NURS 6630 Week 10 Assignment 2: Special Considerations for Patient Populations Paper

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NURS 6630 Week 10 Assignment 2: Special Considerations for Patient Populations Paper – Step-by-Step Guide

The first step before starting to write the NURS 6630 Week 10 Assignment 2: Special Considerations for Patient Populations Paper, it is essential to understand the requirements of the assignment. The first step is to read the assignment prompt carefully to identify the topic, the length and format requirements. You should go through the rubric provided so that you can understand what is needed to score the maximum points for each part of the assignment. 

It is also important to identify the audience of the paper and its purpose so that it can help you determine the tone and style to use throughout. You can then create a timeline to help you complete each stage of the paper, such as conducting research, writing the paper, and revising it to avoid last-minute stress before the deadline. After identifying the formatting style to be applied to the paper, such as APA, you should review its use, such as writing citations and referencing the resources used. You should also review how to format the title page and the headings in the paper.

How to Research and Prepare for NURS 6630 Week 10 Assignment 2: Special Considerations for Patient Populations Paper

The next step in preparing for your paper is to conduct research and identify the best sources to use to support your arguments. Identify the list of keywords from your topic using different combinations. The first step is to visit the university library and search through its database using the important keywords related to your topic. You can also find books, peer-reviewed articles, and credible sources for your topic from PubMed, JSTOR, ScienceDirect, SpringerLink, and Google Scholar. Ensure that you select the references that have been published in the last words and go through each to check for credibility. Ensure that you obtain the references in the required format, for example, in APA, so that you can save time when creating the final reference list. 

You can also group the references according to their themes that align with the outline of the paper. Go through each reference for its content and summarize the key concepts, arguments and findings for each source. You can write down your reflections on how each reference connects to the topic you are researching about. After the above steps, you can develop a strong thesis that is clear, concise and arguable. Next you should create a detailed outline of the paper so that it can help you to create headings and subheadings to be used in the paper. Ensure that you plan what point will go into each paragraph.

How to Write the Introduction for NURS 6630 Week 10 Assignment 2: Special Considerations for Patient Populations Paper

The introduction of the paper is the most crucial part as it helps to provide the context of your work, and will determine if the reader will be interested to read through to the end. You should start with a hook, which will help capture the reader’s attention. You should contextualize the topic by offering the reader a concise overview of the topic you are writing about so that they may understand its importance. You should state what you aim to achieve with the paper. The last part of the introduction should be your thesis statement, which provides the main argument of the paper.

How to Write the Body for NURS 6630 Week 10 Assignment 2: Special Considerations for Patient Populations Paper

The body of the paper helps you to present your arguments and evidence to support your claims. You can use headings and subheadings developed in the paper’s outline to guide you on how to organize the body. Start each paragraph with a topic sentence to help the reader know what point you will be discussing in that paragraph. Support your claims using the evidence conducted from the research, ensure that you cite each source properly using in-text citations. You should analyze the evidence presented and explain its significance and how it connects to the thesis statement. You should maintain a logical flow between each paragraph by using transition words and a flow of ideas.

How to Write the In-text Citations for NURS 6630 Week 10 Assignment 2: Special Considerations for Patient Populations Paper

In-text citations help the reader to give credit to the authors of the references they have used in their works. All ideas that have been borrowed from references, any statistics and direct quotes must be referenced properly. The name and date of publication of the paper should be included when writing an in-text citation. For example, in APA, after stating the information, you can put an in-text citation after the end of the sentence, such as (Smith, 2021). If you are quoting directly from a source, include the page number in the citation, for example (Smith, 2021, p. 15). Remember to also include a corresponding reference list at the end of your paper that provides full details of each source cited in your text. An example paragraph highlighting the use of in-text citations is as below:

The integration of technology in nursing practice has significantly transformed patient care and improved health outcomes. According to Smith (2021), the use of electronic health records (EHRs) has streamlined communication among healthcare providers, allowing for more coordinated and efficient care delivery. Furthermore, Johnson and Brown (2020) highlight that telehealth services have expanded access to care, particularly for patients in rural areas, thereby reducing barriers to treatment.

How to Write the Conclusion for NURS 6630 Week 10 Assignment 2: Special Considerations for Patient Populations Paper

When writing the conclusion of the paper, start by restarting your thesis, which helps remind the reader what your paper is about. Summarize the key points of the paper, by restating them. Discuss the implications of your findings and your arguments. End with a call to action that leaves a lasting impact on the reader or recommendations.

