Category: Health Care and Life Sciences : Nursing

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-page paper 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 7 style format guidelines will apply.
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.
THE ASSIGNMENT
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.
Reminder: All papers submitted include a title page, introduction, summary, and references.
 

Review the video, Case Study: Petunia Park. You will use this case as the basis of this Assignment. In this video, a Walden faculty member is assessing a mock patient. The patient will be represented onscreen as an avatar.
Consider what history would be necessary to collect from this patient.
Consider what interview questions you would need to ask this patient.
Consider patient diagnostics missing from the video: Provider Review outside of interview:Temp 98.2  Pulse  90 Respiration 18  B/P  138/88Laboratory Data Available: Urine drug and alcohol screen negative.  CBC within normal ranges, CMP within normal ranges. Lipid panel within normal ranges. Prolactin Level 8; TSH 6.3 (H)
Develop a Focused SOAP Note, including your differential diagnosis and critical-thinking process to formulate a primary diagnosis. Incorporate the following into your responses in the template:
Subjective: What details did the patient provide regarding their chief complaint and symptomatology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life? 
Objective: What observations did you make during the psychiatric assessment?  
Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest to lowest priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
Plan: What is your plan for psychotherapy? What is your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters as well as a rationale for this treatment and management plan. Also incorporate one health promotion activity and one patient education strategy.
Reflection notes: Reflect on this case. Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), social determinates of health, health promotion, and disease prevention that takes into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

How does the bureaucracy affect your life and freedom as an ordinary citizen? In what ways does it hinder or help your life? Do you see the bureaucracy as an effective aspect in your life, or do you see issues with the bureaucracy as it stands? Why/why not? List one issue you would change concerning the bureaucracy and how you would remedy the issue.
Use a minimum of 2 scholarly sources.

ab safety is integral to any laboratory experience. Laboratory experimentation can be a fun, hands-on way of connecting with the content, but, from chemicals to electrical equipment, many of the things that will be encountered while performing a chemistry experiment can be dangerous to oneself or others if not handled appropriately. Being prepared for a laboratory experiment and knowing what to do if an emergency arises can be the difference between a successful outcome and permanent injury. This assignment allows for students to internalize what lab safety means to them, and to examine some of the potential sources of hazard that will be faced in the laboratory.
After watching the GCU “Safety Videos for Chemistry,” write a 500- to 700-word paper on the importance of safety in a chemical laboratory. Include a description of proper personal protective equipment (PPE) that should be worn in the laboratory, the purpose of each PPE item, at least two examples of potential hazards that students could face in a chemistry laboratory setting, and a brief description on how a chemistry laboratory differs from biology or anatomy laboratory settings.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

Change is part of our daily healthcare environment. Clinical nursing judgments based on quality and safety, as well as protocols and standards, reflect our patient-centered care values.
What steps could you take to develop more resilience in your practice setting?
How might you communicate a change in practice to patients and nursing peers?

You must access the following article to answer the questions:
Boyle, D. K., & Thompson, S.A. (2020). CMSRNs’ continuing competence methods and perceived value of certification: A descriptive study. MEDSURG Nursing, 29(4), 229-254. https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=145282314&site=eds-live&scope=siteLinks to an external site.
Locate the literature review section. Summarize using your own words from one of the study/literature findings. Be sure to identify which study you are summarizing.
Discuss how the author’s review of literature (studies) supported the research purpose/problem. Share something that was interesting to you as you read through the literature review section.
Describe one strategy that you learned that would help you create a strong literature review/search for evidence. Share your thoughts on the importance of a thorough review of the literature.

