discussion(NURS 5051/NURS 6051: Transforming Nursing and Healthcare Through Technology)


1. A description of observations about how nurse informaticists and/or data or technology specialists interact with other professionals within your healthcare organization (hospital setting). 

2. Suggest at least one strategy on how these interactions might be improved. Be specific and provide examples. Then,

3. Explain the impact you believe the continued evolution of nursing informatics as a specialty and/or the continued emergence of new technologies might have on professional interactions. 

(minimum of 2 references)

Medical Terminology


The patient, an elderly man, had an acute onset of fever, dysuria, abdominal pain, and tenderness in the left flank. He was admitted for evaluation and urine analysis and culture. The radiological finding showed two medium-sized renal calculi associated with pyelonephritis in the left kidney. The culture revealed severe E.coli UTI that responded well to IV Cipro therapy.

Discharge Diagnosis & Recommended follow up

1) UTI (2) Renal calculi & Follow up for Shock Wave Lithotripsy (SWL)

Identify as many medical terms and abbreviations as you can from the passage above and rewrite the passage using your own words.

Responses to a discussion post


For this Discussion, review the case Learning Resources and the case study excerpt presented. Reflect on the case study excerpt and consider the therapy approaches you might take to assess, diagnose, and treat the patient’s health needs.  

Case: An elderly widow who just lost her spouse. 

Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications: 

Metformin 500mg BID 

Januvia 100mg daily 

Losartan 100mg daily 

HCTZ 25mg daily 

Sertraline 100mg daily 

Current weight: 88 kg

Current height: 64 inches

Temp: 98.6 degrees F

BP: 132/86 

By Day 3 of Week 7

Post a response to each of the following:

• List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions. 

• Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why. 

• Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used. 

• List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why. 

• List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other. 

• For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities?

• Include any “check points” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen. 

Respond to the these discussions. All questions need to be addressed.


 Discussion 2 Me

Treatment of a Patient with Insomnia       

           The case presented this week, is that of a 75-year-old widow who just lost her spouse 10-months ago. Th patient presents with chief complaints of insomnia. Past medical history of DM, HTN, and MDD is reported. Since the passing of her husband, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications: Metformin 500mg BID, Januvia 100mg daily, Losartan 100mg daily, HCTZ 25mg daily, and Sertraline 100mg daily. Current weight: 88 kg. Current height: 64 inches. Temp: 98.6 degrees F. BP: 132/86 (Walden University).

           Question number one, what brings you in today? By asking an open-ended question, the patient is more willing to share information with the provider (Stern, 2016). Another question that would be of beneficial knowledge during the interview is, do you consume caffeine? If so, how much caffeine do you consume in a day? Caffeine consumption close to bedtime contributes greatly to insomnia (Farazdaq et al., 2018). Lastly, the third question that should be asked is, do you suffer from Gastro Esophageal Reflux Disease (GERD). According to Farazdaq, Andrades, and Nanji, (2018) GERD is a contributing factor to insomnia in elderly patients. By asking the above questions, the provider can rule out environmental factors while assessing the patients concerns with open-ended questions.

           People in the patient’s life that could provide further information is children or caretakers. Questions that would be appropriate to ask the patient’s children or caretaker would be if there is a recent decrease in her appetite, energy, mood, or interests. By asking about these areas of the patient’s life will provide external information that the patient might be withholding or may be unaware of. 

Insomnia relies heavily on self-report for a diagnosis (Levenson et al., 2015). Also, a physical exam could be performed with the order of blood testing to rule out thyroid problems. According to Dr. Abhinav Singh (2021), hyperthyroidism results in nervousness from overactivity of this hormone, and insomnia is often a symptom. Administering the Hamilton Anxiety Rating Scale (HAM-A) would assess the severity of the patient’s anxiety. The HAM-A results would aid with further treatment of the patient’s insomnia, if related to anxiety (Psychiatry & Behavioral Health Learning Network, 2021). Another appropriate scale to administer to this patient is the Hamilton Depression Rating Scale (HDRS). HDRS is an assessment that focuses on feelings of guilt, mood, suicidal ideation, activities, weight, various stages of insomnia, and many more important areas (Hamilton, 1960).