How to Format the Reference List for NURS 6630 Week 10 Assignment 2: Special Considerations for Patient Populations Paper

The reference helps provide the reader with the complete details of the sources you cited in the paper. The reference list should start with the title “References” on a new page. It should be aligned center and bolded. The references should be organized in an ascending order alphabetically and each should have a hanging indent. If a source has no author, it should be alphabetized by the title of the work, ignoring any initial articles such as “A,” “An,” or “The.” If you have multiple works by the same author, list them in chronological order, starting with the earliest publication. 

Each reference entry should include specific elements depending on the type of source. For books, include the author’s last name, first initial, publication year in parentheses, the title of the book in italics, the edition (if applicable), and the publisher’s name. For journal articles, include the author’s last name, first initial, publication year in parentheses, the title of the article (not italicized), the title of the journal in italics, the volume number in italics, the issue number in parentheses (if applicable), and the page range of the article. For online sources, include the DOI (Digital Object Identifier) or the URL at the end of the reference. An example reference list is as follows:

References

Johnson, L. M., & Brown, R. T. (2020). The role of telehealth in improving patient outcomes. Journal of Nursing Care Quality, 35(2), 123-130. https://doi.org/10.1097/NCQ.0000000000000456

Smith, J. A. (2021). The impact of technology on nursing practice. Health Press.

NURS 6630 Week 10 Assignment 2: Special Considerations for Patient Populations Paper Instructions

To complete this assignment, you will utilize the case study assigned to you by faculty for a patient population for special consideration during prescribing practices. You will consider the specific patient and determine the appropriate medication to prescribe, based on the patient specifics and medication attributes in various case studies. You will construct a 4- to 5-page paper in which you determine the medication, the dosing, necessary patient education, and potential side effects. You will also indicate why the other medications would not be appropriate, as well as any necessary labs or diagnostics that might be needed. You will develop a plan to enhance medication adherence for the nonadherent patient.

Special Considerations for Patient Population Cases:

  • Patient 1: 82-year-old male presenting with cognitive decline. He had always been a very active individual. Over the past year, he has become less active in the community. Previously, he played cribbage weekly with friends at the local senior center but has been struggling with the math involved with the game and no longer attends the weekly card game. He had also volunteered as a crossing guard for the local public school. He quit doing that after he took the wrong turn to get home and drove around the town feeling lost. He acknowledges he is “sensitive” to this and can be irritable towards his children when they bring up these concerns. He was diagnosed with mild neurocognitive disorder after completing neuropsychological testing. Of the following medications, which would be the most appropriate to prescribe? Explain why you chose this medication. What would be the dosing schedule for this patient? Provide education to the patient and review risks, benefits, and potential side effects of the medication. In addition, explain why the other medications listed are not appropriate for this patient. Med List: lorazepam, olanzapine, memantine
  • Patient 2: 76-year-old female who recently moved from her home to an assisted living. After 1 week of moving in, she has become extremely confused. Staff have attempted to re-orient her, and she struggles to focus on what they are saying. She is only oriented to self. She has become very agitated and has even thrown breakable objects in her room. Her family is concerned stating she is “out of it.” The PCP ordered labs and UA. Labs are unremarkable outside of mild leukocytosis and positive dipstick analysis for nitrite and red blood cells. Med List: valproate, alprazolam, trimethoprim
  • Patient 3: A 33-year-old female that is 6 weeks postpartum. She presents with depressed mood, sadness, easily emotional, difficulties with sleep even when the infant is sleeping. She has lost weight and has a poor appetite. You note psychomotor retardation. She has limited interests in hobbies or bonding with the infant. Her partner is concerned and reports she is typically active and “bubbly” and enjoys the outdoors. She is diagnosed with major depressive disorder, with postpartum onset. She denies suicidal ideation, homicidal ideation, or infanticidal ideation. No psychotic symptoms are present. She is nursing the infant and wants to continue this hoping it will assist with bonding with the infant. Med List: lithium, paroxetine, sertraline
  • Patient 4: 10-year-old male who comes in with his father. He has been diagnosed with generalized anxiety disorder. He has constant worries that he cannot control. He feels nervous and tense. He is easily irritable. He struggles to settle down or relax. He is also quite fidgety and restless. He and his father are interested in medications to manage these symptoms. Med List: quetiapine, duloxetine, fluoxetine
  • Patient 5: 27-year-old male with a diagnosis of schizophrenia. He has been hospitalized three (3) times in the past 1 year due to symptoms. When symptomatic, he becomes disorganized and paranoid. He will respond to auditory hallucinations. He will scream out at night after seeing a shadow in his room. He has delusions that the CIA is poisoning food and will not eat for multiple days. He has unintentionally hurt his mother after “slapping” food out of her hand, as he did not want her to ingest the “poisoned food.” Symptoms are treated very well with paliperidone, but he struggles to remember to take it. Med List: paliperidone palmitate, clozapine, lamotrigine

To Prepare:

  • Review the Learning Resources.
  • Carefully review your assigned vulnerable population patient.
  • Carefully review the medication list to determine the best medication to prescribe.
  • Consider the implications, impact, advantages, and disadvantages of the listed medications.

