The client is an 8-year-old African American male who arrives at the ER with his mother. He is exhibiting sig ns of depression. Client complained of feeling “sad” Mother reports that teacher said child is withdrawn from peers in class Mother notes decreased appetite and occasional periods of irritation Client reached all developmental landmarks at appropriate ages Physical exam unremarkable Laboratory studies WNL Child referred to psychiatry for evaluation MENTAL STATUS EXAM Alert & oriented X 3, speech clear, coherent, goal directed, spontaneous. Self-reported mood is “sad”. Affect somewhat blunted, but child smiled appropriately at various points throughout the clinical interview. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. Judgment and insight appear to be age-appropriate. He is not endorsing active suicidal ideation, but does admit that he often thinks about himself being dead and what it would be like to be dead. You administer the Children’s Depression Rating Scale, obtaining a score of 30 (indicating significant depression) Decision Point One Begin Zoloft 25 mg orally dailyBegin Zoloft 25 mg orally daily RESULTS OF DECISION POINT ONE Client returns to clinic in four weeks No change in depressive symptoms at all Decision Point Two Increase dose to 50 mg orally daily RESULTS OF DECISION POINT TWO Client returns to clinic in four weeks Depressive symptoms decrease by 50%. Cleint tolerating well Decision Point Three Maintain current DOSE Guidance to Student At this point, sufficient symptom reduction has been achieved. This is considered a “response” to therapy. Can continue with current dose for additional 4 week to see if any further reductions in depressive symptoms are noted. An increase in dose may be warranted since this is not “full” remission- Discuss pros/cons of increasing drug dose with client at this time and empower the client to be part of the decision. There is no indication that the drug therapy should be changed to an SNRI at this point as the client is clearly responding to this therapy. When pediatric patients present with mood disorders, the process of assessing, diagnosing, and treating them can be quite complex. Children not only present with different signs and symptoms than adult patients with the same disorders, they also metabolize medications much differently. Yet, there may be times when the same psychopharmacologic treatments may be used in both pediatric and adult cases with major depressive disorders. As a result, psychiatric nurse practitioners must exercise caution when prescribing psychotropic medications to these patients. For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat pediatric patients presenting with mood disorders. To prepare for this Assignment: Review this week’s Learning Resources, including the Medication Resources indicated for this week. Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of pediatric patients requiring antidepressant therapy. The Assignment: 5 pages Examine Case Study: An African American Child Suffering From Depression. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature. Introduction to the case (1 page) Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient. Decision #1 (1 page) Which decision did you select? Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. Decision #2 (1 page) Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. Decision #3 (1 page) Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. What were you hoping to achieve by making this decision?

Designing a Population Health Quality Improvement Initiative

Instructions:

Write a plan for a 2-year long population health improvement initiative aiming to improve adolescent’s mental health, using a population health framework and using quality improvement methods. You may choose the setting and scope of the initiative. Think innovatively, and be realistic.

Introduction to the problem

Adolescent Mental Health Issue

About 50% of all mental health problems in adults start by the age of 14; however, most of the cases are not detected nor treated. Violence, poverty and other forms of adversity increase the risk of developing mental health disorders among adolescents. Adolescent depression is found to be a leading cause of mental illness and disability; and suicide is, in fact, the second leading cause of death in adolescents. (1) One way to improve healthcare services to adolescents with mental health problems is to adopt QI methodologies and develop strategies to implement or disseminate interventions. Nonetheless, there is no strong evidence for the effectiveness this approach in the literature. (2) 

References:

1. WHO. Available from https://www.who.int/news-room/fact-sheets/detail/adolescents-health-risks-and-solutions

2. Forman-Hoffman VL, Middleton JC, McKeeman JL, Stambaugh LF, Christian RB, Gaynes BN, Kane HL, Kahwati LC, Lohr KN, Viswanathan M. Strategies to improve mental health care for children and adolescents.

Deliverables: 2 pages (Max 1000 words) and 1 table summarizing the QI methodologies adopted and the relevant population HI frameworks in the development of a workable plan to implement or disseminate interventions.

Key points to be considered:

1. Approaches to population health improvement;

2. The interaction between these approaches

3. Quality improvement methods

In this design, combine population health and quality improvement approaches. Apply the methods and principles of quality improvement to a population health issue utilizing the relevant HI framework.

I got an impression that my prof wanted us to integrate the Population HI frame works with the Quality improvement methodologies to form a workable plan delivering quality health service to the adolescents. Pick the salient features of the relevant frameworks (See lecture notes) and collaborate the frame works with the appropriate QI methods such as PDSA cycles, patient, public and community participation, process mapping etc.

The aim is to establish a multi-discipline team to address this population health issue. Describe the interactions between the adopted QI methodology and the relevant population HI frameworks. Comments on the strengths and weaknesses of their interactions and the predicted outcomes. Set up a timeline of 2 years in this plan and specify the milestones along the way to validate the implementation and dissemination of the interventions proposed.