             The patient presents with a previous diagnosis of depression. The differential diagnosis for this patient is Generalized Anxiety Disorder (GAD), secondary to husband’s death. There are many possible changes within the living dynamics, such as financial burdens, fear of her own death, and suddenly sleeping alone.  Changes within this patient’s routine may be a cause of reported insomnia.  

           Temazepam is FDA approved for insomnia, and used off-label for anxiety disorders, acute mania, psychosis, and catatonia (Puzantian & Carlat, 2020). Temazepam is generally effective in the treatment of insomnia, by enhancing widespread inhibitory activity of GABA (Levenson et al., 2015). Temazepam is metabolized through the liver without CYP450 (Puzantian & Carlat, 2020). Another good sleep aid choice is Trazodone. Trazodone is widely used for insomnia (Levenson et al., 2015). Trazodone is FDA approved for the treatment of major depression and used off-label for insomnia and anxiety (Puzantian & Carlat, 2020). Trazodone inhibits serotonin reuptake, alpha-1 adrenergic receptor antagonist, and serotonin 5-HT2A and 5-HT2C receptor antagonist (Puzantian & Carlat, 2020). And Trazodone is metabolized primarily through CYP3A4 to active metabolite mCPP, that is metabolized by 2D6, inducing P-glycoprotein (Puzantian & Carlat, 2020). Trazodone, however, carries the side effect of daytime somnolence and dizziness (Puzantian & Carlat, 2020).

           The favorable medication for this patient, is Temazepam. Temazepam is a safer medication to use in elderly patients because of the lack of active metabolites, its short half-life and absence of drug interactions (Puzantian & Carlat, 2020). The patient is currently taking Metformin, Januvia, Losartan, HCTZ, and Sertraline. Based on the current medications, the patient is being treated for diabetes mellitus, hypertension, and depression. Adding Temazepam to the patient’s medication regimen would not result in toxicity of other medications. Sleep is heritable and regulated by numerous genes. A genome wide association study found numerous single-nucleotide polymorphisms (SNPs) significantly associated with insomnia symptoms. The most significant SNPs occurred within genes involved in neuroplasticity, stress reactivity neuronal excitability, and mental health (Rajib, 2020).

           The starting dose of Temazepam is lower in the elderly population (Puzantian & Carlat, 2020). The proper dose to begin with this patient, is Temazepam 7.5mg tab PO QHS. At the 4-week checkup, the expected outcome would be an increased ability to sleep, and reduced anxiety. If these results have not been achieved, Temazepam 15mg tab PO Q HS would be ordered. Temazepam does have the risk of weakness and dizziness, so great care and caution would need to be taken when increasing the dose. There needs to be an evaluation of the effects at week 8, or sooner if needed. The maximum dose of Temazepam is 30mg PO Q HS, and even lower in the elderly (Puzantian & Carlat, 2020).


Farazdaq, H., Andrades, M., & Nanji, K. (2018, December 31). Insomnia and its correlates among elderly patients presenting to family medicine clinics at an academic center. Malaysian family physician: the official journal of the Academy of Family Physicians of Malaysia. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6382090/.

Hamilton, M. (1960). Hamilton Rating Scale for Depression. PsycTESTS Dataset, 23, 56–62. https://doi.org/10.1037/t04100-000

Levenson, J. C., Kay, D. B., & Buysse, D. J. (2015). The Pathophysiology of Insomnia. Chest, 147(4), 1179–1192. https://doi.org/10.1378/chest.14-1617

Puzantian, T., & Carlat, D. J. (2020). Medication fact book for psychiatric practice. Carlat Publishing, LLC.

Rajib, D. (2020). Do genes matter in sleep? -A comprehensive update. Journal of Neuroscience and Neurological Disorders, 4(1), 014–023. https://doi.org/10.29328/journal.jnnd.1001029

Singh, A. (2021, March 8). Could Your Thyroid be Causing Sleep Problems? Sleep Foundation. https://www.sleepfoundation.org/physical-health/thyroid-issues-and-sleep.

Stern, T. A. (2016). Massachusetts General Hospital: psychopharmacology and neurotherapeutics (1st ed.). Elsevier.

Walden University. (n.d.). Treatment for a Patient with a Common Condition. https://class.content.laureate.net/14884e77402afe219224c67c4f0463b3.html.

patho discussion post mod 2

 see attachment

Decision Tree


Mrs. Maria Perez is a 53 year old Puerto Rican female who presents to your office today due to a rather “embarrassing problem.”


