BE SURE TO READ ALL DIRECTIVES

Instructions for Answer to 2 Question

1- After Each DQ (question), write down references

2- 300 minimum words for every DQ, you can go up to 800 words but answer should be complete.

3- 2-3 Peer Reviewed/ scholarly references for each question

4- References should be within 4 years

5- I am in acute care nurse practitioner program.

6- The response to the DQ is expected to be a minimum of 300 words. A minimum of two peer reviewed/ scholarly  resources are expected. These need to be appropriate for a clinical professional to guide decisions about patient care. If a textbook is used for one of these responses, the other needs to be journal or professional-level website. The references need to be correctly formatted, as do the citations for those references.  “ Question words” don’t count towards 300 minimum count”

cause  and effect

Due December 1st

Create a PowerPoint presentation and answer the following question in 1-2 slide using each component of the MAP-IT project (mobilize, assess, plan, implement and track) the link to assess this is provided below.

PICOT QUESTION:  In adults living in assisted living, does participation in social activity positively impact feeling of loneliness?

Question: In adults living in assisted living, does participation in social activity positively impact feeling of lonlines?​

Population of interest (P) = Adults residing in assisted living facilities​

Variable of Interest = Different activities plan (dance group, movies, games)​

The Intervention or Interest (I) = The use of activities in adult residing in assisted living facilities to prevent loneliness​

Comparison of Interest (C) = No Activities​

Outcome of Interest (O) = To promote interaction and prevent loneliness in adult living in assissted living facilities​

Time (T) = Within 3 months of stay.​
 

Each MAP-IT segment  to follow

Mobilize,  

Questions to Ask and Answer:

• What is the vision and mission of the coalition?
• Why do I want to bring people together?
• Who should be represented?
• Who are the potential partners (organizations and businesses) in my community?

Assess 

 Questions to Ask and Answer:

• Who is affected and how?
• What resources do we have?
• What resources do we need?

Assess both needs and assets (resources) in your community.
This will help you get a sense of what you can do, versus what you would like to do.

Plan

Questions to Ask and Answer:

• What is our goal?
• What do we need to do to reach our goal? Who will do it?
• How will we know when we have reached our goal?

A good plan includes clear objectives and concrete steps to achieve them.
The objectives you set will be specific to your issue or community; they do not have to be exactly the same as the ones in Healthy People 2020.

Consider your intervention points.
Where can you create change?

Think about how you will measure your progress.
How will you know if you are successful?

When setting objectives, remember to state exactly what is to be achieved. What is expected to change, by how much, and by when? Make your objectives challenging, yet realistic.

Remember: Objectives need a target. A target is the desired amount of change (reflected by a number or percentage). A target needs a baseline (where you are now—your first data point).

Implement

 Questions to Ask and Answer:

• Are we following our plan?
• What can we do better?

First, create a detailed workplan that lays out concrete action steps, identifies who is responsible for completing them, and sets a timeline and/or deadlines.

Make sure all partners are on board with the workplan.

Next, consider identifying a single point of contact to manage the process and ensure that things get done.

Be sure to share responsibilities across coalition members. Do not forget to periodically:

• Bring in new partners for a boost of energy and fresh ideas.
• Check in with existing partners often to see if they have suggestions or concerns.

Get the word out: develop a communication plan.

Convene kick-off events, activities, and community meetings to showcase your accomplishments (and partners).

Tract 

Questions to Ask and Answer:

• Are we evaluating our work?
• Did we follow the plan?
• What did we change?
• Did we reach our goal?

Plan regular evaluations to measure and track your progress over time.

Consider partnering with a local university or state center for health statistics to help with data tracking. Some things to think about when you are evaluating data over time:

• Data Quality: Be sure to check for standardization of data collection, analysis, and structure of questions.
• Limitations of Self-Reported Data: When you are relying on self-reported data (such as exercise frequency or income), be aware of self-reporting bias.
• Data Validity and Reliability: Watch out for revisions of survey questions and/or the development of new data collection systems. This could affect the validity of your responses over time. (Enlist a statistician to help with validity and reliability testing.)
• Data Availability: Data collection efforts are not always performed on a regular basis.

