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For this assignment you will be asked to apply course concepts and learn to develop one Literature Review Table that includes 2 articles.

Please use the Literature Review Template provided within the course content and the evidence rating scale adapted from Melnyk found in course content. There is a video explaining how to complete the table in your course content.

Will I be adding this assignment to the final paper? Yes! The completed Literature Review Table from this week will be used again in the Appendix of your research paper (future assignment).

Will I need to create new literature review tables again for the final paper? No-this is the only assignment you’ll use the table format for. You will summarize 5 additional research articles in the Findings section of your Research Review, so please save those for the future.

Key Information for this assignment:

· You should not copy information from the research you obtain. All information from the research should be paraphrased in your own words (less than 6 words in one sentence should match). Plagiarism checkers should result in less than 10% for the literature review tables.

· All Searches for your Research Review must be completed through the Minnesota State University, Mankato library. Online searches will not be accepted with the exception of Google Scholar. Supply a pdf of your 2 full text articles in the drobox with your literature review table. Do not send links.

· A Data Search Table must be submitted with the Literature Review Assignment and is worth 5 points. Please provide a screen shot of one of your key term searches within the library databases.

Criteria

Possible Points

Points Earned

Clarification/Instructions

Article title, author, and date is listed in APA format and is current (not older than 5 years)

2

List the reference as a citation in the text would be cited. Include the reference in the reference section of the paper.

Purpose of article is clear and paraphrased from the article

2

Why was the research conducted? What was the goal /discovery that researcher was trying to achieve

Sample size of study article used is stated and numeric values are given (when applicable)

2

N=total number

n=subset

Study Design is clearly stated, and level of evidence is provided correctly (Evidence Rating Pyramid adapted from Melnyk in course content)

Strongest, stronger, strong, moderate, weak, weakest

5

Include design Quantitative, qualitative design, meta-analysis: retrospective chart review, surveys, etc.

Where does this fall Evidence pyramid Melnyk?

Variables/measurement included briefly; reliability of measurement data is included

4

Statistical test used for quantitative; qualitative may use pain score, survey, depression rating scale etc.

Results/findings are clear and statistical significance is included (for example p value)

5

Findings should have an associated statistical value if quantitative, if qualitative may have results of response to treatment 26 had pain relieved vs 13 did not….

Implications of research for nursing practice and how they apply to or support your research topic

Should include limitations

3

Did this article support your PICO? Did it lead you to search in a different direction? Does it demonstrate that there is not enough research to support a practice change

Correct APA format, free of spelling and grammatical errors

2

Follow APA for listing authors Page 286 7th ed.

Includes Data Search Table completed with search terms and screen shot of one search from table

5

Total

30

reply1,2

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

When assessing this patient, it's important to ask questions that will help the provider understand the underlying causes and potential treatment options. Given the patient's recent loss and significant life changes, it's crucial to approach the assessment with sensitivity. Here are three questions I'd like to ask, along with their rationales:

1. Have you observed any changes in your sleep pattern, mood, or feelings since your husband passed away?

Rationale: This question allows the patient to provide insight into the nature and duration of her sleep disturbances and changes in her mood or feelings. Understanding the onset and progression of depression symptoms can related to her recent bereavement following her husband's passing.

2. Could you describe your emotions and have you ever experienced thoughts of self-harm or suicide?

Rationale: This question aims to comprehend a person's emotional state and evaluate the presence of suicidal thoughts or self-harm ideation. It's important to ask such questions without delay in treatment. Since the patient has a history of major depressive disorder (MDD), and her depression has worsened, it's crucial to explore her emotional state.

3. How have you been coping with the loss of your husband, and have you sought support or counseling to help you through this difficult time?

Rationale: Inquiring about coping strategies and support systems is essential for assessing the patient's resilience and identifying potential sources of assistance. Grief counseling or therapy can be invaluable in helping individuals navigate the complex emotions associated with loss. Additionally, it's important to assess whether the patient has been utilizing any resources to manage her depression.

·
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.