Mrs. Perez admits that she has had “problems” with alcohol since her father died in her late teens. She reports that she has struggled with alcohol since her 20’s and has been involved with Alcoholics Anonymous “on and off” for the past 25 years. She states that for the past two years, she has been having more and more difficulty maintaining her sobriety since they opened the new “Rising Sun” casino near her home. Mrs. Perez states that she and a friend went to visit the new casino during their grand opening at which point she was “hooked.” She states that she gets “such a high” when she is gambling. While gambling, she “enjoys a drink or two” to help calm her during high-stakes games. She states that this often gives way to more drinking and more reckless gambling. She also reports that her cigarette smoking has increased over the past two years and she is concerned about the negative effects of the cigarette smoking on her health.

She states that she attempts to abstain from drinking but that she gets such a “high” from the act of gambling that she needs a few drinks to “even out.” She also notices that when she drinks, she doesn’t smoke “as much” but enjoys smoking when she is playing at the slot machines. She also reports that she has gained weight from drinking so much- she currently weights 122 lbs., which represents a 7 lb. weight gain from her usual 115 lb. weight.

Mrs. Perez is quite concerned today because she has borrowed over $50,000 from her retirement account to pay off her gambling debts. She is very concerned because her husband does not know that she has spent this much money.


The client is a 53 year old Puerto Rican female who is alert, oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. Her speech is clear, coherent, and goal directed. Her eye contact is somewhat avoidant during the clinical interview. As you make eye contact with her, she looks away or looks down. She demonstrates no noteworthy mannerisms, gestures, or tics. Her self-reported mood is “sad.” Affect is appropriate to content of conversation & self-reported mood. She visual or auditory hallucinations, no delusional or paranoid thought processes are readily appreciated. Insight and judgment are grossly intact, however, impulse control is impaired. She is currently denying suicidal or homicidal ideation.

Diagnosis: Gambling disorder, alcohol use disorder

Co-morbid Addiction (ETOH and Gambling) 53-year-old Puerto Rican Female

Puerto Rican female

Decision Point One

Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the Naltrexone (Vivitrol) Injection, 380mg intramuscularly in gluteal region every 4 weeks

n every 4 weeks


· Client returns to clinic in four weeks

· Mrs. Perez said that she felt “wonderful” as she has not “touched a drop” to drink since receiving the injection

· Client reports that she has not been going to the casino, as frequently, but when she does go she “drops a bundle” (meaning, spends a lot of money gambling)

· Client She is also still smoking, which has her concerned. She is also reporting some problems with anxiety, which also have her concerned

Decision Point Two

Refer to a counselor to address gambling issues address gambling issues


· Client returns to clinic in four weeks

· Client reports that the anxiety that she had been experiencing is gone

· Client reports that she has met with the counselor, but did not really like her. She did start going to a local meeting gamblers anonymous. She stated that last week, for the first time, she spoke during the meeting. She reports feeling supported in this group

Decision Point Three

Explore the issue that Mrs. Perez is having with her counselor, and encourage her to continue attending the Gambler’s Anonymous meetings

Guidance to Student Although controversy exists in the literature regarding how long to maintain a client on Vivitrol, four weeks is probably too soon to consider discontinuation. The psychiatric mental health nurse practitioner should explore the issues that Mrs. Perez is having with her counselor. As you will learn in future courses, ruptures and the therapeutic alliance can result in clients stopping therapy. Clearly, if the client does not continue with therapy, the likelihood of the gambling problem spontaneously remitting is lower (than had the client continued to receive therapy). Recall that there are no FDA approved treatments for gambling addiction, and the mainstay of treatment for this disorder is counseling. Since Mrs. Perez reports good perceived support from the gamblers anonymous meetings, she should be encouraged to continue her participation with this group.

The PMHNP needs to discuss smoking cessation options with Mrs. Perez in order to address the totality of addictions, and to enhance her overall health.

Examine Case Study: A Puerto Rican Woman With Comorbid Addiction. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following:

·  Decision #1

·  Which decision did you select?

·  Why did you select this decision? Support your response with evidence and references to the Learning Resources.

·  What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

·  Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?

·  Decision #2

·  Why did you select this decision? Support your response with evidence and references to the Learning Resources.