Do not forget to share your progress—and successes—with your community.
If you see a positive trend in data, issue a press release or announcement.

Follow the above information provided and create a POWERPOINT PRESENTATION ADDRESSING THE ABOVE.

Please follow the link for program planning https://www.healthypeople.gov/2020/tools-and-resources/Program-Planning 

The rubric to follow is attached 

Provide references in APA format 7th edition

You have probably seen one or more of the many inspirational posters about decisions. A visual such as a forked road or a street sign is typically pictured, along with a quote designed to inspire.

Often decisions are not so easily inspired. Perhaps you discovered this when choosing a specialty within the MSN program. This decision is a critical part of your plan for success, and you no doubt want to get it right. This is yet another area where your network can help, as well as other sources of information that can help you make an informed choice.

To Prepare:

Reflect on your decision to pursue a specialty within the MSN program, including your professional and academic goals as they relate to your program/specialization.

By Day 3

Post an explanation of your choice of a nursing specialty within the program. Describe any difficulties you had (or are having) in making your choice, and the factors that drove/are driving your decision. Identify at least one professional organization affiliated with your chosen specialty and provide details on becoming a member 

Fair Standards and Procedures

For this discussion, research fair standards and procedures in the school online library and on the Internet.

• Describe common situations or experiences (e.g., in the workplace, among family members, in public settings such as shopping or eating at a restaurant) in which fair standards or practices would apply.
• Identify potential resolutions that would be acceptable for all parties.
• Explain your response and provide examples.

Cite and reference sources according to APA Style.

Pathological conditions that might affect the sexual responses in the elderly population

Sexuality is a very vital component of physical and emotional intimacy that women and men experience throughout their active lives. Female sexual dysfunction and male erectile failure increase with an individual’s age.  About 30 percent of older adults have at least a single complaint with their sexual function. However, about three-quarters of the older adults still expresses their interest to maintain their proper sexual function. Certain normal transformation tends to occur with aging, for example, in older men requiring more time and stimulation to obtain a complete erection. (Robert C. Dean, 2005)

In as much as sexual dysfunction is related to aging, it is important not to rule out the possibility of disease conditions or medication side effects as being related to sexual dysfunction. The most prevalent pathological disorders related to sexual dysfunction include lower urinary tract symptoms, diabetes, depression, and cardiovascular disorders. It has been established that the occurrence of erectile dysfunction can be reduced through early control of cardiovascular risk factors that help in improving endothelial function. And that modification of lifestyle-related risk factors such as obesity and treatment of the predisposing disorders may help curb sexual dysfunction in the elderly. 

Both chronic and acute conditions cause sexual dysfunction and decreased sexual interest. Pathological disorders lower tolerance to physical activity and mobility thus minimizing sexual desire. Cardiovascular disorders are the main cause of morbidity in older adults and more often associated with sexual dysfunction. The vascular system and the neurological systems should be intact for normal arousal in women and erection in men, however, the elderly often experience neurological degenerations. (Robert C. Dean, 2005)

The pathophysiology of erectile dysfunction can then be classified into; psychogenic dysfunction which is the most common. Psychogenic dysfunction occurs through alteration of the brain areas that control sexual behaviors such as the limbic system, hypothalamus, and cerebral cortex. The other classifications include the neurogenic (affecting the pudendal and cavernous nerves, spinal cord, and brain.), endocrinologic as a result of hypogonadism that occurs with old age, and arteriogenic such as structural changes, impaired endothelium-dependent vasodilation, and vasoconstriction. Diabetes has also been massively associated with sexual dysfunction among the elderly since these conditions seriously affect the vascular system. (Robert C. Dean, 2005)

Nutritional factors that affect immune systems

Older adults tend to develop nutritional deficiencies due to poor appetite caused by chronic conditions, loneliness, depression, or multiple medications that cause interference with normal nutrient absorption. Nutrient deficiency even a single nutrient may lead to alteration in the body’s immune response. Studies have indicated that deficiencies in selenium, iron, zinc, folic acid, copper, and vitamins can cause alteration in the immune response. The poorly nourished are therefore at a greater risk of infections. (CHAN)

Psychological factors that affect immune response among the elderly.

