Understanding what resources are available for vulnerable populations is an important aspect of holistic patient care. Many patients lack access to affordable healthcare, have a low income, poor health literacy and experience difficulty navigating the system. As a trusted member of their healthcare team, it often falls to you, the nurse, to make recommendations and referrals to services within the patient’s local area that could improve your patient’s long-term health modifications. What public resources exist within your community that are beneficial for your patient population? Please identify and briefly discuss three (things to include: what type of services does it provide, how is it funded, who is eligible).

 For example, in East Texas we have:

1. The Salvation Army – Homeless shelter, grocery assistance/soup kitchen, rehab programs, after school programs, employment assistance. Government funded.
2. NET (North East Texas) Public Health Center for Healthy Living – Goal is to prevent illness, promote health, and protect the community. Low cost STD testing, Surveillance of emergency & disaster preparedness, affordable immunizations, monitors vital statistics, provides environmental health services. Sets patrons up with free preventative screens, diabetes education classes, substance abuse assistance, and smoking cessation assistance. Government funded.
3. P. A.T.H. – People Attempting To Help – not for profit organization that assists individuals with dental, medical, prescription, visual, food, rent, utilities, housing assistance.

Respond  of your colleagues who were assigned to a   different case than you. Explain how you might apply knowledge gained   from your colleagues’ case studies to you own practice in clinical   settings as a Psychiatric Nurse Practitioner.

NOTE: Positive comment

                                            Main Post

The three questions this writer would as the patient are: 

Did your depressive symptoms worsen after the death of your husband? 

How many hours per night do you sleep on average? 

Do you sleep throughout those hours of sleep or do you wake constantly? 

Do you ingest any stimulants like coffee or chocolate before bed? 

Do you sleep during the daytime? 

The rationale behind question one is to gauge the timeline of the  patient’s depression. She appears to have been suffering with untreated  depression for a long time, however the additional symptoms of insomnia  and tearfulness seemed to worsen after his death. With this information  the nurse practitioner will know if her depression is in an acute state  and the severity of her illness.The patient is reporting sleeplessness;  however the nurse practitioner needs to gauge if the patient is  participating in restful sleep. Sleep of two hours or less may only  consist of REM sleep (Boland et al., 2020). If the patient is not  getting restful sleep, she is not benefiting from the bodily repair that  takes place during sleep (Fitzgerald et al., 2017).  This can place her  at an increased risk for other illnesses and heighten depressive  symptoms (Uchmanowicz et al., 2019).Knowing if the patient sleeps  consistently throughout those hours of sleep will provide information to  the nurse about the kind and amount of sleep the patient is getting.  Ingesting certain stimulants like caffeinated drinks, coffee or  chocolate can affects the client’s sleep by providing wakefulness (Ulke  et al., 2017).  If the patient is sleeping during the daytime, her  circadian rhythm could have been reversed where she will need less sleep  during the night time hours (Fitzgerald et al., 2017).

The people this writer would interview are:

The patient’s aide 

The patient’s son 

The patient aide may be able to provide more information about  observed sleepiness during the daytime. In addition, she will be able to  provide information on the patient’s dietary patterns and physical  activity. The questions to the aide would be:    

Does she easily nod off during the daytime? 

Does she easily become fatigued? 

Does she consume a well-balanced diet? 

Question one would illicit answers about her getting sleep. 

It appears that she in fact getting sleep but because of a revered  circadian rhythm she is not able to get the sleep at the night which is  the desired time.  Question two will help the nurse practitioner gauge  the extent of the effects that non sleep has taken on the patient’s  life. The patient, if constantly fatigued throughout the day has a life  that has been highly impacted by the lack of sleep. The aide would be  able to provide a clear, picture of the patient’s diet. The aide would  be able to reveal if the patient consumes a vast amount of sugar or  caffeine which could interrupt sleep.

Questions to the son would surround the family’s psychiatric history.   These questions will help the nurse practitioner construct the family  history of the patient and rule out or consider familial history as a  cause for her symptoms.

Can you recall any maternal family members with psychiatric disorders including depression and insomnia? 

Did the symptoms start after the death of the client’s husband?  

This would help the nurse practitioner rule out depressive symptoms as the cause of her insomnia.

Physical Examinations and Tests

Sleep Study:

Polysomnogram – The sleep study or polysomnogram  measures the brain waves, blood oxygen, leg movements and breathing  during sleep (Meghdadi et al., 2019). The Nurse Practitioner would be  able to rule out physiological reason’s ad the cause for the patient’s  insomnia.

Actigraphy: This is where a small device is worn on  the wrist and it measures the person’s sleep wake cycle for a specified  period (Meghdadi et al., 2019). This is convenient for this client and  the Nurse Practitioner would be able to monitor the client’s sleep  health and gauge the severity of the disruption of her sleep.The nurse  practitioner could also physically examine the patient’s nares for  septal occlusion.

Septal occlusion or deviation could lead to problems  with sleeping even during sleep, this would be important for the nurse  practitioner to evaluate as this could be interfering with the patient’s  sleep.

