NURS 6540 Assignment: PICO Analysis of Depression

The PICO question should include the patient or population (P), anticipated intervention (I), comparison group or current standard (C) and outcome desired (O).

Locate five articles related to your PICO question. At least one article must be a systematic review. All of the articles should be primary sources. NURS 6540 Assignment: PICO Analysis of Depression.

Reflect on the five articles you selected as indicated in Part III: Analysis of Literature. Consider the conceptual framework/theory main finding, research method, strengths of study, weaknesses, and level of evidence for each article.

Consider how to use the summaries in Part III to create an evidence table. Use this evidence table to determine appropriate treatment options for patients who present with the disorder you selected as your topic.

To complete this NURS 6540 Assignment: PICO Analysis of Depression:

Formulate a question around the disorder you selected as indicated in Part I: PICO Analysis of Research Topic.

Identify the resources you will use, search terms and criteria, and Boolean search strings as indicated in Part II: Search Strategy.

Summarize the five articles you selected as indicated in Part III: Analysis of Literature. Describe the conceptual framework/theory main finding, research method, strengths of study, weaknesses, and level of evidence for each article.

Create an evidence table based on the article summaries in Part III. Describe appropriate treatment options for patients based on this evidence table. NURS 6540 Assignment: PICO Analysis of Depression.

PICO question: Do elderly nursing home residents suffer from depression at a higher rate than elderly people living in their own home?

NURS 6540 Week 4 Discussion Question

Pharmacokinetic and pharmacodynamic processes differ among patients across their life spans. For geriatric patients, alterations due to aging make them especially prone to adverse drug reactions. The various health issues that affect many geriatric patients further complicate this, as the need to treat these multiple health issues often results in polypharmacy. Although treatments are frequently drugs rescribed by the health care provider, many geriatric patients also take over-the-counter (OTC) drugs. While the provider sometimes recommends these OTC drugs, patients often select the drugs on their own. This makes patient education on pharmacology key when caring for geriatric patients. Many patients assume that if drugs are available over the counter, then they are safe to take. However, due to issues related to polypharmacy and how their aging bodies process drugs, OTC drugs may have serious implications
for patients.

To prepare:

Review the American Geriatrics Society article and interactive media piece in this week’s Learning Resources.

Select one of the following over-the-counter drugs commonly used by geriatric patients:

• Antacids or acid suppressants
• Antidiarrheal
• Antihistamines
• Antimicrobial ointments
• Antispasmodics for the bladder
• Cough suppressants
• Laxatives
• Neutraceuticals (choose one; e.g., ginseng, St. John’s wart, etc.)
• Pain medications (choose one; e.g., acetaminophen, ibuprofen, rub-on pain ointments/patches, etc.)
• Supplements (choose one; e.g., calcium, iron, etc.)
• Vaginal creams

Research the over-the-counter drug you selected. Visit a local pharmacy and explore the types/varieties of the drug that are available.
Reflect on the ingredients in each type/variety, including additional active ingredients.

Consult with the pharmacist about the ingredients in each type/variety, including how to make safe and effective clinical decisions in relation to this drug. Discuss potential interactions in frail elders and
precautions related to the drug based on Beers Criteria. If one is available, you may consult with a pharmacist at your practicum site as an alternative to visiting a pharmacy.

Consider ways to educate elders about the OTC drug you selected.

Post on or before Day 5 a PowerPoint presentation that addresses the following:

Describe the over-the-counter drug that you selected.

Identify the types/varieties of the drug that are available.

Describe the ingredients in each type/variety including additional active ingredients.

Explain the key information that you need to know about this OTC drug to make safe and effective clinical decisions. Include potential interactions in frail elders and describe any precautions related to the drug based on Beers Criteria.

Explain how you would educate elders about the OTC drug you selected.

Read a selection of your colleagues’ responses.

Respond on or before Day 7 to at least two of your colleagues on two different days in one or more of the ways listed below.

Respond to colleagues who selected a different drug than you did.

Suggest additional interactions in frail elders that may be caused by the ingredients in your colleagues’ drugs.

Provide insights to drug-drug interactions between the drug you selected and the drugs your colleagues selected.

Validate an idea with your own clinical experiences and additional literature search.

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NURS 6540 Week 10 Discussion – Community Advocacy Agencies

Having received a diagnosis of Alzheimer’s and encountering the associated stigmas, Michael Ellenbogen encourages increased advocacy efforts for the geriatric population struggling with this disease. He says, “We did nothing wrong to get this disease, and we need to speak up to let our voice be heard…There are no excuses for not wanting to help. The human cost factor is too high, and we are all accountable to do something” (Ellenbogen, 2012). As an advanced practice nurse caring for the geriatric population, it is important for you to join in advocacy efforts within your community whether it is in support of Alzheimer’s or another prevalent need such as abuse. You should be aware of community agencies that advocate for the well-being and care of your local geriatric population, as these agencies often provide resources and assistance to the elderly in need. In your role of care, you are able to identify prevalent needs and work with patients, their families, and agencies to promote change and impact lives.

To prepare:

Review this week’s media presentation, as well as the American Geriatric Society’s Public Policy and Advocacy website in the Learning Resources

Locate and research two agencies that advocate for the elderly in your community. Consider their current advocacy actions and/or campaigns.