Studies carried on brain behavior and immunity indicates the correlation between psychopathology and personality to immunity, changes in immune responses induced by stress, and the behavioral conditioning of immunity. Empirical evidence suggests that psychological processes can impinge upon modulating immune responses. This is shown by a revelation of the fact that immune competence is malleable, a fact validated by the differences in responsiveness of cell functioning in elderly and young people. Older adults’ unstable psychological conditions, therefore, predispose them to immune incompetency. (Christopher L. Coe, 2017)

How drugs and alternative and complementary medications affect the immune system.

It has been realized that Complementary and Alternative medicine (CAM) is effective in boosting immune response. CAM, curcumin, and polyphenolic compounds obtained from common food colorant turmeric can enhance the antibody’s responses even at low doses. some drugs can, however, cause considerable damage to many systems including the immune system through intoxication. (Nilashi, 2020)

References

Beers, M., Fink, A., & Beck, J. C. (2016). Screening Recommendations for the. American Journal of Public Health, 81(9), 1131-1139.

Burke, S. A. (2016). Influence through policy: Nurses have a unique role. Retrieved from Sigma Nursing: https://www.reflectionsonnursingleadership.org/commentary/more-commentary/Vol42_2_nurses-have-a-unique-role

CHAN, H. T. (n.d.). The Nutrition Source. HAVARD T.H. CHAN. Retrieved from https://www.hsph.harvard.edu/nutritionsource/nutrition-and-immunity/#:~:text=A%20deficiency%20of%20single%20nutrients,E%20can%20alter%20immune%20responses.

Choi, S., Cheung, K., & Pang, S. (2015). A field study of the role of nurses in advocating for safe practice in hospitals. Journal of Advanced nursing, 70(7), 1584-93. doi:10.1111/jan.12316

Christopher L. Coe, M. L. (2017). Psychosocial influences on immunity, including effects on immune maturation and senescence. HHS Public Health Access. doi: 10.1016/j.bbi.2007.06.015

Nilashi, M. (2020). Can complementary and alternative medicines be beneficial in the treatment of COVID-19 through improving immune system function? J Infect Public Health. doi:doi: 10.1016/j.jiph.2020.05.009

Robert C. Dean, M. a. (2005). Physiology of Penile Erection and Pathophysiology of Erectile Dysfunction. HHS Public Access. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1351051/

Torrey, T. (2020, March 09). End of Life and Advance Directive Documents. Retrieved from Verywell Health: https://www.verywellhealth.com/advance-directives-documents-2615080

REPLY 2

Cardiovascular diseases and osteoporosis as well as dementia are the common chronic conditions that occur in adults especially those at the age of above 85 years. There are many other conditions as well that affect adults even those not at old age. In this study, we will focus on those pathological conditions that affect that affect the sexual responses in older adults, whether or not the nutritional factors, psychological factors, drugs as well as complementary and alternative medications affect the immune system in older adults.

The sexual disorders include; one lacking sexual desires or not having any interest for sex. The person develops disorders in arousal process, meaning the person cannot be physical aroused or even get excited during sex. There is also a problem when it comes to orgasm, that is, the person can delay or even absence of orgasm. There are those who also experience pain during sex, a condition referred to as pain disorder. The conditions that affect the sexual response in adults are grouped into two categories, the physical causes and psychological causes.