Epworth sleepiness scale – assesses the patient’s  tendency to nod off in various situations (Meghdadi et al., 2019).  For  this client it would be necessary for the nurse practitioner to assess  the severity of her nodding off during the day time especially at  unexpected times like during eating and other activities that would put  her safety at risk. 

Differential Diagnosis

G47.00 Unspecified Insomnia Disorder– The patient is  experiencing insomnia at nighttime that could be related to several  factors. She reports staying up late to watch T.V., depressive symptoms,  restless leg syndrome, sleep apnea and sleeping during the daytime.  Some of these factors have not been ruled out yet as the cause of her  anxiety. 

G47.23 Persistent Irregular Sleep Wake type severe 

F32.9 Unspecified Depressive Disorder 

G25.81 Restless legs syndrome 

Medications:

Trazodone 50 mg – This medication would be the first choice as it  offers antidepressant properties as well as promotes sleep in those  diagnoses with insomnia. It is generally safe for the elderly population  at low doses (Pagel et al., 2018). The Nurse Practitioner should  monitor the patient and evaluate the needs to slowly increase or in some  cases decrease the dose. 

Rozerem 8 mg- Is a nonbenzodiazepine hypnotic that promotes sleep.  The patient would benefit from his, but an added benefit would be that  she would be at a diminished risk of falls as this is a concern  following the use of hypnotics in the elderly. This drug is reported as  one that would prevent less falls from over sedation (Pagel et al.,  2018).

Lessons Learned            

This writer has learned that it is important to conduct a complete  evaluation of the patient and not just focus on the presenting symptoms.  There are additional environmental and physiological symptoms that  could be attributed to the patient’s insomnia. In this case the patient  had several factors that could be contributing her insomnia and they  needed to be ruled out. The cause of her insomnia could have been  physiological from the sleep apnea or from her habits of staying up tool  late at nights and sleeping during the daytime. It is also important to  evaluate medications, social and economic factors before the resorting  to pharmacological interventions. 

References

Boland, E. M., Vittengl, J. R., Clark, L. A., Thase, M. E., &  Jarrett, R. B. (2020). Is sleep disturbance linked to short- and  long-term outcomes following treatments for recurrent depression? Journal of Affective Disorders, 262, 323–332. 

FitzGerald, J. M., O’Regan, N., Adamis, D., Timmons, S., Dunne, C. P., Trzepacz, P. T., & 

Meagher, D. J. (2017). Sleep-wake cycle disturbances in elderly acute  general medical inpatients: Longitudinal relationship to delirium and  dementia. Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring, 7, 61–68. 

Meghdadi, A. H., Popovic, D., Rupp, G., Smith, S., Berka, C., &  Verma, A. (2019). Transcranial Impedance Changes during Sleep: A  Rheoencephalography Study. IEEE Journal of Translational Engineering  in Health and Medicine, Translational Engineering in Health and  Medicine, IEEE Journal of, IEEE J. Transl. Eng. Health Med, 7, 1–7.  

Pagel, T., Seithikurippu R. Pandi-Perumal, & Jaime M. Monti. (2018). Treating insomnia with medications. Sleep Science and Practice, (1), 1. Uchmanowicz I, Markiewicz K, 

Uchmanowicz B, Kołtuniuk A, & Rosińczuk J. (2019). The  relationship between sleep disturbances and quality of life in elderly  patients with hypertension. Clinical Interventions in Aging, 155. 

Ulke, C., Sander, C., Jawinski, P., Mauche, N., Huang, J., Spada, J.,  Hegerl, U. (2017). Sleep disturbances and upregulation of brain arousal  during daytime in depressed versus non-depressed elderly subjects. World Journal of Biological Psychiatry, 18(8), 633–640.    

Comment (1) 150 words references and citation

Health Issues of Middle Age that Exercise can Prevent

Prevalence of the Problem in the US

Health promotion measures you would introduce/ physical exercise you would suggest/ Approach to gain cooperation

Obesity- Obesity is defined by the CDC as having a body mass index of 30 or more. Those with a body mass index of 25.0 to <30 are considered overweight and at-risk for obesity (CDC, 2019).

42.8% of middle-aged adults in the U.S. are obese.

For patients who are already obese, the likelihood that they are getting enough physical activity is low. When developing a health promotion plan, the nurse should include the patient in formulating that plan. Activities should be based upon patient’s current level of fitness. It is not realistic that someone who is already obese would be able to go out and run a mile every day. The Physical Activity Guidelines for Americans recommends starting with low expectations and slowly increasing physical activity as tolerance is built (Department of Health and Human Services, 2018). Activities such as swimming, biking, walking, playing sports and even gardening are good ways to start. If someone’s current health state or physical fitness does not allow for much exercise, it is important to remind them that any activity is better than none. They can start as low as they need to, once their small goals are attained, they move on to bigger ones. They should continue doing this until they can meet the recommendations for physical activity. 150 minutes per week of moderate-intensity aerobic activity is the recommended amount of physical activity for adults (CDC, 2020). Moderate-intensity aerobic activity is any activity that causes an increase in heart rate. Allowing for patient to slowly increase activity over time is a good approach to increase their cooperation.

