Marketing Objectives

 

For your Milestone 2 paper about your chosen organization, you will outline your marketing objectives, describe any research you would do, and describe your target market(s). Paper length: 3-4 pp. not including title page and references.

Your text does not go into exhaustive detail on marketing objectives, but they really form the basis of your marketing plan. You should read the box on page 249 of your text on how to tell a good objective from a bad one. Basically: specificity and detail. It does not reference SMART objectives, but all the pieces of SMART are there: Specific, Measurable, Achievable, Realistic, and Time-bound. If I give you feedback on your Milestone 2 paper that you have not been specific enough, you will need to rectify that before incorporating Milestone 2 into your final paper.

Remember, papers may only be submitted as Word documents.

PLEASE NOTE: These milestone papers and your final marketing plan are not intended to be “term papers” in which you simply report what has already happened. What we are looking for is your analysis and your ideas. Your assignment is to identify a company with a marketing problem that needs to be solved, and develop a marketing plan of your own to solve the problem.

ECE 312 FINAL ASSIGNMENT WEBSITE

High-Quality Early Childhood Program Google Site

Prior to beginning work on this assignment, please review the following early childhood education websites:

Many parents begin their child’s program search via the Internet. Therefore, as a leader, having a vision for a program website, as well as the ability to create and develop a website, can benefit you in your future. Your program’s website plays a very important role in communicating a first impression to families. Many prospective parents use the Internet to help them identify possible early childhood programs in their geographic area, and then choose which programs they would like to visit or learn more about based on the information they find online. This is your opportunity to market your program. An attractive and well-designed website should be easy to read. Visitors to the site should be able to find the information they need quickly, with just a few clicks of a mouse.

For your Final Project, you will create a Google site for your own childcare program and facility using Google sites (Links to an external site.). Your Google site will be targeted toward prospective families and can be creative in the development but must include all of the following requirements. See the following exemplar for additional support: ECE312 Summative Assessment Example (Links to an external site.).

On your webpage, develop the following:

  • Home Page
    • Create a Google site for your own childcare program and facility using Google sites
    • Develop an introduction that welcomes families to your center and webpage
  • About Us Page
    • Summarize your credentials and biography
    • Explain the centers scope of services including: Ages served, hours of service, location of center and tuition or fees.
  • Program Structure
    • Establish daily structure including a curriculum unit plan, a sample lunch and snack menu, and explanation of your curriculum and developmentally appropriate practices.
  • Philosophy
    • Outline the philosophy and focus of the program, including your chosen theory from Chapter 1 and construct your center’s philosophy based on this theory.
    • Design a statement that demonstrates how your center will address each of the ten NAEYC Standards:
      • Relationships
      • Curriculum
      • Teaching
      • Assessment of Child Progress
      • Health
      • Teachers (how you support your staff)
      • Families
      • Community Relationships
      • Physical Environment (indoors and out)
      • Leadership and Management (summary of your most recent professional development experience)

The Google Site must have a home page and at least five additional pages, with as many subpages as you would like, to address the required content above. You are encouraged to creatively address the material using graphics, visuals, charts, graphs, and sound and at least one visual (photo, drawing, clip art, word art., graphic) on each page. The website should be designed to clearly and concisely address the material for families. Be sure to use at least two professional resources and the course text.

The High Quality Early Childhood Program Google Site

  • Must be five to 10 pages in length and formatted according to APA style as outlined in the University of Arizona Global Campus Writing Center’s APA St

Module 2-SLP

INPATIENT, OUTPATIENT, AND ANCILLARY SERVICES

Cultural competency is extremely important in health care, as the consumers we serve come from diverse backgrounds. Inpatient and outpatient services account for the largest sector of health care services; however, cultural competency extends to all health care sectors. It is vital that as a health care professional, we are culturally competent to provide our consumers with high-quality health care.

Test your cultural competency on all three of the test below:

Health Inclusion. (2020). Cultural competence quiz. Retrieved from https://healthinclusion.com/cultural-competence-quiz/

SUNY Downstate Health Sciences University. (2020). Cultural competency in nursing homes: Test your knowledge on cultural competence. Retrieved from https://www.downstate.edu/cultural-competency/test.html

The London School of International Communication. (2020). Part 1 – Cultural knowledge. Retrieved from https://www.londonschool.com/lsic/resources/intercultural-quiz/

Based on your results and research, answer the following questions in a 2- to 3-page paper:

  1. On a scale of 1 to 5, with 1 being needs improvement and 5 being exceeds expectations, rate yourself on the answers to each test, you should have three (3) ratings in total. (Note: Your personal rating does not affect your grade).
  2. Describe how you would improve upon your rating.
  3. Explain the importance of cultural competency in the U.S. health care system.
  4. Rationalize in detail why health care leaders play a vital role in embracing and implementing cultural competency.

