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Addressing Mental Health and Psychological Issues of Nursing Home ResidentsIntro ...

Addressing Mental Health and Psychological Issues of Nursing Home Residents

Introduction/Problem Description

Considering the high number of nursing home residents with mental illnesses, the quality of care in these homes is a critical clinical and policy matter. Common mental health problems among elderly people in nursing homes include psychosis, anxiety, depression, and dementia. Besides, elderly people also suffer from other psychological problems such as deterioration in cognitive functioning, behavioral and sleep disorders. These issues are a big problem for nursing homes because they are not well-equipped to cater to residents with mental health problems. Despite years of reforms in nursing homes intended to cater to the needs of nursing home residents with mental disorders, the issue of the quality of mental health care in these homes continues to persist.

The patient identified is a 56-year-old retiree suffering from dementia and is living in a nursing home. The patient suffers from severe memory loss and has a short attention span. The patient also has a problem coping with new situations, and difficulty in organizing his thoughts and words. Dementia is one of the many forms of mental disorders where an individual exhibits a very rigid and unusual pattern of reasoning or thinking and behavior. Patients with dementia usually have difficulty in perceiving things and people. This usually brings about problems to such individuals and hampers greatly their social activities and even work. An individual’s personality is shaped and influenced by their surroundings, experiences, surrounding environment, and inherited traits and characteristics. Dementia affects the brain and affects how they think and behave which usually goes against societal expectations.

Common symptoms in all mental disorders mentioned above include distortion in perception, a change in behavior which can be classified as being abnormal, becoming anti-social in most cases, and personal distress in individuals afflicted. The one common factor in all the types of mental disorders mentioned above is that an individual’s brain is affected to the extent that their reasoning or thinking abilities are in one way or another affected leading to unreasonable behaviors

Evidence from Peer-Reviewed literature

Nursing homes need to have awareness of the appropriate interventions for mental health problems. They must have specialists who know the management of mental issues. In terms of policy, regulations require nursing homes to be aware of the classification system of mental health problems. There are two ways of classification of mental health problems, the International Classification of Diseases also called ICD-10 by the World Health Organization, and the Diagnostic and Statistical Manual of Mental Disorders also called DSM-5 and is published by the American Psychiatric Association (Fung, Xu, & Bodenreider, 2020). Both classifications have synchronized the characteristics of mental health problems, however, some differences exist in each classification. For example, ICD-10 does not recognize narcissistic disorder as a category of mental health problem in nursing home residents. On the other hand, DSM-5 does not also count personality change occurring after a traumatic experience as a psychological problem (Tolentino, & Schmidt, 2018). Even then, the two classifications of mental disorders by the World Health Organization and American Psychiatric Association have put in place common diagnostic parameters that all cases of mental disorders must meet before further and specific inquiries can be done.

Among the criteria used by health facilities and nursing homes to classify mental disorders include; remarkable changes in behavior and attitudes, an abnormal pattern of behavior that runs for long periods and is not limited to short episodes of abnormal behavior, and the fact that such abnormal behavior appears when one is young and continues throughout his adult life. Nursing homes must be aware of the mental status of their residents and which clusters they belong to for appropriate management.

Mental disorders are clustered into three major groups based on the similarities of their descriptions. Cluster A Mental disorders are disorders that have a close association with Schizophrenia. All mental disorders put under this group have common and similar symptoms that include individuals have very strong discomfort with those they have close relationships. Other common symptoms for mental disorders under this group include; distortion of perceptions and exhibiting eccentric behavior. Cluster B personal disorders, also called erratic or emotional disorders are characterized by antisocial behavior which entails a disregard for other people and having a bloated self-image (Liu et al., 2017). Other common symptoms under this cluster include excessive emotions, attention-seeking tendencies, and having no empathy whatsoever to others. Cluster C which is also a fearful and anxious disorder is characterized by such symptoms as being dependent on other people, becoming excessively controlling, and seclusion of oneself from leisure activities and people.

There are many types of mental disorders among nursing home residents. Some of the mental health problems include paranoid mental disorder, Schizoid mental disorders, avoidant mental disorder, and dependent mental disorder among many others. Paranoid mental disorder is characterized by having strong suspicion and distrust of other people, having the belief that other people are out to harm them, having strong suspicion about other people’s loyalty towards oneself, reacting angrily to perceived insults, and distorted perceptions.  Schizoid mental disorder has the following symptoms; always preferring to be alone, lack of interest in social activities, having limited or no emotional expressions, being indifferent to other people. Dependent mental disorder on the other hand is characterized by being excessively reliant on other people, being too submissive to other people, lack of self-confidence with a high degree of low self-esteem, and fear of being left alone. With avoidant mental disorder, an individual may experience certain symptoms such as; being extremely harsh on criticism, feeling insecure, having an inferiority complex, fear of rejection, and fear of embarrassment.

Practice Standards for Nursing Homes in dealing with Mental and Psychological issues

In the United States, over 600,000 people with mental disorders reside in nursing homes on any given day. This figure significantly exceeds the number of all other patients/persons admitted in all other health care facilities combined. Based on this analogy, mental illness sometimes become the decisive factor for admission into nursing homes. However, the issue of the appropriateness of nursing homes as a residing place for people with mental disorders is a controversial matter. After the dramatic closure of state psychiatric facilities in the 80s and the 90s, nursing homes gradually became the de facto facilities for caring for persons suffering from mental disorders.

The standards of care for nursing homes aim to improve the quality of care given to the residents of these homes. The Federal Nursing Home Reform Act of 1987-also known as OBRA sets the minimum standards of care and the rights of people living in nursing homes (Popp, 2018). The minimum health requirements for a nursing home are achieved through a variety of protocols established both by regulatory authorities and the nursing home itself. Based on this analogy, all nursing homes must use OBRA as the foundation stone of creating an environment that provides care, safety, fulfillment, and joy to residents of nursing homes.

One of the critical practice standards for nursing homes is the pre-screening process. The Federal government introduced the Pre-Admission Screening and Resident Review Program-PASRR that requires all states in America to pre-screen all persons seeking admission into nursing homes (Carpenter, 2018). The objective of the PASRR program is to identify persons with mental disorders and other people with intellectual disabilities. Most nursing homes are ill-equipped to deal with patients with mental disorders, especially severe disorders such as bipolar or schizophrenia. The facilities that admit people with severe mental disorders without having the requisite staff, equipment, and appropriate facilities put themselves and their patients in danger.

Some state laws and policies make it difficult for nursing homes to effectively manage and care for patients with mental problems/disorders. For example, patients with bipolar or schizophrenic conditions may get into altercations with other patients in the nursing home. However, creating separate quarters or units for such patients to secure them may be viewed as an unnecessary restriction which in some states is an infringement on the rights of nursing home residents.

