Marcus, an 18-year-old high school senior, presents with symptoms of difficulty sleeping and feeling sad, which result in an initial diagnosis of depression. His mother later reports, however, that Marcus exhibits symptoms of irritability and risk-taking behaviors. (His little brother reported to his mother that they were driving over 90 miles an hour on the highway.) After further evaluation, Marcus’ psychiatric nurse practitioner diagnoses him with bipolar disorder. 

Cases like this are not uncommon with bipolar disorder, as initial assessments rarely provide all the information needed. In your role, as a psychiatric nurse practitioner, you must develop strategies for properly assessing and diagnosing these patients because treatments for bipolar disorder are significantly different than treatments for depression or other mood disorders. 

This week, as you examine bipolar therapies, you explore the assessment and treatment of patients with bipolar disorder. You also consider ethical and legal implications of these therapies. 

Assignment: Assessing and Treating Patients With Bipolar Disorder

Bipolar disorder is a unique disorder that causes shifts in mood and energy, which results in depression and mania for patients. Proper diagnosis of this disorder is often a challenge for two reasons: 1) patients often present as depressive or manic but may have both; and 2) many symptoms of bipolar disorder are similar to other disorders. Misdiagnosis is common, making it essential for you to have a deep understanding of the disorder’s pathophysiology. For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat patients presenting with bipolar disorder.

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 requiring bipolar therapy.

The Assignment: 5 pages

Examine Case Study: An Asian American Woman. Diagnosis-Bipolar Disorder. 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.

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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.

Discussion Question:

What community health nursing intervention strategies will best be suited to address your selected health concern? How you will integrate these methods into your project?

Your initial posting should be 400 words in length and utilize at least one scholarly source other than the textbook.

Discussion Question:

Define patient-centeredness in the context of evidence-based practice. Describe barriers to the implementation of patient-centered evidence-based care in your practice environment and share actions that might be taken to alleviate these barriers. 

Your initial posting should be at least 400 words in length and utilize at least one scholarly source other than the textbook

Blueprints are used by others besides architects. New home buyers may use the blueprint of their future home to better understand the architect’s vision and to consult with the architect on changes. Municipalities will use the blueprint to issue building permits. Builders will use it to plan construction and estimate costs.

Likewise, you don’t have to be a database designer to apply visual tools such as database diagrams. For example, creating or studying a database diagram can help you, as a leader in a healthcare organization, understand the data needs of the organization or of your team.

This is in turn can create efficiencies and drive improvements at varied levels of patient care. As a nurse, database diagrams can help you analyze the data structure and how to make best use of the available data and functionality in the provision of care. At every level of an organization, an understanding of database diagrams can help in providing feedback to database managers that in turn can help drive improvements.

In your Module 2 Assignment, you create a database diagram for the database that you proposed in the Week 3 Discussion and built upon in the Week 4 Discussion. You also create a PICOT question to be used to search your proposed database. Finally, you develop an analysis of your database design, explaining the proposed structure and design elements while justifying your approach.

To prepare:

• Review the Learning Resources.
• Review your posts from the Weeks 3 and 4 Discussions and the scenario on which they are based.
• Consider a clinical research question you might ask that could be informed by the data in your database.
• Restate your clinical question as a PICOT question.

Assignment (2- to 3-page paper and a diagram of a database as an appendix):

Using the scenario from Week 3, create a diagram of your proposed database using Microsoft Word.

• Include the additions made in Week 4.
• Complete the diagram first, but place it as the final page or pages of your submission. The diagram is separate from the required page count.

In the narrative portion of the assignment:

• Explain how your diagram articulates your planned design.
• Explain the principles behind selecting key fields and defining relationships. Be specific and support your response with evidence.
• Write a sample PICOT question (i.e., a query) you might ask based on the information in the database created during Weeks 3 and 4 to demonstrate your understanding of the connection between data and research.
• List the tables in the database that you would need to include when answering your question.

BETH MARTINS

Explain the difference  between the types of diabetes, including type 1, type 2, gestational, and juvenile diabetes 

Type I Diabetes is hyperglycemia due to insulin deficiency. This is caused by autoimmune destruction of B cells that are within the islets of Langerhans (Chetan, Thrower,& Narendran, 2019). Some signs surrounding Type I DM is polydipsia, polyuria, and weight loss. This is more common in children, but can be diagnosed at any age throughout life. Type I diabetes used to be called juvenile diabetes,but this is now known to not be the correct way to view this disease. 