In your scholarly paper, you should include an introduction and conclusion paragraph. 

SLP Assignment Expectations

  1. Conduct additional research to gather sufficient information to justify/support your responses.
  2. Limit your response to a maximum of 3 pages.
  3. Support your report with peer-reviewed articles, with at least 3 references. Use the following link for additional information on how to recognize peer-reviewed journals. Angelo State University Library (n.d.) Library guide: How to recognize peer reviewed (refereed journals). Retrieved from: https://www.angelo.edu/services/library/handouts/peerrev.php
  4. You may use the following source to assist in formatting your assignment. Purdue Online Writing Lab. (n.d.). General APA guidelines. Retrieved from: https://owl.english.purdue.edu/owl/resource/560/01/.
  5. For additional information on reliability of sources review the following source. Georgetown University Library (n.d.) Evaluating internet resources. Retrieved from https://www.library.georgetown.edu/tutorials/research-guides/evaluating-internet-content

Principles of Management HS410M6-01

 

This Competency Assessment assesses the following outcome(s):

HS410-6: Evaluate organization and management principles in healthcare settings.

PC-1.2: Contribute to team goals and objectives through active participation and collaboration.

GEL-1.02: Demonstrate college-level communication through the composition of original materials in Standard English.

There are five essential principles of management. These include planning, organizing, directing, controlling, and leading. You have been asked to give a presentation to a group of new managers hired or promoted in your healthcare organization. The purpose of this presentation is to train the new managers how they may apply principles of management to specific scenarios in the health care setting.

In order to gather information and further research this topic it is recommended that you review the reading for this course. In addition, you must conduct outside research on the principles of management, which may include use of the University library and reliable internet resources.
Your presentation must include:

  • at least three of the five principles discussed above
  • real world examples for each principle, including how you and at least one other leader have successfully applied each of the presented principles, describing the function of the principle and its impact
  • A specific example of how the principles of management can be applied to tasks involving teamwork in the health care setting. This example must include how your own role contributed to achieving the team’s goals and objectives. 

Minimum Submission Requirements

  • This Assessment must be a Microsoft PowerPoint.
  • You will also need to write a script in a separate Microsoft Word to accompany the slide presentation. The script should
    • be double-spaced;
    • be typed in Times New Roman, 12 -point font;
    • be written in Standard English with no spelling or punctuation errors 
  • Respond to the questions in a thorough manner, providing specific examples of concepts, topics, definitions, and other elements asked for in the questions. Your presentation should be highly organized, logical, and focused.
  • Your PowerPoint and script must be written in Standard English and demonstrate exceptional content, organization, style, and grammar and mechanics.
  • Your PowerPoint and script should provide a clearly established and sustained viewpoint and purpose.
  • You will also need to write a script in a separate Microsoft Word to go along with each slide.
  • Your writing should be well ordered, logical and unified, as well as original and insightful.
  • A separate slide at the end of your presentation should contain a list of references, in APA format. Use your textbook, the Library, and the internet for research.
  • Be sure to cite both in-text and reference list citations where appropriate and reference all sources. Your sources and content should follow proper APA citation style. Review the writing resources for APA formatting and citation found in Academic Tools. Additional writing resources can be found within the Academic Success Center.
  • Your submission must:
    • include a cover slide;
    • utilize spacing and font size and style appropriate for a presentation;
    • include correct citations; and
    • be written in Standard English with no spelling or punctuation errors.

If work submitted for this competency assessment does not meet the minimum submission requirements, it will be returned without being scored.

Plagiarism

Plagiarism is an act of academic dishonesty. It violates the University Honor Code, and the offense is subject to disciplinary action. You are expected to be the sole author of your work. Use of another person’s work or ideas must be accompanied by specific citations and references. Whether the action is intentional or not, it still constitutes plagiarism.

“Who am I”: Students After Graduate

There is a myth that “if you have advanced education, you have work”. The truth of the matter is that numerous understudies of university or college graduates are jobless or working in a task that doesn’t need a four-year certification. It takes the normal college alumni three to a half year to get work after graduation. An understudy profits by having a vocation looking for methodology and past work encounters. Something else, her resume may be lost in a pile of hundreds for a particular work.