Reflect on your experiences and observations at your practicum site. Consider new advocacy actions you might suggest to the agencies you selected. Based on these advocacy actions, think about new policies that might improve the care of the population at your current practicum site.

Post on or before Day 3 a description of two agencies that advocate for the elderly in your community, including their current advocacy actions and/or campaigns. Then, explain new advocacy actions you might suggest to these agencies based on your experiences and observations at your practicum site. With these advocacy actions in mind, suggest at least one new policy that might improve the care of the population at your current practicum site.

Read a selection of your colleagues’ responses.

Respond on or before Day 6 to at least two of your colleagues on two different days who are in different practicum settings than you. Explain issues within your own community that might impact the advocacy actions and policies suggested by your colleagues.

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NURS 6540 Week 11 Discussion – Discussing End-of-Life Care

There is a human tendency to postpone uncomfortable or unpleasant tasks.

—Nancy Kummer, geriatric patient

This human tendency to avoid the unpleasant makes end-of-life care and hospice decisions difficult for many patients to discuss with their families. Kummer is a former social worker who used to counsel patients with terminal illnesses, yet she avoided discussing her own end-of-life wishes with her children. While many Americans, like Kummer, agree that these discussions need to take place, few have actually had these conversations with their families (Lazar, 2012). Although initiating conversations about end-of-life care and hospice might be difficult for patients, as an advanced practice nurse, facilitating these conversations is an integral part of your geriatric nursing practice. For this Discussion, consider how you would facilitate care conversations with the patients and families in the following case studies:

Case Study 1:

Mrs. Sloan, a 69-year-old widow, is about to enter the hospital for an elective cholecystectomy; she is being medically cleared by her primary care provider. During the discussion, she requests to be placed on a no code status during her hospitalization. Mrs. Sloan claims that besides her gallbladder problem, her general health status is good. She wishes to have the surgery to avoid any further attacks, which have been very painful. She states, however, that if during surgery or her postoperative period, she undergoes a cardiac arrest, she would prefer not to be resuscitated. She has read about the chances of successful resuscitation, and has determined that the risk of brain damage is too high. For this reason, she is requesting a no code status.

Case Study 2:

Ms. Stearns is an 83-year-old nursing home resident with hypertension, coronary artery disease, arthritis, renal insufficiency, hearing impairment, and a previous history of stroke. She also has a foot deformity from childhood polio. She is disoriented at times. She has lived in the nursing home for 10 years and rarely leaves the chair beside her bed. She has recently developed urinary incontinence, but has refused a bladder catheterization to determine postvoid residual urine or possible bladder infection. She does not have a diagnosis of dementia; however, current testing reveals that she performs poorly on a standardized mental status examination. She can, however, identify all the staff in the nursing home, and she can describe each patient who has been in the bed next to hers over the past 10 years. When asked to explain why she does not want bladder catheterization, she gives several reasons. She states that the incontinence does not bother her, and that she has always been a very private person. She particularly dislikes and objects to any examination of her pelvic organs; in fact, she has never had a pelvic examination nor has she ever had sexual intercourse. She realizes that she has a number of medical problems and that any one of them could worsen at any time. She states she is not willing to undergo any treatment for any of her current problems should they become worse.

Case Study 3:

Mr. Marley, age 91, is admitted to the intensive care unit following a stroke. The stroke progressed from mild hemiparesis and difficulty speaking to complete unresponsiveness and an inability to swallow. His daughter feels certain, based on prior explicit conversations with her father, that he would not want to have any treatment that would prolong his life and leave him in a severely disabled state. Mr. Marley’s oldest son disagrees with his sister’s assessment of their father. The son claims that their father still has a strong desire to live, and that he has been very active in his church until this stroke. Because Mr. Marley cannot swallow, he cannot be fed The family is asked about insertion of a feeding tube. It is explained to the family that without food and fluids, their father will die fairly quickly. There are no existing advance directives or a designated health care decision maker noted for Mr. Marley.

To prepare:

Review Chapter 14 of the Holroyd-Leduc and Reddy text.

Reflect on the role of the advanced practice nurse in facilitating the discussion of end-of-life care with patients and their families.

Think about how you, as an advanced practice nurse, would approach a family who wants “everything” done for a patient with only a limited time to live.

Consider when it is appropriate to involve hospice and how to approach patients and/or families who refuse hospice services.

Select one of the three provided case studies related to the end-of-life care of the frail elderly. Reflect on potential patient outcomes and how you would facilitate the discussion of care with this patient’s family.

Post on or before Day 3 an explanation of the role of the advanced practice nurse in facilitating the discussion of end-of-life care with patients and their families. Explain how you would approach a family who wants “everything” done for a patient with only a limited time to live. Then, explain when it is appropriate to involve hospice and how to approach patients and/or families who refuse hospice services. Finally, explain potential outcomes of the patient in the case study you selected and how you would facilitate the discussion of end-of-life care with this patient’s family.

Read a selection of your colleagues’ responses.

Respond on or before Day 6 to at least two of your colleagues on two different days who selected different case studies than you. Based on the site of care, suggest strategies for establishing the role of advanced practice nurses in end-of-life discussions with patients.

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