There are many physical or medical conditions that can affect the sexual response in older adults; they include conditions such as diabetes, heart as well as vascular diseases, the neurological disorders, the hormonal imbalances, some chronic infections such as liver and kidney failure. Alcoholism as well as drug abuse can also affect the sexual conditions in adults.

  There are also some medications that may have side effects like the side effects of antidepressants that can affect the sexual function.  Some antidepressants can reduce the sexual desire and this can interfere with one’s ability to orgasm, examples of these drugs are Prozac and Zoloft. These same effects can as well occur with SNRI antidepressants such as cymbalta. Other medications that can as well affect the sexual desire are the drugs to curb anxiety like diazepam, the antifungal like ketoconazole, the blood for blood pressure like the atenolol as well as the heartburn drugs such as famotidine (Obos 2014).  

The psychological conditions are mainly the work related problems such as stress, being anxious, some are concerns on sexual performance, the marital as well as problems related to relationships, depression, the guilt feeling, having concerns on the body image and also being affected by the past sexual trauma can also lead to effects on sexual response among adults.

In the line of nutrition, there are also foods that can reduce ones sex drive, they make one to have a reduction in the level of sex demand. This foods include, processed food like bread, diet soda, the microwave popcorns, marijuana as a food and drug, shrimps, alcohol as a drug especially beer, edamame, cheese, sugar, canned soup, licorice and many others just to mention but a few (Stoddard 2017).

To conclude, from the research, it is clear that drugs, nutrition, the psychological factors as well as medications can affect the sex response of a person. The effects can be positive or negative effects, a person can either have high desire for sex or low desire for sex. One can even end up not in need of sex at all. The best way to know if what you eat or the medications you take affect your sexual desire is by continuous monitoring of what you take and the effects it’s having on you with time.  

References

Grant Stoddard, (2017), 27 Foods that Kill your Sex Drive.

Obos Sexuality and Relationship Contributors, (2014), Medications that can affect sexual desire and pleasure.

All replies must be constructive and use literature where possible.

Your assignment will be graded according to the grading rubric.

Give your opinion about the advantages and disadvantages of the EHR, remember that the technology has made it possible to access a patient’s information in seconds through computer technology, however this technology may be vulnerable in terms of privacy so the confidential information of the patients could be in danger.

The format must be APA, give at least two references from 2016 to 2020, a minimum of 250 words.

As a nurse leader, it is important to understand a variety of leadership models and styles. This will help you adapt to different settings and apply strategies to support and inspire others. It may also be necessary to apply models in different professional settings to satisfy certification requirements. Write a 1,000-1,250 word paper about your personal model of leadership, including the following:

1. How might your personal model of leadership be applied in your professional setting?
2. Compare your personal leadership model to servant leadership, transformational leadership, and at least one other model of leadership.
3. Describe your personal worldview, including the religious, spiritual, and cultural elements that you think most influence your personal philosophy of practice and attitude towards leadership.
4. Describe how your professional leadership behaviors can inspire others.

Use a minimum of three peer-reviewed resources (published within the last 5 years) as evidence to support your views.

Prepare this assignment according to the APA guidelinea. An abstract is not required.

How do beta-blockers work? What exactly do antibiotics do to the bacteria they target? What effects does an anti-depressant have on blood flow?

Questions like these are related to the underlying pharmacokinetic and pharmacodynamic processes of pharmacotherapeutics. As an advanced practice nurse, understanding these fundamental pharmacotherapeutic concepts is important to ensure that the prescription drugs you recommend for your patients will be safe and effective to treat and/or manage their symptoms. Additionally, as the advanced practice nurse, it is your responsibility to ensure that when prescribing prescription drugs, you adhere to the ethical and legal principles set forth for prescribing drugs as an added layer of protection and safety for the patients you will treat.

