nursing

/in /by

10/13/23, 4:23 PM IMG-1781.jpg

https://mail.google.com/mail/u/0/?tab=rm&ogbl#inbox/FMfcgzGtxdZHwPFPvtDdMWfptLSpKXWV?projector=1 1/1

HEALTH ASSESSMENT

/in /by

NUR2092 WRITE-UP—HEALTH HISTORY
Classroom Assignment Week Two

Date __________________________ Examiner ______________________

1. Biographic Data Name _______________________________________________ Phone________________________ Address____________________________________________________________________________ Birthdate ________________________________ Birthplace _________________________________ Age __________ Gender __________ Marital Status ______________ Occupation _______________ Race/ethnic origin __________________________________ Employer ________________________

2

. Source and Reliability

3. Reason for Seeking Care

4.
Present Health or History of Present Illness

Past Health History

Describe general health ______________________________________________________________ Childhood illnesses __________________________________________________________________ Accidents or injuries (include age) ______________________________________________________ Serious or chronic illnesses (include age) ________________________________________________ Hospitalizations (what for? location?) ____________________________________________________ Operations (name procedure, age) ______________________________________________________
Obstetric history: Gravida ____________ Term ____________ Preterm ____________ (# Pregnancies)
(# Term pregnancies) (# Preterm pregnancies)
Ab/incomplete _____________________ Children living _____________________ (# Abortions or miscarriages) _____

Course of pregnancy__________________________________________________________________ (Date delivery, length of pregnancy, length of labor, baby’s weight and sex, vaginal delivery or cesarean section, complications, baby’s condition)
Immunizations_____________________________________________________________________

Last examination date: Physical ________________

Dental ________________ Vision ________________
Allergies _________________________________ Reaction __________________________________

Current medications _________________________________________________________________ _

6. Family History—Specify Which Relative(s)

Heart disease___________________________ High blood pressure______________________ Stroke_________________________________ Diabetes_______________________________

Blood disorders_________________________ Breast or ovarian cancer___________________

Cancer (other)__________________________ Sickle cell______________________________ Arthritis_______________________________
Allergies_______________________________ Asthma _______________________________ Obesity________________________________ Alcoholism or drug addiction ______________

Mental illness ___________________________ Suicide ________________________________

Seizure disorder ________________________ Kidney disease __________________________ Tuberculosis _____

Review of Systems (Circle/highlight both past health problems that have been resolved and current problems, including date of onset.)

General Overall Health State: Present weight (gain or loss, period of time, by diet or other factors), fatigue, weakness or malaise, fever, chills, sweats or night sweats

Skin: History of skin disease (eczema, psoriasis, hives), pigment or color change, change in mole, excessive dryness or moisture, pruritus, excessive bruising, rash or lesion

Hair: Recent loss, change in texture

Nails: Change in shape, color, or brittleness

Health Promotion: Amount of sun exposure, method of self-care for skin and hair

Head: Any unusually frequent or severe headache, any head injury, dizziness (syncope), or vertigo

Eyes: Difficulty with vision (decreased acuity, blurring, blind spots), eye pain, diplopia (double vision), redness or swelling, watering or discharge, glaucoma or cataracts

Health Promotion Eyes: Wears glasses or contacts, last vision check or glaucoma test, how coping with loss of vision, if any

Ears: Earaches, infections, discharge and its characteristics, tinnitus, or vertigo

Health Promotion Ears: Hearing loss, hearing aid use, how loss affects daily life, any exposure to environmental noise, method of cleaning ears

Nose and Sinuses: Discharge and its characteristics, any unusually frequent or severe colds, sinus pain, nasal obstruction, nosebleeds, allergies or hay fever, or change in sense of smell

Mouth and Throat: Mouth pain, frequent sore throat, bleeding gums, toothache, lesion in mouth or tongue, dysphagia, hoarseness or voice change, tonsillectomy, altered taste

Health Promotion/Mouth & Throat: Pattern of daily dental care, use of prostheses (dentures, bridge), and last dental checkup

Neck: Pain, limitation of motion, lumps or swelling, enlarged or tender nodes, goiter