The Assignment (4–5 pages)

Construct a paper concerning your assigned vulnerable population patient case. In your paper include the following:

  • Determine which medication would be most appropriate to prescribe from the assigned vulnerable population patient case medication choices. Have a look at NURS 6630 Week 10 Assignment 3: Writing Prescriptions.
  • Explain your rationale for choosing this medication. Explain why the other medications listed are not appropriate for this patient.
  • Explain the dosing schedule for the specific patient including the therapeutic endpoint.
  • Provide necessary education to the patient to review risks, benefits, and potential side effects of the medication.
  • Describe any necessary labs or additional diagnostics needed prior to prescribing this medication.
  • Explain how you might monitor efficacy or side effects of the medication.
  • Include any additional collaboration or education to others that would be necessary for this patient. Consider family members, home health care, primary care providers, etc.
  • What would you need to include in your assessment for a patient who may become nonadherent with your prescribing plan for your scenario? What are alternative treatment solutions based upon how you assessed? Describe your new treatment plan.

This Assignment requires a minimum of five (5) peer-reviewed, evidence-based scholarly references outside of course resources.

Note: You will need to include the APA style formatting.

NURS 6630 Week 10 Assignment 2: Special Considerations for Patient Populations Paper Example

Comprehensive Treatment Plan for Schizophrenia: Optimizing Medication Adherence and Symptom Management

The case of a 27-year-old male schizophrenic patient underscores the complexities involved in managing the disease, particularly in relation to medication adherence. Despite the proven effectiveness of paliperidone, the patient finds it challenging to maintain a regular medication schedule, leading to relapses and multiple hospital readmissions. Schizophrenia poses unique challenges in medication adherence due to a variety of factors, including cognitive deficits, a lack of insight into the illness, and the occurrence of psychotic symptoms such as delusions and hallucinations, which can hinder the patient’s ability to acknowledge the necessity for medication (Guo et al., 2023).

One of the primary pharmacological approaches to improve medication adherence in patients with schizophrenia is the utilization of long-acting injectable (LAI) antipsychotics, with paliperidone, highlighted in the case study, being an example. The aim of this paper is to formulate a comprehensive treatment approach for the patient, which encompasses the choice of medication, dosing determination, patient education, required laboratory tests or diagnostics, monitoring of side effects and drug efficacy, clarification on the unsuitability of other medications, and any further collaboration or education that might be needed.

Selected Medication, Dosing, and Patient Education

Paliperidone, an atypical antipsychotic, is selected due to its established efficacy in controlling schizophrenia symptoms. Considering the patient’s history of medication non-adherence, an LAI drug, paliperidone palmitate, is recommended to maintain steady blood concentrations and enhance adherence. The medication has the benefit of guaranteeing consistent medication delivery, eliminating the requirement for daily pill intake, and minimizing the likelihood of non-compliance (Minwalla et al., 2021).

For the patient in this case study, Invega Trinza, a three-month injectable variant of paliperidone, offers a practical solution with fewer dosing intervals, which could potentially boost adherence. The recommended maintenance dose for Invega Trinza is 117 mg IM on a monthly basis, with some patients requiring a lower or higher dosage within a monthly dosage range of 39-234 mg (Minwalla et al., 2021; Riboldi et al., 2022).

However, before starting Invega Trinza, patients must have been treated with the monthly paliperidone injection for a minimum of four months. When transitioning from the monthly injection to Invega Trinza, it is crucial to adjust the dose carefully based on the previous monthly dose. While Invega Trinza provides the benefit of less frequent dosing, it is crucial to closely monitor the patient due to delayed response to dose adjustments.

Patient education is vital for treatment adherence and efficacy. The patient and their family must comprehend the significance of taking medication consistently. They should also receive information about paliperidone’s mechanism of action, potential side effects such as sedation and weight gain, as well as methods for addressing any adverse effects. Furthermore, it is crucial to address crisis management strategies to assist the patient and their family in effectively managing symptomatic episodes. Crisis management education should underscore the crucial need for building a robust support network, involving both healthcare professionals and close relations, to offer steadfast guidance and aid throughout demanding phases.

