema.

Ears, Nose, Throat:
No signs of infection or inflammation. Tympanic membranes clear.

Neck:
Supple, no lymphadenopathy or thyromegaly.

Neurological:
Alert and oriented to person, place, and time. Cranial nerves II-XII intact. Strength 5/5 in all extremities. Sensation intact. No signs of meningismus or focal neurological deficits.

Assessment:

Primary Diagnosis:
Tension-type headache (G44.209)

Differential Diagnoses:

Migraine Headache:
Although the patient’s father has a history of migraines, the patient’s symptoms lack the characteristic throbbing pain, nausea, and sensitivity to light and sound associated with migraines. The absence of aura and the bilateral nature of the pain also make this less likely.
Cluster Headache:
Cluster headaches are typically unilateral and present with severe, sharp pain around one eye, often accompanied by autonomic symptoms like tearing or nasal congestion. The patient’s description does not match these criteria, making this diagnosis unlikely.
Sinusitis:
Sinusitis often presents with facial pain, pressure, and nasal discharge. However, the patient denies nasal congestion or discharge, and the physical exam did not reveal any signs of sinus tenderness or inflammation.
Refractive Error:
Visual disturbances and eye strain can lead to headaches. While the patient denies vision changes, a comprehensive eye exam may still be warranted to rule out refractive error as a contributing factor.
Intracranial Mass:
Severe, persistent headaches accompanied by neurological deficits raise concern for an intracranial mass. However, the patient’s normal neurological exam and lack of severe symptoms make this diagnosis less likely at this time.

Plan:

Education and Reassurance:
Educate the patient and parents about tension headaches and their association with stress and poor sleep.
Stress Management:
Recommend relaxation techniques, regular physical activity, and a balanced schedule to manage school-related stress.
Sleep Hygiene:
Advise the patient on maintaining a regular sleep routine, creating a restful environment, and limiting screen time before bed.
Analgesics:
Suggest over-the-counter acetaminophen or ibuprofen for headache relief, as needed, while avoiding overuse to prevent rebound headaches.
Follow-Up:
Schedule a follow-up visit in four weeks to assess the effectiveness of interventions and re-evaluate the patient if headaches persist or worsen.
Referral:
Consider referral to a pediatric neurologist if symptoms persist despite initial management or if any concerning features develop.

References

American Academy of Pediatrics. (2019). Clinical Practice Guideline for the Diagnosis and Management of Acute Bacterial Sinusitis in Children Aged 1 to 18 Years.

This guideline provides comprehensive information on the diagnosis and management of sinusitis, a differential diagnosis in this case.

Evers, S., & Marziniak, M. (2020). Clinical features, pathophysiology, and treatment of tension-type headache. The Lancet Neurology, 19(1), 37-46.

This article discusses the clinical features and management strategies for tension-type headaches.

Goadsby, P. J., Holland, P. R., Martins-Oliveira, M., Hoffmann, J., Schankin, C., & Akerman, S. (2017). Pathophysiology of Migraine: A Disorder of Sensory Processing. Physiological Reviews, 97(2), 553-622. https://pubmed.ncbi.nlm.nih.gov/28179394/

This review provides detailed insights into the pathophysiology and clinical presentation of migraines, useful for differential diagnosis.

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Hemorrhagic disorders

November 3, 2023/in Assignment Help, Assignment Help Nursing, Homework Help, Nursing Exam Help, Nursing Paper Help, Psychology assignment help, Solved Nursing Essays /by Stephen

Hemorrhagic disorders

How do alterations in the clotting cascade contribute to the development of hemorrhagic disorders, and how can nurse practitioners use their understanding of the underlying pathophysiology to develop targeted interventions that address the various aspects of care for patients with these conditions?

Hemorrhagic disorders

Alterations in the Clotting Cascade and Hemorrhagic Disorders

Alterations in the clotting cascade significantly contribute to the development of hemorrhagic disorders. The clotting cascade involves a series of complex steps that lead to the formation of a stable blood clot. Any disruption in this cascade can result in inadequate clot formation, leading to excessive bleeding.

Pathophysiology of Hemorrhagic Disorders

Hemorrhagic disorders often arise from deficiencies or dysfunctions in clotting factors. For instance, hemophilia A and B result from deficiencies in clotting factors VIII and IX, respectively. These deficiencies hinder the intrinsic pathway, impairing thrombin formation and subsequent clot stabilization. Similarly, von Willebrand disease, the most common inherited bleeding disorder, involves a deficiency or dysfunction of von Willebrand factor. This factor is crucial for platelet adhesion and protection of factor VIII. Without it, patients experience prolonged bleeding due to poor platelet plug formation and rapid factor VIII degradation.