Breast: Pain, lump, nipple discharge, rash, history of breast disease, any surgery on breasts Axilla: Tenderness, lump or swelling, rash

Health Promotion Breast: Performs breast self-examination, including frequency and method used, last mammogram and results

Respiratory System: History of lung disease (asthma, emphysema, bronchitis, pneumonia, tuberculosis), chest pain with breathing, wheezing or noisy breathing, shortness of breath, how much activity produces shortness of breath, cough, sputum (color, amount), hemoptysis, toxin or pollution exposure
Health Promotion Respiratory: Last chest x-ray examination

Cardiovascular System: Precordial or retrosternal pain, palpitation, cyanosis, dyspnea on exertion (specify amount of exertion it takes to produce dyspnea), orthopnea, paroxysmal nocturnal dyspnea, nocturia, edema, history of heart murmur, hypertension, coronary artery disease, anemia

Health Promotion Cardiovascular: Date of last ECG or other heart tests and results

Peripheral Vascular System: Coldness, numbness and tingling, swelling of legs (time of day, activity), discoloration in hands or feet (bluish red, pallor, mottling, associated with position, especially around feet and ankles), varicose veins or complications, intermittent claudication, thrombophlebitis, ulcers
Health Promotion Peripheral Vascular: If work involves long-term sitting or standing, avoid crossing legs at the knees; wear support hose.

Gastrointestinal System: Appetite, food intolerance, dysphagia, heartburn, indigestion, pain (associated with eating), other abdominal pain, pyrosis (esophageal and stomach burning sensation with sour eructation), nausea and vomiting (character), vomiting blood, history of abdominal disease (ulcer, liver or gallbladder, jaundice, appendicitis, colitis), flatulence, frequency of bowel movement, any recent change, stool characteristics, constipation or diarrhea, black stools, rectal bleeding, rectal conditions, hemorrhoids, fistula)

Health Promotion Gastrointestinal: Use of antacids or laxatives

Urinary System: Frequency, urgency, nocturia (the number of times awakens at night to urinate, recent change), dysuria, polyuria or oliguria, hesitancy or straining, narrowed stream, urine color (cloudy or presence of hematuria), incontinence, history of urinary disease (kidney disease, kidney stones, urinary tract infections, prostate); pain in flank, groin, suprapubic region, or low back

Health Promotion Urinary: Measures to avoid or treat urinary tract infections, use of Kegel exercises

Male Genital System: Penis or testicular pain, sores or lesions, penile discharge, lumps, hernia

Health Promotion Male Genital: Perform testicular self-examination? How frequently?

Female Genital System: Menstrual history (age at menarche, last menstrual period, cycle and duration, any amenorrhea or menorrhagia, premenstrual pain or dysmenorrhea, intermenstrual spotting), vaginal itching, discharge and its characteristics, age at menopause, menopausal signs or symptoms, postmenopausal bleeding.

Health Promotion Female Genital: Last gynecologic checkup, last Pap test and results

Sexual Health: Presently in a relationship involving intercourse? Are aspects of sex satisfactory to you and partner, any dyspareunia (for female), any changes in erection or ejaculation (for male), use of contraceptive, is contraceptive method satisfactory? Use of condoms, how frequently? Aware of any contact with partner who has sexually transmitted infection (gonorrhea, herpes, chlamydia, venereal warts, HIV/AIDS, syphilis)?

Musculoskeletal System: History of arthritis or gout. In the joints: pain, stiff-ness, swelling (location, migratory nature), deformity, limitation of motion, noise with joint motion. In the muscles: any pain, cramps, weakness, gait prob-lems or problems with coordinated activities. In the back: any pain (location and radiation to extremities), stiffness, limitation of motion, or history of back pain or disk disease.

Health Promotion Musculoskeletal: How much walking per day? What is the effect of limited range of motion on daily activities, such as on grooming, feeding, toileting, dressing? Any mobility aids used?

Neurologic System: History of seizure disorder, stroke, fainting, blackouts. In motor function: weakness, tic or tremor, paralysis, coordination problems. In sensory function: numbness and tingling (paresthesia). In cognitive function: memory disorder (recent or distant, disorientation). In mental status: any nervousness, mood change, depression, or any history of mental health dysfunction or hallucinations.

