Week 5: Anxiolytic Therapy & PTSD Treatment
“I’m no longer at the mercy of my PTSD, and I would not be here today had I not had the proper diagnosis and treatment. It’s never too late to seek help.”
—P.K. Philips, PTSD patient
For individuals suffering from posttraumatic stress disorder (PTSD) and other anxiety disorders, everyday life can be a constant challenge. Clients requiring anxiolytic therapy may present with anxiousness, depression, substance abuse issues, and even physical symptoms related to cardiovascular, respiratory, and gastrointestinal ailments. As a psychiatric mental health nurse practitioner, you must be prepared to address the many needs of individuals seeking treatment for PTSD and other anxiety disorders.
This week, as you study anxiolytic therapies and PTSD treatments, you examine the assessment and treatment of clients with PTSD and other anxiety disorders. You also explore ethical and legal implications of these therapies.
Photo Credit: [shironosov]/[iStock / Getty Images Plus]/Getty Images
Assignment: Assessing and Treating Clients With Anxiety Disorders
Common symptoms of anxiety disorders include chest pains, shortness of breath, and other physical symptoms that may be mistaken for a heart attack or other physical ailment. These manifestations often prompt clients to seek care from their primary care providers or emergency departments. Once it is determined that there is no organic basis for these symptoms, clients are typically referred to a psychiatric mental health practitioner for anxiolytic therapy. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with anxiety disorders.
Learning Objectives
Students will:
- –Assess client factors and history to develop personalized plans of anxiolytic therapy for clients
- –Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring anxiolytic therapy
- –Evaluate efficacy of treatment plans
- –Analyze ethical and legal implications related to prescribing anxiolytic therapy to clients across the lifespan.
sample that can be audit and submit with plagiarism less than 15%
Assessing and Treating Clients with Anxiety Disorder
Assessing and Treating Clients with Anxiety Disorders.
Anxiety disorders are the most prevalent category of mental illness and are characterized by chronic anxiety causing distress and interference in the individual’s life. According to DSM-5, excessive anxiety and worry must cause significant distress or impairment and occurs on more days than not for at least six months for diagnostic criteria (Stein et al., 2015) The disorder can be effectively treated with medication, psychotherapy, or a combination of the two modalities.
This paper addresses the pharmacology approach in treating a 46 year- old white male who is experiencing anxiety, and the impact pharmacokinetic and pharmadynamic processes will be explored to guide for the appropriate treatment.
Case Scenario
A 46-year-old white male who initially presented to ER with a complaint of chest pain and cardiac work- up was negative, and a PMHNP consult was sought for psychiatric evaluation. The client ‘s Hamilton Anxiety Rating Scale( HAM-A) was 26 indicating moderate to severe anxiety phase. The PMHNP decides to start the client on medications.
Options: Zoloft 50 mg Po Daily, imipramine 25 mg po BID, buspirone 10 mg BID.
Decision: Zoloft 50 mg PO daily.
Rationale: Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs ) benzodiazepines, buspirone, and α2δ ligands such as pregabalin and gabapentin are recommended as first line treatments for anxiety disorders spectrum (Stahl, 2017) However, SSRI and SNRIs are efficacious in the treatment of generalized anxiety disorder (GAD) and panic attack as in the case of our patient in the scenario. Additionally, in cases of co-occurring GAD and depression, a common comorbidity, SSRIs can provide effective treatment for both GAD and major depression ( Johnson & Coles, 2014) .
Selecting sertraline (Zoloft) was based on the fact it belongs to the family of SSRI, and well recognized in the treatment of GAD and panic attack. Secondly, possible side effects of Zoloft which include sexual dysfunction, gastrointestinal abnormalities (nausea and diarrhea), insomnia, weight gain, and agitation and/or hyperactivation (Kamo et al.,2016) were explored prior selecting Zoloft. The patient was overweight (15 lb), hence a healthy lifestyle will be important for education, and the rest of side effects can be monitored and managed early in treatment.
Sertraline affects the serotonin neurotransmitter in the synaptic cleft by blocking the serotonin transporter from returning the remaining serotonin to the presynaptic cell. Sertraline is well absorbed in gastrointestinal tract, highly protein bound, predominantly metabolized by CYP 450 system with half-life of 24- 26 hrs and removed primarily by kidneys ( Woo & Wayne, 2013).