Diabetes Mellitus Type II- Diabetes is a chronic disease in which your body either does not produce enough insulin which is Type I, or your body’s cells have become resistant to insulin which is Type II. The most common form of Diabetes is Type II. 90-95% of Diabetics are Type II (CDC, 2019).

9.4% of people in the U.S. have Diabetes, 33.9% have prediabetes.

One of the leading risk factors for Type II Diabetes is Obesity. Given that, recommendations the nurse should make for activity to prevent Diabetes Type II are the same as those to someone who is obese. One difference would be the education needed regarding blood sugars. Patient’s with diabetes need to be educated on the effects exercise can have on blood sugar levels and the need to monitor levels more closely when increasing activity levels in order to prevent hypoglycemic episodes. This is extremely important if the patient is utilizing insulin. They may need to plan to exercise during specific times of day depending on how it effects their blood sugar levels (Colberg, 2008).

References

Centers for Disease Control (CDC). (2019, December 23). Diabetes. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/diabetes/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fdiabetes%2Findex.htm

Centers for Disease Control and Prevention (CDC). (2019, November 21). Overweight and Obesity. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/obesity/index.html

Centers for Disease Control and Prevention (CDC). (2020, January 9). Physical Activity. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/physicalactivity/basics/adults/index.htm

Colberg, S. (2008, December 30). Timing of Exercise and Your Insulin Levels. Retrieved from Diabetes in Control: http://www.diabetesincontrol.com/timing-of-exercise-and-your-insulin-levels/

Department of Health and Human Services. (2018). Physical Activity Guidelines for Americans. Retrieved from Department of Health and Human Services: https://health.gov/paguidelines/second-edition/pdf/Physical_Activity_Guidelines_2nd_edition.pdf

comment (2) 150 words references citation

Health Issues of Middle Age that Exercise can Prevent

Prevalence of the Problem in the US

Health promotion measures you would introduce/ physical exercise you would suggest/ Approach to gain cooperation

 Type 2 Diabetes Diabetes  have increased as well. In 2017, the CDC reported that more than 100 million Americans have diabetes (CDC, 2017d).

 Type 2 diabetes can be reversed with weight loss and diet modification.

Develop a healthy eating and activity plan

Drinking more water and fewer sugary drinks

Eating more fruits and vegetables

Making favorite foods healthier

Making physical activity more fun

 Hypertension (HTN) Per centre of disease control the prevalence of hypertension has been increased in middle age from 18 to 39 from 7.2% to 33.2%, also the report says that 74 millian people is suffering from hypertension (2020), it is overall 54% that means 1 out of 3 adult does hav HTN

For health promotion and prevention of hypertension i will suggesst my patient that  High blood pressure increases your risk for heart disease and stroke, two leading causes of death in the United States. No matter your age, you can take steps each day to keep your blood pressure in a healthy range.

By living a healthy lifestyle, you can help keep your blood pressure in a healthy range and lower your risk for heart disease and stroke. A healthy lifestyle includes:

Eating a healthy diet.

Maintaining a healthy weight.

Getting enough physical activity.

Not smoking.

Limiting alcohol use.

As an example of health eating habit considers prevent salt on top of the food, try to follow ‘ B ‘ diet that mean baked, boiled, broiled, Also help to eucatate the patient by adding green vegetable, fruit, fibers,in regular basis 

we sould encourage patients to maintain healthy weight by having a healthy choice in eating, early habits of eating, avoid junk food, soda, sweets, oily food.

I would also introduce to manage or prevent HTN is 30-60 minutes of aerobic activity, specifically a brisk walk, 3-4 times a week with a long-term goal of 60 minutes, four time a week.start going to the gym do cardio exercise, running.

quit smoking is also very healpfull in decreasing hypertension rate

Referance

Centers for Disease Control and Prevention. (2017d). New CDC report: More than 100 million Americans have diabetes or prediabetes. Retrieved from https://www.cdc.gov/media/releases/2017/p0718-diabetes-report.html

center of disease contro and prevention(october 2018) nach data 

Submit a paper which compares and contrasts two mental health theories:

• You may choose your theories from the textbook or from other sources.
• Describe each theory, including some history about the person who developed the theory and the major ideas and applications of the theory.
• Describe the ways in which the two theories are similar, and how they differ.
• Include a statement of how each theory could be used in your nursing practice. Include specific patient examples if you have them. You may also critique the theory: Is there anything with which you disagree or are there any problems you can identify?
• It is expected that this essay will be 2-3 pages in length (not including the title page), double-spaced. Your paper should include an introduction and conclusion and proper APA citations from any source material you use, including your text.

View the scenario called “Critical Decision Making for Providers” found in the Allied Health Community media (https://lc.gcumedia.com/hlt307v/allied-health-community/home.html).

In a 750‐1,200 word paper, describe the scenario involving Mike, the lab technician, and answer the following questions:

1. What were the consequences of a failure to report?
2. What impact did his decision have on patient safety, on the risk for litigation, on the organization’s quality metrics, and on the workload of other hospital departments?
3. As Mike’s manager, what will you do to address the issue with him and ensure other staff members do not repeat the same mistakes?

A minimum of three academic references from credible sources are required for this assignment.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.