Hematologic System: Bleeding tendency of skin or mucous membranes, excessive bruising, lymph node swelling, exposure to toxic agents or radiation, blood transfusion and reactions.

Endocrine System: History of diabetes or diabetic symptoms (polyuria, polydipsia, polyphagia), history of thyroid disease, intolerance to heat or cold, change in skin pigmentation or texture, excessive sweating, relationship between appetite and weight, abnormal hair distribution, nervousness, tremors, need for hormone therapy.

Functional Assessment (Including Activities of Daily Living)

Self-Esteem, Self-Concept: Education (last grade completed, other significant training) ______________

Financial status (income adequate for lifestyle and/or health concerns) __________

Value-belief system (religious practices and perception of personal strengths) ___________

Self-care behaviors ______________________

Activity and Exercise: Daily profile, usual pattern of a typical day ________________________________

Independent or needs assistance with ADLs, feeding, bathing, hygiene, dressing, toileting, bed-to-chair transfer, walking, standing, climbing stairs _________________________________

Leisure activities ________________________________________

Exercise pattern (type, amount per day or week, method of warm-up session, method of monitoring

Sleep and Rest: Sleep patterns, daytime naps, any sleep aids used ___________________

Nutrition and Elimination: Record 24-hour diet recall. _______________________________________ _____________________________________________________________________________________

Is this menu pattern typical of most days? ___________________________________________________

Who buys food? ____________________________

Who prepares food? __________________________

Finances adequate for food? __________________________________

Who is present at mealtimes? __________________________________

Interpersonal Relationships and Resources: Describe own role in family _________________________

How getting along with family, friends, co-workers, classmates ______________________

Get support with a problem from? ______________________________________________

How much daily time spent alone? _______________________________________________________
Is this pleasurable or isolating? ___________________________________________________________

Coping and Stress Management: Describe stresses in life now __________________________________ _____________________________________________________________________________________
Change(s) in past year ______________________________________________

Methods used to relieve stress _______________________

Are these methods helpful? ___________________________

Personal Habits:

Daily intake caffeine (coffee, tea, colas) ______________________________________

Smoke cigarettes? ____________________________
Number packs per day ______________

Daily use for how many years __________________
Age started ___________

Ever tried to quit? ____________________________
How did it go? _____________________________

Drink alcohol? ____________________ Date of last alcohol use _______

Amount of alcohol
that episode __________________________________________________________

Out of last 30 days, on how many days had alcohol? ____________________________________

Ever told had a drinking problem? ________________________________________________________
Any use of street drugs? ___________
Marijuana? _________________________________

Cocaine? __________________________________
Crack cocaine? ______________________________
Amphetamines? _____________________________
Heroin? __________________

Prescription painkillers? _____________________
Barbiturates? _______________________________
LSD? _____________________________________

Ever been in treatment for drugs or alcohol? ________________________________________________

Environment and Hazards: Housing and neighborhood (type of structure, live alone, know neighbors) _____________________________________________________________________________________

Safety of area _________________________________________________________________________
Adequate heat and utilities ____________________________________________________________

Access to transportation ____________________________________________________________

Involvement in community services _______________________________________________________
Hazards at workplace or home ___________________________________________________________
Use of seatbelts ____________________________________________________________________

Travel to or residence in other countries ___________________________________________________
Military service in other countries ________________________________________________________
Self-care behaviors _____________________________________________________________________
Intimate Partner Violence: How are things at home? Do you feel safe? __________________

Ever been emotionally or physically abused by your partner or someone important to you___-

Ever been hit, slapped, kicked, pushed, or shoved or otherwise physically hurt by your partner or ex-partner? _____________________________________________________________________________________
Partner ever force you into having sex? ____________________________________________________
Are you afraid of your partner or ex-partner? ________________________________

Occupational Health:

Please describe your job. ______________________________________________

Work with any health hazards (e.g., asbestos, inhalants, chemicals, repetitive motion)? ___________________________________________________________________________________

Any equipment at work designed to reduce your exposure?