“Post-Graduation Depression”

Post-Graduation Depression isn’t a term that could be found in the American Psychiatric Association’s dictionary, research shows what genuine it is and the mean for it has on ongoing graduates. Many people use different therapies. Well, some people did not need this type of “treatment” at all. Nevertheless, sometimes it is simply useful to share your experiences with someone. Many experts advise writing your interruptions on paper, so many students tell about their problems in essays,  maybe you can find some useful thoughts from your peers on https://studymoose.com/who-am-i it will help interface with basic reasoning or simply be useful for some different students. An issue is only a chance, to discover choices for addressing it and transform you and the existences of others as drastically as could be expected. Depression in youthful grown-ups regularly happens when they start to feel lonely, bitterness leaving their school friends and life behind, or just after they complete college coursework, frequently because of strain to move a task immediately.

Factors That Could Prompt Post-Graduation Sadness:

progress including changes in understudies’ day by day living plans; 

lack of connection with friends after graduating; 

challenges in adjusting to life in the “standards”; 

Symptoms of post-graduation depression:

diminished inspiration; 

loss of interest in pleasurable things; 

a feeling of disruption; 

sadness;

general feeling of sadness;

Tips to prevent post-graduation depression:

plan  accommodation;

prepare to deal with the stressors that may go along after graduation;

find out career opportunities or postgraduate study;

Postgraduate Study

Another option is to get back to college to learn at the postgraduate level. Nonetheless, reading for a Masters requires significant investment and cash so ensure you’re going into it for the correct reasons. 

Try not to take on a Masters degree to slow down for time or to help general employability. Courses are costly and pointless for specific positions. Address your vocations administration to weigh up your postgraduate choices and converse with relatives, postgraduate course pioneers, and individuals effectively in the positions you’d prefer to do to inquire as to whether a Masters is beneficial. 

While a postgraduate qualification is fundamental for certain spaces of work, for other people, investing energy in getting more work experience might be more important. As far as employability, many alumni managers do esteem extra capabilities, however, the onus will be on you to disclose why you decided to do additional contemplate and what you have acquired from it that separates you from others as far as your appropriateness for a specific work.

Get the Job

If you understand what sort of work you’re keen on and you believe you have the sort of abilities, capabilities, and experience pertinent alumni managers are searching for, you may be in a situation to begin going after graduate positions straight away. See the alumni occupations and plans segment for data about what kinds of graduate positions are accessible and when to apply.

In case you just graduate, there’s a decent possibility you can discover a place that works for you, particularly on the off chance that you are free on a full-time premise. In addition to the fact that internships offer significant work insight, however, they are an astounding method to make associations with possible bosses.

Finding Work Abroad

If you need to travel while as yet acquiring a check, another choice is to seek after a “working occasion” visa. Certain nations, including Canada and New Zealand, offer “working occasion” visas in which U.S. residents are allowed to remain in the country and maintain impermanent sources of income.

An enormous number of Americans land occupations abroad every year. English has become the predominant language for worldwide exchange so trade nations, especially in Asia and Latin America, are anxious to have their residents gain proficiency with the language.

In all actuality, however, living abroad (regardless of whether you’re exploring and visiting, or you’re working in one spot) may probably intrigue potential businesses once you’re back home.

critical investigation

Critical Investigation

Use Paul and Elder’s (2012) intellectual standards to find a topic or problem that is clear, relevant, significant, and precise. Select an issue that you wish to investigate critically (social, professional, or personal). Examples of topics

How can I secure a job in accounting when I have no experience in the field?

What proposals has the city of Denver made to reduce water consumption? How might this impact individual consumers?

What financial changes do I need to make to retire at the age of 62?

Should wolves be reintroduced to Rio Blanco County?

How can I manage my children’s cell phone usage?

How can the pay gap between men and women best be addressed in my company?

What are the most effective ways to address anxiety and depression? How can I use these to better my health?

Your final portfolio submission should include the following sections:

Title page

Introduction

Engagement with issue or problem using scholarly sources and the intellectual standards proposed by Paul and Elder (2012): What is the issue? Why is it significant? Why is this issue relevant to you (and/or your community)? What have you learned about the depth and breadth of the issue or problem from scholarly sources?

