week 14 journal

Purpose of the visit is evaluation of any significant new issues and overall functioning since last visit, effectiveness of medication, progress related to symptoms.

On assessment, patient is alert and oriented, pleasant and cooperative slight symptoms of irritability. Speech normal, engaging, attentive open to sharing feelings and thoughts.

Patient was seen couple weeks ago because of report of increased anxiety “I have been having a lot of mini panic attacks lately”, heightened stress level related to recent stressors.  Besides other life stressors like stressed by work demand lately, feels like her boss picks on her by giving her more work than other coworkers, looking for stable housing, being a single mother, patient found her biological sister from Facebook, reconnected with her, learned that her biological father has passed away recently, a father that she never met.  She has mixed feeling about losing her father and adjusting to a new sister.  She was however surprised to find out that her sister is dealing with same mental condition with her, increased anxiety, poor ability to handle stress.  Denied any SI, no significant past trauma, denies use of recreational drugs, social drinker, no concern with eating, weight gain. .  She said that her scheduled trazadone is effective in helping her sleep at night, but does not always taking it, because it makes her feel tired all the time.  Reluctant as well about using her PRN Ativan for anxiety “unless severe panic attacks”. 

Life stressor, coping methods reviewed, emotions feelings frustrations acknowledge and validated emotional support and positive reinforcement given.   Med option discussed.  Amenable to trial PRN trazadone for increased anxiety.  bedtime trazadone d/c, start trazadone PRN every 6 hours as needed. Other meds options discussed to help with anxiety and mood improvement, agree with having a trial on Neurontin, scheduled dosing along with Zolof, Neurontin expect to augment effects of zolof and help improve anxiety symptoms.  Will start with Neurontin 100 mg bid as a starting dose. Risk, benefits, potential side effects reviewed.

During follow up appointment

Happy with positive changes occurring in her life, found new apartment near works, mood stable.  Panic attacks still present but less frequent.  Agree to have PRN Ativan D/C while on Neurontin.  will keep PRN trazadone for now until Neurontin takes effects.  Pt verbalized understanding and agreed with the treatment plan

A 68-year-old female patient with a history of asthma, COPD, arthritis, tobacco use, bipolar disorder, and schizophrenia is the subject of this case. Although the patient denied drinking but do smoke a pack of cigarettes daily. In order to undergo a reevaluation due to recent increases in delusions and paranoia, the patient was brought to the clinic by family members and Chronic obstructive pulmonary disease flare-ups. (COPD) are an important clinical issue that are linked to decreasing quality of life, lower levels of physical activity, and impaired lung function. Even a single exacerbation can have negative consequences on the mental health of the patient. (Hurst et al, 2020) 

When interrogated, patient is “concerned about her daughter being held hostage by family friend. And someone who injected in her chest. Patient stated that her friend and daughter think she is crazy and that she will make sure her daughter stays safe. She was able to maintain appropriate eye contact. 

Engaged in interview. Linear thought process. Disorganized thought content. Impaired insight and judgment into current condition because of psychotic symptoms increasing disorganization and paranoid delusional content. 

It is difficult to ascertain given her confounding delusion. Per collateral obtained by family friend, and daughter, it was unclear that patient was taking her medication as prescribed. It is believed that she has been experiencing worsening delusion and paranoia at home where she lives alone in eldercare home, but her daughter is very involved in her care and does frequent 

check on her. Medication adherence can have a tremendous impact on quality and length of life, health outcomes, and overall healthcare costs. Engaging patients and the healthcare team is essential to success in achieving medication adherence and persistence. Notable interventions include face-to-face counseling, electronic reminders, regimen simplification, adherence packaging, minimizing adverse effects, (Sabate, 2017). In the interview, Patient denied any active bodily complaints outside of left leg pain and increased fatigue which appear to be more chronic in nature. 