Here is what I think the table looks like:

Summary of Population HI Frameworks & Quality Improvement Interactions

150-200 words

1 reference within 5 years

APA style

1 Oscar

Recently, there has been debate on where CAM provides safety approaches in promoting health. Some of these approaches have undergone vigorous evaluation and have been found to be safe and even effective in managing patients with chronic illness such as cancer, diabetes, and HTN. Some of the approaches of CAM include yoga, meditation, acupuncture, massage, and many others. These approaches are used to treat and even manage symptoms of chronic illness, for example cancer. In most cases, cancer patients tend to prefer using CAM approaches because it helps in managing pain and when used alongside standard or traditional medicine, it lessen the side effects of the treatment (Complementary and alternative medicine (CAM) 2019). For example, chemotherapy has been known to have severe side effects such as nausea and vomiting and even having difficulty sleeping. These alternative approaches help in reducing the side effects and giving the patient ways to cope during the treatment. CAM therapies include vast arrays of botanical and nutritional products, which most of these have been approved by FDA. Another reason why patients tend to opt for CAM is because most of these supplements do not require prescription to purchase them. This means that it is the decision of the individual or the patient to decide what is best for them.

There have also been growing debate between holistic approach and allopathic care. Both of these are considered to promote healthcare. Holistic approach refers ways to provide support that focuses on the whole individual rather than not just their mental health needs. This means that the support also focuses on the physical and emotional needs of the person as well as social and spiritual wellbeing of the person. These aspects are considered important in the wellbeing of the individual. The aspects in holistic care aim at preventing disease rather than treating the symptoms (Evangelatos & Eliadi, 2019). On the other hand refers to science based or evidence based model. This is focused on more conventional and it is evidence based where it uses doctors and other professional healthcare providers such as nurses to treat symptoms using conventional approaches in medicine. All of these approaches, that is, allopathic and holistic care aim in promoting healthcare. The difference is that, unlike CAM or holistic care, allopathic medicine tends to depend on clinical studies and screening to establish diagnosis by focusing on a person’s symptoms and signs before instilling treatment (Complementary and alternative medicine (CAM) 2019). In my opinion, both of these approaches promote healthcare and because of this, I don’t have any conflict if the patient decide to use either of them.

References

Complementary and alternative medicine (CAM). (2019). Medical Sociology, 312–332.  https://doi.org/10.4324/9781315618692-17

Evangelatos, N., & Eliadi, I. (2019). Are allopathic and holistic medicine incommensurable? Complementary Medicine Research, 23(1), 37–42. https://doi.org/10.1159/000443996

2. Elena

CAM refers to medical practices that are not considered to be part of standard medical care. People tend to prefer using CAM due to the safety and effectiveness of its practices. There are no proven data that they cure the chronic illness such as cancer but most of the patients tend to prefer it because it helps them cope with the diseases and mostly it helps them through the treatment phases. These practices help them by reducing the symptoms of cancer and even limiting the side effects of the treatment when they are used alongside standard medical practices (Kuo et al., 2018). Some examples of CAM approaches include acupuncture, yoga, massage, drinking green tea, and many others. These practices have also been considered safe because of their nature of using harmless practices to try and help the patients cope with the diseases or limit the severe side effects of the treatment. In addition to this, these approaches are also used to comfort the patients and ease their worries (Kuo et al., 2018). This is based on helping their spiritual and psychological wellbeing thus helping in their healing process. When these approaches are used alongside modern medicine or traditional approach, they have benefits the patients and most likely have higher positive results in terms of promoting health.

Despite the debate surrounding holistic and allopathic medicine, both of these approaches in care tend to promote healthcare. Holistic care focuses mainly on prevention where the practices are to maintain the connectedness of an individual to its environment, which is both internal and external (Evangelatos & Eliadi, 2019). On the other hand, allopathic medicine is an approach where it uses evidence based to promote healthcare, for example, it uses nurses, therapists, and doctors to treat symptoms of a disease such as cancer, diabetes, and hypertension.

Both of these approaches have their own benefits. Holistic medicine includes the overall health improvement of an individual. It is important to note that the holistic care aims at improving the general health and the healing process of the individual, which includes physical health, and their emotional and spiritual health (Evangelatos & Eliadi, 2019). In holistic care, the practitioners are allowed to work with their patients to develop plans that aim to help health the mind, body, and spirit of the patients. On the other hand, allopathic care have several significant benefits when promoting health. In allopathic care, doctors are able to access latest scientific approaches in technology to make a diagnosis and provide the best alternative treatment of the disease. I have no conflict between allopathic and holistic care because they both are designed to promote healthcare.