Leadership Strategies to Improve Patient Outcomes in Nursing Homes

Leadership is integral for any organization to function optimally. Leadership comes in several styles; toxic leadership is one of them. Many leaders spend most of their time trying to pump in positivity in the workplace while reducing negative aspects to the bare minimum to create better systems of management. To do this, leaders must exhibit characteristics such as inspiration, motivation, and the ability to influence people into achieving goals set by the organization.

Collaborative leadership is essential in the healthcare sector for effective decision-making. Collaboration is essential because it promotes teamwork. Where people work together harmoniously, they find solutions for complex problems (Crowne et al., 2017). Collaboration also creates an inclusive environment where employees release their creativity and creates a productive work culture. Communication is another critical component of effective leadership. Good communication is essential for relaying information. It curbs chances of frequent misunderstandings as well as errors.

The increased complexity of the operations of modern-day organizations and globalization leads to the greater need for cooperation within members of the staff and with it come increased possibilities for conflicts. As a result, the functions of organizations are more involved, and the requirement by organizations to create a healthy working environment for their employees has created a greater need for employees from different sectors of the organization to come together to accomplish the mission of their organization. This interaction and cooperation between people with different backgrounds, ideas, opinions, beliefs, and education standards are bound to create some discord or conflict in the organization.

Dealing with mental disorders in nursing homes requires skills, tact, and effective leadership. Leaders of such facilities must create effective strategies to manage and cope with mental disorders within their facilities. Behavior management/therapy is one of the best strategies to improve patient outcomes in nursing homes. The theory of behavior therapy operates on the premise that all positive behaviors are learned whereas negative behaviors can be unlearned/changed. Thus, the focus of treating patients with mental disorders is to change current problems and the change will be achieved. The objective here is to identify unhealthy and destructive behaviors and change them. Cognitive-behavioral therapy is one of the most popular forms of therapy for mental disorders. This therapy combines both cognitive and behavioral therapy intending to influence a person’s actions and moods by influencing their beliefs and thoughts. The long-term objective of cognitive behavioral therapy is to change a person’s thoughts and behavior.

References

  • Carpenter, J. (2018). PASRR: A unique gateway to community services. Commonwealth Medicine Publications. https://doi.org/10.13028/at5q-ar52.
  • Crowne, K. A., Young, T. M., Goldman, B., Patterson, B., Krouse, A. M., & Proenca, J. (2017). Leading nurses: Emotional intelligence and leadership development effectiveness. Leadership in Health Services, 30(3), 217-232. https://doi.org/10.1108/lhs-12-2015-0055
  • Fung, K. W., Xu, J., & Bodenreider, O. (2020). The new International Classification of Diseases 11th edition: a comparative analysis with ICD-10 and ICD-10-CM. Journal of the American Medical Informatics Association27(5), 738-746. https://doi.org/10.1093/jamia/ocaa030
  • Liu, N. H., Daumit, G. L., Dua, T., Aquila, R., Charlson, F., Cuijpers, P., Druss, B., Dudek, K., Freeman, M., Fujii, C., Gaebel, W., Hegerl, U., Levav, I., Munk Laursen, T., Ma, H., Maj, M., Elena Medina-Mora, M., Nordentoft, M., Prabhakaran, D., Pratt, K., … Saxena, S. (2017). Excess mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice, policy and research agendas. World Psychiatry: Official Journal Of The World Psychiatric Association (WPA), 16(1), 30–40. https://doi.org/10.1002/wps.20384
  • Popp, L. (2018). The Nursing Home Reform Act of 1987: A Policy Analysis. California State University, Long Beach.
  • Tolentino, J. C., & Schmidt, S. L. (2018). DSM-5 criteria and depression severity: implications for clinical practice. Frontiers in Psychiatry9, 450. https://doi.org/10.3389/fpsyt.2018.00450

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Addressing An Unmet Need Through Strategic Planning DQ 4Addressing An Unmet Need ...

Addressing An Unmet Need Through Strategic Planning DQ 4

Addressing An Unmet Need Through Strategic Planning DQ 4

Post an explanation of the unmet need that affects a specific group, unit, or organization that you would like to focus on for your Course Project. Share data from your historical analysis and forecasting, and identify stakeholders who should be included in the strategic planning process. Explain your vision for addressing this need at the organizational or systems level.

ORDER THROUGH BOUTESSAY

Michele V. Sare and LeAnn Ogilvie, Strategic Planning for Nurses: Change Management in Health Care

As a nurse leader-manager, you can dynamically impact health care through your involvement in strategic planning. Identifying an unmet need is a critical aspect of strategic planning; however, the real value of this process lies in moving a group, unit, or organization through the analysis and actions required to address the unmet need effectively.

This week, you consider how the foundational topics introduced in the first several weeks of this course relate to the creation of a strategic plan. As you move forward, you will be guided through the strategic planning process to develop your Course Project: Developing a Strategic Plan.

Learning Objectives

Students will:

· Analyze historical data and forecasting pertaining to an unmet need in health care or nursing

· Analyze potential stakeholders for a strategic planning effort

· Formulate a vision for addressing an unmet health care-related need at the organizational or systems level

·: Hero Images/Hero Images/Getty Images

Learning Resources

Note: To access this week’s required library resources, please click on the Course Readings List link in the Course Materials section of your Syllabus.

Required Readings

Balicer, R. D., Shadmi, E., Lieberman, N., Greenberg-Dotan, S., Goldfracht, M., Jana, L., . . . Jacobson, O. (2011). Reducing health disparities: Strategy planning and implementation in Israel’s largest health care organization. Health Services Research, 46(4), 1281–1299.

Retrieved from the Walden Library databases.

 

The authors examine the planning, implementation, and evaluation of an organization-wide strategy to address the need to reduce healthcare inequalities and improve quality in Israel.

Schaffner, J. (2009). Roadmap for success: The 10-step nursing strategic plan. Journal of Nursing Administration, 39(4), 152–155.

Retrieved from the Walden Library databases.

 

The author outlines a 10-step strategic planning process for nursing.

Strubhar, A. J. (2011). Applying an environmental scanning and strategic planning framework in an academic physical therapy department. Journal of Physical Therapy Education, 25(3), 53–59.

Retrieved from the Walden Library databases.

 

The author examines strategic planning, including environmental scanning, within a physical therapy department in an academic institution.

Authenticity Consulting. (n.d.b). Basic description of strategic planning. Retrieved March 13, 2013, from http://managementhelp.org/strategicplanning/basics.htm

 

This online article provides an overview of the strategic planning.

Authenticity Consulting. (n.d.c). Basic overview of various strategic planning models. Retrieved March 13, 2013, from http://managementhelp.org/strategicplanning/models.htm

 

This online article describes different models of strategic planning, including issues-based planning.

PlanWare. (n.d.). Business planning papers: Developing a strategic plan. Retrieved March 13, 2013, from http://www.planware.org/strategicplan.htm

 

View the strategic planning information on this website.

Required Media

Laureate Education (Producer). (2013d). Elements of a strategic plan model [Video file]. Retrieved from https://class.waldenu.edu

Note: The approximate length of this media piece is 6 minutes.