Imipramine, a tricyclic antidepressant was not my first choice because its possible side effects: blurred vision, dry mouth, urinary retention, drowsiness, weight gain, hypotension, and seizures (Stahl,2017)
Buspirone (Buspar), a serotonin receptor partial agonist can be appropriate for augmentation but not as first line treatment of GAD. Additionally, Buspirone takes longer (2 – 4 weeks) to have a full effect, and due to its sedation side effect, it would not be appropriate in our patient who has history of increased alcohol intake.
The goals of treatment of anxiety disorders are resolution of symptoms and prevention of relapse.
The client returns in four weeks, responding well to medication, anxiety decreased HAM A 18 from 26.
Options : Increase dose to 75 mg daily, increase dose to 100 mg daily, no change in drug/ dosage
Decision # 2 Increase dose to 75 mg daily.
Rationale: Sertraline dosing in panic, PTSD, and social anxiety begin with 25 mg/day; increase to 50 mg/day after 1 week thereafter, usually wait a few weeks to assess drug effects before increasing dose; maximum generally 200 mg/day; single dose (Stahl,2017).
Moreover, increasing dosage slowly will reduce the possibility of acquiring side effects from the medication (Stein et al., 2014)
The client returns in four weeks, reports further reduction in anxiety symptoms HAM- A 10 (mild anxiety)
Options: Maintain current dose, increase to 100 mg daily, add Buspirone.
Decision: Maintain current dose
Rationale: Major errors in psychopharmacological treatment of anxiety disorders include not achieving full remission of symptoms but instead accepting partial response, and not providing an adequate trial of medications (8 to 12 weeks ) before switching, discontinuing, or augmenting ( Woo & Wayne, 2013) . The patient was responding pretty well to medication ( 50% reduction in symptoms) , and reported no side effects. Therefore, continuing the same dosage, providing regular follow up with the patient to ensure medication adherence would be appropriate to meet the goals of remission.
References
Johnson, E. M., & Coles, M. E. (2014). Failure and Delay in Treatment-Seeking Across Anxiety Disorders. Community Mental Health Journal, 49(6), 668-674. Retrieved from https://web-a-ebscohost-com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=29&sid=7eabbc3a-b3a4-4cbf-b934-aa75c2e5b6fd%40sessionmgr4007
Kamo, T., Maeda, M., Oe, M., Kato, H., Shigemura, J., Kuribayashi, K., & Hoshino, Y. (2016). Dosage, effectiveness, and safety of sertraline treatment for posttraumatic stress disorder in a Japanese clinical setting: a retrospective study. BMC Psychiatry, 16(1). Retrieved from https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=6&sid=2ee0b7c6-b1c7-44e7-9b93-42c3b9a745c3%40sessionmgr102
Stein, D. J., Craske, M. A., Friedman, M. J., & Phillips, K. A. (2014). Anxiety Disorders, Obsessive-Compulsive and Related Disorders, Trauma- and Stressor-Related Disorders, and Dissociative Disorders in DSM-5. American Journal of Psychiatry, 171(6), 611-613. Retrieved from https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2014.14010003
Woo, T. M., & Wynne, A. L. (2013). Pharmacotherapeutics for nurse practitioner prescribers(3rd ed.). Philadelphia, PA: F.A. Davis Co.
- 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?
Capstone Nursing Project
UncategorizedQuestion Description
In this assignment, students will pull together the change proposal project components they have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. At the conclusion of this project, the student will be able to apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice.
Students will develop a 1,250-1,500 word paper that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal:
Review the feedback from your instructor on the Topic 3 assignment, PICOT Statement Paper, and Topic 6 assignment, Literature Review. Use the feedback to make appropriate revisions to the portfolio components before submitting.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.
Below are papers to REFERENCE only. No plaragism please.
the strengths and weaknesses of healthcare delivery in the U.S.
Nursing HomeworksDiscussion Question:1
Based on your course readings in Module 1 and additional research, prepare and post to the Discussion Area the strengths and weaknesses of healthcare delivery in the U.S., as compared to other developed nations such as England or Australia. In addition discuss the factors that contribute to the strengths and weaknesses of healthcare delivery in the U.S. Justify your viewpoint using examples. Our current system is in disarray and needs repair. However, the fix for our system is highly debated. What do you think? Do we Reform or Not Reform?