Any work programs designed to monitor your exposure? _________________________________

Any health problems that you think are related to your job? _____________________________

What do you like or dislike about your job? _________________________________________________

Perception of Own Health:

How do you define health? ________________________________________

View of own health now ________________________________________________________________

What are your concerns? ________________________________________________________________

What do you expect will happen to your health in future? _______________________

Your health goals ______________________________________________________________________

Your expectations of nurses, physicians ___________________________________________________

help

/in /by

Analyze how the Institute for Healthcare Improvement article entitled Addressing Institutional Racism can positively affect the future of nursing. Examine how these strategies can contribute towards advanced practice nurses’ empowerment and patient safety. What strategies are required for nurses to shape a better future in healthcare?

1 page

PLEASE ONLY USE 2 REFERENCES

1 references will be from the article uploaded

Nutritional Principles in Nursing

/in /by

Module 03 Discussion – Nutrition and Weight Status

Discussion Topic


Directions:

Review all the materials discussed in this and the preceding module. After reading the information and guidelines, discuss why nutrition and weight status are important for health. Post one reference you used for the evidence-based information you are discussing.

Unit 7 Discussion Case Study —2 Peer Response 600w. Due 10-20-23

/in /by

Unit 7 Discussion Case Study —2 Peer Response 600w. Due 10-20-23

Please read and respond to at least two of your peers' initial postings. You may want to consider the following questions in your responses to your peers:

· Compare and contrast your initial posting with those of your peers.  

· How are they similar or how are they different?

· What information can you add that would help support the responses of your peers?

· Ask your peers a question for clarification about their post.

· What most interests you about their responses? 

Please be sure to validate your opinions and ideas with citations and references in APA format.

Unit 7: Initial Discussion-Case Study RM

· A 70-year-old woman has scheduled an initial evaluation with you. Her medical diagnoses include hypertension, hyperglycemia, mild obesity, and hyperlipidemia. Her psychiatric diagnoses include anxiety and depression. Her current medications are atorvastatin 20 mg daily for seven years, Ozempic 1 mg injection weekly for three years, lisinopril 10 mg daily for 10 years, and Abilify 5 mg daily for six years. 

· Labs: Fasting Blood Glucose – 115, HbgA1C – 6.9, Total Cholesterol – 200, LDL – 100, HDL – 37. Her height is 5’2” and her weight is 176 pounds. Her blood pressure was 146/83 upon arrival at the office.  

· During your interview, she explains she became depressed following the death of her husband seven years ago. She became anxious about performing everyday tasks without him present.  After starting Abilify, she gained 25 pounds and required an increased dose of atorvastatin and Ozempic. She has been unable to lose the weight she gained and tries to closely monitor her dietary intake due to her persistently elevated glucose but reports still craving carbohydrates.  Her depression has improved slightly but she is still anxious to go out alone, so she no longer goes for daily walks to exercise. 

Subjective: 

CC: initial evaluation 

HPI: A 70-year-old female presents to the clinic for initial evaluation. She is a new patient in the practice. She reports a current history of hypertension, hyperglycemia, mild obesity, and hyperlipidemia. She also reports currently being diagnosed with anxiety and depression. She reports taking atorvastatin 20 mg daily for 7 years for hyperlipidemia, Ozempic 1 mg injection weekly for three years for hyperglycemia, lisinopril 10 mg daily for 10 years for hypertension, and ability 5 mg daily for 6 years for depression. 

PMH: Hypertension, hyperlipidemia, hyperglycemia, mild obesity, anxiety, and depression.  

Allergies: none reported 

Medications: atorvastatin 20 mg daily for 7 years for hyperlipidemia, Ozempic 1 mg injection weekly for three years for hyperglycemia, lisinopril 10 mg daily for 10 years for hypertension, and Abilify 5 mg daily for 6 years for depression. 

SH: Patient lost her husband seven years ago and became depressed. The patient reports her anxiety increased to perform everyday tasks without her husband. The patient states, that after starting Abilify she gained 25 pounds and required an increased dose of atorvastatin and Ozempic.  She has been unable to lose the weight she gained and tries to closely monitor her dietary intake due to her persistently elevated glucose but reports still craving carbohydrates.  Her depression has improved slightly but she is still anxious to go out alone, so she no longer goes for daily walks to exercise. 