Dr. Carol Huston describes elements common to strategic planning models and discusses ways to approach the development of a strategic plan.

Accessible player

Optional Resources

Authenticity Consulting. (n.d.a). All about strategic planning. Retrieved March 13, 2013, fromhttp://managementhelp.org/strategicplanning/index.htm

Discussion: Addressing an Unmet Need Through Strategic Planning

Challenges can seem ever present in the health care field. Problems related to the quality of patient care, financial matters, technology, and interdisciplinary collaboration, for example, are often evident in organizations and professional groups.

In your role as a nurse leader-manager, it is important to consider challenges and how these translate into unmet needs. You can then create valuable change by addressing these unmet needs through strategic planning.

Through this Discussion, you may distinguish the focus for your Course Project. Your instructor and colleagues will provide feedback to help you refine your idea as you progress.

To prepare:

  • Consider the information presented by Dr. Carol Huston in this week’s media program. Think about the process of moving from the identification of an unmet need through the development, implementation, and evaluation of a strategic plan.
  •  Reflect on the initial thinking about trends and unmet nursing and health care needs that you addressed in Week 5.
  •  Consider how the information in this week’s Learning Resources deepens and expands your understanding of these trends and unmet needs in relation to the strategic planning process.
  • Proceed with planning for your Course Project as follows:
  •  Select an unmet need that affects a specific group, unit, or organization.
  • If possible, Deepen your understanding of this group, unit, or organization by examining the stated mission, vision, and values.
  •  Analyze historical data related to the unmet need, and review the evidence in the literature. Use this information to engage in forecasting.
  • Consider which stakeholders should be included in the strategic planning process.
  •  Begin to formulate a vision for addressing this need at the organizational or systems level. (Note: Although not required for this Discussion, you will need to develop a strategic goal for your Course Project.)

Also Read: Professional Nursing and State-Level Regulations DQ 4


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Advanced Pharmacology Asthma Discussion PaperAdvanced Pharmacology: AsthmaAmong ...

Advanced Pharmacology Asthma Discussion Paper

Advanced Pharmacology: Asthma

Among the appropriate pharmacological therapies to be prescribed for Johnathan is STEP therapy as recommended by EPR3, which places him in step three, due to his known use of Albuterol that is in step 1. Further, with a viral asthmatic attack, an inhaled corticosteroid (ICS) is recommended, which could be administered via a nebulizer machine (Lizzo & Cortes, 2020). The above, in combination with a leukotrine receptor antagonist (LTRA) would increase the efficacy of ICS.

Asthma exacerbation presents as medical emergency, which necessitates prompt treatment. Jonathan and his mother will therefore need to understand the need for an ICS inhaler even while in school. She also needs to know the need to involve the teacher in the management of Johnathan’s condition, in case of an exacerbation in school. Spirometric indices such as forced exhalation volume are integral in the assessment of asthma especially among children. EPR3 recommends this test among children above 5 years to measure the lung functionality through breath volumes using a spirometer (Dinakar & Chipps, 2017).

Asthma is classified on frequency of exacerbations and severity (Oksel et al., 2018). Mild intermittent asthma presents mildly for less than 2 days a week, resolving spontaneously. This type does not hinder performance of daily activities and includes exercise-induced asthma. Mild persistent asthma presents symptomatically more than twice a week, with symptoms persisting more than a day. Moderately persistent asthma presents symptomatically in most days of the week and at least one night each week. Severe persistent asthma, the most chronic, presents almost every day and severally at night. This type does not respond well to medications.

Johnathan’s mother needs education on the need to change the inhaler to an ICS inhaler. She also should be made aware of benefits of including Johnathan’s teacher in care for Johnathan. This will ease the use and storage of the inhaler in school setup. She also should be educated on the need to prevent Johnathan from contracting URTI from family and friends due to his sensitivity and vulnerability. The plan of care for Jonathan will include pharmacological management and health education. Pharmacological therapy will address the attack as an emergency, as well as prevention of future occurrences.

References

  • Dinakar, C. & Chipps, B. (2017). Clinical Tools to Assess Asthma Control in Children. Pediatrics. 139 (1) e20163438; DOI: https://doi.org/10.1542/peds.2016-3438
  • Lizzo, J. M. & Cortes, S. (2020). Pediatric Asthma. StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551631/
  • Oksel, C., Haider, S., Fontanella, S., Frainay, C., & Custovic, A. (2018). Classification of Pediatric Asthma: From Phenotype Discovery to Clinical Practice. Frontiers in Pediatrics, 6(258), 258–. doi:10.3389/fped.2018.00258

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Adoption Sample PaperThe biggest psychological issue of adoption on children is ...

Adoption Sample Paper

The biggest psychological issue of adoption on children is mental and emotional trauma. Younger children such as infants may not experience trauma from adoption because they may not recall the ordeal. However, older children often have vivid memories of the process and may experience the trauma associated with losing a parent or being separated from a biological parent. Another common psychological problem associated with adoption is the identity problem (Anthony et al., 2020). Adopted children have to forget their history and ‘rewrite’ new ones as they struggle to fit into their new environment.

Dealing with Mental/Emotional Trauma in Adoption

Being a traumatic experience for a child, adoption affects childhood brain development. If not dealt with early, the trauma may make a child resort to negative behavior such as truancy, risky sexual behavior, and drug use. The best method of dealing with adoption trauma is by providing a home environment that exudes stability, support and understanding, nurturance, and predictability. Such an environment, as Sargent (2019) opines, helps a child to heal and adapt to their new environment. The efficacy of this intervention method draws from the fact that it helps a child to erase their old memories gracefully while creating pleasant new ones. The only remedy for helping adopted children deal with adoption trauma is to ensure that they are happy in their new environment. Loving and happy environments help adopted children forget their past traumatic experiences.

Treatment Options available for Adopted Children and Adolescents

One of the best intervention/treatment options for adopted children is behavioral family therapy. This technique is superior to other therapies such as the standard psychodynamic therapy and client-centered therapy because it uses operant principles (Dowell et al., 2018). Operant conditioning is a technique where the consequence is used as a motivation for behavior. A foster parent can leverage this concept by demonstrating certain desired behaviors to an adopted child. The parent then motivates the child to follow the demonstrated behavior. At the same time, the parent makes it clear to the child that following the demonstrated behavior is rewarded positively while doing the opposite attracts punishment. This method depends heavily on positive reinforcement of behavior, punishment for wrong-doing, and rewards for doing right. Foster parents need to create a stable and loving environment for adopted children to nurture love and discipline.

Explain how Culture influence Adoption

Cultural beliefs influence adoption positively or negatively. In some societies, adopted children cannot hold the same statuses as biological children. For example, some cultures may not permit adopted children to inherit their parent’s wealth as would biological children. In some societies, adopted children are not permitted to take the name of their adopted parents due to a lack of blood relationship. These practices are not healthy for children because they lead to long-term emotional trauma (Ma, 2017). Another critical cultural factor in adoption is the cross-cultural response to adoption. Some cultures are not yet open to adopting children from different ethnic and racial backgrounds. Furthermore, cross-cultural adoption raises pertinent questions about culture, class, and race, an aspect that makes the issue of identity a critical factor for adopted children. Further, cross-cultural adoption exposes children to anxiety and stress as they try to fit in their new environment.