Discussion Question2
Primary care and secondary care are both provided in an outpatient setting, mostly in a doctor’s office. What are the benefits and risks in this provision of healthcare? Describe the difference between “primary” and “secondary” care in your response.
By the due date assigned respond to the discussion question assigned by the Faculty. Submit your response to the appropriate Discussion Area. Use the same Discussion Area to comment on your classmates’ submissions and continue the discussion through the end of module. Comment on how your classmates would address differing views.
Discussion Question2
Primary care and secondary care are both provided in an outpatient setting, mostly in a doctor’s office. What are the benefits and risks in this provision of healthcare? Describe the difference between “primary” and “secondary” care in your response.? How do we view health care from a primary and secondary source? With this view, does it need to change to improve care?
By the due date assigned respond to the discussion question assigned by the Faculty. Submit your response to the appropriate Discussion Area. Use the same Discussion Area to comment on your classmates’ submissions and continue the discussion through the end of module. Comment on how your classmates would address differing views.
>Computer Science homework help
UncategorizedPlease write a research paper that answers the following questions:
What are mobile forensics and do you believe that they are different from computer forensics?
What is the percentage of attacks on networks that come from mobile devices?
What are challenges to mobile forensics?
What are some mobile forensic tools?
Should the analysis be different on iOS vs Android?
Your paper should meet the following requirements:
Be approximately four to six pages in length, not including the required cover page and reference page.
Follow APA7 guidelines. Your paper should include an introduction, a body with fully developed content, and a conclusion.
Support your answers with the readings from the course and at least two scholarly journal articles to support your positions, claims, and observations, in addition to your textbook. The UC Library is a great place to find resources.
Be clearly and well-written, concise, and logical, using excellent grammar and style techniques. You are being graded in part on the quality of your writing.
Evaluation Table
UncategorizedUse this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research
Full citation of selected article
Article #1
Article #2
Article #3
Article #4
Dubin, J (2018)
Pediatric obesity in primary practice. Pediatric Nursing .44(4), 202-206.
Hargreaves, m., Orfield, C., Honeycutt, T., Vine, M., Cabili, C., Coffee- Boden, B., Fisher, S. (2017). Addressing childhood obesity through multisector collaboration: Journal of community health, 42 (4) 656-663
Kitson, S (2018). Intervention for weight in obesity to improve survival in women with endometrial cancer. Retrieved from https//www.waldenulibrary.org
Ruopeng An, Mengmeng Ji, & Zhang. (2017). Effectiveness of social media intervention on weight related behavior and body weight status. American Journal of health behavior 41(6), 670-682
Conceptual Framework
Describe the theoretical basis for the study
Design/Method Describe the design
and how the study
was carried out
Sample/Setting
The number and
characteristics of
patients,
attrition rate, etc.
Major Variables Studied
List and define dependent and independent variables
Measurement
Identify primary statistics used to answer clinical questions
Data Analysis
Statistical or
qualitative
findings
Findings and Recommendations
General findings and recommendations of the research
Appraisal
Describe the general worth of this research to practice. What are the strengths and limitations of study? What are the risks associated with implementation of the suggested practices or processes detailed in the research? What is the feasibility of
use in your practice?
General Notes/Comments
Levels of Evidence Table
Use this document to complete the levels of evidence table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research
Author and year of selected article
Article #1
Article #2
Article #3
Article #4
Study Design
Theoretical basis for the study
Sample/Setting
The number and
characteristics of
patients
Evidence Level *
(I, II, or III)
Outcomes
General Notes/Comments
* Evidence Levels:
Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis
Quasi-experimental studies, systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis
Nonexperimental, systematic review of RCTs, quasi-experimental with/without meta-analysis, qualitative, qualitative systematic review with/without meta-synthesis
Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence
Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence
Outcomes Synthesis Table
Use this document to complete the outcomes synthesis table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research
Author and year of selected article
Article #1
Article #2
Article #3
Article #4
Sample/Setting
The number and
characteristics of
patients
Outcomes
Key Findings
Appraisal and Study Quality
General Notes/Comments
Law homework help
Uncategorizedhttps://ccs.instructure.com/courses/1961380/discussion_topics/11340616?module_item_id=46516483 1/2
The forum on “Greater Equality” (This is “Test 2 question “) 3 3
Read the article Greater Equality in the module 8, and combine the content in Spokesman- Review article “Neighborhood matters” , link is here: https://www.spokesman.com/stories/2012/sep/23/solving-a-health-gap/, (https://www.spokesman.com/stories/2012/sep/23/solving-a-health-gap/,) the pdf file of this Neighbor matters article is also located in module 8 (but maybe it is hard to read because it is made from hard copy). Also read: A critical analysis of the Equality ACT
Think deeply about following questions, choose two out of three in the following to reply, in addition, try to integrate the contents in”Neighborhood matters” article in the reply of two questions you choose to reply, —-this means to use Neighborhood matters content to support your view.