·  What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

·  Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?

·  Decision #3

·  Why did you select this decision? Support your response with evidence and references to the Learning Resources.

·  What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

·  Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

Decision Point One

Select what you should do:

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/DT/week_08/img/pill-red.pngVivitrol (naltrexone) injection, 380 mg intramuscularly in the gluteal region every 4 weeks

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/DT/week_08/img/pill-blue.pngAntabuse (disulfiram) 250 mg orally daily

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/DT/week_08/img/pill-yellow.pngCampral (acamprosate) 666 mg orally three times/day

Decision Point Two

Select what you should do next:

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/DT/week_08/img/pill-red.pngAdd on Valium (diazepam) 5 mg orally TID/PRN/anxiety

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/DT/week_08/img/pill-blue.pngRefer to a counselor to address gambling issues

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/DT/week_08/img/pill-yellow.pngAdd on Chantix (varenicline) 1 mg orally BID

Decision Point Three

Select what you should do next:

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/DT/week_08/img/pill-red.pngExplore the issue that Mrs. Perez is having with her counselor, and encourage her to continue attending the Gamblers Anonymous meetings

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/DT/week_08/img/pill-blue.pngEncourage Mrs. Perez to continue seeing her current counselor as well as continuing with the Gamblers Anonymous group

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/DT/week_08/img/pill-yellow.pngDiscontinue Vivitrol. Encourage Mrs. Perez to continue seeing her counselor and to continue participating in the Gamblers Anonymous group

Literature Review Paper

Analyze 3 peer reviewed articles about nursing informatics. All within 5 years of being published.  

APA format

3 pages (excluding cover page and reference page)


 Reflect on the analysis of the sin of suicide and, thus, euthanasia from the topic readings. Do you agree? Why or why not? Refer to the lecture and topic readings in your response 

Clinical Supervision



 According to the Center for Disease and Control (2016), Behavior therapy is an effective treatment for attention-deficit/hyperactivity disorder (ADHD) that can improve a child’s behavior, self-control, anger outburst, and self-esteem. It is most effective in young children when parents deliver it. Studies recommend that providers refer parents of children younger than 12 years old for training in behavior therapy. For children younger than six years old, parent training in behavior management should be utilized before prescribing ADHD medicine (CDC 2016) 

       A significant outcome is noted. When parents are trained in behavior therapy, they learn skills and strategies to help their child with ADHD succeed at school, at home, and in relationships. This process appeared very time consuming; however, that helps resolve some of the behavioral problems at home. 

The idea of home alone for a couple of hours with his child is not the best because anything can happen in a minute; his parent must find a way to fill in those hours of him being home alone. 

       Medicines are usually given to children or teens with ADHD, ODD, and DBD only if psychosocial treatment alone does not help enough. Medications are generally taken together with psychosocial treatment (Agency of Healthcare Research and Quality 2016)

       I am glad Depakote is helping him with his aggression, and using a case management program will also help manage treatment. Reward systems have been proven to be effective in changing behaviors. 


Agency of Healthcare Research and Quality (2016) Treating Disruptive Behavior Disorders in Children and Teens. Retrieved from Treating Disruptive Behavior Disorders in Children and Teens | Effective Health Care Program (ahrq.gov)

Center for Disease and Control (2020) Parent Training in Behavior Management for ADHDA. Retrieved from Parent Training in Behavior Management for ADHD | CDC


 Pharmacology for Family nurse practitioner (FNP) course

1. What is your professional or career goal and why is this course important?

2. Describe your language proficiency entering this course.

3. What is your knowledge or work experience background that prepares you for this course?

4. Describe your strengths and weaknesses as a student

5. What are your expectations of the course based on the described objectives?

no title needed

Please find that AACN Masters Degree Essentials attached as a reference.

(AACN Essentials I, II, IV, V, VI, and VIII).

readings and review of the (AACN Essentials I, II, IV, V, VI, and VIII)  Think about how these essentials may apply to you.


All assignments must be completed and submitted as Microsoft Word documents. 

All assignments must follow APA 7th edition format. 

minimum of 250 words

three references needed (one the reference’s book )

All written assignments will be submitted via Turnitin for evaluation. Papers submitted with a Similarity Index of greater than 20% will be viewed as an indication of high plagiarism content and subject to receive a grade of zero