Liver disease can also disrupt the clotting cascade since the liver synthesizes most clotting factors. Consequently, liver dysfunction can lead to decreased production of these factors, resulting in coagulopathy and increased bleeding risk. Additionally, disseminated intravascular coagulation (DIC) represents a severe condition characterized by widespread activation of the clotting cascade. It depletes clotting factors and platelets, causing uncontrolled bleeding and microvascular thrombosis.

Nurse Practitioners’ Role in Managing Hemorrhagic Disorders

Nurse practitioners play a critical role in managing patients with hemorrhagic disorders by understanding the underlying pathophysiology. They can develop targeted interventions to address various aspects of patient care.

Accurate Diagnosis and Assessment:
Nurse practitioners should perform thorough assessments to identify signs of bleeding and review patients’ medical histories for potential clotting disorders. They should also order and interpret appropriate diagnostic tests, such as coagulation profiles and genetic tests, to confirm diagnoses and assess severity.
Patient Education and Counseling:
Educating patients about their condition, including potential triggers and preventive measures, is essential. Nurse practitioners should explain the importance of avoiding medications like nonsteroidal anti-inflammatory drugs (NSAIDs) that can exacerbate bleeding. They should also provide guidance on managing minor bleeds at home and recognizing signs that require immediate medical attention.
Individualized Treatment Plans:
Based on the specific clotting disorder, nurse practitioners can develop individualized treatment plans. For hemophilia, this may involve prophylactic or on-demand replacement therapy with clotting factor concentrates. For von Willebrand disease, desmopressin or von Willebrand factor concentrates may be used. In cases of liver disease, managing the underlying liver condition and providing vitamin K or fresh frozen plasma may be necessary.
Multidisciplinary Collaboration:
Managing hemorrhagic disorders often requires a multidisciplinary approach. Nurse practitioners should collaborate with hematologists, primary care providers, and other specialists to ensure comprehensive care. This collaboration can facilitate timely interventions and optimize patient outcomes.
Monitoring and Follow-Up:
Regular monitoring of patients’ coagulation status and treatment response is crucial. Nurse practitioners should schedule follow-up appointments to assess treatment efficacy, adjust therapy as needed, and address any complications.

Conclusion

Understanding the alterations in the clotting cascade helps nurse practitioners develop targeted interventions for hemorrhagic disorders. By accurately diagnosing, educating patients, creating individualized treatment plans, collaborating with multidisciplinary teams, and ensuring regular follow-up, they can effectively manage these conditions and improve patient outcomes.

References:

Hemophilia A and B. (2022). National Hemophilia Foundation.
National Hemophilia Foundation
Von Willebrand Disease. (2021). Mayo Clinic.
Mayo Clinic
Disseminated Intravascular Coagulation (DIC). (2023). American Society of Hematology.
American Society of Hematology

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Leadership profile – an effective leader

November 3, 2023/in Assignment Help, Assignment Help Nursing, BLOG, Homework Help, Nursing Exam Help, Nursing Paper Help, Psychology assignment help, Solved Nursing Essays /by Stephen

Leadership profile – an effective leader

(Leadership profile – an effective leader) Do you believe you have the traits to be an effective leader? Perhaps you are already in a supervisory role, but as has been discussed previously, appointment does not guarantee leadership skills.

How can you evaluate your own leadership skills and behaviors? You can start by analyzing your performance in specific areas of leadership. In this Discussion, you will complete Gallup’s StrengthsFinder assessment. This assessment will identify your personal strengths, which have been shown to improve motivation, engagement, and academic self-conference. Through this assessment, you will discover your top five themes—which you can reflect upon and use to leverage your talents for optimal success and examine how the results relate to your leadership traits. To Prepare: Complete the StrengthsFinder assessment instrument, per the instructions found in this Module’s Learning Resources. Please Note: This Assessment will take roughly 30 minutes to complete.