1. What does the author try to say in this paragraph? —-in Pg. 9, left hand section in the 4th paragraph, the sixth line it says: “People are now more likely to see psycho-social well being as dependent on what can be done at the individual level, using cognitive behavioral therapy—one person at a time—or on providing support in early childhood, or on the reassertion of religious or family values. Every problem is seen as needing its own solution—-unrelated to others. People are encouraged to exercise, not to have unprotected sex, to say no to drugs, to try to relax, to sort out their work-life balance, and to give their children ‘quality’ time. The only thing that many of these policies do have in common is that they often seem to be based on the belief that the poor need to be taught to be more sensible. The glaringly obvious fact that these problems have common roots in inequality and relative deprivation disappears from view. ”
2. What is your spontaneous response to view and solve poverty, crime and health issues? What is this article’s (Greater Equality)perspective to view and solve poverty, crime, health issues? Try to compare yours and the article’s solution in specific way. Summarize the differences or similarities that you and the article have.
3. What did you learn in this article? Or has this article challenged your assumptions of the society’s wealth and income distribution issue, or your assumption of the solution to these issues? Reflect on your assumptions. If you say there is not much you learn in this article because you don’t trust these data, then provide your evidence/data , with the source of your data, date of publication, etc., provide the perspective you read from credible sources that is opposite to this article i.e. Greater Equality, cite year of publication, where was it published.
If in your reply to two questions from the three listed above, you had shown nothing about what you learned or getting informed from Neighborhood matters article, your grade is going to be negatively affected.
https://www.spokesman.com/stories/2012/sep/23/solving-a-health-gap/,
11/9/2020 Topic: The forum on “Greater Equality” (This is “Test 2 question “)
https://ccs.instructure.com/courses/1961380/discussion_topics/11340616?module_item_id=46516483 2/2
Replies are only visible to those who have posted at least one reply.
Search entries or author
Reply
The length of your post of two questions: 150-200 words.
Remember: you need to respond to ONE classmate’s post, share your thoughts on: what is something valuable you learned or got informed from your classmates, or ask a further question to deepen the discussion. Please pose your post directly on the discussion forum, don’t attach a pdf format file on the discussion forum. And post your thoughts to two questions in TWO or THREE separate paragraphs. Don’t jam everything in one huge paragraph.
Ecology Research Assignment
Nursing HomeworksEcology Research Assignment
Choose one of the assignments described below. Research the required information and write a short paper on the topic. The paper should be at least 4 pages in length including title page and reference page, no larger than size 12 font, no more than 1.5 spacing between lines. Please properly cite your source(s). No plagiarizing!
Topic Choices
*Invasive species
Choose an invasive species and research the following: What is the definition of invasive species? Name and describe your chosen species. What is its native country/area? What areas has it invaded? What is the result of this invasion (be specific)? Is there a plan to eradicate or control the species? Has the plan been successful?
*Keystone species
Choose a keystone species and research the following: What is the definition of keystone species? Name and describe your chosen species. Where does it live? Why is it considered a keystone species? What is its role in its community and what might happen if it was removed from this community?
*Rehabilitation/restoration of an ecosystem
Choose an ecosystem that has been disrupted by human activities and is now being (or has been) restored and research the following: Where is the ecosystem? What kind of ecosystem is it (desert, river, swamp, etc.)? What was it like before human disruption? What impact has the disruption had on the ecosystem (be specific)? What is being done to restore/rehabilitate the ecosystem? Has it been successful?