References

  • Anthony, R., Paine, A., Westlake, M., Lowthian, E., & Shelton, K. (2020). Patterns of adversity and post-traumatic stress among children adopted from care. Child Abuse & Neglect, 104795. https://doi.org/10.1016/j.chiabu.2020.104795
  • Dowell, T., Donovan, C., Farrell, L., & Waters, A. (2018). Treatment of Anxiety in Children and Adolescents. Current Treatment Options In Psychiatry5(1), 98-112. https://doi.org/10.1007/s40501-018-0136-2
  • Ma, K. (2017). Korean Intercountry Adoption History: Culture, Practice, and Implications. Families In Society: The Journal Of Contemporary Social Services98(3), 243-251. https://doi.org/10.1606/1044-3894.2017.98.25
  • Sargent, J. (2019). 8.4 ADOPTION: WORKING WITH FAMILIES TO PROMOTE CONNECTIONS AND COMPETENCE. Journal Of The American Academy Of Child & Adolescent Psychiatry58(10), S145-S146. https://doi.org/10.1016/j.jaac.2019.07.675

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Advanced Pharmacology DiscussionsDiscussion 1Howard appears to have chronic pain ...

Advanced Pharmacology Discussions

Discussion 1

Howard appears to have chronic pain which needs multidisciplinary approach. All clients presenting with chronic pain require an extensive physical evaluation including neurological, cardiovascular, renal and mental status examination to try and identify underlying etiologies and associated features such as decreased overall physical and mental function, depression, sleep disturbances and fatigue (Henry et al., 2017). In addition, Howard complains of previous ulcer problem hence pain medications that cause gastric irritation such as Non-Steroidal Anti-inflammatory Drugs (NSAIDs) should be avoided.

Five schedules of controlled substances exist in their decreasing order of potential risk for addiction and dependence according to the united Nations classification of drugs (Uzuegbu-Wilson, 2019). Schedule 1 medications include Marijuana, Heroine, Methaqualone, Mescaline, Lysergic acid etc. Schedule 2 medications are the opioid class, including morphine, meperidine, fentanyl, hydromorphone and barbiturates such as pentobarbital. Schedule 3 medications are easily prescribed and include ketamine and anabolic steroids. Schedule 4 medications include benzodiazepines and tramadol. Finally, schedule 5 drugs are less likely to be misused and include drugs with codeine less than 200mg per 100 ml, pregabalin.

A long-acting narcotic will be a valuable prescription to this patient over the short acting. This helps to improve compliance, reduces opioid overdose and dependence associated with habit forming potential of the short acting drugs.

Discussion 2

Howard can benefit from analgesics such as paracetamol and adjuncts of pain management such as corticosteroids, antidepressants, anticonvulsants and skeletal muscle relaxants (Weyker & Webb, 2018). For such, advise the patient on the side effects of the above drugs and advise the patient to take the drugs as instructed by the physician.

According to WHO analgesic ladder and opioid crisis, which specifies treatment on pain intensity, Step 1 entails Non-opioid alongside optional adjuvant analgesics, which are recommended for mild pain. Step 2 entail Weak opioid medications alongside non-opioid and adjuvant analgesics, recommended for mild to moderate pain. Step 3 entail Strong opioid medications alongside non-opioid and adjuvant analgesics recommended for moderate to severe pain. For this patient, I would recommend step 2 and even step 3 depending on the response.

Discussion 3

Screening tools available include abnormal urine testing and opioid risk tool score. The former being most reliable because the sample is collected from the patient and subjected to laboratory testing (Kaye, 2017).

Substance abuse problem is a complex but manageable condition that affect the brain behavior and function. At first, I will consider a rehabilitation program for Howard. Howard will also benefit from counselling services and behavioral therapies. In addition, I will constantly evaluate his mental status and treat any underlying anxiety and depression. Withdrawal medications and devices for treatment of withdrawal symptoms cannot be ignored. Long term follow-up strategies to prevent relapse is ideal as well (NIDA, 2019).

I will refer Howard to a psychiatrist to try and institute cognitive behavioral and psychotherapy. Howard will also see a neurologist and a physician to assess his neurological health status and prescribe any withdrawal medications.

Discussion 4

The use of epidural injections as a way of managing chronic pain permits the use of smaller doses of other analgesics including opioids to reduce their toxicity (Weyker & Webb, 2018). This, therefore means that I will prescribe smaller doses of narcotics to Howard.

Howard can also be given alpha-2 adrenergic agonists such as clonidine, botulinum toxin and neuroleptics such as haloperidol and fluphenazine. Acupuncture, cognitive and behavioral therapy, heat and cold, assistance with vocational training, exercises, music, hypnosis, relaxation and biofeedback techniques (Gokhale, 2017) will all be of help to Howard.

Discussion 5

Substance abuse programs for Howard include family therapy, cognitive behavioral therapy, group therapy, individual therapy in addition to harm reduction model and inpatient addiction treatment (Miller, 2021). The nurse practitioner must be licensed under the respective state laws to prescribe schedule 3-5 drugs for pain, must have completed not less than 24 hours of appropriate education through a qualified provider and demonstrates the ability to treat and manage opioid disorder through training and experience (“Buprenorphine Waiver Management”, 2021).

The patient enrolled in a medication assisted opioid treatment program requires a consent for treatment, a plan for relapse prevention, a procedure through which the patient can discuss the treatment and doses with a staff at request and a regular assessment.

References

  • Buprenorphine Waiver Management. ADVOCACY. (2021). Retrieved 21 April 2021, from https://www.asam.org/advocacy/practice-resources/buprenorphine-waiver-managementhttps://www.asam.org/advocacy/practice-resources/buprenorphine-waiver-managementhttps://www.asam.org/advocacy/practice-resources/buprenorphine-waiver-management.
  • Gokhale, S. (2017). “Non-Pharmacological Methods for Pain Management”. JOJ Nursing & Health Care4(4). https://doi.org/10.19080/jojnhc.2017.04.555642
  • Henry, S., Bell, R., Fenton, J., & Kravitz, R. (2017). Goals of Chronic Pain Management. The Clinical Journal Of Pain33(11), 955-961. https://doi.org/10.1097/ajp.0000000000000488
  • Kaye, A. (2017). Prescription Opioid Abuse in Chronic Pain: An Updated Review of Opioid Abuse Predictors and Strategies to Curb Opioid Abuse: Part 1. Pain Physician2(20;2), s93-s111. https://doi.org/10.36076/ppj.2017.s111
  • Miller, L. (2021). Types of Addiction Treatment Programs. Drug Rehab Options. Retrieved 21 April 2021, from https://www.rehabs.com/addiction/types-of-treatment-programs/.
  • NIDA. (2019). Treatment Approaches for Drug Addiction DrugFacts. Retrieved from https://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction
  • Uzuegbu-Wilson, E. (2019). Narcotics Drug Use in West Africa and Its Impact on Human Security. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.3456528
  • Weyker, P., & Webb, C. (2018). Comprehensive Pain Management in the Rehabilitation Patient. Anesthesia & Analgesia127(1), 299. https://doi.org/10.1213/ane.0000000000003390

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Advanced Pharmacology Gastrointestinal Drugs DQ 5Advanced Pharmacology Gastroint ...