This week, you will analyze factors that may influence pharmacokinetic and pharmacodynamics processes of a patient and assess the details of a personalized plan of care that you develop based on influencing factors and patient history. You will also evaluate and analyze ethical and legal implications and practices related to prescribing drugs, including disclosure and nondisclosure, and analyze the process of writing prescriptions to avoid medication errors.

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Chapter 1, “Prescriptive Authority” (pp. 1–3)
Chapter 2, “Rational Drug Selection and Prescription Writing” (pp. 4–7)
Chapter 3, “Promoting Positive Outcomes of Drug Therapy” (pp. 8–12)
Chapter 4, “Pharmacokinetics, Pharmacodynamics, and Drug Interactions” (pp. 13–33)
Chapter 5, “Adverse Drug Reactions and Medication Errors” (pp. 34–42)
Chapter 6, “Individual Variation in Drug Response” (pp. 43–45)

American Geriatrics Society 2019 Beers Criteria Update Expert Panel. (2019). American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 67(4), 674–694. doi:10.1111/jgs.15767
American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults by American Geriatrics Society, in Journal of the American Geriatrics Society, Vol. 67/Issue 4. Copyright 2019 by Blackwell Publishing. Reprinted by permission of Blackwell Publishing via the Copyright Clearance Center.

This article is an update to the Beers Criteria, which includes lists of potentially inappropriate medications to be avoided in older adults as well as newly added criteria that lists select drugs that should be avoided or have their dose adjusted based on the individual’s kidney function and select drug-drug interactions documented to be associated with harms in older adults.

Drug Enforcement Administration. (n.d.-a). Code of federal regulations. Retrieved February 1, 2019, from https://www.deadiversion.usdoj.gov/21cfr/cfr/1300/1300_01.htm

This website outlines the code of federal regulations for prescription drugs.

Drug Enforcement Administration. (n.d.-b). Mid-level practitioners authorization by state. Retrieved May 13, 2019 from http://www.deadiversion.usdoj.gov/drugreg/practioners/index.html

This website outlines the schedules for controlled substances, including prescriptive authority for each schedule.

Drug Enforcement Administration. (2006). Practitioner’s manual. Retrieved from http://www.legalsideofpain.com/uploads/pract_manual090506.pdf
This manual is a resource for practitioners who prescribe, dispense, and administer controlled substances. It provides information on general requirements, security issues, recordkeeping, prescription requirements, and addiction treatment programs.

Drug Enforcement Administration. (n.d.-c). Registration. Retrieved February 1, 2019, from https://www.deadiversion.usdoj.gov/drugreg/index.html

This website details key aspects of drug registration.

Fowler, M. D. M., & American Nurses Association. (2015). Guide to the Code of Ethics for Nurses with Interpretive Statements: Development, Interpretation, and Application (2nd ed.). Silver Spring, Maryland: American Nurses Association.

This resource introduces the code of ethics for nurses and highlights critical aspects for ethical guideline development, interpretation, and application in practice.

Institute for Safe Medication Practices. (2017). List of error-prone abbreviations, symbols, and dose designations. Retrieved from https://www.ismp.org/recommendations/error-prone-abbreviations-list

This website provides a list of prescription-writing abbreviations that might lead to misinterpretation, as well as suggestions for preventing resulting errors.

Ladd, E., & Hoyt, A. (2016). Shedding light on nurse practitioner prescribing. The Journal for Nurse Practitioners, 12(3), 166–173. doi:10.1016/j.nurpra.2015.09.17

This article provides NPs with information regarding state-based laws for NP prescribing.

Sabatino, J. A., Pruchnicki, M. C., Sevin, A. M., Barker, E., Green, C. G., & Porter, K. (2017). Improving prescribing practices: A pharmacist‐led educational intervention for nurse practitioner students. Journal of the American Association ofNursePractitioners, 29(5), 248–254. doi:10.1002/2327-6924.12446

The authors of this article assess the impact of a pharmacist‐led educational intervention on family nurse practitioner (FNP) students’ prescribing skills, perception of preparedness to prescribe, and perception of pharmacist as collaborator.