FH: N/A 

Health promotion and maintenance: N/A 

ROS:  

Constitutional 

reports weight gain of 25 lbs. 

Head 

N/A 

Eyes 

N/A 

Ears, Nose, Mouth, Throat 

N/A 

Neck 

N/A 

Cardiovascular/Peripheral Vascular 

N/A 

Respiratory 

N/A 

Breast 

N/A 

 

 

Gastrointestinal 

Reports increased cravings for carbohydrates. 

Genitourinary 

N/A 

Musculoskeletal 

N/A 

Integumentary 

N/A 

Neurological 

Alert and oriented x 3.  

Psychiatric (screening tools: Ex: PHQ-9, MMSE, GAD-7) 

Reports anxiety to go out of her house alone and depression slightly improved 

Endocrine 

Reports persistent elevated glucose and carbohydrate cravings. 

Hematologic/Lymphatic 

N/A 

Allergic/Immunologic 

N/A 

Other 

  

Objective:   

Her height is 5’2” and her weight is 176 pounds. Her blood pressure was 146/83 upon arrival at the office.  Labs: Fasting Blood Glucose – 115, HbgA1C – 6.9, Total Cholesterol – 200, LDL – 100, HDL – 37. 

·
What advice or modifications to his treatment regimen would you recommend for your new patient? (Discuss a minimum of two). Please support your answer with research-based evidence.  

This 70-year-old female patient presents with diabetes as evidenced by a FBS of 115 

and a HgbA1C of 6.9. A HgbA1C level equal to 6.5% or greater indicates a diagnosis of diabetes mellitus 

(Centers for Disease Control and Prevention, 2023). The patient is currently at considerable risk for cardiovascular disease due to her borderline total cholesterol level of 200, LDL of 100, and HDL 37. The patient’s height is 5’2″ and weight is 176 lbs, BMI is 32.2 as per CDC (Centers for Disease Control) guidelines patient is obese which also contributes to cardiovascular disease (Centers for Disease Control and Prevention, 2022). The normal weight for the height of this patient is between 101lbs-136lbs (Centers for Disease Control and Prevention, 2022). According to Healthline, total cholesterol levels should be less than 200, LDL less than 100, HDL greater than 60, and triglycerides less than 149 for adult patients (2021). The patient has also been experiencing high blood pressure, BP 146/83 upon arrival. The patient has currently been taking lisinopril 10 mg daily for hypertension, atorvastatin 20 mg daily for 7 years for hyperlipidemia and Ozempic 1 mg injection weekly for three years for hyperglycemia. 

The patient has also been taking Abilify 5 mg daily for 6 years for depression. During this time, the patient gained twenty-five pounds and required an increased dose of Ozempic and atorvastatin. The patient has been unable to lose the weight she gained and reports closely monitoring dietary intake due to persistently increased glucose levels and carbohydrate cravings. The patient’s states depression slightly improved, however, anxiety has not improved and now the patient is having trouble leaving the house alone.  

According to the patient’s assessment, my treatment plan would be to continue Ozempic 1 mg injections weekly for diabetes management and add metformin IR 500mg PO BID with meals (Corcoran & Jacobs, 2023). Patient to check finger stick blood glucose levels 1-2 times daily on an empty stomach. Recommend the patient to a diabetes education program. To manage her cholesterol levels, I would titrate her atorvastatin from 20 mg to 40 mg PO daily. Re-check patient's lipid levels in 2-4 weeks (Drugs, 2023). To manage her high blood pressure, I would increase her lisinopril to 10 mg PO BID as a study shows that prescribing lisinopril twice daily vs once daily shows more improvements in SBP. Mean adjusted SBP reduction was 10.2 mm Hg greater in the twice‐daily cohort compared with the once‐daily cohort (Tsai et al., 2017). The patient will be coming back for follow-up in 2-4 weeks for further treatment outcome and if necessary, treatment plan adjustment.  