*Population control policies of Japan, Thailand, China, or India
Choose one of these countries and research the following: What are the population numbers in this country? What are the living conditions like? What is the population control policy, and how long has it been in effect? What results have they seen or do they hope to see? What attitudes do the citizens of the country have toward the policy?
Business
UncategorizedIncidence and Prevalence
Nursing HomeworksIncidence and Prevalence
Case Studies in Applied Epidemiology No. 891-903
Paralytic Illness in Ababo Student’s Guide
Learning Objectives After completing this case study, the participant should be able to:
G Define incidence, prevalence, and case-fatality rate;
G Define surveillance and identify the key features of a surveillance system;
G List the types of information that should be collected on a surveillance case report form;
G List the factors that can account for a change in the reported incidence of a disease;
G Define sensitivity of a surveillance system, and the effect of different case definitions on sensitivity.
This case study was originally developed by Nancy Binkin (EIS ’80) in 1989. The current version was revised and edited by Richard Dicker with input from EIS Summer Course instructors and students over the years
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service
PART I It is the early 1990s. The World Health Organization is planning a program for the global eradication of polio by the year 2000. Likura, a fictitious nation in south-central Africa, may become one of the countries selected to test the effectiveness of WHO’s polio eradication strategies. Unfortunately, little is known about polio in Likura. The Minister of Health therefore assigned the task of assessing the polio situation to a Ministry worker who has recently
returned from an epidemiology course in Atlanta, and who is about to become the District Health Officer in the Ababo District. The Ababo District is a relatively poor, rural district with a single hospital and several health centers. The Ababo District has attempted to conduct surveillance on polio cases and deaths over the past five years. The hospital, health centers, and all health workers are supposed to report such cases to the District Health Officer.
Question 1: What is incidence?
One measure of the polio situation in a community is the prevalence of lameness in
children, since lameness is a common sequela of polio.
Question 2: What is prevalence?
Question 3a: What data might you use (or collect) to determine the incidence of polio in the population?
Question 3b: What data might you use (or collect) to determine the prevalence of the sequelae of polio (lameness) in the population?
Question 4: What are the key elements included in the definition of public health surveillance?
Question 5: What is the difference between active and passive surveillance systems? Is the Ababo surveillance system for polio passive or active?
PART II To characterize the incidence of polio over time, the new District Health Officer tabulated the routinely collected surveillance records for the past five years. In Ababo, the operational surveillance case definition for polio is acute onset of flaccid paralysis plus fever. The data are shown in Table 1.
The most recent census was conducted in 1986, when the population of the Ababo District was determined to be 360,000 persons. The population in Ababo is assumed to be growing at a constant rate of 3.8% per year.
Table 1. Polio Morbidity and Mortality, Ababo District, 1986-1990
Year #New Cases # Deaths
Midyear Population
Incidence Rate
Per 100,000
Mortality Rate
Per 100,000 Case-fatality
Rate (%)
1986 54 5 360,000
1987 56 7
1988 50 6
1989 68 8
1990 74 10
Question 6a: What is a case-fatality rate? What does it measure?
Question 6b: Complete Table 1 by calculating the annual midyear population estimates, polio incidence rates, disease-specific mortality rates, and case-fatality rates for each of the past five years.
Question 7: Plot the trends in incidence rates, mortality rates, and case-fatality rates. Interpret these data.
The District Health Officer is concerned that the number of reported cases seems low. He is concerned that sensitivity may be one of
several weaknesses of the polio surveillance system.
Question 8a: Define sensitivity. If the sensitivity of the system is indeed low, can these data still be used to describe the trends?
Question 8b: In addition to sensitivity, what other attributes of a surveillance system should you evaluate in determining whether the system is meeting its objectives?
Question 9: What might account for the increase in the number of new cases observed during the two most recent years?
To characterize the population that has come down with polio in Ababo, the District Health Officer went to the hospital to review the charts of all children admitted with polio during the past two years. To his surprise, he found more
cases with a discharge diagnosis of polio from the hospital in 1989 and 1990 than were reported from the whole district during the same years.
Question 10: How might you explain the discrepancy between the hospital cases and reported cases?
Recall that, in Ababo, the working surveillance case definition for polio was acute onset of flaccid paralysis plus fever. In reviewing the records, the Health Officer found that the data on signs and symptoms of children given the diagnosis of polio were not uniformly recorded.
