Care coordination

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DE-PRESCRIBING

**PLEASE FOLLOW THE RUBRIC ATTACHED IN FILES!!**

What is the importance of de-prescribing? How might you assist a patient to taper from a medication safely or transition to a new medication?

In this Assignment, you will use the following patient examples to write a 5- to 6-p P on considerations you have for how you might de-prescribe. Support your answers with five (5) evidence-based, peer-reviewed scholarly literature resources outside of Required Learning Resources in this course.

Note: APA style format

Patient Examples:

Patient 1: A 36-year-old male presents to your office being prescribed by his primary care physician (PCP) for the past 3 years an opioid analgesic medication for a work accident. He has chronic pain and is attending a pain clinic. It is determined the best course of treatment for pain is to remain on opioid medication. The patient is also being prescribed clonazepam 1mg BID for “relaxation” and panic attacks.

Patient 2: A 42-year-old female on alprazolam 1mg BID for panic attacks. Panic attacks have been in remission and the patient wants to taper off the medication. But, every time she has attempted to do so in the past, she experienced withdrawal effects. She is wondering how to safely taper off the benzodiazepine medication without having withdrawal effects.

Patient 3: A 24-year-old female prescribed lorazepam 1mg TID for generalized anxiety disorder. She recently found out she is pregnant (9 weeks gestation). She was referred to you by her OB-GYN to discuss this medication for her current situation. The patient is wondering if she can stay on the lorazepam through her pregnancy and postpartum, as it is an effective medication for anxiety symptoms. She plans to exclusively breastfeed for the first 6 months postpartum. She has not had any other trials of medication to treat anxiety as lorazepam has been effective.

Patient 4: A 71-year-old-male who comes to see you at the insistence of his daughter. His daughter expresses concern of memory loss and is wondering if he has the beginning stages of dementia. He is forgetful and seems to be tripping on things or walking into walls, although he has lived in the same home for the past 35 years. The patient does not agree with his daughter but does admit he has had a “few stumbles and falls” lately. Medication reconciliation shows the following medications: metoprolol ER 50mg q day, omeprazole 20mg q day, clonazepam 1mg TID, levothyroxine 75mcg q am. His daughter is wondering if he should be started on a “dementia medication.”

TO PREPARE FOR THIS ASSIGNMENT:

  • Review the assigned Learning Resources for this week.
  • Review the definitions presented in your text and resources for de-prescribing and tapering.
  • Consider the importance of de-prescribing.
  • Based on the example(s) provided, consider how you might de-prescribe a patient.

Answer the following questions using the patient examples described above.

Patient 1

  • What are the concerns of the patient remaining on the opioid medication and clonazepam?
  • How might you educate the patient about these risks and concerns?

The patient agrees that he should not continue both medications in combination. He would like to “get off” the clonazepam but worries about “bad withdrawals” that he’s heard about from stopping clonazepam “cold turkey” and is concerned about re-occurring panic attacks. How might you respond to the following:

  • How would you instruct the patient to taper off clonazepam?
  • What other medication would you recommend for the patient for the treatment of his panic attacks? Keep in mind, he will continue the opioid medication for pain relief.
  • How would you start the new recommended psychotropic medication for the patient?
  • Discuss one legal, ethical, or social consideration with the treatment plan.

Patient 2

  • The patient reports withdrawal symptoms when previously tapering off the alprazolam. What symptoms are common withdrawal symptoms from this medication?
  • Provide the patient education of withdrawal symptoms that range from common and less serious to withdrawal symptoms that are a cause for concern and that should prompt patient should seek medical attention.
  • Given the patient’s history of having withdrawal effects from attempting to taper off alprazolam, what longer-acting benzodiazepine would you choose to convert the patient to?
  • What is the dose you would prescribe and how would you taper off the medication?

Patient 3

  • Review the potential risks, benefits, and side effects of continuing lorazepam throughout the pregnancy and postpartum for both the patient and fetus.
  • Review other alternative medications to treat generalized anxiety disorder. Include risks, benefits, and potential side effects to both the patient and the developing fetus. Keep in mind, the patient is looking to breast feed for 6 months postpartum.
  • The patient agrees that it would be safest for her pregnancy and fetus to discontinue the lorazepam. How would you recommend she discontinue lorazepam? Provide education on potential side effects from tapering off the medication, including common side effects to more serious side effects and when to seek medical attention.
  • The patient would like to forgo medications at this time, given she is early in her pregnancy and is concerned about “damage” to the fetus if she were to continue medications. Provide education to the patient about the risks of untreated anxiety symptoms during pregnancy for both the patient and the fetus.

Patient 4

  • Review potential side effects for elderly on benzodiazepines providing education to both the patient and the patient’s daughter. What are the risks of continuing the benzodiazepine for this patient?
  • How would you evaluate the patient for these side effects?
  • The patient and daughter agree he will need to taper off the clonazepam given the risks of continuing this medication. How would you recommend tapering off this medication?
  • Review with the patient and daughter potential side effects of tapering off the medication. Review with them common side effects to more serious side effects and when to seek medical attention.

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4k25 research

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Nursing homework help

Select two health care service providers.

Write a 700- to 1,050-word paper discussing the health care service providers selected and the products and support they provide.