After evaluation agreed with the plan as documented 

Referrals to Physical therapy to manage generalized pain and to increase mobility 

Referrals to tabaco sensation group 

Initiated on olanzapine 20 mg at bedtime 

Will continue on Divalproex 125 mg and Chlorpromazine 75 mg at bedtime 

Will continue to work on management of her psychosis with psychotherapy 

 References: 

 John R. Hurst, Neil Skolnik, Gerald J. Hansen, Antonio Anzueto, Gavin C. Donaldson, Mark T. Dransfield, Precil Varghese, (2020). Understanding the impact of chronic obstructive pulmonary disease exacerbations on patient health and quality of life, European Journal of Internal Medicine, Vol 73,2020.Pages 1-6, ISSN 0953-6205, 

https://doi.org/10.1016/j.ejim.2019.12.014. 

 Sabaté E. (2017). Adherence to long-term therapies: evidence for action. Geneva: World Health Organization. 2003. www.who.int/chp/knowledge/publications/adherence_report/en/. Accessed June 10, 2017 

State’s Healthcare Policy

Different healthcare policies have been passed in the United States before. These include improvement of healthcare quality, enhanced Medicare, availability of health care services, and improved patients’ safety. However, these policies have failed and have never been implemented despite all the efforts of the healthcare sector. This has raised lots of debates about the efficiency of these policies because there is continuity of high cost and poor quality of health delivery to patients all over the states of America.

Our State government has failed in implementing these healthcare policies which have placed the government on the spotlight for the past years. Healthcare setbacks have been all over the news, for example, high cost of medical acquisition, poor access to health services by patients and poor quality of healthcare delivery. First, despite the State administrators’ spending money to improve the healthcare sector, it has never borne fruits. Patients continue to acquire healthcare at a costly amount. Getting healthcare services is very expensive, and the less fortunate in the community are affected the most, and some cannot wholly afford to receive treatment. Secondly, there is poor access to medical services in our state. Most of the healthcare facilities are located far from our home town. Patients with severe illness cannot access referral facilities for more treatment on time because they have to travel miles away to reach the referral hospitals. Lastly, there is the poor quality of healthcare services. There are a few numbers of health care providers compared to the high demand of patients. Due to this, patients do not get the needed attention. Patients with severe illness are the most affected because they cannot get to see the medical provider frequently for check-ups.

Besides the inadequate provision of health care services by the government, there are other upstream concerns in my community. This is because of the social, physical and economic constraints of health which has led to poor healthcare among people. First, there are concerns about negligence by the government; old people in my community have little access to health insurance and they have to pay before getting medical attention, which many cannot afford. This has affected quality living and caused psychological frustration. Secondly, there are concerns about the unavailability of community-based resources in support of recreational and leisure-time activities. These activities could help people avoid stress and improve their physical and emotional health, but there are no government supports for these activities, which are highly beneficial to human health.

However, the introduction of advanced practice registered nurses in the health care system could significantly impact health care. Their support could improve the health sector and enhance quality and affordable health care services to patients since they are primarily-based. As doctoral advanced practice nurses we act as health advocates. We are involved in initiating proposals to be included in the policy bills discussed in the senate. Besides, we push for the implementation of quality and equal healthcare services to patients; this will also keep the cost of services low, doctoral advanced nurses enhance the accessibility of healthcare, and promote good relationships between patients and the healthcare providers. There are ways a doctorally-prepared APRN could positively affect the health of patients and promote patient outcomes.

 First, by advocating for strong health policies and implementing them, we offer quality and equal healthcare services and break the monotony of physicians by increasing the supply of health services. This will reduce the cost of medication since we offer cheaper services. Secondly, I believe that APRNs enhance easy accessibility of healthcare to patients since they tend to establish their clinics. These clinics bring services to people in their grassroots which saves the patients from travelling to far hospitals. Lastly, we build a good relationship between patients and healthcare providers since we take time to listen to patients before providing the necessary medication.  This creates patients’ positive attitude towards healthcare providers.