On most charts it was noted that the child had fever and acute onset of flaccid paralysis. On about 1/3 of the charts, however, there was no notation of fever but only the acute onset of paralysis.
Question 11: What is the effect of including the children without fever status recorded on the chart in your case definition?
Returning to the office, the District Health Officer learns that the disease report forms have run
out. He sees this as an opportunity to design a new disease report form.
Question 12: What types of information would you ask for on the new polio report form?
The hospital review identified a total of 150 cases of polio. Characteristics of the cases are provided in the following tables.
Table 2. Seasonal Distribution of Polio, Ababo District Hospital, 1989 and 1990 Month 1989 1990 Month 1989 1990 January 5 7 July 2 3 February 19 16 August 0 2 March 4 8 September 1 1 April 9 13 October 2 1 May 4 8 November 4 4 June 4 5 December 7 5
Question 13: Describe the seasonal occurrence of polio in Ababo. (Note that Ababo is in the Southern Hemisphere.)
Table 3. Age Distribution of Polio Cases, Ababo District Hospital, 1989 and 1990 Age (in years) Number Age (in years) Number
<1 34 5 2 1 50 6 3 2 25 7 2 3 27 $8 0 4 7
Question 14: Determine the median and mean age of cases.
Table 4. Sex and Ethnic Distribution of Polio Cases, Ababo District Hospital, 1989 and 1990
Sex
Male Female
Zanu 73 53 126
Hanzu 12 2 14
Other 8 2 10
93 57 150
Question 15: What is the ratio of male to female cases?
Question 16: Review the ethnic distribution of cases. Can you conclude, based on these results, that being a member of the Zanu tribe is a risk factor for polio? Why or why not?
To gather information on polio prevalence, vaccine coverage, and risk factors for polio, the District Health Officer conducted a survey of
children in the district. Lameness was used as a surrogate for polio. The prevalence of lameness by vaccination status is shown in Table 5.
Table 5. Lameness by Vaccination Status among Children 12-23 Months of Age, Ababo District, 1991
Lame Normal Total
Polio Vaccine
$1 dose 1 242 243
0 doses 9 667 676
10 909 919
Question 17a: What is the prevalence of polio (lameness) among vaccinated ($1 dose) children?
Question 17b: What is the prevalence of polio (lameness) among the unvaccinated children?
Question 17c: What is the vaccine coverage (at least one dose) in this population?
Question 17d: Interpret these data.
The District Health Officer plans to review the polio surveillance data each month. Knowing that part of a good surveillance system involves
disseminating the information to “those who need to know,” the District Health Officer begins to compile a list.
Question 18: To whom should surveillance information be disseminated? How might you disseminate this information?
A few months after the hospital chart review was completed, the medical officer on the hospital pediatric service called the District Health
Officer. She has seen 12 and 34 cases in the months of January and February of 1991, respectively.
Question 19a: What is the expected number of cases for January and February?
Question 19b: In your opinion, is Ababo experiencing an epidemic of polio?
A meeting was held to discuss the situation. The results of the vaccine coverage survey
were reviewed, and the authorities decided to launch an intensive polio vaccination campaign.
EPILOGUE
In 1988, the World Health Assembly launched a global initiative to eradicate polio by the end of the year 2000. This initiative was not without controversy. Some public health officials argued that polio, a potentially fatal or crippling disease, could be eradicated, so it should. In the long run, eradication would save billions of dollars. Others felt that the money and energy that would be expended in eradicating polio, a disease already of low prevalence in most countries, could be better spent on comprehensive public health interventions rather than a single disease, and that the eradication effort might divert time, attention, and resources from other programs.
From the inception of the Global Polio Eradication Initiative in 1988 to the end of 2002, the number of cases has fallen by over 99%, from an estimated more than 350 000 cases in 1988 to 1919 reported cases in 2002 (as of 16 April 2003). In the same time period, the number of polio-infected countries was reduced from 125 to 7. Polio is now found only in parts of Africa and south Asia. Meanwhile, polio surveillance is thought to have improved, with rates of detected acute flaccid paralysis (AFP) rising from 1.6 to 1.9 per 100,000 children <15 years of age between 2001 and 2002.
REFERENCES 1. CDC. Principles of Epidemiology, 2nd ed. Atlanta: CDC, 1992.