Type 2 Diabetes is impaired insulin secretion and abnormal suppression of postprandial (Hurtado & Vella, 2019). Type 2 DM the pancreas resists insulin, or does not produce enough insulin on  its own. Often Type I and Type 2 DM  are diagnosed incorrectly or mistaken for each other as signs and symptoms are similar. Being overweight or reduced amount of exercise is though to be a contributing factor as well as genetics, but this is till not fully understood. 

Gestational diabetes is characterized by spontaneous hyperglycemia during pregnancy. Some risk factors include family history of diabetes, obesity during pregnancy, and advanced maternal age (Plows, Stanley, Baker, 2019). B cell dysfunction which lacks the ability to release insulin when the body needs it is what causes gestational diabetes. 

Consider one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Then, reflect on dietary considerations related to treatment.

Patients who have Type 2 DM have both insulin resistance and impaired insulin secretion (Rosenthal & Burchum, 2021). The liver, muscle and adipose tissue are insulin resistant and increased blood sugar causes B cell function to fail. Insulin secretion decreases and B cells must increase how hard they must work to work against insulin resistance within the tissues (Rosenthal & Burchum, 2021).  

The medication I chose os Metformin from the class of Biguanide medications for treatment of Type 2 DM. Metformin uses 3 mechanisms to help lower blood sugar. 

• Inhibits glucose production in the liver
• Reduces glucose absorption in the gut
• Sensitizes insulin receptors in fat and skeletal muscle 

Metformin is taken by mouth and is absorbed by the small intestines and excreted by the kidneys. Metformin is known to be a great choice for those who skip meals as it will not make blood sugar levels become dangerously low. Those with DM Type 2 should eat healthy carbs such as fruits and vegetables and not indulge in sugary drinks. Protein and polyunsaturated fats should be a staple in the everyday diet. Alcohol should be avoided, and the patient should try to eat several small “meals” per day tp keep blood sugar steady. If blood sugar becomes low  having a sugary snack with a complex carbohydrate such as peanut butter and crackers should be on hand.

Short-term and long-term impact of DM Type 2, including effects of drug treatments.

Metformin is not considered to be a good consideration of DM Type 2 treatment with patients who have impaired kidney function. Patients with liver impairment, history of lactic acidosis, severe infection, or are heavy drinkers are not appropriate for treatment with Metformin as it can cause metabolic acidosis and can be deadly (Rosenthal & Burchum, 2021). Metformin can commonly cause decreased appetite, nausea and gastrointestinal upset. Metformin can also be helpful with some weight loss along with proper diet and nutrition. Chronic issues with diabetes type 2 are mitochondrial overproduction of oxidative gree radicals which causes damage to micro- and macrovascular system and causes many of the complications diabetics suffer from (McCance & Huether, 2019) This can be the cause of cardiovascular disease, stroke, infection, PAD, neuropathy, retinopathy, and kidney disease to name a few complications. 

 Chetan, Thrower, Narendran, (2019) What is type 1 diabetes?(2019),ISSN 1357-3039,https://doi.org/10.1016/j.mpmed.2018.10.006.(http://www.sciencedirect.com/science/article/pii/S1357303918302664) Medicine,Volume 47, Issue 1

Hurtado, M. D., & Vella, A. (2019). What is type 2 diabetes? Medicine, 47(1), 10–15. https://doi-org.ezp.waldenulibrary.org/10.1016/j.mpmed.2018.10.010 

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.

Plows, J. F., Stanley, J. L., Baker, P. N., Reynolds, C. M., & Vickers, M. H. (2018). The Pathophysiology of Gestational Diabetes Mellitus. International journal of molecular sciences, 19(11), 3342. https://doi.org/10.3390/ijms19113342 

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

AUGUSTA URUBISI

Endocrine System Disorder and the Treatment of Diabetes

In the United States, approximately 34.2 million people have diabetes which covers 10.5% of the total population. Other than this, around 88 million people above 18 years old are considered to be pre-diabetic which is 34.5% of the adult US population. This makes diabetes as one of the top public health issues in the country (Centers for Disease Control and Prevention, 2020).