Once you have completed your assessment, you will receive your “Top 5 Signature Themes of Talent” on your screen. Click the Download button below Signature Theme Report, and then print and save the report. We also encourage you to select the Apply tab to review action items. Post a brief description of your results from the StrengthsFinder assessment. Then, briefly describe two core values, two strengths, and two characteristics that you would like to strengthen based on the results of your StrengthsFinder assessment. Be specific. Note: Be sure to attach your Signature Theme Report to your Discussion post. (Leadership profile – an effective leader)

Evaluating Leadership Skills through StrengthsFinder Assessment

The Gallup StrengthsFinder assessment helps individuals identify their unique strengths, enhancing their leadership abilities. Upon completing the assessment, I received my top five themes: Learner, Input, Responsibility, Analytical, and Achiever. These themes provide insights into my leadership traits and areas for improvement.

Description of Assessment Results

Learner:
I have a strong desire to learn and continuously improve. I enjoy the process of becoming more competent.
Input:
I am inquisitive and collect information. I find joy in gathering knowledge, which helps in making informed decisions.
Responsibility:
I take ownership of tasks and am committed to completing them with high standards. I am dependable and trustworthy.
Analytical:
I have the ability to think critically and examine situations from various perspectives. I seek to understand the underlying factors.
Achiever:
I have a constant drive for accomplishing goals. I find satisfaction in productivity and meeting challenges head-on.

Core Values to Strengthen

Integrity:
Integrity is essential in leadership. It fosters trust and sets a moral example for others to follow. By aligning actions with words and consistently upholding ethical standards, I can reinforce my commitment to integrity.
Empathy:
Understanding and sharing the feelings of others is vital in leadership. It helps build strong relationships and fosters a supportive environment. I aim to actively listen and be more considerate of others’ perspectives.

Strengths to Enhance

Communication:
Effective communication is crucial for successful leadership. It ensures clarity, fosters teamwork, and helps convey visions and goals. I plan to work on delivering clear and concise messages and actively engaging in dialogues.
Adaptability:
Flexibility in adapting to changes and new challenges is a valuable trait. It allows for resilience and effective problem-solving. By embracing change and remaining open-minded, I can strengthen my adaptability.

Characteristics to Develop

Delegation:
While I often take responsibility, effective delegation is essential. It empowers team members and improves overall efficiency. I aim to trust others with tasks and provide necessary support while avoiding micromanagement.
Conflict Resolution:
Handling conflicts constructively is a critical leadership skill. It maintains harmony and ensures productive outcomes. I will focus on addressing conflicts promptly and fairly, seeking win-win solutions.

Applying Strengths Finder Results

Reflecting on these results, I can leverage my strengths to enhance my leadership capabilities. For example, as a Learner, I can promote a culture of continuous improvement within my team. By utilizing my Analytical skills, I can make informed decisions and provide strategic guidance. My Responsibility trait ensures that I maintain high standards, fostering a trustworthy and dependable leadership style. Meanwhile, focusing on improving Communication and Adaptability will help me engage more effectively with my team and navigate challenges.

By developing Integrity and Empathy, I can build stronger, more meaningful relationships with my team members. Strengthening Delegation and Conflict Resolution will allow me to lead more efficiently, empowering others and maintaining a cohesive work environment.

Conclusion

Using the insights from the StrengthsFinder assessment, I can refine my leadership skills and behaviors. Emphasizing continuous learning, effective communication, and ethical conduct will enhance my ability to lead successfully. This self-awareness fosters personal growth and improves team dynamics, leading to optimal success.

References

Gallup. (2024). Clifton Strengths for Students.
https://www.gallup.com/cliftonstrengths/en/252137/home.aspx

Northouse, P. G. (2021). Leadership: Theory and Practice (9th ed.). Sage Publications.
https://us.sagepub.com/en-us/nam/leadership/book272020

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Week 5 Reflection – Answered

November 3, 2023/in Assignment Help, Assignment Help Nursing, BLOG, Homework Help, Nursing Exam Help, Solved Nursing Essays, Uncategorized /by Stephen

Week 5 Reflection – Answered

In what ways could an understanding of systems theory and complexity science impact the role of the NP? Take a few minutes to reflect on the NP practice model that is most predominant in advanced practice environments you have observed. Are you satisfied with the demonstrated level of interprofessional collaboration? Briefly consider what appears to be the driving practice model for advanced practice nursing in your state. If your state lags behind in its practice model language, what might you do to facilitate change? (Week 5 Reflection – Answered)

Answer

The Impact of Systems Theory and Complexity Science on Nurse Practitioners (NPs)