2. PAHO. Polio Eradication Field Guide, 2nd ed. Washington, DC, PAHO, 1994.
3. WHO. Poliomyelitis (Fact Sheet no. 114). Geneva: WHO, April 2003.
Assessing and Treating Clients With Anxiety Disorders
Nursing HomeworksWeek 5: Anxiolytic Therapy & PTSD Treatment
For individuals suffering from posttraumatic stress disorder (PTSD) and other anxiety disorders, everyday life can be a constant challenge. Clients requiring anxiolytic therapy may present with anxiousness, depression, substance abuse issues, and even physical symptoms related to cardiovascular, respiratory, and gastrointestinal ailments. As a psychiatric mental health nurse practitioner, you must be prepared to address the many needs of individuals seeking treatment for PTSD and other anxiety disorders.
This week, as you study anxiolytic therapies and PTSD treatments, you examine the assessment and treatment of clients with PTSD and other anxiety disorders. You also explore ethical and legal implications of these therapies.
Assignment: Assessing and Treating Clients With Anxiety Disorders
Common symptoms of anxiety disorders include chest pains, shortness of breath, and other physical symptoms that may be mistaken for a heart attack or other physical ailment. These manifestations often prompt clients to seek care from their primary care providers or emergency departments. Once it is determined that there is no organic basis for these symptoms, clients are typically referred to a psychiatric mental health practitioner for anxiolytic therapy. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with anxiety disorders.
Learning Objectives
Students will:
sample that can be audit and submit with plagiarism less than 15%
Assessing and Treating Clients with Anxiety Disorder
Assessing and Treating Clients with Anxiety Disorders.
Anxiety disorders are the most prevalent category of mental illness and are characterized by chronic anxiety causing distress and interference in the individual’s life. According to DSM-5, excessive anxiety and worry must cause significant distress or impairment and occurs on more days than not for at least six months for diagnostic criteria (Stein et al., 2015) The disorder can be effectively treated with medication, psychotherapy, or a combination of the two modalities.
This paper addresses the pharmacology approach in treating a 46 year- old white male who is experiencing anxiety, and the impact pharmacokinetic and pharmadynamic processes will be explored to guide for the appropriate treatment.
Case Scenario
A 46-year-old white male who initially presented to ER with a complaint of chest pain and cardiac work- up was negative, and a PMHNP consult was sought for psychiatric evaluation. The client ‘s Hamilton Anxiety Rating Scale( HAM-A) was 26 indicating moderate to severe anxiety phase. The PMHNP decides to start the client on medications.
Options: Zoloft 50 mg Po Daily, imipramine 25 mg po BID, buspirone 10 mg BID.
Decision: Zoloft 50 mg PO daily.
Rationale: Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs ) benzodiazepines, buspirone, and α2δ ligands such as pregabalin and gabapentin are recommended as first line treatments for anxiety disorders spectrum (Stahl, 2017) However, SSRI and SNRIs are efficacious in the treatment of generalized anxiety disorder (GAD) and panic attack as in the case of our patient in the scenario. Additionally, in cases of co-occurring GAD and depression, a common comorbidity, SSRIs can provide effective treatment for both GAD and major depression ( Johnson & Coles, 2014) .
Selecting sertraline (Zoloft) was based on the fact it belongs to the family of SSRI, and well recognized in the treatment of GAD and panic attack. Secondly, possible side effects of Zoloft which include sexual dysfunction, gastrointestinal abnormalities (nausea and diarrhea), insomnia, weight gain, and agitation and/or hyperactivation (Kamo et al.,2016) were explored prior selecting Zoloft. The patient was overweight (15 lb), hence a healthy lifestyle will be important for education, and the rest of side effects can be monitored and managed early in treatment.
Sertraline affects the serotonin neurotransmitter in the synaptic cleft by blocking the serotonin transporter from returning the remaining serotonin to the presynaptic cell. Sertraline is well absorbed in gastrointestinal tract, highly protein bound, predominantly metabolized by CYP 450 system with half-life of 24- 26 hrs and removed primarily by kidneys ( Woo & Wayne, 2013).