Engagement with your own assumptions or thinking about the issue. What assumptions do you bring to this subject? What concepts are “at work” in your mind as you investigate this issue? Why is this subject of interest to you and how might this skew your investigations? These questions constitute some of the issues covered by Paul and Elder (2012) in their “elements of reason.”

Engagement with scholarly sources: How do the scholarly sources aid you as you think about the issue fair-mindedly and with depth? What have you learned from the scholarly sources that have helped you analyze the issue?

Conclusion: Reflect on your issue or problem and how the sources informed your thinking. What have you learned? How can you apply the intellectual standards and elements of reason to this issue or problem to come to creative solutions? What critical questions remain?

References Page

Details:

You may write in the first person for your Final Portfolio Project.

Your paper should engage a minimum of six scholarly sources that are not required or recommended readings for this course. The CSU Global Library (Links to an external site.) is a good place to find these sources.

Your paper should be 7-8 pages in length and formatted according to the CSU Global Writing Center (Links to an external site.).

3 Page Paper APA FORMAT

3 Page Paper APA FORMAT

  • First, consider the cellular basis of long-term potentiation (LTP). Where in the brain does this occur and what happens? In your answer, include details of the neurotransmitters and receptors involved as well as what happens at the level of the receptor to enable LTP. Also, describe the changes that occur in both the presynaptic and post-synaptic cells as a result of LTP.
  • Summarize the attached article “ Changes in synaptic plasticity are associated with electroconvulsive shock-induced learning and memory impairment in rats with depression-like behavior” in enough detail that your reader will understand what was done in the study and what the results of the study were
  • Evaluate how the findings might apply to a clinical setting, such as Alzheimer’s disease, anterograde or retrograde amnesia, or a condition such as post-traumatic stress disorder (PTSD).

References MUST come from the attached PDF 

  • First, consider the cellular basis of long-term potentiation (LTP). Where in the brain does this occur and what happens? In your answer, include details of the neurotransmitters and receptors involved as well as what happens at the level of the receptor to enable LTP. Also, describe the changes that occur in both the presynaptic and post-synaptic cells as a result of LTP.
  • Summarize the attached article “ Changes in synaptic plasticity are associated with electroconvulsive shock-induced learning and memory impairment in rats with depression-like behavior” in enough detail that your reader will understand what was done in the study and what the results of the study were
  • Evaluate how the findings might apply to a clinical setting, such as Alzheimer’s disease, anterograde or retrograde amnesia, or a condition such as post-traumatic stress disorder (PTSD).

References MUST come from the attached PDF 

Tips on How to Draw a Mandala

Oh, hi there! Today I’m bringing you a tutorial for something that I get questions about all of the time… how to draw a Mandala. I’ve been drawing mandalas as a way to relax and unwind for some time now, and I often get asked where I learned and how I got started.

Unfortunately, there’s not a lot of information out there on how to draw a mandala. There’s plenty of pretty pictures for reference though, and that is how I learned… by copying what I could see.

Drawing mandalas is such a relaxing and meditative process. I hope you’ll learn a thing or two from this tutorial and I can’t wait to see the beautiful designs that you come up with when you give it a try.

 Get your supplies together

This is a list of the supplies that I use. Feel free to use what you have on hand. Circles can be made using random items from around the house if you don’t have a compass handy.

l Beinfang Heavyweight Drawing Paper

l Blackwing Pearl Pencil

l Compass & Protractor

l Staedtler Pigment Liners

l Clear Flexible Ruler (not the exact one I use but darn close!)

l  Draw your circles

Use your compass (or whatever small round objects you have laying around) and pencil to draw out concentric circles. Some people like to measure the distance between their circles but I like to just wing mine. This makes each mandala that I draw 100% unique and different. All these tools are needed to draw the mandala on paper. However, simple mandala designs are used for more than just paper drawings. The use of the mandala is very varied.

Draw your vertical & horizontal lines

This type of ruler makes it super simple to make sure your lines are at a perfect 90º angle to each other.

Draw your diagonal lines

Use your protractor to mark out the 45º marks between your vertical and horizontal lines. Then mark halfway between those lines as well. Connect your marks through the center line all the way across your circle. This will divide your circle into 16 equal sections.

Start to draw your pattern

Working from the inside out, start to draw your pattern. Here, you can start by simply drawing a flower in the center circle.

Start adding the layers

Pick what your next shape will be and repeat it 8 times around the circle. Here, you can chose a flower petal. The sky is the limit here… be creative! Just remember to repeat the same pattern all the way around to keep everything symmetrical.