Advanced Pharmacology Gastrointestinal Drugs DQ 5

Advanced Pharmacology Gastrointestinal Drugs DQ 5

As an advanced practice nurse, you will likely encounter patients who will present with symptoms affecting the gastrointestinal (GI) tract. Of particular note is the consideration that most symptoms concerning the GI tract are non-specific, and therefore, diagnosing diagnoses of the GI tract requires thoughtful and careful investigation. Similarly, hepatobiliary disorders may also mirror many of the signs and symptoms that patients present when suffering from GI disorders.

How might you tease out the specific signs and symptoms between these potential disorders and body systems? What drug therapy plans will best address these disorders for your patients?

This week, you examine GI and hepatobiliary disorders. You will review a patient case study and consider those factors in recommending and prescribing a drug therapy plan fo your patient.

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

Chapter 64, “Drugs for Peptic Ulcer Disease” (pp. 589–597)
Chapter 65, “Laxatives” (pp. 598–604)
Chapter 66, “Other Gastrointestinal Drugs” (pp. 605–616)
Chapter 80, “Antiviral Agents I: Drugs for Non-HIV Viral Infections” (pp. 723–743)
Chalasani, N., Younossi, Z., Lavine, J. E., Charlton, M., Cusi, K., Rinella, M., . . . Sanya, A. J. (2018). The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance fro

Advanced Pharmacology Gastrointestinal Drugs DQ 5 ASSIGNMENT:

Gastrointestinal (GI) and hepatobiliary disorders affect the structure and function of the GI tract. Many of these disorders often have similar symptoms, such as abdominal pain, cramping, constipation, nausea, bloating, and fatigue. Since multiple conditions can be tied to the same symptoms, it is important for advanced practice nurses to carefully evaluate patients and prescribe a treatment that targets the cause rather than the symptom.

Once the underlying cause is identified, an appropriate drug therapy plan can be recommended based on medical history and individual patient factors. In this Assignment, you examine a case study of a patient who presents with symptoms of a possible GI/hepatobiliary disorder, and you design an appropriate drug therapy plan.

To Prepare

  •  Review the case study assigned by your Instructor for this Assignment
  • Reflect on the patient’s symptoms, medical history, and prescribed drugs.
  • Think about a possible diagnosis for the patient. Consider whether the patient has a disorder related to the gastrointestinal and hepatobiliary system or whether the symptoms result from a disorder from another system or other factors, such as pregnancy, drugs, or a psychological condition.
  •  Consider an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
  • Write a 1-page paper that addresses the following:
  •  Explain your diagnosis for the patient, including your rationale for the diagnosis.
  •  Describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
  •  Justify why you would recommend this drug therapy plan for this patient. Be specific and provide examples.

This week we will discuss the gastrointestinal and hepatobiliary systems and drugs used to treat those disorders. We will specifically focus on nausea/vomiting, gastroesophageal reflux disease, peptic ulcer disease, constipation, diarrhea, irritable bowel syndrome, inflammatory bowel disease, and cirrhosis.

CASE STUDY: Patient HL comes into the clinic with the following symptoms: nausea, vomiting, and diarrhea. The patient has a history of drug abuse and possible Hepatitis C. HL is currently taking the following prescription drugs:

  • Synthroid 100 mcg daily

ORDER THROUGH BOUTESSAY

 


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Advanced Pharmacology Pharmacological Management of Respiratory IllnessPharmacol ...

Advanced Pharmacology Pharmacological Management of Respiratory Illness

Pharmacological Management of Respiratory Illness

JD presents with signs and symptoms suggesting an upper airway tract infection. However, there is a productive cough with greenish sputum suggesting a lower respiratory tract infection as well. The frontal headache, sinus tenderness, and nasal congestion are classical sinus presentations in acute rhinosinusitis. He thought that these symptoms would subside on their own but progressed instead.

Missing Information and Need for Treatment

Chest examination revealed bilaterally clear lungs but this does not rule out concurrent pneumonia. A piece of subjective information ruling out chest pain with difficulty in breathing would be needed. A chest plain radiograph finding would be required to rule out lung consolidation as the source of the productive cough. JD’s immune status and presence of comorbidities such as diabetes and hypertension are missing and would be used to rule out the possibility of fungal sinusitis (Husain et al., 2018) in the patient. Information about recent antibiotics use would also be essential (American Academy of Family Physicians, 2020). Nevertheless, JD would require treatment because his symptoms had lasted more than 10 days with postnasal discharge.

Pharmacotherapy

JD has had severe sinusitis symptoms for more than 10 days (NICE, 2018) and this warrants medical treatment. The ideal prescription would be Augmentin 875 mg PO TID. Augmentin prevents cell wall synthesis in bacteria while inhibiting beta-lactamase enzymes. Its excretion is predominantly renal with hepatic components for the clavulanic acid. This mediation may cause fatal anaphylactic reactions in those allergic to penicillin (Food and Drug Administration, n.d.).

If JD were a child, say 10 years old and weighing 78lbs, the medication would not change but alterations would be made to the dosage quantities. It would be essential to monitor the patient for allergy symptoms and educate him properly regarding medication adherence. Monitoring his response to antibiotic treatment would be essential in his further treatment.

Conclusion

JD most likely has acute bacterial rhinosinusitis requiring antibiotic treatment due to the severity of his symptoms lasting more than 10 days. The best choice of antibiotics would be Augmentin since he has reported no known food or drug allergies. This medication choice would be maintained even if JD were a child weighing 78 pounds. However, monitoring for possible allergic reaction would be necessary.

References

  • American Academy of Family Physicians. (2020). Adult Sinusitis. Aafp.Org. https://www.aafp.org/family-physician/patient-care/clinical-recommendations/all-clinical-recommendations/adult-sinusitis.html
  • Food and Drug Administration. (n.d.). Augmentin Label – FDA. Fda.Gov. www.accessdata.fda.gov
  • Husain, S., Amilia, H. H., Rosli, M. N., Zahedi, F. D., Sachlin, I. S., & Development Group Clinical Practice Guidelines Management of Rhinosinusitis in Adolescents & Adults. (2018). Management of rhinosinusitis in adults in primary care. Malaysian Family Physician: The Official Journal of the Academy of Family Physicians of Malaysia13(1), 28–33. https://www.ncbi.nlm.nih.gov/pubmed/29796207
  • NICE. (2018, April 3). NICE sinusitis (acute): antimicrobial prescribing. Guidelines.Co.Uk; Guidelines. https://www.guidelines.co.uk/infection/nice-sinusitis-acute-antimicrobial-prescribing/454117.article

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Advanced Pharmacology Sample Paper 2What would you add to the current treatment ...