Understanding Systems Theory and Complexity Science

Systems theory and complexity science offer valuable insights into how nurse practitioners (NPs) can enhance their practice. Systems theory emphasizes the interconnectedness of various components within a system, which in healthcare translates to recognizing how different elements—patients, healthcare providers, and administrative processes—interact and influence each other. Complexity science, on the other hand, focuses on how complex systems behave in unpredictable and non-linear ways. For NPs, applying these theories can lead to a more holistic approach to patient care, improved decision-making, and better adaptation to changes in the healthcare environment. By understanding that healthcare is a dynamic system with many interacting parts, NPs can better anticipate how changes in one area might affect others, leading to more effective interventions and strategies. (Week 5 Reflection – Answered)

NP Practice Models and Interprofessional Collaboration

In many advanced practice environments, the predominant NP practice model is collaborative, where NPs work closely with physicians, specialists, and other healthcare professionals. This model promotes shared decision-making and leverages the diverse expertise of the healthcare team to provide comprehensive patient care. However, the level of interprofessional collaboration can vary significantly. In some settings, collaboration is robust and well-integrated, while in others, it might be limited by organizational barriers or professional silos. Evaluating the effectiveness of these collaborations is crucial for identifying areas where improvements can be made. For instance, frequent team meetings, clear communication channels, and mutual respect among team members can enhance collaborative efforts and ensure that patient care is optimized. (Week 5 Reflection – Answered)

Driving Practice Models and State-Specific Considerations

The practice model for advanced practice nursing can differ widely from state to state. In states where NP practice is restricted by limited prescriptive authority or collaborative agreement requirements, there may be a need for advocacy and policy change. If your state lags behind in adopting more progressive practice models, several strategies can be employed to facilitate change. Engaging in legislative advocacy, participating in professional organizations, and educating policymakers about the benefits of expanded NP roles can help drive reform. Additionally, demonstrating the positive outcomes of advanced practice models through data and case studies can strengthen the case for policy adjustments. By leveraging systems theory and complexity science, NPs can better navigate the complexities of healthcare systems and advocate for changes that enhance their practice. Understanding and addressing the nuances of interprofessional collaboration and staying informed about state-specific practice models are essential for advancing the role of NPs and improving patient outcomes.

References

Phelan, S. E. (2001). What is complexity science, really?. Emergence, A Journal of Complexity Issues in Organizations and Management, 3(1), 120-136. https://www.tandfonline.com/doi/pdf/10.1207/S15327000EM0301_08

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DIABETES AND DRUG TREATMENTS – Answered

November 3, 2023/in Assignment Help, Assignment Help Nursing, BLOG, Homework Help, Nursing Exam Help, Nursing Paper Help, Psychology assignment help, Solved Nursing Essays, Uncategorized /by Stephen

DIABETES AND DRUG TREATMENTS – Answered

Each year, 1.5 million Americans are diagnosed with diabetes (American Diabetes Association, 2019). If left untreated, diabetic patients are at risk for several alterations, including heart disease, stroke, kidney failure, neuropathy, and blindness. There are various methods for treating diabetes, many of which include some form of drug therapy. The type of diabetes as well as the patient’s behavior factors will impact treatment recommendations. For this Discussion, you compare types of diabetes, including drug treatments for type 1, type 2, gestational, and juvenile diabetes (DIABETES AND DRUG TREATMENTS – Answered).

To Prepare: Review the Resources for this module and reflect on differences between types of diabetes, including type 1, type 2, gestational, and juvenile diabetes. Select one type of diabetes to focus on for this Discussion. Consider one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Then, reflect on dietary considerations related to treatment. Think about the short-term and long-term impact of the diabetes you selected on patients, including effects of drug treatments. Post a brief explanation of the differences between the types of diabetes, including type 1, type 2, gestational, and juvenile diabetes. Describe one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Be sure to include dietary considerations related to treatment. Then, explain the short-term and long-term impact of this type of diabetes on patients. including effects of drug treatments. Be specific and provide examples.

Answer

Understanding Type 1 Diabetes and Its Management

Differences Between Types of Diabetes

Diabetes mellitus encompasses several types, each with distinct characteristics. Type 1 diabetes is an autoimmune disorder where the immune system attacks and destroys the insulin-producing beta cells in the pancreas, resulting in little to no insulin production (American Diabetes Association, 2020). It primarily affects children and young adults, necessitating lifelong insulin therapy. Type 2 diabetes, in contrast, involves insulin resistance and a relative deficiency of insulin production. It is more common in adults, though increasing rates in children are observed due to rising obesity levels. This type is often managed with lifestyle modifications and oral hypoglycemic agents (Centers for Disease Control and Prevention, 2022). Gestational diabetes occurs during pregnancy and usually resolves postpartum, but it increases the risk of type 2 diabetes later for both mother and child (National Institute of Diabetes and Digestive and Kidney Diseases, 2021). Juvenile diabetes typically refers to type 1 diabetes in children and adolescents, emphasizing its early onset and impact.