Necessary Labs, Diagnostics and Monitoring

Before initiating treatment with paliperidone, a series of lab tests and diagnostic procedures are performed to safeguard patient health and enhance the effectiveness of the treatment. Key metabolic parameters, such as fasting blood glucose levels and lipid profile, are established at the outset to evaluate metabolic status and identify any risk factors for metabolic syndrome, a side effect associated with antipsychotic medications (DeJongh, 2021). Tests to assess liver function are vital to monitor hepatic health and identify any potential liver irregularities.

In contrast, tests for renal function are necessary to ensure uninterrupted renal clearance of the medication. An electrocardiogram (ECG) is recommended to evaluate heart function and identify any existing heart abnormalities or risk factors, particularly given the possibility of QT interval prolongation linked to the use of paliperidone (Ruiz Diaz et al., 2020). Furthermore, monitoring the baseline weight and BMI and conducting a psychiatric assessment are essential steps to understanding the patient’s health condition and making informed treatment decisions. These baseline evaluations are critical in ensuring safe prescription practices and facilitating continuous monitoring to reduce potential side effects related to paliperidone treatment.

Monitoring the effectiveness of paliperidone requires regular assessment of symptom progression, functional status, and adherence to medication. Keeping track of metabolic parameters such as weight, blood glucose, and lipid levels forms the foundation for identifying and managing the metabolic side effects related to paliperidone (DeJongh, 2021). Regular clinical checks for symptoms related to the extrapyramidal system, orthostatic hypotension, and heart abnormalities, in conjunction with psychiatric evaluations and patient feedback, allow for prompt modifications to the treatment plan to maximize effectiveness and minimize side effects.

Al-Mahrouqi et al. (2021) reported a case of a 20-year-old woman diagnosed with schizophrenia who experienced debilitating side effects following paliperidone injection. After receiving six doses of LAI paliperidone palmitate, she experienced severe side effects that significantly impaired her daily life. The adverse effects observed, encompassing respiratory distress, dysphagia, heightened salivation, urinary incontinence, marked muscle rigidity, and tremors, align with the established DSM-5 diagnostic criteria indicative of neuroleptic malignant syndrome (NMS), a severe neurological emergency associated with the administration of both conventional and atypical antipsychotic agents (Al-Mahrouqi et al., 2021). In the case study, the 27-year-old patient with schizophrenia has not yet shown the severe side effects associated with paliperidone. However, vigilant observation is crucial as the patient could start exhibiting these symptoms at any moment.

Explanation of why other Medications are not Appropriate.

The other drugs listed, including clozapine and lamotrigine, might not be suitable for the patient in the case study for various reasons. Clozapine, although effective in treatment-resistant schizophrenia, has the potential for severe adverse effects such as agranulocytosis, myocarditis, and metabolic syndrome, necessitating rigorous monitoring protocols (Wagner et al., 2021). Agranulocytosis induced by Clozapine can result in a heightened risk of infections, underscoring the necessity for regular complete blood count (CBC) tests.

Besides, monitoring an ECG, lipid profile, and BMI are equally important to keep track of other potential adverse effects such as myocarditis and metabolic syndrome. Considering the patient’s challenges with medication adherence, the demanding monitoring needs and the possibility of severe side effects linked to clozapine, this medication might not be practical or suitable.

Likewise, lamotrigine, while sometimes used as an adjunctive treatment in certain schizophrenia cases, mainly focuses on mood stabilization in bipolar disorder and does not directly address the psychotic symptoms typical of schizophrenia (Hashimoto et al., 2020). Therefore, given the patient’s primary symptoms of disorganization, paranoia, and hallucinations (psychotic features), paliperidone continues to be the most suitable option due to its established effectiveness, tolerability, and appropriateness for long-acting injectable use, which addresses the patient’s adherence issues.

Additional Collaboration or Education necessary for the Patient

Besides medication management, working with a diverse team of professionals, including psychiatrists, psychologists, social workers, and caregivers, is essential for providing holistic care and support for patients with schizophrenia. Psychosocial interventions such as cognitive-behavioral therapy (CBT), family therapy, and supportive therapy are key in enhancing outcomes and strengthening coping mechanisms. Studies suggest that combining psychosocial interventions with pharmacological therapy result in better symptom management, lower relapse rates, and improved quality of life for people with schizophrenia (Ventriglio et al., 2020).