Advanced Pharmacology Sample Paper 2

What would you add to the current treatment plan? Why?

Based on Mr. EBR’s presenting symptoms and a history of CAD, he is most likely suffering from stable angina. In addition to the current treatment plan for the patient, I would recommend an ECG to evaluate his cardiac condition. The immediate intervention would be to reduce or eliminate the patient’s anginal chest pain. Further, I would refer him to a cardiologist for stress test and, possibly, cardiac catheterization if needed.

Would you discontinue any of the currently prescribed medication? Why or why not?

I would not recommend the discontinuation of any of Mr. EBR’s current prescriptions as they crucial in managing his blood pressure, type 2 diabetes and hyperlipidemia. The patient is already on beta blockers which serve to decrease myocardial contractility, in addition to decreasing both heart rate and conduction velocity. Beta blockers also work by reducing the systemic vascular resistance as well as blood pressure (Laurent, 2017). Put together, the medication serves to reduce myocardial oxygen demand, thus relieving the patient’s anginal pain. Aspirin, at a dose of between 81mg and 162 mg per day is recommended for patients with angina as it also serves to reduce mortality rates among those suffering from CAD.

How does the diagnosis stage 3 chronic kidney disease affect your choices?

Gabapentin is the preferred medication for diabetic neuropathy among patients with no chronic kidney disease (CKD). With Mr. EBR’s stage 3 CKD, gabapentin is discouraged due to the elevated risks of high toxicity. Further, as Lefebvre et al. (2020) observe, for patients with such comorbidities as CKD, CHF, liver cirrhosis, etc., drug combinations that include renin-angiotensin blockers, NSAIDS and diuretics can result in acute renal failure.

How is the patient prescribed more than one antihypertensive?

            Current hypertension therapy guidelines recommend combined therapies with separate agents or fixed-dose combinations that are more effective in lowering blood pressure within a short time, while at the same time minimizing possible adverse effects. Further, studies have shown that different classes of hypertensive drugs can work to offset the adverse reactions associated with either. Additionally, the fact that most hypertensive patients require more than one antihypertensive agent, more so when there are comorbid conditions, makes it easier to understand Mr. EBR’s case. For instance, for hypertensive patients, particularly those at elevated risks of coronary disease, current treatment recommendation includes diuretics, beta-blockers, and angiotensin-converting enzyme inhibitors (Cuspidi et al., 2018).

What is the benefit of the aspirin therapy in this patient?

Aspirin, being an antiplatelet agent, reduces the ability of blood to clot. This makes blood flow easier in narrowed arteries. With Mr. EBR’s history of CAD and MI, reducing the risks of blood clot formation in his arteries is crucial to managing his conditions. For this, Aspirin is recommended.

References

  • Cuspidi, C., Tadic, M., Grassi, G., & Mancia, G. (2017). Treatment of hypertension: The ESH/ESC guidelines recommendations. Pharmacological Research, 128(), 315-321. doi:10.1016/j.phrs.2017.10.003
  • Laurent, S. (2017). Antihypertensive drugs. Pharmacological Research, 124(), 116-125. https://doi.org/10.1016/j.phrs.2017.07.026
  • Lefebvre, C., Hindié, J., Zappitelli, M., Platt, R. W., & Filion, K. B. (2019). Non-steroidal anti-inflammatory drugs in chronic kidney disease: a systematic review of prescription practices and use in primary care. Clinical Kidney Journal, 13(1), 63-71. https://doi.org/10.1093/ckj/sfz054

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Advanced Pharmacology Sample DiscussionDiscussion 1What pain relieving medicatio ...

Advanced Pharmacology Sample Discussion

Discussion 1

  1. What pain relieving medications would you prescribe? Defend your choice.

For patients with acute musculoskeletal and soft tissue injuries, the most appropriate treatment choice for pain remains NSAIDs. However, since this patient reports being intolerant to NSAIDs and aspirin, the alternative medication would be a topical NSAID, such as diclofenac. While topical NSAIDs have been subject to extensive studies on efficacy with varying results, Busse et al. (2020) for non-low back musculoskeletal injuries, topical nonsteroidal anti-inflammatory agents offer the greatest benefits, “followed by oral NSAIDs and acetaminophen with or without diclofenac.” Unlike ordinary NSAIDs that must be used with caution in patients with a history of GI and Kidney problems, or intolerance, topical NSAIDs are safe alternatives. This is because they have a small amount of systemic absorption and yet offer pain relieving and anti-inflammatory benefits to patients.

  1. How would you prescribe them?

Prescribe Diclofenac 1.3% topical system. Diclofenac Topical Dosage (2019) recommends application of 1 topical system to the area with most pain, twice daily, for up to 7 days.

  1. What side effects should you educate the patient about?

Inform the patient that while this is a topical NSAID as opposed to an oral one, such side effects as GI symptoms may occur. Further, with application on the skin, irritation or rash may occur, prompting the need to notify the provider should it worsen. Educate the patient on proper usage as well, especially on the need to apply it on a clean dry skin, and not to wear the patch when showering. Inform the patient to always secure the patch with tape whenever it begins to peel off.

  1. Does the age of the patient influence what your choice?

The patient’s age to an extent influences the choice of treatment. Topical diclofenac is recommended for patients aged >6 years. However, there are no other age limitations associated with this medication.

Discussion 2

Metabolism and excretion of NSAIDs occur in the liver and through the kidney respectively. As such, these are the organs that are likely to incur damage. For this reason, it is important to assess liver and skin function prior to administering NSAIDs. Further, as Rakoski et al. (2018) observe, there is need to decrease the dosage when administering the drugs to patients with cirrhosis since they are likely to experience increased unbound drug levels and reduced clearance. Further education should regard patients with heart conditions as they are at increased risks of developing renal insufficiency, hence the need for close monitoring. Also, educate the patient on the risks of fluid retention caused by NSAIDs, which may result in changes in BP. Equally important is to educate the patient on the interaction between NSAIDs and other prescription medications, especially since many drugs tend to interact negatively with NSAIDs.

Taking too much aspirin can affect the liver. As such, it is advisable to monitor LFTs and continually assess the patient for liver dysfunction symptoms and jaundice. Patient education regarding aspirin use should cover self-monitoring of liver dysfunction signs and GI problems, especially GI bleeding (Lavie et al., 2017). To minimize the risks of GI bleeding, recommend the use of enteric coated aspirin. Educate the patient to monitor for such toxicity symptoms as tinnitus, impaired hearing and dizziness. The patient should stop Aspirin prescription immediately upon noticing the said symptoms.