To gain a more comprehensive understanding of the patient's situation and evaluate her social support network, I would identify individuals in the patient's life, such as family members or close friends. Engaging in conversations with these individuals can be beneficial because they may have insights into the patient's emotional well-being and daily functioning. I would ask Questions like: “Could you please share any observations regarding alterations you may have noticed in the patient's behavior, mood, or sleep patterns following her husband's passing?” Family members and close friends are often the first to detect significant shifts in a person's behavior and emotional state. Their observations can offer valuable insights into the patient's emotional condition and the way the loss of her husband has affected her daily life.

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

In evaluating a 75-year-old patient with a chief complaint of insomnia and depression, diabetes (DM), and hypertension (HTN), a thorough assessment should include both physical exams and diagnostic tests: A physical examination should include checking blood pressure, heart rate, heart sounds, peripheral pulses, respiratory rate, and temperature. It should also involve assessing the patient's overall appearance and evaluating their general health.  In addition, assessing mental status, cognitive function, and neurological signs can help identify any neurological issues that may be contributing to sleep disturbances. Consider arranging a sleep study, also known as polysomnography (PSG). This medical test monitors various physiological functions while a person sleeps.

Diagnostic Tests include the following Blood Tests: Complete Blood Count (CBC) will check for anemia or other blood-related issues that can affect sleep and overall health; a Comprehensive Metabolic Panel (CMP), assess kidney and liver function, electrolytes, and glucose levels; The HbA1c (Glycated Hemoglobin) test can monitor her long-term blood glucose control, can provide valuable insights into her diabetes management. The results of these exams and tests will inform a comprehensive treatment plan tailored to the patient's specific needs.

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

When assessing a patient with insomnia, along with chronic medical conditions like diabetes and hypertension, this patient likely has Major Depressive Disorder (MDD). She had no history of MDD before her husband's passing, and the current worsening of her depression may be attributed to his death. Although anxiety can cause insomnia problems, MDD with Bereavement seems most likely. However, we need to ensure there aren't other underlying causes, such as sleep problems or medical issues. To do that, we should conduct thorough assessments and laboratory tests. She needs to seek help from both her regular doctor and a mental health professional to find the right treatment and support.

·
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.

When selecting pharmacologic agents for this 75-year-old patient, the choice of antidepressant therapy should consider pharmacokinetics and pharmacodynamics. Reduced kidney and liver function in elderly individuals can potentially affect both pharmacokinetics and pharmacodynamics.

SSRIs, such as sertraline (Zoloft) and escitalopram (Lexapro), are two preferred for elderly patients. They are generally well-tolerated and have a lower risk of certain side effects, such as sedation or anticholinergic effects, which can be problematic for older adults. Sertraline (Zoloft) 150mg once daily or Escitalopram (Lexapro) 20 mg daily would be appropriate for this patient.

The patient has been taking Sertraline (Zoloft), her start dose was 100mg daily; increase slowly, no more than a maximum Dose of 200 mg once daily; sertraline increases serotonin levels and can be effective in treating depression. Escitalopram is considered perhaps the best-tolerated SSRI, with the fewest cytochrome P450 (CYP450)-mediated drug interactions. (Stahl, 2021). Escitalopram (Lexapro) 20 mg daily is also the appropriate choice.

·
For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on ethical prescribing or decision-making. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals based on ethical prescribing guidelines or decision-making?

When prescribing antidepressant therapy, it's important to consider drug contraindications and alterations. For the selected antidepressant, escitalopram (Lexapro), don't use it with MAOIs or within 14 days after stopping an MAOI to prevent serotonin syndrome. This is a contraindication due to the risk of serotonin syndrome, a potentially life-threatening condition characterized by agitation, confusion, rapid heart rate, and other symptoms. Escitalopram is primarily metabolized in the liver; it should be used with caution in patients with severe hepatic impairment or elderly with decreased liver function. In such cases, a lower initial dose and slower titration may be considered, as drug clearance may be reduced.

In all cases, ethical prescribing involves a thorough assessment of the patient's medical history, medication history, and potential contraindications. Dosing adjustments, when necessary, should be made to maximize therapeutic benefits while minimizing risks and adverse effects.

·
Include any “checkpoints” (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.

In depression treatment, scheduled follow-up appointments are vital for assessing progress, managing side effects, and adjusting treatment. Common intervals are every 4 weeks. At the checkpoint, like follow-up data at weeks 4, 8, 12, etc., make treatment decisions based on the patient's response, side effects, and goals. If there's significant improvement with few side effects, stick with the current dose. If there's limited improvement or major side effects, consider increasing the dose (if not already at the maximum) or trying a different antidepressant. In cases of long-term remission with a low risk of recurrence, think about tapering or discontinuing the medication.

