MY NUMBER ASSIGNED WAS 7 WHICH IS:  Tension hemo/pneumothorax – when does this occur, s/s, treatment, and complication 

Each student will be assigned a number randomly.  Whatever your number is, select the corresponding topic below, then post a minimum of 5 bullet points about the topic.  

Your bullet points should address key components of the topic, such as what, how, who, & why.  This information should not be basic things you learned in Med/Surg, but rather advanced critical care based.  

Think about this as a group effort to create a study guide. Use ONLY your textbook, but do not cut & paste from the book.  

Then create, find, or borrow a test style question about your topic & post at the bottom of your bullet points. The format needs to be multiple choice or select all that apply. Think NCLEX style. 

PART 2:

Take a few minutes and ask 2 people about their personal coping mechanisms for dealing with the stress of working in healthcare during this unique time of Covid. Stress can be physical, emotional, spiritual, or any combination of triggers. Ask a diverse variety of people, don’t forget those in other departs at different points of hierarchy. For example, ask your unit manager, environmental services, volunteers, patients, fellow nurses, etc.  Write 2-3 paragraphs on your findings and impressions while respecting the person’s identity. 

To Prepare:

• reflect on a time when you experienced a patient being brought into (or not being brought into) a decision regarding their treatment plan.
• Review the Ottawa Hospital Research Institute’s Decision Aids Inventory at https://decisionaid.ohri.ca/.
  • Choose “For Specific Conditions,” then Browse an alphabetical listing of decision aids by health topic.
• After you have chosen a topic (or condition) and a decision aid, consider if social determinants of health were considered in the treatment plan Social determinants of health can affect a patient’s decision as these are conditions in the patient’s environment, such as economic stability, education access, health care access and quality, neighborhood, and social and community context.
• NOTE: To ensure compliance with HIPAA rules, please DO NOT use the patient’s real name or any information that might identify the patient or organization/practice.

 Post a brief description of the situation you experienced and explain how incorporating or not incorporating patient preferences, social determinants of health, and values impacted the outcome of their treatment plan. Be specific and provide examples and at least 3 references. Then, explain how including patient preferences, social determinants of health, and values might impact the trajectory of the situation and how these were reflected in the treatment plan. Finally, explain the value of the patient decision aid you selected and how it might contribute to effective decision making, both in general and in the experience you described. Describe how you might use this decision aid inventory in your professional practice or personal life.

(Please Note: The underlined “social determinants of health” in the above content is meant to hotlink to the following Walden webpage and content:

Social Determinants of Health – Social Determinants of Health – Academic Guides at Walden University)

Unit 8 Medications for Sleep Disorders —2 Peer Response 600w. due 10-25-23

Please read and respond to at least two of your peers' initial postings. You may want to consider the following questions in your responses to your peers:

• Compare and contrast your initial posting with those of your peers.

• How are they similar or how are they different?

• What information can you add that would help support the responses of your peers?

• Ask your peers a question for clarification about their post.

• What most interests you about their responses?

Please be sure to validate your opinions and ideas with citations and references in APA format.

Ingrid A.

· There are multiple sleep disorders such as insomnia, sleep apnea, restless leg syndrome, hypersomnia, circadian rhythm disorders, and parasomnia which I think is “sleepwalking” or at least very similar to sleepwalking (Sleep Disorders, 2020).

Screening tools to diagnose sleep disorders can be just as gathering information from the patient, like history and physical. There are other screening tools such as actigraphy which is something like a watch the patient must wear and this tracks the movements the patient makes when sleeping and being awake (How is actigraphy used to evaluate sleep?, 2022)

Adding more we also have polysomnography also known as the “sleep study”, and this particular test records brain waves, oxygen level as well as heart rate (Polysomnography (Sleep Study) 2023). Epic (electronic health record) has something called the stop-bang questionnaire and it basically asks questions about snoring, blood pressure, and the size of the neck. There is also something called the Athens Insomnia Scale and Epworth Sleepiness Scale (Sleep disorders: Clinical tools, 2023).

Z-drugs such as zolpidem, zopiclone, and zaleplon are innovative hypnotics that aid with sleep, reduce sleep latency, and improve quality. These drugs are prescription dispensed only and they work by slowing the activity in the brain (Commissioner, 2023).

Benzodiazepines are medications such as lorazepam, diazepam, temazepam, alprazolam, and clonazepam among others that can have potential side effects such as respiratory depression, drowsiness, impaired judgment, nausea and vomiting, confusion, addiction, and even respiratory distress (Brandt & Leong, 2017).

