Please respond to the following :

 The purpose of this discussion is to analyze the definition and cause of fatigue as well as explain how thyroid function impacts this symptom. Fatigue can be acute or chronic; it is often described as weariness not relieved by rest, affecting energy, motivation and concentration (“Fatigue definition,” 2020). Other coinciding symptoms involve stress, anxiety, irritability and muscle weakness. There are many causes of fatigue since it is a general symptom; differentials to consider are excessive stress, sleep disorders (such as insomnia and sleep apnea), altered thyroid function and respiratory conditions (such as COPD) (“Fatigue,” 2020). More specifically, stress and sleep disorders go together. When a person faces excessive stress from life events, such as death or loss of a job, they can be irritable, depressed, and hopeless for a long period of time. This constant state of arousal can lead to sleeping trouble, ultimately causing a sleep disorder. The mix of these two conditions can cause fatigue (Browne, 2018). In addition, the thyroid impacts fatigue because this structure is responsible for metabolism. With too much thyroid hormone, the body goes into overdrive. When there is too little hormone, the body slows down. Organs involved in thyroid function include the brain, liver, kidneys, bones, and skin. Fatigue is mostly impacted by hypothyroidism because there is a slowing of body systems causing not only fatigue, but also constipation, dry skin, and brittle nails and skin (“The lowdown on thyroid slowdown,” 2018). Hence, fatigue is a general symptom caused by several different conditions.  

APA References, 2

Critical Reflective AnalysisIn developing your genogram and learning plan you were required to collect significant personal data that has influenced your lifestyle and consequently your personal health and wellness. Looking at this information and your personal learning plan a meaningful event must have come to mind. This event would have been an incident that probably impacted your lifestyle in a negative fashion; as an example a divorce, an accident or a sudden death of a family member from familial links. How did this affect your overall health using the six dimensions of wellness?  How does the research support the findings?  What does this mean for you?  With the knowledge you have gained how has this changed your perspective? Why? What changes will you make?Using the LEARN headings write a critical analyses highlighting the abstract ideas underlying your reflection.  Use specific details and at least three references to defend your conclusions. Criteria for Evaluation and GradingFormat:

1. 5 pages (excluding title and reference page)
2. 12 font Arial or Times New Roman
3. Double spaced
4. Minimum of 3-4 references
5. APA format (link)
6. Submit in a Word.doc document

LEARN HEADINGS

1. Look Back
   1. Present a meaningful event
   2. Outline event concisely
2. Elaborate
   1. Summarize event in detail (what happened, who was involved, where the event occurred, your involvement)
   2. Describe personal feelings and perceptions of self and others
3. Analyze
   1. Identify one key issue to analyze
   2. Use literature as a guide with at least 3 evidence based journal articles
   3. Compare and contrast the event with knowledge acquired in reading
   4. Discuss the new perspective (view) you have acquired through the literature
4. Revise
   1. Refer back to your acquired knowledge and analysis
   2. Explain how you would preserve or change your perspective
   3. Discuss rationale for considering the change in your life
   4. Suggest alternative strategies you are presently using as a result of this analysis
5. New Perspective
   1. Identify recommendations for future revision of your lifestyle

Guidelines to assist reflective writing:

1. Occasion for reflection: (an experience – seen, read, heard)
   1. Presents experience through use of concrete, sensory language, quotations and narrative accounts
   2. Shows depth of thought
   3. Indicates creativity
2. Reflection ( exploration and analyzes)
   1. Reveals feelings and thoughts through presentation of the experience
   2. Conveys evidence of a personal response to the experience
   3. Enables reader to understand the abstract ideas underlying the reflection through use of specific detail
   4. Demonstrates good meta-cognition
3. Writing Strategies
   1. Uses convincing language and scenarios to detail reflection
   2. Uses comparison and imagery
   3. Enhances reflection through contrasting and explaining possibilities
   4. Makes inferences
   5. Develops new ways of reflecting upon nursing and nursing practice
4. Coherence and style:
   1. Demonstrates insight through natural flow of ideas
   2. Provides an effective conclusion
   3. Presents ideas in natural progression