Imipramine, a tricyclic antidepressant was not my first choice because its possible side effects: blurred vision, dry mouth, urinary retention, drowsiness, weight gain, hypotension, and seizures (Stahl,2017)
Buspirone (Buspar), a serotonin receptor partial agonist can be appropriate for augmentation but not as first line treatment of GAD. Additionally, Buspirone takes longer (2 – 4 weeks) to have a full effect, and due to its sedation side effect, it would not be appropriate in our patient who has history of increased alcohol intake.
The goals of treatment of anxiety disorders are resolution of symptoms and prevention of relapse.
The client returns in four weeks, responding well to medication, anxiety decreased HAM A 18 from 26.
Options : Increase dose to 75 mg daily, increase dose to 100 mg daily, no change in drug/ dosage
Decision # 2 Increase dose to 75 mg daily.
Rationale: Sertraline dosing in panic, PTSD, and social anxiety begin with 25 mg/day; increase to 50 mg/day after 1 week thereafter, usually wait a few weeks to assess drug effects before increasing dose; maximum generally 200 mg/day; single dose (Stahl,2017).
Moreover, increasing dosage slowly will reduce the possibility of acquiring side effects from the medication (Stein et al., 2014)
The client returns in four weeks, reports further reduction in anxiety symptoms HAM- A 10 (mild anxiety)
Options: Maintain current dose, increase to 100 mg daily, add Buspirone.
Decision: Maintain current dose
Rationale: Major errors in psychopharmacological treatment of anxiety disorders include not achieving full remission of symptoms but instead accepting partial response, and not providing an adequate trial of medications (8 to 12 weeks ) before switching, discontinuing, or augmenting ( Woo & Wayne, 2013) . The patient was responding pretty well to medication ( 50% reduction in symptoms) , and reported no side effects. Therefore, continuing the same dosage, providing regular follow up with the patient to ensure medication adherence would be appropriate to meet the goals of remission.
References
Johnson, E. M., & Coles, M. E. (2014). Failure and Delay in Treatment-Seeking Across Anxiety Disorders. Community Mental Health Journal, 49(6), 668-674. Retrieved from https://web-a-ebscohost-com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=29&sid=7eabbc3a-b3a4-4cbf-b934-aa75c2e5b6fd%40sessionmgr4007
Kamo, T., Maeda, M., Oe, M., Kato, H., Shigemura, J., Kuribayashi, K., & Hoshino, Y. (2016). Dosage, effectiveness, and safety of sertraline treatment for posttraumatic stress disorder in a Japanese clinical setting: a retrospective study. BMC Psychiatry, 16(1). Retrieved from https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=6&sid=2ee0b7c6-b1c7-44e7-9b93-42c3b9a745c3%40sessionmgr102
Stein, D. J., Craske, M. A., Friedman, M. J., & Phillips, K. A. (2014). Anxiety Disorders, Obsessive-Compulsive and Related Disorders, Trauma- and Stressor-Related Disorders, and Dissociative Disorders in DSM-5. American Journal of Psychiatry, 171(6), 611-613. Retrieved from https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2014.14010003
Woo, T. M., & Wynne, A. L. (2013). Pharmacotherapeutics for nurse practitioner prescribers(3rd ed.). Philadelphia, PA: F.A. Davis Co.
Marketing Techniques and Strategies in Health Care
UncategorizedUnit 3 IP Type: Individual Project Unit: Marketing Techniques and Strategies in Health Care Deliverable Length: 700 words Both social media and the Internet have changed the way that health care organizations market to their target populations. Complete the following: You have been asked by the chief executive officer (CEO) of a local health care organization in your city or town to create a viable social media strategy for the target market. Additionally, he asks that you develop a marketing research tool that will help the organization understand its target market. Use the city data from your Unit 2 Discussion Board assignment to assist you in the creation of the social media strategy. The use of APA Style and at least 3 references in required. UNIT 4 DB Type: Discussion Board Unit: The Marketing Process Deliverable Length: 300 words Primary Task Response: Within the Discussion Board area, write 300 words that respond to the following questions with your thoughts, ideas, and comments. This will be the foundation for future discussions by your classmates. Be substantive and clear, and use examples to reinforce your ideas. Health care is changing rapidly, and health care marketers must be prepared to face the challenges the future will bring. Discuss the following: Examine and discuss 2 emerging trends in health care. Analyze what the health care marketer can do to address the challenges that are associated with those trends.