References:

Brandt, J., & Leong, C. (2017). Benzodiazepines – statpearls – NCBI bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK470159/

Commissioner, O. of the. (2023). Taking z-drugs for insomnia? know the risks. U.S. Food and Drug Administration. https://www.fda.gov/consumers/consumer-updates/taking-z-drugs-insomnia-know-risks

How is actigraphy used to evaluate sleep?. Sleep Foundation. (2022, May 10). https://www.sleepfoundation.org/sleep-studies/actigraphy

Mayo Foundation for Medical Education and Research. (2023, February 17). Polysomnography (Sleep Study). Mayo Clinic. https://www.mayoclinic.org/tests-procedures/polysomnography/about/pac-20394877#:~:text=Polysomnography%2C%20known%20as%20a%20sleep,measures%20eye%20and%20leg%20movements.

Sleep disorders: Clinical tools. CAMH. (2023). https://www.camh.ca/en/professionals/treating-conditions-and-disorders/sleep-disorders/sleep-disorders—clinical-tools

U.S. National Library of Medicine. (2020, January 3). Sleep disorders. MedlinePlus. https://medlineplus.gov/sleepdisorders.html

Mojgan A

Week 8, Medications for Sleep Disorders

What screening tools can be used to affirm your initial diagnosis that a patient may meet the diagnostic criteria for a sleep disorder?

        There are different tools for assessing sleep disorders. Among various rating scales, the Pittsburgh Sleep Quality Index (PSQI) was specifically designed to evaluate overall sleep quality and is among the recommended questionnaires for examining global sleep patterns and symptoms related to insomnia (Zitser et al., 2022). It is a self-report questioner and will assess the sleep quality over one month. Another useful scale is the Epworth Sleepiness Scale (ESS), which is a questionnaire designed to assess daytime sleepiness. A higher score on the ESS suggests the need for further evaluation for possible sleep disorders (Clinical application of headache impact test (HIT)-6 and Epworth Sleepiness Scale, 2023).

        According to the literature, the gold standard for monitoring sleep and breathing is polysomnography (PSG). PSG observes various physiological factors during sleep, including brain activity, eye movement, heart rate, and muscle activity. It involves the use of special bands around the chest and abdomen, as well as sensors for temperature and airflow in the nose. PSG also utilizes a device to measure airflow and sensors for air pressure in the airway. However, it's important to note that these methods can be invasive and time-consuming to set up and understand (Naik et al., 2023). Home sleep apnea testing (HSAT) is a simplified version of PSG that can be conducted at home and offers several potential benefits compared to traditional PSG, such as increased accessibility, quicker treatment initiation, and cost savings (Johns et al., 2022).

Describe the pharmacological actions of non-z sleep medications?

       Non-benzodiazepine (non-Z) sleep medications, such as zolpidem (Ambien), eszopiclone (Lunesta), and zaleplon (Sonata), function by enhancing the activity of the neurotransmitter known as gamma-aminobutyric acid (GABA) in the central nervous system. GABA is an inhibitory neurotransmitter that promotes relaxation and facilitates sleep. One key distinction between benzodiazepine medications and non-Z medications is their selectivity in targeting GABA receptors (Stahl, 2021).

       Benzodiazepines act on various GABA receptor subunits (including alpha 1, alpha 2, alpha 3 and alpha 5 receptors) nonselectively. Benzodiazepines acting on alpha2 and alpha3 receptor subtypes have effects that reduce anxiety, promote muscle relaxation, and enhance the effects of alcohol. On the other hand, the alpha5 subtype, found in the hippocampus, may be implicated in cognitive processes. As a result, benzodiazepines are employed for the treatment of sleep disorders, seizure disorders, and anxiety disorders due to their broader spectrum of activity (Stahl, 2021).

        In contrast, non-Z medications selectively target alpha 1 receptors, which are primarily associated with the sleep process. Therefore, non-Z medications are specifically designed to induce and improve sleep without affecting the full spectrum of GABA receptors. Another distinction to note is that benzodiazepines typically have longer half-lives, which means they remain in the body for a more extended period compared to non-Z medications. This difference in half-life can have implications for factors such as prolong sedation and potential for dependence or withdrawal when using these medications. Non- Z medications are usually used for short amount of time and do not cause dependence or withdrawal symptoms (Stahl, 2021).

What problems can occur when benzodiazepines are used to help with sleep?