References

Kuo, Y.-hui, Tsay, S.-L., Chang, C.-C., Liao, Y.-chi, & Tung, H.-H. (2018). Cancer impact, complementary/alternative medicine beliefs, and quality of life in cancer patients. The Journal of Alternative and Complementary Medicine, 24(3), 276–281. https://doi.org/10.1089/acm.2016.0396

Evangelatos, N., & Eliadi, I. (2019). Are allopathic and holistic medicine incommensurable Complementary Medicine Research, 23(1), 37–42. https://doi.org/10.1159/000443996

Article Review

Student’s Name

Institution/Affiliation

Course

Professor

Date

Part 1

The article “Age-Related Changes in Instrumental and Basic Activities of Daily Living Impairment in Older Adults with Very Mild Alzheimer’s Disease” by Tabira et al. (2020) focuses on age-related changes linked to mild Alzheimer’s disease within the aging population. The authors acknowledge that age-related changes in patients with mild Alzheimer’s have been rarely explored. Thus it clarifies the characteristics linked to Alzheimer’s disease cognitive impairment and compares how these impairments differ from older adults without the disease. To achieve this, the paper undertook a study whereby 107 older adults with mild Alzheimer’s disease were first-time patients at the Kumamoto University Hospital dementia clinic. The control group encompassed 682 older adults living within that community. The results showed impairments in managing finances, medication, shopping, and dressing. Additionally, fewer individuals with this condition could conduct these activities independently. The article’s main conclusion was that patients who have very mild Alzheimer’s disease depict considerably decreased activities of daily living independence from early old age.

Tabira et al. (2020) acknowledged that aging is often linked to decreased independence among individuals; hence, they often require help with instrumentals and basic activities of daily living. These include feeding, bathing, and others they would have done better. However, adults with mild Alzheimer’s disease require more care because Alzheimer’s disease is known to interfere with the psychological well-being of individuals. This condition results in psychological function impairment, a predictive element for dementia. Patients with this condition show the most significant impairment in minor activities of daily living, including using transport means, shopping, and handling finances and medicines.

This article can be applauded for creating insight into how age-related impairments are worsened by conditions such as Alzheimer’s disease, whether mild or severe. Normally aging comes with significant impairments because as people age, they become more dependent even on simple tasks because of their frailty. However, illnesses can worsen this situation, thus requiring caregivers to attend to the needs of the older adult population. The control group was an excellent way to prove the difference between normal older adults and those affected by very mild Alzheimer’s disease. The control group is considered equally important to the experiment group because, without it, there will be no experiment (Curtis et al., 2018). Without the control group, the authors would not confidently determine the changes that occur in older adults with the condition and those without it. This was a critical procedure to validate the findings and substantiate their claims.

Additionally, as with any research, Tabira et al. (2020) outlined their methods to validate that older adults with very mild Alzheimer’s disease require more assistance with activities than normal older adults. The methodology gives legitimacy and offers scientifically sound findings. Additionally, it helps maintain the researchers on track, making their process seamless and 4effecrively manageable. The methodology has allowed the authors to uncover new information that requires more attention regarding age-related changes among older adults. Furthermore, the article encompasses applicability since the results and findings can help the medical field move forward toward caring for older adults. The lack of attention shows that older adults with very mild Alzheimer’s disease had otherwise been overlooked when it comes to the degree of help they need to carry out their activities of daily living. Still, now their needs can be met better.

Overall, older adults continue to go through age-related changes as they grow older. They go through psychological changes that affect their ability to perform these activities. The article considers how very mild Alzheimer’s disease can deepen these needs because of its impact on individuals’ cognitive ability. It proves, through research on older adults with this condition, that they require more help due to the psychological impact of Alzheimer’s on their independence to conduct activities of daily living.

Part 2

Depression

Although feeling depressed is an everyday part of life, it is not normal for aging. According to studies, most older adults are satisfied with their lives despite facing more illnesses and physical issues than the younger generation (Canuto et al., 2018). However, if individuals experience depression during their younger years, they might face it even in older age. Older adults might experience the major depressive disorder, which includes symptoms that interfere with their ability to perform their daily tasks. Another is medicine or substance-induced depressive disorder, associated with using substances such as pain medication or alcohol. Another one is a depressive disorder due to a medical condition that is linked to separate illnesses such as multiple sclerosis. Older adults experience changes related to their mood where they feel empty and feel worthless; they get fatigued, walk or move slowly, and have difficulty concentrating.

Delirium

As people grow older, they begin to experience changes related to delirium. Delirium encompasses a confused mental state that happens suddenly. An individual can change their mental status and suddenly start to act distracted and disoriented. This is common in older adults, especially those with dementia who need hospitalization. Over time, the aging starts to have brief confusion episodes and absentmindedness. They also have trouble thinking clearly and paying attention.