3 Diagnoses for which NSAIDs would be appropriate:

  • Muscle or Join pain following a sprain or strain
  • Arthritis
  • Postpartum pain

3 Diagnoses for which Aspirin would be ideal:

  • Coronary Artery Disease
  • Transient Ischemic Attack
  • Angina Pectoris

References

  • Busse, J. W., Sadeghirad, B., Oparin, Y., Chen, E., Goshua, A., May, C., Hong, P. J., Agarwal, A., Chang, Y., Ross, S. A., Emary, P., Florez, I. D., Noor, S. T., Yao, W., Lok, A., Ali, S. H., Craigie, S., Couban, R., Morgan, R. L., … Guyatt, G. H. (2020). Management of Acute Pain From Non–Low Back, Musculoskeletal Injuries: A Systematic Review and Network Meta-analysis of Randomized Trials. Annals of Internal Medicine, 173(9). https://doi.org/10.7326/M19-3601
  • Drugs.com. (2019). Diclofenac Topical Dosage. Accessed April 1st 2021 from https://www.drugs.com/dosage/diclofenac-topical.html
  • Lavie, C. J., Howden, C. W., Scheiman, J., & Tursi, J. (2017). Upper Gastrointestinal Toxicity Associated With Long-Term Aspirin Therapy: Consequences and Prevention. Current Problems in Cardiology, 42(5), 146–164. doi:10.1016/j.cpcardiol.2017.01.006
  • Rakoski, M., Goyal, P., Spencer-Safier, M., Weissman, J., Mohr, G., & Volk, M. (2018). Pain management in patients with cirrhosis. Clinical Liver Disease, 11(6), 135–140. https://doi.org/10.1002/cld.711

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Advanced Practice Nurse Role In Facilitating End-Of-Life CareCruz-Oliver et al. ...

Advanced Practice Nurse Role In Facilitating End-Of-Life Care

Cruz-Oliver et al. (2017) defines end of life care as the type of care offered to patients in their final hours or days of life, as well as to patients who are suffering from advanced terminal illnesses or diseases, and whose conditions have progressed to the level of being incurable. Nurses play a significant role in ensuring that this type of health care is available and delivered effectively by performing a variety of small tasks that ensure the patient is cared for holistically.

The most important role of an advanced practice nurse in facilitating Mrs. D’Angelo’s end-of-life care is to identify her needs (Abelsson & Willman, 2020). These needs range from basic dietary requirements to advanced emotional, spiritual, psychological, and even economic requirements. The involved nurse should strive to identify these needs and reason out possible ways to meet them, and if possible, involve Mrs. D’Angelo’s family. These needs can be identified by asking Mrs. D’Angelo about her thoughts on the subject, conducting a physical examination, analyzing her medication profile and allergies, observing her coping abilities, assessing support needs, and screening for implementation needs (Morioka et al., n.d.). By identifying the needs, the nurse in charge is able to plan how to meet those needs in the best interests of the patient.

Making decisions is an important part of the end-of-life process (Abelsson & Willman, 2020). The nurse(s) in charge play an important role in assisting Mrs. D’Angelo in making decisions such as whether to continue or discontinue the current chemotherapy regimen, whether to make plans to receive care somewhere other than at home, whether to discuss her wishes for care and treatment planning with her family, and whether to appoint someone to be her substitute decision maker. This helps in clarifying unsure concerns, avoiding distress or upset, eliminating concerns about negative outcome, helping Mrs. D’Angelo on being sure on what to do next and avoid cases her being preoccupied with the decision made.

Advance practice nurses also play important role in promoting meaningful interactions between Mrs. D’Angelo and her significant others (Abelsson & Willman, 2020). By encouraging Mrs. D’Angelo to make informed decisions, she will find it easier to decide what to discuss with a specific family member or significant other. Time is an important consideration. In the event that she develops advanced pancreatic cancer, which significantly reduces her life expectancy, she can discuss and plan with her family on how to manage the available family resources. By ensuring that the correct information is shared with Mrs. D’Angelo’s family, the family members can interact without fear of losing their loved one at any time, especially if the pancreatic cancer is not in an advanced stage and a cure can be achieved through surgery. This reduces the likelihood of emotional instability interfering with Mrs. D’Angelo’s expected interaction with her significant others.

Advanced practice nurse plays a role in controlling Mrs. D’Angelo’s symptoms and, in the event that she does not recuperate from the adverse reaction to chemotherapy or the cancer, facilitates a peaceful death (Abelsson & Willman, 2020). Nurses first do the assessment of Mrs. D’Angelo before coming up with a nursing diagnosis. They then come up with a plan on how to alleviate the patient’s symptoms before implementing the plan. Implementation includes psychological care, eliminating any form of fear, be it of pain, of feeling meaningless or fear of loneliness and abandonment. I the event that Mrs. D’Angelo’s cancer turns out to be non-curable, the nurses help in ensuring that she is able to make proper arrangements for whoever or whatever is going to be left behind, enjoy her final moments and, live a satisfactory final moments. This help in facilitating peaceful death.

Advance Directives

Advance directives, according to Dalmau-Bueno et al. (2021) are legal documents that outline formal preferences on actions that caretakers or doctors should take if the individual’s health deteriorates to an extent that they are no longer able to make appropriate decisions about self. The goal and objectives of advance directives is to ensure patient autonomy during end-of-life care, thereby enabling the caregivers to prioritize the patient’s medical care preferences, which must be within reasonable clinical options. Advance directives come in a various types and include a living will, durable power of attorney, advanced healthcare directive, preferred intensity of care(PIC) form and, do not resuscitate (DNR) order (Dalmau-Bueno et al., 2021).

A living will is a legal document that outlines an individual’s needs and wishes when they are unable to make competent decisions on their own. The living will, unlike the other forms, does not allow the patient to name someone to make decisions for him or her. In addition, unlike the other forms, two witnesses who are not related to the patient are required for validation. A durable power of attorney, on the other hand, is a legal device that allows one person, known as the “principle”, to delegate authority to another person, known as the “attorney-in-fact”, to act on his or her behalf (Dalmau-Bueno et al., 2021).

As a result, the decision is based on what the “attorney-in-fact” believes is appropriate for the “principle”. Unlike the appointed “attorney-in-fact”, the appointed “attorney-in-fact” is limited by their own knowledge of legal matters and finances, leaving room for error. The durable power of attorney is used for financial matters, whereas the advanced healthcare directive is used for medical matters.

The advanced healthcare directive specifies who you want to make healthcare decisions for you and only becomes active if the patient is unable to make decisions or is unconscious. In the event of a medical emergency, the PIC form is typically used to specify what should and should not be done. The DNR order is a form that requests that cardiopulmonary resuscitation not be performed if the patient’s heart stops beating or if he or she stops breathing (Dalmau-Bueno et al., 2021).