        Benzodiazepines are potent medications known for their effectiveness, but they come with a range of significant concerns and potential problems. They have sedative properties, leading to drowsiness and increased sleepiness in patients. Additionally, benzodiazepines exhibit a prolonged half-life, resulting in an extended duration of action within the body, which can impact a patient's overall quality of life. These medications have been associated with several adverse effects (Stahl, 2021).

        Benzodiazepines can impair cognitive function, memory, and coordination, potentially leading to accidents and reduced overall performance. A major concern with benzodiazepines is the development of tolerance. Over time, patients may require higher doses to achieve the same therapeutic effect. This can lead to physical and psychological dependence, as patients become addicted to the sedative properties of the medication (Stahl, 2021).

        Abruptly discontinuing benzodiazepines can result in unpleasant withdrawal symptoms, which can be challenging for patients. One study by Ritvo et al. (2023) revealed that over 40% of the respondents reported experiencing 17 or more symptoms persisting for at least one year after discontinuing their use of benzodiazepines. Common side effects associated with benzodiazepines include dizziness, drowsiness, and coordination problems, which can be especially problematic for individuals who need to remain alert and functional. It's essential to be mindful of potential drug interactions, as benzodiazepines can interact with other medications, potentially affecting their effectiveness or causing unexpected side effects (Stahl, 2021)

        Given these concerns, it is advisable to use benzodiazepines cautiously and only for short durations. When discontinuing their use, a slow tapering approach is often recommended to minimize the risk of withdrawal symptoms. This ensures that the benefits of these medications are balanced against the potential risks and adverse effects they may cause.

References

Clinical application of headache impact test (HIT)-6 and Epworth Sleepiness Scale (ESS) for sleep apnea headache. (2023). 
Sleep Science and Practice, 7, 1-9. 
https://doi.org/10.1186/s41606-023-00084-2Links to an external site.

Johns, J. D., Armin, M., Alexandra, W., Jeffrey, K. H., Mikula, S. K., & Hoa, M. (2022). Reliability of home sleep apnea testing for diagnosing obstructive sleep apnea in patients with spontaneous cerebrospinal fluid leaks. 
Cureus, 14(10)

https://doi.org/10.7759/cureus.29854

Naik, G. R., Breen, P. P., Jayarathna, T., Tong, B. K., Eckert, D. J., & Gargiulo, G. D. (2023). Morphic sensors for respiratory parameters estimation: Validation against overnight polysomnography.
 Biosensors, 13(7), 703. 
https://doi.org/10.3390/bios13070703Links to an external site.

Ritvo, A. D., Foster, D. E., Huff, C., Reid Finlayson, ,A.J., Silvernail, B., & Martin, P. R. (2023). Long-term consequences of benzodiazepine-induced neurological dysfunction: A survey.
 PLoS One, 18(6) https://doi.org/10.1371/journal.pone.0285584

Stahl, S. M. (2021). 
Stahl’s essential psychopharmacology: Neuroscientific basis and practical application (5th ed.).

Zitser, J., Allen, I. E., Falgàs, N., Le, M. M., Neylan, T. C., Kramer, J. H., & Walsh, C. M. (2022). Pittsburgh Sleep Quality Index (PSQI) responses are modulated by total sleep time and wake after sleep onset in healthy older adults.
 PLoS one, 17 (6) https://doi.org/10.1371/journal.pone.0270095

 Reply

State Powers

Assignment

Required Resources

Read/review the following resources for this activity:

· Textbook: Chapter 1, 2, 3

· Lesson

· Minimum of 2 scholarly sources in addition to the textbook.

Instructions

Review the Bill of Rights for the U.S. Constitution (the first 10 amendments) to understand what rights are listed. There are numerous online sources to find the Bill of Rights.
Next, go online and look up your state's constitution. Find three state sections that are similar to or align with the Bill of Rights (the first 10 amendments to the U.S. Constitution). Examples include religious freedom, freedom of speech or association, etc. Compare and contrast these three state sections from your state’s constitution with their comparable sections in the Bill of Rights found in the U.S. Constitution and discuss the guidelines for each. 

Requirements

· Length: 1.5-2 pages (not including title page or references page)

· 1-inch margins

· Double spaced

· 12-point Times New Roman font

· Title page

· References page (minimum of 2 scholarly sources in addition to textbook if cited)

Ebook:
https://bookshelf.vitalsource.com/reader/books/9780135246849/pageid/11

The Struggle for Democracy, 2018 Elections and Updates Edition

Or
[email protected]

PWD: Bryanthierry@09