“Mike is considering going on a new diet that emphasizes eating only fruits before noon, meat at lunchtime, and starch and vegetables at dinner. In addition, the diet recommends “cleansing” the intestines with laxatives and enemas every other week.”

1. Provide 3 specific reasons that you would advise Mike to steer clear of this diet.

2. Identify any harmful side effects of this diet;  including anatomical structures and functions that may be compromised.

Sleep disorders are conditions that result in changes in an individual’s pattern of sleep (Mayo Clinic, 2020). Not surprisingly, a sleep disorder can affect an individual’s overall health, safety, and quality of life. Psychiatric nurse practitioners can treat sleep disorders with psychopharmacologic treatments; however, many of these drugs can have negative effects on other aspects of a patient’s health and well-being. Additionally, while psychopharmacologic treatments may be able to address issues with sleep, they can also exert potential challenges with waking patterns. Thus, it is important for the psychiatric nurse practitioner to carefully evaluate the best psychopharmacologic treatments for patients that present with sleep/wake disorders.

Reference: Mayo Clinic. (2020). Sleep disorders. https://www.mayoclinic.org/diseases-conditions/sleep-disorders/symptoms-causes/syc-20354018

To prepare for this Assignment:

· Review this week’s Learning Resources, including the Medication Resources indicated for this week.

· Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients with sleep/wake disorders.

The Assignment: 5 pages

Examine Case Study: Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult. (https://mym.cdn.laureate media.com/2dett4d/Walden/NURS/6630/DT/week_11/index.html) 

You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

Introduction to the case (1 page)

· Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Decision #1 (1 page)

· Which decision did you select?

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #2 (1 page)

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #3 (1 page)

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Conclusion (1 page)

· Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.

Discuss the various tools and techniques used by an HCO to increase logistical efficiency. Why would an organization need to measure the capacity (throughput) of the various resources (x-ray equipment, exam rooms, length of stay, etc.)? How does capacity utilization support decision making? PLEASE INCLUDE IN-TEXT CITATIONAND REFERENCE

Cystic Fibrosis is considered a multiorgan disease that affects the lungs, digestive tract, and reproductive organs (Huether, McCance, & Brashers, 2020).  Clinical manifestations include high chloride content of sweat, meconium ileus, distal intestinal obstruction, exocrine pancreatic insufficiency, growth disturbance, male infertility, and chronic and recurrent pulmonary infections (Malhotra, Hayes, & Wozniak, 2019).  This disease is characterized by airway obstruction, chronic bacterial infection, and excessive inflammatory response (Chmiel & Davis, 2003). 

Cystic Fibrosis is caused by a mutation of the CFTR gene; this gene encodes the cystic fibrosis transmemberane conductance regulator (CFTCR).  This mutation results in abnormal expression of cystic fibrosis transmembrane conductance regulator (CFTCR) protein (an activated chloride channel that exists on the surface of many types of epithelial cells).  As a result of CFTR dysfunction, chloride and water are not transported appropriately across epithelial membranes and this results with thick and dry mucus secretions.  Approximately 2,000 different mutations in the CFTR gene have been identified (Kiedrowski & Bomberger, 2018).  These mutations are further subdivided into five classes based on how they lead to defective defective production of the CFTR protein (Kiedrowski & Bomberger, 2018).  Chronic respiratory infections and ineffective inflammatory response leading to respiratory failure and primary causes in death of these patients (Kiedrowski & Bomberger, 2018). 

Essentially, in the CF respiratory tract, there are numerous contributing factors that result from the dysfunctional CFTR protein combine to create a favorable environment for the promotion of chronic bacterial and viral infections. 

It is suggested that CFTR dysfunction results in an inability to secrete chloride and bicarbonate ions into the airway lumen; unopposed sodium reabsorption results in net water uptake by the respiratory epithelium which liquid (further results in dehydration of airway surface (Malhotra, Hayes, & Wozniak, 2019).  Dehydrated mucus affects mucociliary and cough clearance of mucus, thus providing a favorable environment for colonization and infection of opportunistic pathogens (Malhotra, Hayes, & Wozniak, 2019). 

Another suggestion is that the impairment of CFTR is related to the altered pH of airway surface liquid (ASL).  Studies suggest that CF ASL show reduced bacterial killing due to impaired function of cationic antimicrobial peptides (AMPs); AMPs are innate immune proteins within leukocyte and epithelial secretions, with broad antimicrobial activity against infectious pathogens and immunomodulatory functions (Malhotra, Hayes, & Wozniak, 2019).  Antimicrobial killing of AMPs within the airway of those with CF, is said to be reduced in acidic pH conditions (Malhotra, Hayes, & Wozniak, 2019). 

Furthermore, there is another suggestion that basal inflammation promotes bacterial infection.  It is suggested that excess production of proinflammatory cytokines within the CF airway is related to early promotion and recruitment of inflammatory cells, such as neutrophils.  Neutrophil proteases are able to degrade immune antimicrobials, thus contributing to a secondary bacterial infection (Malhotra, Hayes, & Wozniak, 2019). 

Ultimately, the above-mentioned deficiencies in the CF respiratory tract prevent effective clearance of pathogens from the airway and create an environment favorable for infective pathogens.

References

Chmiel, J.F., & Davis, P.B. (2003). State of the Art:  Why do lungs of patients with cystic fibrosis become

               Infected and why can’t they clear the infection? Respiratory Research 4(1).

https://dx.doi.org/10.1186%2F1465-9921-4-8

Huether, S.E., McCance, K.L., & Brashers, V.L. (2020).  Understanding Pathophysiology (7th ed.).  Elsevier.

Kiedrowski, M.R., & Bomberger, J.M. (2018). Viral-Bacterial Co-Infections in the Cystic Fibrosis

               Respiratory Tract.  Frontiers in Immunology, 9. https://doi.org/10.3389/fimmu.2018.03067

Malhotra, S., Hayes Jr., D., & Wozniak, D.J. (2019).  Cystic Fibrosis and Pseudomonas aeruginosa: the

               Host-Microbe Interface.  American Society For Microbiology 32(3).

               https://doi.org/10.1128/CMR.00138-18.