Mrs. D’Angelo will need an advanced directive if she wants to legally protect herself from unwanted medical procedures, such as when she does not want to be resuscitated in the event of cardiac failure (do not resuscitate order). In addition, if her cancer is advanced and she is unlikely to recover, the directives may specify the type of care she prefers, such as whether she wants to continue with chemotherapy or discontinue it. Advanced directives will also be useful if she wishes to receive a specific type of treatment regardless of how ill she is. Mrs. D’Angelo will also be able to relieve her family of the need to sit down and make difficult decisions about her care.

How To Approach The Topic Of Advanced Directive With A Patient.

The first step is to disclose all information about pancreatic cancer to Mrs. D’Angelo in a way that she understands, including the stage and the options for treatment available (Gieniusz et al., 2018). In the event that the cancer is at an advanced stage, explain to her the terminality of the condition. Also, explain to her the side effects of the available treatment modes. After the above disclosure of information, always give the patient hope, but not false hope. Explain to her the probable outcomes in case of ongoing treatment. Listen actively, assist her with medical decision making and also ensure effective communication with all individuals involved in her care and her family members. If she resents grieving, allow her to finish grieving until she gets to the acceptance phase.

Once she does accept her condition (s) and the possible outcomes, explain to her the prospect of advanced directives and allow her to make her own decision with your help on what she wants about her health and her financial capability. You can allow her to consult with a legal team if she has one. Help her select a directive that is in accordance with her religion, financial ability and, culture or ethnicity. Once she has decided on an advance directive, she can fill out the form in the presence of witnesses if necessary and present it to her advocate or legal team.

Ethical Principles and Legal Challenges related to End-of-life and Palliative Care.

Ethical Principles

Beneficence: This is the balance between what is good and what is harmful to the patient (Brodtkorb et al., 2017). The nurse and the involved healthcare officer should make decisions and take actions that will improve Mrs. D’Angelo’s life rather than worsen it. If, for example, the use of chemotherapy causes more harm than benefit in the form of adverse reactions, it can be discontinued and the Whipple procedure performed without initiating chemotherapy.

Autonomy: It is defined as the right of self-governance (Sprung et al., 2019). In this situation, it is allowing Mrs. D’Angelo to decide for herself the type of treatment she is to receive and also have a final say in her financial and family matters. This can be done through advanced directives.

Legal Challenges

Limitation to patient autonomy: Mrs. D’Angelo cannot demand a treatment that is not in their best interests. Further, the intervening doctors and the doctors need not to strive to preserve life.

Withholding and withdrawing treatment: If Mrs. D’Angelo and the doctor agree that there is no benefit of continuing chemotherapy they can stop it (Sprung et al., 2019). The doctor and Mrs. D’Angelo should agree to withdraw or discontinue the chemotherapy prior to the Whipple procedure.

Effective Communication Strategy for End-of-life Care

Mrs. D’Angelo is entitled to bad news if her condition worsens and she is diagnosed with a terminal illness. However, there may be some good news in between the bad news, and what is most important is how the advance practice nurse communicates the same news to Mrs. D’Angelo. This necessitates a communication strategy that includes skills for communicating with the seriously ill as well as responding to serious questions with sensitivity.

Upon diagnosing an individual with a serious or life-threatening illness and noticing that the individual is nearing the end of their life, effective communication is critical. As Anderson et al. (2019) notes, good and timely communication can help alleviate stress and distress, in addition to enabling the patient and the caregiver to discuss and plan for advanced care. The best known approach is the 9-Step Approach (Anderson et al., 2019).

To begin, the meeting must be convened. This entails gathering the members of the medical professional and Mrs. D’Angelo’s family in a private and quiet location and having all members introduce themselves to establish a good rapport. Second, it entails reaching an agreement on the meeting’s purpose. Update everyone on Mrs. D’Angelo’s health from your perspective, breaking the news about her health. After that, discuss the decision with the appropriate members. Help anyone who may require emotional or psychological support.

Third, find out what the patient or family knows and assess their level of understanding, language they understand better, potential misconceptions or misinformation, and the last time they were updated. Fourth, find out what information they need to make a decision and show them how much you appreciate them in the process. This includes the diagnosis, likely course of action, and prognosis.

Fifth, share the necessary information with them and try to get them to agree on their common desires in a peaceful manner. Try to evaluate them to discover their goals, hopes, expectations and, fear with the hope of understanding their “history”. Try to address their needs as per their financial capability and for the best interest of the patient. Create a plan for them that include when to break the bad news to them, decision-making and anticipated decisions, and the necessary support to assist them and Mrs. D’Angelo in coping and reducing potential fears. Finally, schedule a follow-up with them, inviting them to share any unresolved concerns and, in doing so, normalize their experience (Anderson et al., 2019)

References

  • Abelsson, A., & Willman, A. (2020). Caring for patients in the end-of-life from the perspective of undergraduate nursing students. Nursing Forum55(3), 433–438. https://doi.org/10.1111/nuf.12448
  • Anderson, R. J., Bloch, S., Armstrong, M., Stone, P. C., & Low, J. T. (2019). Communication between healthcare professionals and relatives of patients approaching the end-of-life: A systematic review of qualitative evidence. Palliative Medicine33(8), 926–941. https://doi.org/10.1177/0269216319852007
  • Brodtkorb, K., Skisland, A. V.-S., Slettebø, Å., & Skaar, R. (2017). Preserving dignity in end-of-life nursing home care: Some ethical challenges. Nordic Journal of Nursing Research37(2), 78–84. https://doi.org/10.1177/2057158516674836
  • Cruz-Oliver, D. M., Little, M. O., Woo, J., & Morley, J. E. (2017). End-of-life care in low- and middle-income countries. Bulletin of the World Health Organization95(11), 731. https://doi.org/10.2471/BLT.16.185199
  • Dalmau-Bueno, A., Saura-Lazaro, A., Busquets, J. M., Bullich-Marín, I., & García-Altés, A. (2021). Advance directives and real-world end-of-life clinical practice: a case-control study. BMJ Supportive & Palliative Care. https://doi.org/10.1136/bmjspcare-2020-002851
  • Gieniusz, M., Nunes, R., Saha, V., Renson, A., Schubert, F. D., & Carey, J. (2018). Earlier goals of care discussions in hospitalized terminally ill patients and the quality of end-of-life care: A retrospective study. The American Journal of Hospice & Palliative Care35(1), 21–27. https://doi.org/10.1177/1049909116682470
  • Sprung, C. L., Ricou, B., Hartog, C. S., Maia, P., Mentzelopoulos, S. D., Weiss, M., Levin, P. D., Galarza, L., de la Guardia, V., Schefold, J. C., Baras, M., Joynt, G. M., Bülow, H.-H., Nakos, G., Cerny, V., Marsch, S., Girbes, A. R., Ingels, C., Miskolci, O., … Avidan, A. (2019). Changes in end-of-life practices in European intensive care units from 1999 to 2016. JAMA: The Journal of the American Medical Association322(17), 1692–1704. https://doi.org/10.1001/jama.2019.14608

 


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