The patient has chronic depression that has improved slightly; however, she does voice increased anxiety and new symptoms of fear of going out alone since her husband died seven years ago. The patient is now restricting herself from going out for walks and exercise. She is starting to exhibit symptoms of agoraphobia. The patient is currently taking Abilify 5 mg PO daily for 6 years. Typically, second-generation antipsychotics are not the first line of treatment for depression, they are used once they have tried many antidepressants with no effect. I suggest treatment augmentation with an antidepressant. Zoloft is an SSRI that does not counteract Abilify, start Zoloft at 25 mg PO daily and increase the dose weekly as needed. Zoloft is used for depression and social anxiety disorder (Psych Central, 2021). The patient will also benefit from psychopharmacology, psychotherapy, cognitive behavioral therapy. 

Lastly, lifestyle change recommendations include diet and exercise modification. Work your way up to 150 minutes of moderate-intensity aerobic activity each week. This could be brisk walking 30 minutes a day, 5 days a week. Or you could do 75 minutes of vigorous-intensity aerobic activity each week, such as swimming laps. Regular physical activity provides immediate and long-term 

health benefits.Links to an external site.
 Physical activity and weight loss will Improve sleep quality, reduce high blood pressure, and reduce risk for type 2 diabetes, heart attack, stroke, and 

several forms of cancerLinks to an external site.
. It can help reduce arthritis pain and associated disability, reduce the risk for osteoporosis and falls, and reduce symptoms of depression and anxiety (Centers for Disease Control and Prevention, 2023). 

·
If you suggested additional medication, look up your state’s prescribing laws. Are PMHNP’s able to prescribe the medication you recommended?  

 Yes, as a practicing PMHNP for the state of Pennsylvania, prescribe drugs, devices, and Schedule II-V controlled substances if there is a written collaboration agreement with a physician (Pennsylvania Coalition of Nurse Practitioners, n.d.).  

References: 

Balaram, K., & Marwaha, R. (2023). Agoraphobia.
 NIH. 


https://www.ncbi.nlm.nih.gov/books/NBK554387/Links to an external site.
 

Centers for Disease Control and Prevention. (2022). Adult BMI calculator. CDC. 


https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.htmlLinks to an external site.
 

Centers for Disease Control and Prevention. (2023). Diabetes tests. 
CDC. 

  

https://www.cdc.gov/diabetes/basics/getting-tested.htmlLinks to an external site.
 

Centers for Disease Control and Prevention. (2023). Physical activity for a healthy weight. 
CDC. 


https://www.cdc.gov/healthyweight/physical_activity/index.htmlLinks to an external site.
 

Corcoran, C., & Jacobs, T.F. (2023). Metformin. 
NIH. 

https://www.ncbi.nlm.nih.gov/books/NBK518983/Links to an external site.
 

Drugs. (2023). Atorvastatin dosage. 


https://www.drugs.com/dosage/atorvastatin.html#Usual_Adult_Dose_for_HypertriglyceridemiaLinks to an external site.
 

Pennsylvania Coalition of Nurse Practitioners. (n.d.). Scope of Practice. PACNP. 


https://www.pacnp.org/page/ScopeofPractice#:~:text=In%20Pennsylvania%2C%20an%20NP%20may,collaboration%20agreement%20with%20a%20physicianLinks to an external site.
. 

Psych Central. (2021). Zoloft: What you want to know? 

https://psychcentral.com/drugs/zoloft#basicsLinks to an external site.
 

Tsai, T., Kroehl, M. E., Smith, S. M., Thompson, A. M., Dai, I. Y., & Trinkley, K. E. (2017). Efficacy and 

safety of twice- vs once-daily dosing of lisinopril for hypertension. 
Journal of clinical hypertension (Greenwich, Conn.), 
19(9), 868–873. https://doi.org/10.1111/jch.13011 

Unit 7 Discussion Case Study MV

What would be your approach to managing this patient’s weight concern? (Discuss at least two aspects of your approach). Support your answer with research-based evidence.