 Post a description of the patient case from your experiences, observations, and/or clinical practice from the last 5 years. Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient you identified. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case. Be specific and provide examples. 

At least 2 citations APA format 7th edition

FU

One patient case from my experience that addresses the principles of pharmacokinetics and pharmacodynamics is where my patient was a 55 years old female, of African American decent, had a history of diabetes, hyperlipidemia, and hypertension. The patient was presented to our hospital with severe nausea, vomiting and abdominal pain. Assessment and lab work showed the patient’s blood glucose was 605mg/dL, HgA1C 8.5%, cholesterol 180 mg/dl, weight 290 lbs, height 68inches, BP 90/75, pulse 118, Respiration 23 bpm. Patient stated she had been very stressed lately and had mostly been dining out at fast-food restaurants and has not had the time to exercise. Patient had been prescribed insulin however, she stated she has not been checking her blood glucose level like she should have. 

This patient was presenting with symptoms of diabetic ketoacidosis (DKA). DKA is a medical emergency that occurs when the body is unable to produce adequate insulin to decrease blood glucose level and leads to the production of high levels of acids in the blood called ketones (Alshammari et. al., 2017). This was a medical emergency that required immediate intervention of fluid repletion and the administration of insulin. It also involved the frequent monitoring of patient’s vital signs, glucose levels, and electrolyte levels. 

Factors that might have influenced pharmacokinetics of insulin the patient was receiving are diet (eating fatty foods or foods high in carbohydrates increases glucose levels in the body), stress (cortisol increases insulin resistance), and lack of exercise. Eating a balanced diet decreases the likelihood that the patient will consume mostly foods high in fats and carbohydrates. When someone is stressed, the body produces stress hormones called cortisol which to a diabetic patient can significantly affect their health because it causes the body to release more glucose and to become resistant to the insulin the patient needs to reduce that blood glucose to a healthy level (Alshammari et. al., 2017). Exercise redistributes and lowers the blood glucose level. It could cause patients to go into hypoglycemia that is why it is important to check glucose levels before, during, and after exercise.

The personalized care plan that I would develop for this patient would include; a Dietary and lifestyle change plan – here the patient will be educated on how to count her carbohydrates and caloric intake. The Center for Disease Control has dietary guidelines for the different age groups. The site also provides “My Food Diary” (CDC, 2019) a flow sheet to help individuals keep a day-to-day record of how much food is consumed for breakfast, snacks, lunch, and dinner. I would also recommend she exercise regularly but that to check her blood glucose before, during and after exercise. “The adoption and maintenance of physical activity are critical foci for blood glucose management and overall health in individuals with diabetes” (Colberg, 2016). Also, I would suggest she check her blood glucose before each insulin administration, as this may affect the dosage to be administered.

References

Alshammari, A. A., Alahdal, L. M., Jawi, J. T., Alnofaie, H. A., Aldossari, N. A., AbdulazizAlassaf, H. M., Ramel, A. I., Almshikhess, S. H., Felemban, A. S., Alanazi, S. A., Joharji, R. N., Alzahrani, A. M. B., Almaghamsi, S. A. D., Alalawi, M. S. M., Alasmari, H. I., Abduljabbar, A. M., & alzahrani, A. fahad. (2017). First Line Management of Adult Diabetic Ketoacidosis Patients. Egyptian Journal of Hospital Medicine, 67(2), 571–577. https://doi-org.ezp.waldenulibrary.org/10.12816/0037808

Centers fo Disease Control and Prevention [CDC], 2019. Eating Out. Retrieved from https://www.cdc.gov/diabetes/managing/eat-well.html

Colberg, S.R., Sigal, R. J., Yardley, J. E., Riddle, M.C., Dunstan, D.W., Dempsey, P.C., … & Tate, D.F. (2016). Physical activities/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes care, 39(11), 2065-2079