Providers of Service Options:

  • Preventative care or public health
  • Ambulatory or primary care
  • Subacute or long-term care
  • Acute care
  • Auxiliary services
  • Rehabilitative services
  • End-of-life care
  • Mental health services
  • Emergency management or disaster preparedness
  • Dental services
  • Military and veteran services
  • Indian health services

Include the following in your paper:

  • Identify the selected health care service provider.
  • Identify two services and products they provide to help with quality of care.

Cite at least one peer-reviewed or scholarly reference and your textbook to support your information. For additional information on how to properly cite your sources check out the Reference and Citation Generator resource in the Center for Writing Excellence.

Format your paper according to APA guidelines. Your paper must include an introduction, conclusion, and a reference page.

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Interpreting Statistical Output for Data Analysis PowerPoint Presentation

Assignment – Interpreting Statistical Output for Data Analysis PowerPoint Presentation

Purpose:

The purpose of this Assignment is to enable you to present the information that you gather from a systematic review on your PICOT topic. This activity will give you the experience to present what your research findings to others.

My PICOT question is: The Benefits of a Kidney Transplant versus Dialysis

 

Directions:

  1. Define the clinical key questions based on PICOT.
  2. Briefly review the database selected for key clinical questions.
  3. Identify the studies of the database search that are a Level I or II evidence.
  4. Interpret the statistical results of the studies identified in Step 3.
  5. Design a presentation.
    1. Place results /overview of research in PowerPoint.
    2. Length of the presentation should be 12–15 slides.
  6. Follow APA format.

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Proposal for Change Paper

 This paper is a proposal for change paper, meaning how and what Nurse Practitioners (a leader) can do to enact the change. attached you will see a list of change theories, you have to select a change theory and use it as a framework for the change you want to implement. Make sure in the first part of the paper you discuss the topic licensing/credentialing issues, why its a problem, and the change model you chose, the purpose statement/ thesis.
the second part would be about how to enact the change, how you will communicate with people, how to get peoplel to collaborate, what strategies will you use. and the 3rd part is about the disadvantages and advantages.
please include an intro and conclusion

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Nursing homework help

Why have specific laws pertaining to the health care? If you had the ability to create and enact a new healthcare law, what would it be? Why would you enact it? What would be its impact on the healthcare field?

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Critique article analysis

Please use the article Preview the documentView in a new windowThe lived experience of women victims of intimate partner violence”Preview the documentView in a new window to complete this critique.

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Nursing homework help

Working in a diverse environment lends to the opportunity of a variety of people bringing forward different ideas to increase the patient experience. In your role as an allied healthcare professional, you will interact with patients from a variety of cultures, backgrounds, religious practices. For this week’s assignment predict at least 2 diversity issues that you might encounter in your role as an allied healthcare provider. How will these issues impact care? What can health care organizations do to assist their employees in providing care to a diverse patient population?

Submit your completed assignment to the drop box below. Please check the Course Calendar for specific due dates.

Save your assignment as a Microsoft Word document. (Mac users, please remember to append the “.docx” extension to the filename.) The name of the file should be your first initial and last name, followed by an underscore and the name of the assignment, and an underscore and the date. An example is shown below:

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WK 9 DISCUSSION

Chronic Back Pain

 

Patients frequently present with complaints of pain such as chronic back pain. They often seek medical care with the intent of receiving drugs to manage the pain. Typically, for this type of pain, narcotic drugs are often prescribed. This can pose challenges for you as the advanced practice nurse prescribing the drugs. While there is a process for evaluating back pain, it can be difficult to assess the intensity of a patient’s pain because pain is a subjective experience. Only the person experiencing the pain truly knows whether there is a need for drug treatments. This makes it important for you, as the prescriber, to watch for red flags and warning signs of abuse. In this Discussion, you explore the ethical implications of prescribing narcotics to patients with chronic back pain.

 

 

 

To prepare:

 

•Review this week’s media presentation on evaluating back pain, as well as Chapter 15 of the Buttaro et al. text in the Learning Resources. Reflect on the evaluation process for a patient with a history of back pain.

 

•Consider how you might evaluate a patient that presents with back pain. Think about potential red flags and warning signs of drug abuse.

 

•Reflect on the ethical implications of prescribing narcotics for chronic back pain.

 

•Think about what you would prescribe and why.

 

 

 

Post  1 to 2 page  paper on:  A  description of how you might evaluate a patient who presents with back pain. Then, describe potential red flags and warning signs of drug abuse. Explain the ethical implications of prescribing narcotics for chronic back pain. Finally, explain what you would prescribe for patients and why.

 

 

 

References

 

Readings

 

•Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2013). Primary care: A collaborative practice (4th ed.). St. Louis, MO: Mosby.

 

◦Part 2, “Primary Care: Adolescence Through Adulthood”

 

◾Chapter 15, “Chronic Pain” (pp. 96–101)

 

◦Part 15, “Evaluation and Management of Musculoskeletal and Arthritic Disorders” (pp. 887–983)

 

Media

 

•Laureate Education, Inc. (Executive Producer). (2013b). Case study: Evaluating back pain. Baltimore, MD: Author.

 

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