In managing this patient's weight concern, a comprehensive approach that addresses both behavioral and pharmacological aspects would be necessary. First and foremost it's crucial to evaluate if the patient is prepared to make changes and how motivated she is to lose weight. We can use motivational interviewing techniques to delve into her reasons, for wanting to shed pounds and uncover any obstacles or difficulties she might encounter (Bischof et al., 2021). To address her worries, about how her weight might affect her ability to care for her child it could be advantageous to involve a team of professionals that includes a registered dietitian, an exercise specialist and a psychologist or therapist. The dietitian can work with the patient to develop a personalized meal plan that takes into consideration her busy schedule and frequent eating out habits. Emphasizing portion control, incorporating healthier food choices, and encouraging mindful eating practices have been shown to be effective in managing obesity (Foster et al., 2018). In terms of physical activity, an exercise specialist can help the patient create an individualized exercise routine that is feasible given her current responsibilities as a stay-at-home mother. Promoting regular physical activity has been found to aid in weight loss so finding activities that she enjoys and can incorporate into her daily routine will enhance adherence maintenance (Posadzki et al., 2020).

What would be our approach to the sexual side effects she is experiencing?

Regarding the sexual side effects experienced by the patient, it is crucial to address these concerns openly and compassionately. It's important to determine whether the issues are primarily caused by medication use or if they're influenced by factors, like stress or relationship dynamics. It might be beneficial to educate the patient about how fluoxetine and olanzapine can affect sexual functioning. If it is determined that the medication is causing these problems switching from fluoxetine to another antidepressant that has a less impact on sexual function could be considered. Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine have been linked to sexual dysfunction (Yuan et al., 2021). Bupropion, which is an atypical antidepressant, with a lower likelihood of causing sexual side effects could be an alternative option worth exploring (Montejo et al., 2019).

If you suggest additional medication, look up your state’s prescribing laws. Are PMHNPs able to prescribe the medication you recommend?

Before suggesting any additional medication options such as Bupropion, it is essential to review prescribing laws specific to Illinois. As a PMHNP prescribing additional medication for the above concerns would depend on state laws. According to the Illinois Nurse Practice Act (2017), advanced practice registered nurses (APRNs) including PMHNPs have prescriptive authority. However, there are specific conditions and restrictions outlined in the Act (AANP, 2022). Therefore, it is necessary to review the current regulations and guidelines set forth by the Illinois Department of Financial and Professional Regulation (IDFPR) to ensure compliance with prescribing laws when considering Bupropion as a treatment option for this patient (Kleinpell et al., 2023). Psychiatric Mental Health Nurse Practitioners (PMHNPs) in Illinois have prescriptive authority to reduce practice. Illinois state law requires a career-long regulated collaborative agreement with a psychiatrist in order for the NP to prescribe medication. The nurse practitioner-psychiatrist collaborative practice agreement outlines their working relationship. It describes the categories of care, treatment, and procedures the nurse practitioner expects to perform (AANP, 2022). In Illinois, psychiatrists are not required to be physically present with the PMHNP. The psychiatrist must be available for consultation whether in person or by phone. A collaborating psychiatrist and PMHNP are required to meet at least once a month (AANP, 2022).

Include the subjective and objective information in this post.

Subjective information:

The patient reports concerns about her weight and its impact on her ability to care for her disabled child after her husband's death. She has tried numerous 'fad diets' without long-term success, losing only 15 pounds at most and maintaining it for three months. The patient expresses feelings of shame related to sexual dysfunction, specifically difficulty achieving orgasm during intimate moments with her husband.

Objective information:

The patient's objective data include being morbidly obese at 340 pounds with a height of 5'5″. She also has type II diabetes, hypertension, and hyperlipidemia. Additionally, she eats out frequently due to her children's busy schedules and leads a sedentary lifestyle with no regular physical activity.

References

American Association of Nurse Practitioners (2022). State practice by type. Retrieved from https://www.aanp.org/legislation-regulation/state-legislation/state-practice-environment/66-legislation-regulation/state-practice-environment/1380-state-practice-by-typeLinks to an external site.

Bischof, G., Bischof, A., & Rumpf, H.-J. (2021). Motivational interviewing: An evidence-based approach for use in medical practice. Deutsches Ärzteblatt international. https://doi.org/10.3238/arztebl.m2021.0014Links to an external site.

Foster, D., Sanchez-Collins, S., & Cheskin, L. J. (2018). Multidisciplinary team–based obesity treatment in patients with diabetes: Current practices and the state of the science. Diabetes Spectrum, 30(4), 244–249. https://doi.org/10.2337/ds17-0045Links to an external site.