Focus on Type 1 Diabetes

For managing type 1 diabetes, insulin therapy is essential. Rapid-acting insulins like insulin lispro (Humalog) are commonly used. Proper administration involves preparing the insulin by checking its clarity and expiration date, ensuring it is free from particles, and following the prescribed dosage. Insulin lispro is administered subcutaneously using syringes, insulin pens, or pumps, usually before meals to effectively control postprandial blood glucose levels (American Diabetes Association, 2020).

Dietary considerations are crucial for effective management. Patients should focus on a balanced diet, emphasizing whole grains, lean proteins, fruits, and vegetables while closely monitoring carbohydrate intake. Carbohydrate counting is vital for adjusting insulin doses to maintain stable blood glucose levels (Kerr et al., 2017).

Impact on Patients

In the short term, proper insulin management helps prevent acute complications such as hyperglycemia and hypoglycemia, which can lead to symptoms like fatigue, blurred vision, and frequent urination. Long-term impacts of type 1 diabetes include an increased risk of serious complications such as cardiovascular disease, neuropathy, nephropathy, and retinopathy. Ongoing glucose monitoring and insulin adjustments are critical to minimize these risks and manage the condition effectively (Wang et al., 2021). Despite advancements in treatment, type 1 diabetes requires continuous vigilance and adaptation to maintain optimal health (DIABETES AND DRUG TREATMENTS – Answered).

References

American Diabetes Association. (2020). Standards of Medical Care in Diabetes—2020. Diabetes Care, 43(Supplement 1), S1-S212. https://doi.org/10.2337/dc20-S001
Centers for Disease Control and Prevention. (2022). Type 2 Diabetes. https://www.cdc.gov/diabetes/basics/type2.html
Kerr, D., M. L. Campbell, & J. E. Davis. (2017). Dietary management and diabetes control. Journal of Diabetes Research, 2017, 134569. https://doi.org/10.1155/2017/134569
National Institute of Diabetes and Digestive and Kidney Diseases. (2021). Gestational Diabetes. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/gestational
Wang, J., Wang, L., & Zhang, Y. (2021). Long-term complications of type 1 diabetes mellitus. Frontiers in Endocrinology, 12, 743095. https://doi.org/10.3389/fendo.2021.743095

Nursing Paper Example on Gastrointestinal Disease: Gastroesophageal Reflux Disease (GORD)

Introduction

Causes

Signs and Symptoms

Etiology

Pathophysiology

DSM-5 Diagnosis

Conclusion

References

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Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis

Introduction

Causes

Signs and Symptoms

Etiology

Pathophysiology

DSM-5 Diagnosis

Treatment Regimens

Conclusion

References

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Nursing Paper Example on Antisocial Personality Disorder (ASPD)

Introduction

Psychopathy & Sociopathy

Subtypes

Differences

Symptom Overlap Between Antisocial and Narcissistic/Histrionic

Etiology

Hypothetical Conceptualization

Psychodynamic

Cognitive-Behavioral

Conclusion

References

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Ethical Conduct

Nursing Ethics in the Context of a Case Study

Respect for Autonomy

Beneficence and Non-Maleficence

Legal and Professional Considerations

Communication and Compassion

Ethical Decision-Making Frameworks

Conclusion

References

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NURS6630 Final Exam (2018): Walden University

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Tension headache in a 13 years old adolescent

Pediatric SOAP Note: Tension Headache in a 13-Year-Old Adolescent

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Hemorrhagic disorders

Alterations in the Clotting Cascade and Hemorrhagic Disorders

Pathophysiology of Hemorrhagic Disorders

Nurse Practitioners’ Role in Managing Hemorrhagic Disorders

Conclusion

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Leadership profile – an effective leader

Evaluating Leadership Skills through StrengthsFinder Assessment

Description of Assessment Results

Core Values to Strengthen

Strengths to Enhance

Characteristics to Develop

Applying Strengths Finder Results

Conclusion

References

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Week 5 Reflection – Answered

The Impact of Systems Theory and Complexity Science on Nurse Practitioners (NPs)

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DIABETES AND DRUG TREATMENTS – Answered

Understanding Type 1 Diabetes and Its Management

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