At Week 4 (four weeks after initiating treatment), it's the time to evaluate the patient's initial response to medication. Inquire about changes in mood, sleep patterns, energy levels, and any side effects.

At Week 8 (eight weeks after starting treatment), it's time to reassess the patient's mood and overall well-being. Keep an eye on side effects, whether they're taking the medication as prescribed, any changes in their medical conditions, and any suicidal ideation.

At Week 12 (12 weeks after starting treatment), continue monitoring the patient's mood and how they're responding to treatment. Check for any signs that their depression might be coming back or getting worse.

Ongoing Follow-up (Regularly, every 3-6 months): Continue to monitor the patient's mental health, medication adherence, and any emerging side effects. Evaluate the need for ongoing treatment.

 


Reference:

Levenson JC, Kay DB, Buysse DJ. The pathophysiology of insomnia. Chest. 2015 Apr;147(4):1179-1192. doi: 10.1378/chest.14-1617. PMID: 25846534; PMCID: PMC4388122.

Stahl, S. M. (2021). Stahl's essential psychopharmacology: Neuroscientific basis and practical applications (5th Ed.) Cambridge University Press.

Lexapro Labeling-508; Reference ID: 4036381 https://www.fda.gov/media/135185/download

informatics

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During the course, you have done a thorough analysis of a company and the health care subsector in which the company operates now is the time to look at all your findings and insights and frame the situation of the company in terms of cost, access, and quality. Specifically:

  1. Are there any major cost-containment policies or practices from private insurers or the government that affect your company? Are there any internal/ competitive forces that are trying to do the same?
  2. How does your company (and industry) is assessed in terms of its ability to offer access to all populations?
  3. What kind of quality assessment and assurance is done? Are there any positive or negative stories about the quality of health care services of the organization?

Staffing Plan & Staffing Budget

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  • Discuss the benefits and disadvantages of a facility using supplemental and floating staff.
  • Compare and contrast how a staffing plan would differ with different nursing units. How does that affect the staffing budget?

Submission Instructions:

  • Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.

w9answer1II

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respond to the topic,(Peripartum depression) say I agree with what you said for this and for this. and add information that deals with the same thing but is not mentioned in that work, the answers that have an argument…

at least 3 references

Peripartum Depression

Women who are depressed during pregnancy have higher rates of use of alcohol, illicit substances, and tobacco in pregnancy, with poorer nutrition and weight gain, and lower rates of prenatal care. Untreated depression in pregnancy increases the risk of low birth weight, preterm birth, and neonatal intensive care unit admission (Konstanatinou et al 2020). Peripartum Depression is one of the most common disorders of pregnancy. It has a higher morbidity and mortality risk than any other condition affecting pregnant people. Symptoms of peripartum depression persist for more than two weeks and include anhedonia, decreased energy, reduced appetite, and poor concentration (Justesen & Jourdaine, 2023).

·
Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your chosen disorder in older adults or pregnant women.

SSRIs are the first choice for moderate to severe peripartum depression treatment. In a randomized controlled trial comparing antidepressants with community-based psychosocial intervention for peripartum depression, SSRIs were superior, with a number needed to treat at four weeks.  Postpartum women can be sensitive to medications because of hormone effects on liver enzymes, increased volume of distribution, and increased levels of drug-binding proteins; therefore, some experts recommend starting a medication at one-half of the regular dose and titrating slowly. In contrast, pregnant women often require higher doses of medications because of larger volumes of distribution (Skånland, & Cieślar-Pobuda,2019).

SSRIs are off-label and prescribed for the treatment of bulimia nervosa leading to trials to evaluate their effect on binge eating disorder. Antidepressants that have shown promising results include 
bupropionLinks to an external site., 
duloxetineLinks to an external site., 
escitalopramLinks to an external site., 
fluvoxamineLinks to an external site., fluoxetine, imipramine, 
sertralineLinks to an external site., and 
venlafaxineLinks to an external site..  

lisdexamfetamineLinks to an external site.
, a 
prodrugLinks to an external site. of D-amphetamine, is the only FDA-approved medication for binge eating disorder and should, as a rule, be preferred over antidepressants.