Kleinpell, R., Myers, C. R., & Schorn, M. N. (2023). Addressing barriers to aprn practice: Policy and regulatory implications during covid-19. Journal of Nursing Regulation, 14(1), 13–20. https://doi.org/10.1016/s2155-8256(23)00064-9Links to an external site.

Montejo, A., Prieto, N., de Alarcón, R., Casado-Espada, N., de la Iglesia, J., & Montejo, L. (2019). Management strategies for antidepressant-related sexual dysfunction: A clinical approach. Journal of Clinical Medicine, 8(10), 1640. https://doi.org/10.3390/jcm8101640Links to an external site.

Posadzki, P., Pieper, D., Bajpai, R., Makaruk, H., Könsgen, N., Neuhaus, A., & Semwal, M. (2020). Exercise/physical activity and health outcomes: An overview of cochrane systematic reviews. BMC Public Health, 20(1). https://doi.org/10.1186/s12889-020-09855-3Links to an external site.

Yuan, S., & Deban, C. E. (2021). Ssri-induced hypersexuality. American Journal of Psychiatry Residents' Journal, 16(3), 9–12. https://doi.org/10.1176/appi.ajp-rj.2021.160305Links to an external site.

Matrix Table (Healthcare) USE TOPIC GIVEN

/in /by

 Due 9/24/23    4 pm EST 

  • For this assignment, you must complete a matrix table for three research articles (see template provided below).
  • You will be identifying the following to complete the table:
    • Articles/reference (in APA format)
    • Purpose of the article/Study question
    • Variables (i.e. independent vs dependent)
    • Study design: Quantitative/Qualitative/Mixed
    • Sampling
    • Methods
    • Instruments
    • Findings/Result
  • You will be identifying the concepts being explored in the study: the “what” of the study, the methods or the “how” of the study, participants in the study or the “who,” along with the instruments/tools used in the study to collect data, i.e., surveys, interviews, etc.
  • Lastly, you will state the findings of the study.
  • Remember, the studies should support your ideas and should be less than five (5) years old.
  • They should not be from the Web, but from the library databases. Use the resources found in the library.
  • In addition, you must follow APA 7th edition guidelines when documenting the reference in the first column.
  • Please use, at minimum three scholarly references for this assignment.

USE THIS TOPIC AND ARTICLES

Topic and 3 articles that were used previously TOPIC:  Healthcare Equity among the Elderly in Europe · Article 1: “ Equity in healthcare access and service coverage for older people: a scoping review of the conceptual literature. “The article evaluates the various interventions on health equity, impact on health outcomes, healthcare access, and reductions in health disparities.· Article 2: “Evaluating Policy Reforms for Healthcare Equity Among the Elderly in Europe”It investigates the impact of policy reforms on health disparities and access to healthcare services.· Article 3: “Socioeconomic Factors and Health Outcomes Among European Elderly: A Critical Analysis of Healthcare Equity Policies”It critically examines the role of socioeconomic factors in healthcare equity and disparities. 

presentation

/in /by

 Next week presentation is intended to cover major cardiovascular diseases (CD). The distribution of the topics for the presentation is as follow: 

 Coronary Heart Disease
Anginas 

** Classification (if there is any)
Pathophysiology
Screening
Prevention 

M6 prep

/in /by

Please follow all directions 

topic : diabetes 

SOAP NOTE

/in /by

 Soap Note 1 “ADULT”  Wellness check up (10 points) 

Reflection week 7

/in /by

 

Reflection: write 1-2 paragraphs reflecting on your learning for the week. Guiding questions are provided or you may write about what you felt was most significant to you for the week.

You will need to post your reflection here before you are able to see other students’ posts.

  • Nearly every student in the course was able to think of a time when they had personally been impacted by or had observed incivility in the workplace. In what ways does this impact your view of the nursing profession?
  • If those outside of healthcare were aware, how might it impact their view?
  • As you move towards your role as an NP, what will you do to support healthful work environments for yourself and your colleagues?
  • Think about your personal use of social media. Are there changes you would like to make in how you use social media?
  • What self-care practices do you engage in to promote personal holistic health?