Diabetes mellitus or commonly known as diabetes is a metabolic disorder that is further divided into several classifications – type 1 or juvenile diabetes, type 2 diabetes and gestational diabetes. All of these share a common feature which is hyperglycemia caused by defects in insulin production, action, or both. Type 1 diabetes is an autoimmune disease wherein there is destruction of the pancreatic β-cell resulting in an absolute deficiency of insulin. It is the most common subtype diagnosed in patients below 20 years old, hence the name juvenile diabetes. Type 2 diabetes or T2D is caused by a combination peripheral resistance to insulin action and abnormal insulin secretion. It is classically considered “adult onset,” however, the prevalence of T2D in children and adolescents has been increasing at an alarming pace (Kumar, Abbas, & Aster, 2020). Lastly, gestational diabetes mellitus is the glucose intolerance developed during pregnancy. It occurs to around 7% of pregnant women in the US in which majority revert to normal postpartum but have an increased risk of developing DM in the next 10-20 years. It can also cause hyperglycemia in the fetus resulting in an increased birth weight and chance of caesarean section (Kasper et al., 2015). With the high prevalence of diabetes among children, adults and even pregnant women, it is important to know the different pharmacologic treatment for each type.

Pharmacologic treatment for gestational diabetes mellitus or GDM is similar to patients with pregnancy-associated diabetes. Insulin is the preferred anti-diabetic drug for managing GDM (Rosenthal & Burchum, 2018). Insulin works by promoting cellular glucose uptake and conversion of glucose to glycogen. Insulin can be divided into rapid-acting, short-acting, intermediate-acting, long-acting and super long-acting depending on the duration of the effects of the drug and its onset. The most common rapid-acting insulin is lispro. It is administered by subcutaneous injection, IV route, and continuous subcutaneous infusion (Katzung, 2018). In preparing the drug, it is important to ensure proper storage of insulin. Unopened vials of single type of insulin can be kept in the refrigerator until expiration date, however, vials that are in use should be stored at room temperature, avoiding proximity to sunlight or intense heat. Before administering insulin, proper dosage should be computed first depending on the patient’s caloric intake, activity, infection and stress. When administering the drug, appropriate needle length should be used as having too short could only reach the intradermal layer while having too long could reach the intramuscular layer. It is important to note that injection sites could affect the absorption of the drug. Highest absorption rate is in the abdomen while the least is in the thigh. When instructing patients, it is also important to ask for a return demo to make sure that the patient could administer the drug independently (ATI Nursing, 2019). Short term effects of this drug include hypoglycemia which is why it is also recommended to instruct the patient to have food always ready. Long term effects of the drug include hypokalemia. Patients are advised to report signs of hypokalemia such as muscle cramping and cardiac dysrhythmias since it can be fatal. Taking food high in potassium such as leafy green vegetables could help in avoiding hypokalemia. Gestational diabetes is usually short-term and resolves following delivery. Prolonged diabetes after parturition is no longer considered GDM and should be re-diagnosed and treated accordingly (Rosenthal & Burchum, 2018).

References

ATI Nursing (2019). RN Pharmacology for Nursing Review module edition 8.0. Assessment Technologies Institute, LLC.

Centers for Disease Control and Prevention (2020). National Diabetes Statistics Report, 2020. https://www.cdc.gov/diabetes/data/statistics-report/index.html

Kasper, D., Fauci, A., Hauser, S., Longo, D., Jameson, J., & Loscalzo, J. (2015). Harrison’s Principles of Internal Medicine (19th edition). McGraw-Hill.

Katzung, B. (2018). Basic and clinical pharmacology (14th edition). McGraw-Hill.

Kumar, V., Abbas, A., & Aster, J. (2020). Robbins & Cotran Pathologic Basis of Disease (10th edition). Elsevier.

Rosenthal, L. D., & Burchum. J. R. (2018). Lehne’s pharmacotherapeutics for nurse practitioners and physician assistants. Elsevier.

PLS USE 3 SOURCES FOR EACH DISCUSSION