M2: Lesson 7 – Discussion

1. Create an original posting with a minimum of 250-300 words.
2. Please respond to one (1) of your classmates with a minimum of 100 words.
3. Back up your arguments with reliable evidence.
4. View Grading Rubric

Systematic Review, Meta-analysis, Clinical Practice Guidelines and Protocols

Instructions:

1. Search and locate one systematic review or practice guideline in your topic of interest (Include the citation).
2. Evaluate the following:
   1. The systematic review or practice guideline relies primarily on studies conducted in the last five years.
   2. The review provides support for the importance of the study
   3. The authors have use primary, rather than secondary sources.
   4. Studies are critically examined and reported objectively
   5. The systematic review or practice guideline is organized so that a logical unfolding of Ideas is apparent that supports the need for the review
   6. The systematic review or practice guideline ends with a summary of the most important knowledge.

To begin the discussion, click on the “Create Thread” link above.

1. In 3 or 4 sentences, explain the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse. Which drugs are contraindicated, if any, and why? Be specific. What is the timeframe that the patient should see resolution of symptoms?
2. List 4 predictors of late onset generalized anxiety disorder. 
3. List 4 potential neurobiology causes of psychotic major depression.
4. An episode of major depression is defined as a period of time lasting at least 2 weeks. List at least 5 symptoms required for the episode to occur. Be specific.
5. List 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia. Be specific. 

 The disorder in my discussion being presented is Generalized Anxiety Disorder (GAD). GAD is one of the most prevalent psychiatric conditions in the United States. Individuals with a poor health status are at a greater risk for GAD. Other factors include being female, lower socioeconomic class, poor education, and a large amount of lifestyle stress (Locke et al., 2015).

          The exact cause for GAD is unknown. However, studies have shown that patients with GAD have shown more significant activity in parts of the brain related to mental activity and introspective thinking after anxiety episodes. Additional studies involving twins have shown that a person’s environment and genetic make-up affect whether or not an individual will be diagnosed with GAD (Locke et al., 2015).

          In the patient diagnosed with GAD, I first chose Zoloft 50 mg oral daily for treatment. I decided on this medication because Zoloft is a selective serotonin reuptake inhibitor (SSRI), and SSRIs are the preferred treatment choice for patients with GAD (Locke et al., 2015). After four weeks of taking Zoloft, the patient had a HAM-A score of 18.

          The HAM-A or Hamilton Anxiety Rating Scale was first used in 1959 and is a survey of 14 questions. Both psychological and somatic symptoms relating to anxiety are assessed in the HAM-A questionnaire.   If patients score greater than 17, then symptoms considered are mild. However, a score of 25-30 indicates moderate to severe anxiety (Thompson, 2015). The patient in the scenario originally had a HAM-A score of 26 that decreased to 18 after one month of taking Zoloft. This was a significant improvement.

          At the first follow-up visit, I would increase the Zoloft to 75 mg. With a HAM-A score of 10 on the follow-up visit, I would not change the dosage of Zoloft at that time and continue to schedule follow-up visits with the patient. Since GAD is a chronic disorder, it is recommended that medication therapy continues for twelve months before considering a slow wean off Zoloft (Rosenthal & Burchum, 2018). I would also highly suggest that the patient undergo psychotherapy treatment. It has been shown that patients with moderate to severe GAD show more significant improvements when medication and psychotherapy are combined (Locke et al., 2015).

  References

Locke, A. B., Nell, K., & Schultz, C. D. (2015). Diagnosis and Management of Generalized Anxiety Disorder and Panic Disorder in Adults. American Family Physician, 91(9), 617–623.

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s Pharmacotherapeutics for Nurse Practitioners and Physician Assistants (1st ed.). Elsevier .

Thompson, E. (2015). Hamilton rating scale for anxiety (ham-a). Occupational Medicine, 65(7), 601–601. https://doi.org/10.1093/occmed/kqv054