In addition, psychoeducation for both the patient and their family members about schizophrenia, the importance of medication adherence, coping mechanisms, and early indicators of relapse is crucial for promoting comprehension, empowerment, and involvement in treatment. Research has demonstrated the effectiveness of psychoeducational interventions in enhancing medication adherence, decreasing the frequency of relapses, and aiding in the recovery of individuals with schizophrenia and their families (Fereidooni et al., 2023; Ventriglio et al., 2020). Therefore, integrating psychosocial strategies and psychoeducation into the treatment approach can improve the overall management of patients with schizophrenia and aid in the patient’s long-term recovery.

Conclusion

Medication adherence poses a major challenge for people with schizophrenia due to factors such as cognitive deficits, lack of insight, and side effects related to the medication. In the case of the 27-year-old male patient, his difficulties with medication adherence have resulted in repeated hospital admissions despite paliperidone’s established efficacy in controlling schizophrenic symptoms.

The appropriateness of paliperidone for this patient lies in its long-acting injectable form, Invega Trinza, which provides a feasible solution to address adherence issues. The long-term care of the patient requires a multidisciplinary approach incorporating psychosocial strategies, education for both the patient and their family, and consistent monitoring of symptoms and side effects. Future research should focus on refining interventions to boost medication adherence and optimize outcomes for people with schizophrenia.

References

Al-Mahrouqi, T., Al-Kindi, A., & Al-Harrasi, A. (2021). Crippling side effects induced by paliperidone palmitate treatment: A case report. Cureus. https://doi.org/10.7759/cureus.13588

DeJongh, B. M. (2021). Clinical pearls for the monitoring and treatment of antipsychotic induced metabolic syndrome. The Mental Health Clinician, 11(6), 311–319. https://doi.org/10.9740/mhc.2021.11.311

Fereidooni, S., Razeghian, L., & Fateh, N. (2023). Effectiveness of group cognitive behavioral therapy in insight and treatment adherence in schizophrenic patients: A randomized controlled trial. Jundishapur Journal of Chronic Disease Care, 12(3). https://doi.org/10.5812/jjcdc-135541

Guo, J., Lv, X., Liu, Y., Kong, L., Qu, H., & Yue, W. (2023). Influencing factors of medication adherence in schizophrenic patients: a meta-analysis. Schizophrenia (Heidelberg, Germany), 9(1). https://doi.org/10.1038/s41537-023-00356-x

Hashimoto, Y., Kotake, K., Watanabe, N., Fujiwara, T., & Sakamoto, S. (2020). Lamotrigine in the maintenance treatment of bipolar disorder. The Cochrane Library. https://doi.org/10.1002/14651858.cd013575

Minwalla, H. D., Wrzesinski, P., Desforges, A., Caskey, J., Wagner, B., Ingraffia, P., Patterson, J. C., II, Edinoff, A. N., Kaye, A. M., Kaye, A. D., Viswanath, O., & Urits, I. (2021). Paliperidone to treat psychotic disorders. Neurology International, 13(3), 343–358. https://doi.org/10.3390/neurolint13030035

Riboldi, I., Cavaleri, D., Capogrosso, C. A., Crocamo, C., Bartoli, F., & Carrà, G. (2022). Practical guidance for the use of long-acting injectable antipsychotics in the treatment of schizophrenia. Psychology Research and Behavior Management, 15, 3915–3929. https://doi.org/10.2147/prbm.s371991

Ruiz Diaz, J. C., Frenkel, D., & Aronow, W. S. (2020). The relationship between atypical antipsychotic drugs, QT interval prolongation, and torsades de pointes: implications for clinical use. Expert Opinion on Drug Safety, 19(5), 559–564. https://doi.org/10.1080/14740338.2020.1745184

Ventriglio, A., Ricci, F., Magnifico, G., Chumakov, E., Torales, J., Watson, C., Castaldelli-Maia, J. M., Petito, A., & Bellomo, A. (2020). Psychosocial interventions in schizophrenia: Focus on guidelines. The International Journal of Social Psychiatry, 66(8), 735–747. https://doi.org/10.1177/0020764020934827

Wagner, E., Siafis, S., Fernando, P., Falkai, P., Honer, W. G., Röh, A., Siskind, D., Leucht, S., & Hasan, A. (2021). Efficacy and safety of clozapine in psychotic disorders—a systematic quantitative meta-review. Translational Psychiatry, 11(1). https://doi.org/10.1038/s41398-021-01613-2