Step 1: Download and complete the Week 3 Practicum Project: Community and Environment Assessment Worksheet Links to an external site..
Step 2: Review the Week 3 Practicum Project: Educational Materials document Links to an external site.. Select one educational resource related to your Practicum Project topic and the Week 3 Community and Environment Assessment findings.
Step 3: Answer the discussion prompts below with explanation and detail.
Paragraph one: Discuss the findings and trends in your community and environment assessment. Explain how they relate to your practicum topic.
Paragraph two: Examine the findings for indications of the social determinants of health (SDOH). Based on your observations, identify two strengths and two areas for improvement within the community.
Paragraph three: Consider your Community and Environment Assessment findings and selected educational material. Explain how this material is appropriate for your community. Discuss how it will help licensed healthcare professionals and community members improve health.
References: Provide complete references for all citations.
Step 4: Attach your educational material to the discussion post or insert the link into the post.
Posts should meet the following criteria:  
Integrate Evidence: Cite at least two sources of evidence in weekly posts. 
Integrate evidence from assigned reading(s) OR lesson. 
Integrate evidence from at least one outside scholarly source as directed in the discussion directions. 
Integrate evidence that supports the discussion. 
Cite all scholarly sources, reading(s) OR lessons in an in-text citation within the post and include a complete reference at the bottom of the post. 
Use sources no more than five years old unless they are historical references. 
Engage in Meaningful Dialogue: Engage with peers and/or faculty by asking questions, and offering new insights, applications, perspectives, information, or implications for practice.  
Respond to a peer and/or faculty post. 
Provide additional information or clarification in the reply post.  
Add depth to the discussion. 
Communicate Professionally: Communicate professionally on all posts.  
Communicate clearly and concisely. 
Communicate respectfully, civilly, and caringly. 
Communicate with minimal errors in English grammar, spelling, syntax, and punctuation. 
Participate: Participate during the assigned week. You are expected to meet the minimum participation requirement described below. You will receive a 10% point deduction in a graded discussion if you do not post at least two (2) times on at least two (2) different days during the assigned week.  
Post in the discussion at least two times. 
Post in the discussion on two different days. 

Mrs. T. is a 62-year-old woman who immigrated from Taiwan with her husband to rejoin their son who moved to the United States for a job eight years ago. Mrs. T. had a difficult time adjusting to life in a new country but was very happy to be reunited with her son and his wife, who are expecting a baby. Mrs. T. only speaks Mandarin and she moved to a neighborhood with a high concentration of Chinese speaking immigrants, which was helpful in acclimating.
About six months after moving, Mr. T. unexpectedly passed away. Her son’s job transferred him to a city two hours away and very soon after, he and his wife had their baby. Mrs. T. loves the new baby very much, but she feels they have no room in their new life for her. She doesn’t want to move from the neighborhood where she can speak her native language, and she is feeling very sad and alone.
Mrs. T. says she doesn’t feel like doing much of anything and says nothing brings her happiness anymore. She hasn’t been sleeping well and says she spends most of the day in bed watching Chinese television. She is not eating much and has lost about 10 lbs.
Her son rearranged the furniture in her home to improve the feng shui. He would like her to see an acupuncturist and a Chinese herbal medicine specialist in her neighborhood to restore balance to her body.
For your initial post, use the biopsychosocial formulation grid system below to formulate your diagnosis and develop a comprehensive treatment plan for the case scenario.
What is your diagnosis? Do you agree with the son’s plan as part of her treatment plan? What is your treatment plan?
Please use two references

Article topic- Postmenopausal Hormone Therapy and Its Association with Breast Cancer
Select one published EBP, QI, or research article- less then 4 years old.
Identify it as a quality improvement article, a research article, or EBP.
On Discussion Board post the title of the article, authors, purpose, and type of study (QI, Research, or EBP).
Discuss why you believe it to be either a research article, EBP article, or a quality improvement article.

Using the course materials and other research materials, present a formal and robust definition of spirituality in relation to and for the purposes of health care.  Use lecture and other materials to explore and address the various issues and challenges that defining spirituality presents.
definition of spirituality using course materials and beyond, and apply that definition to an element of practice or theory in the area of the student’s interest or responsibility. This
a formal and robust definition of spirituality in relation to and for the purposes of health care
Topic: Spirituality in cancer patients