A nonpharmacological intervention for treating peripartum depression is psychotherapy. Nonpharmacologic treatment strategies are similar to prevention strategies, with the U.S. Preventive Services Task Force recommending referral for psychotherapy as the mainstay of treatment. Cognitive behavior therapy and interpersonal psychotherapy are the best studied and have the most robust supporting evidence. Group and individual approaches are effective. The two most common psychotherapies include interpersonal therapy (focus on improving social interactions and coping skills) and cognitive behavioral therapy (focus on adjusting patients' self-detrimental thought processes). Interpersonal therapy has been shown to improve mood during pregnancy, but cognitive behavioral therapy has only been validated for postpartum depression (Spinelly, 2003).

·
Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug?

Risks of medication use during pregnancy and breastfeeding must be weighed against the risks of untreated or inadequately treated depression. Inadequately treated depression has the potential to progress to active suicidality and can lead to impaired bonding for the birth parent, impaired childhood development, and adverse pregnancy outcomes, including preterm birth, low birth weight, and hypertensive disorders. Paroxetine might be associated with major malformations, especially cardiac defects. Some evidence is available of an association between neonatal behavioral syndrome and exposure to SSRIs in utero during the last trimester. Infants with continuous exposure to mother's depression and continuous exposure to SSRIs throughout gestation were more likely to be born preterm than were infants with partial or no exposure. Guidelines suggest that SSRIs should be used with caution during pregnancy, and that paroxetine be avoided (Kupfer, Frank & Phillps, 2012).

·
Explain whether clinical practice guidelines exist for this disorder, and if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration.

·
Support your reasoning with at least three current, credible scholarly resources, one each on the FDA-approved drug, the off-label, and a nonpharmacological intervention for the disorder.

Consistent with the goals of the new FDA and Pregnancy and Lactation Labeling Rule, clinicians must consider the risks of untreated illness as well as pharmacotherapy-related maternal adverse reactions, infant outcomes, and birth complications when counseling patients about medications in pregnancy and postpartum. Discussion of dosing requirements during gestation and any adverse effects related to breastfeeding must also be addressed (Betcher et al, 2019). Nurse practitioners and others who prescribe these drugs need to be aware of potential adverse effects and counsel depressed pregnant women appropriately. Some of the possible risks are drug perfusion to the fetus, adverse birth outcomes, neonatal withdrawal syndrome, and impaired child development. Before nurses can help to treat depression, they must first be able to recognize it. To screen for depression, it is important to be clear about the definition, risk factors, and comorbidity of depression in pregnant women.

SSRI antidepressant use in the final trimester also has been associated with 

persistent pulmonary hypertensionLinks to an external site.
 in the newborn. Researchers utilizing the Medicaid Database with nearly 3.79 million pregnant women compared outcomes of women taking an SSRI, another class of antidepressant, or no antidepressant in the last 90 days of pregnancy. Pregnant women who discontinued their antidepressants proximal to conception were nearly three times more likely to suffer a recurrence of depressive symptoms during pregnancy than women who continued their medication. Small case series studies show that the concentrations of the SSRI 
fluoxetineLinks to an external site., 
sertralineLinks to an external site., 
citalopramLinks to an external site., and 
escitalopramLinks to an external site. decrease throughout pregnancy. Doses may need to be adjusted for pregnant women taking SSRIs. Monitoring symptoms frequently, especially in the second and 

third trimestersLinks to an external site.
, and 

dose increasesLinks to an external site.
 with early symptoms of relapse is a strategy to avoid symptom recurrence (Ververs et al, 2009).