Dementia

Most older adults commonly experience age-related changes linked to dementia, especially because it is a common illness among the older adult population. These older populations start experiencing changes affecting their memory and social and thinking abilities. Older adults start to experience memory loss linked to their aging bodies, which could also be caused by dementia. Additionally, they experience changes in communication because they might find trouble finding words due to memory issues. Finally, they get challenges with spatial and visual abilities which can be characterized by their tendencies to get lost, such as when driving or walking.

Alzheimer’s

Alzheimer’s is a common illness affecting older adults. It affects their cognitive abilities as they grow older. Additionally, the illnesses can also be linked to some of the age-related changes that older adults face. As people age, they start experiencing greater memory loss than in their younger years. This is common, especially for older adults with Alzheimer’s, as they experience a more significant memory loss and face cognitive challenges in general (Lee et al., 2018). For example, they might wander and get lost, repeats questions, and experience personality and behavior changes, such as becoming more irritable and moodier.

Erectile dysfunction

Most older adults have reported erectile dysfunction as they grow older. They experience lower libido and a lower mood for engaging in sexual activity. This can be associated with various conditions linked to the elderly. For example, several heart conditions have been linked to erectile dysfunction among the elderly, including heart disease and atherosclerosis (Tanaka et al., 2020). Other illnesses prevalent among the old that can be linked to erectile dysfunction include diabetes, stroke, and Parkinson’s disease. Additionally, injury and trauma against the spinal cord and pelvic area can lead to nerve damage, thus resulting in erectile dysfunction. Even surgeries such as fistula surgery and orthopedic surgery also decrease sexual dysfunction.

Suicide

Suicide is among the leading causes of death in the United States, which affects individuals of all ages. Older adults are more suspectable to suicide for various reasons, including chronic illnesses and the passing of a loved one. Statistics show that although the older population makes up 12% of the population, they constitute approximately 18%. In 2020, for example, almost 46000 suicides occurred, whereby 9137 of these were older adults (National Council on Aging, 2021). The age-related symptoms contributing to suicide or suicide ideation among older adults include loneliness because they live alone or are homebound. Others include grief over a lost one, chronic pain, financial struggles, and cognitive impairment. Older adults start to avoid social activities, neglect themselves, including grooming and taking their meds, lack concern over their safety, and change or prepare their wills. Through these signs, an individual can recognize the risk of suicide and get help as soon as possible.

References

Canuto, A., Weber, K., Baertschi, M., Andreas, S., Volkert, J., Dehoust, M. C., … & Härter, M. (2018). Anxiety disorders in old age: psychiatric comorbidities, quality of life, and prevalence according to age, gender, and country. The American Journal of Geriatric Psychiatry, 26(2), 174-185. https://doi.org/10.1016/j.jagp.2017.08.015

Curtis, M. J., Alexander, S., Cirino, G., Docherty, J. R., George, C. H., Giembycz, M. A., … & Ahluwalia, A. (2018). Experimental design and analysis and their reporting II: Updated and simplified guidance for authors and peer reviewers. British journal of pharmacology, 175(7), 987-993. https://doi.org/10.1111/bph.14153

Lee, S. D., Ong, B., Pike, K. E., & Kinsella, G. J. (2018). Prospective memory and subjective memory decline: A neuropsychological indicator of memory difficulties in community-dwelling older people. Journal of Clinical and Experimental Neuropsychology, 40(2), 183-197. https://doi.org/10.1080/13803395.2017.1326465

National Council on Aging. (2021). Suicide and Older Adults. Retrieved From: https://ncoa.org/article/suicide-and-older-adults-what-you-should-know

Tabira, T., Hotta, M., Murata, M., Yoshiura, K., Han, G., Ishikawa, T., … & Ikeda, M. (2020). Age-related changes in instrumental and basic activities of daily living impairment in older adults with very mild Alzheimer’s disease. Dementia and Geriatric Cognitive Disorders Extra, 10(1), 27-37. https://doi.org/10.1159/000506281

Tanaka, Y., Bundy, J. D., Allen, N. B., Uddin, S. I., Feldman, D. I., Michos, E. D., … & Greenland, P. (2020). Association of erectile dysfunction with incident atrial fibrillation: the multi-ethnic study of atherosclerosis (MESA). The American journal of medicine, 133(5), 613-620. https://doi.org/10.1016/j.amjmed.2019.08.052

Please prepare a Power Point Presentation on Maintaining Skin Integrity in the Elderly Population.

The presentation must be in APA format, 7th edition, and include a title and reference page.

Please include the following components:

1What is the risk for skin breakdown in adults 65 years of age and older?

2What are different types of pressure ulcers?

3How do you stage a wound?

3What are tools to assess a risk level of skin breakdown?

4What are preventative measures that will help eliminate skin break down?