 

sociology discussion post 3

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Respond to two (2) of the following prompts:

  1. Consider the social stratification of your family tree. Compare your social standing to that of your parents and grandparents. If you are unfamiliar with these people, feel free to substitute other family members or acquaintances from other generations. (USLO 3.1)
  2. What social traits did your forebears pass down to you? Is there consistency or inconsistency in your family’s status? Which theoretical approach best describes your family’s social stratification? What changes do you anticipate for your family’s future generation? (USLO 3.1)
  3. Consider your own experiences with social mobility. How do rules, laws, and societal structures promote wealth and poverty? Do you believe that rules, laws, and societal structure have a greater impact on social mobility than individual traits such as a strong work ethic? Do you believe social mobility has decreased or risen in recent years? How could rules, laws, and societal structures impact your future social mobility? What are some strategies for dealing with this future possibility? (USLO 3.2)
  4. What is the relationship between subjective, absolute, and relative poverty and inequality/inequity? Who benefits from poverty, inequality, and inequity? Can policies be enacted to eliminate various forms of poverty and break the cycle of poverty? What are the advantages and disadvantages of enacting such policies? What role does the cycle of poverty play in maintaining social stratification, especially for women through the global feminization of poverty? (USLO 3.3)
  5. Which of the three theoretical approaches (functionalist, conflict, or symbolic interactionist) would you use to explain why healthcare injustice and inequity occurs and what to do about it? (USLO 3.4)
  6. What role does healthcare injustice play in perpetuating the system of stratification? How does the healthcare system maintain social stratification? Is healthcare injustice harming our society as a whole? (USLO 3.4)

Chapter 3: Healthcare Reform and in the United States

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Using what you learned in Modules 1-3 up to this point, discuss 3 key elements you think should be a part of US Healthcare reform.  Since we do not know at this point whether the ACA will remain or will be repealed and replaced, what are 3 key elements that should remain or be introduced into US healthcare reform legislation? 

For example, children up to the age of 26 being able to remain on their parent’s health insurance or mandates that everyone have healthcare.  These are only examples, feel free to discuss any key elements from the readings or your own research.  This assignment should be a maximum of 2 paragraphs in length and should be your own original thought.  Please cite any sources you used in a standard format (e.g. APA or MLA).  Purdue’s Online Writing Lab (OWL) can help with cited and writing.  You can find OWL at https://owl.english.purdue.edu/owl/section/2/ . The rest of your submission should be 2 paragraphs (no more then 5 sentences in a paragraph!) on the 3 key elements you chose that should remain or be introduced as discussed above.   Remember do not simply state your opinion; explain your rationale for your opinion. Be sure to write properly for an academic audience (review syllabus guidelines).

Grading Rubric:
Submission reflects college level writing. Clear effort is made with sentence structure, word choice, grammar and punctuation. (4pts)

Post discusses 3 key elements of reform and clearly indicates the students perspective supporting it with rationale. (4pts)

Student cites references (2pts)

Requesting writing tutor

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HED

HED

In the article The Quintuple Aim for Health Care Improvement: A New Imperative to Advance Health Equity [PDF], the authors focus on the need for health equity in the U.S. and the World through:

Identification of Disparities

Designing and Implementing Evidence-Based Interventions to Reduce Disparities

Investing in Equity Measurement

Incentivizing the Achievement of Equity

In 250 to 300 words discuss the addition of health equity to complete the Quintuple Aim and outline how you will integrate the recommendations to achieve health equity into the organization if you were the CEO.

nursing

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 What would spirituality be according to your own worldview? How do you believe that your conception of spirituality would influence the way in which you care for patients? 

Peer response

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Peer Response Instructions

· Please respond to at least 
one peer this week. Your response should be thoughtful, respectful, and substantially add value to the discussion. In your response to a peer, explain how you have grown as a BSN nurse in this session.

Kiersten Echols

Oct 23, 2023 at 1:00 AM

  For this discussion board, I chose to appraise the role and responsibilities of the nurse and members of an interdisciplinary team across multiple healthcare settings in recognition, assessment, and interventions for the management of acute and chronic diseases. The role of the nurse is vital to patient care of acute and chronic diseases in many different ways. The nurse's role in all patient care is to educate the patient, advocate for adequate and ethical care, and be a middleman between the patient and the rest of the patient's care team. The nurses are the ones at the bedside assessing the patient and getting to know them. They then take this vital information to the other members of the care team like case management, specialists, or surgeons to provide adequate and holistic care. Without this information from the bedside, the patient wouldn't be able to be taken care of. The other members are vital to the patient's care by providing specific services that the nurse cannot like surgical intervention or certain medication. This class has shown me through each week's case study how important the interdisciplinary team is to the patient's holistic care of acute and chronic conditions. Going further in my practice I will make it a point to advocate for consulting the appropriate teams for adequate and quality care.