Keep adding shapes and patterns

Keep adding layers of different patterns. Sometimes I like to outline a circle or go back and fill in blank spaces with more patterns and designs. Shading in certain areas can make a nice contrast.

Don’t be afraid to deviate from your plan

Here you can do a patterned border to create a separation between the inner and outer sections of my mandala. You can grabbed protractor and pencil and added in a new circle.

Add different line weights

If you want to make this separation nice and bold you can switch from 0.3mm pen to a 0.7mm. 

Fill circles with patterns

Circles like this one are great spaces to fill in with a fun pattern. You can kept this one simple with some swirls, but there are SO many fun patterns you could use. Zentangle patterns are great for something like this!

Keep at it until you’re happy with the size

You’re getting the hang of it now, right? Keep adding layers of patterns until you’re happy with how big your mandala is. Now it’s time to start thinking about the finishing touches.

Fill in blank spaces and create some depth

This I recommend you take a step back and try to look at the big picture. Are there any blank spaces that could be embellished? You can went back in with my 0.7mm pen and thickened up a few lines, adding some circles and scallops where I thought they were needed.

Erase those pencil lines

Check you out! You did it! All that’s left is to erase those pencil lines and admire your beautiful mandala!

Math statistics,paragraph

As a culmination of your learning experience in this course, I would like you to reflect on what you learned, how you learned, and what you will be able to do with statistics in your future.  As you reflect, try to think about big ideas and NOT just the formulas and calculations you learned. As a reminder, here is some of my goals for our work together. 

  1. Students should become critical consumers of statistically-based results reported in popular media, recognizing whether reported results reasonably follow from the study and analysis conducted.
  2. Students should be able to recognize questions for which the investigative process in statistics would be useful and should be able to answer questions using the investigative process.
  3. Students should be able to produce graphical displays and numerical summaries and interpret what graphs DO and DO NOT reveal.
  4. Students should recognize and be able to explain the central role of variability in the field of statistics.
  5. Students should recognize and be able to explain the central role of randomness in designing studies and drawing conclusions.
  6. Students should gain experience with how statistical models, including multivariable models, are used.
  7. Students should demonstrate an understanding of, and ability to use, basic ideas of how a sample can be used to make claims about a population through statistical inference, both hypothesis tests and interval estimation, in a variety of settings.
  8. Students should be able to interpret and draw conclusions from standard output from statistical software packages.
  9. Students should demonstrate an awareness of ethical issues associated with sound statistical practice.

Please respond to the following prompts honestly and thoughtfully. Responses need to include statistically accurate terms and concepts where appropriate. I will use it to help determine your final exam grade. 

Question 1

How has this course changed how you feel about statistics? Summarize how you felt before taking this course and how you feel now. What statistical ideas are you curious to know more about as a result of taking this class? 

Here are some questions and ideas that might help to start you off:

  • You might describe how ability to analyze information and data has grown.
  • When you hear Statistics being used to convince others, are you more or less skeptical about what they are saying?
  • Did you develop an appreciation for how Statistics is useful in making better decisions when used correctly?
  • Do you recognize that many things such as your class grade is an example of a statistic where your graded assignments are just a sample of data that demonstrates your learning, and that sample might have variation that doesn’t always truly represent your learning?
  • Do you ask questions and think about how you might analyze it?
  • Do you see statistical results and start asking more questions?
  • Take one of the topics (make sure to name it) we have studied that you would like to explore further and describe why this is interesting to you.

Question 2

Take one of the topics we have studied (see the course goals above), and find how it can be applied to your field of study. Provide details of how you would use this in your future endeavors. What other problems will you be able to solve with the statistical tools you have learned in this class? Give as many examples as you can. This will require to do research to find where statistics can apply to your field of study!

For example, if you were interested in agriculture you might summarize research from the University of Nebraska about how farmers use statistics to study plant yields, predict demand for crops, and making recommendations for future seasons. 

Question 3

Take one topic you have worked on this semester that you struggled to fully understand and explain how the struggle itself was valuable or indicative or learning. In the context of this question describe the struggle and how you overcame the struggle.

Here are some questions and ideas that might help to start you off:

  • Did your struggle build aspects of character in you such as endurance, self-confidence, or competence to solve new problems, and how might those virtues benefit you later in school, work, or life.
  • What resources or people did you use to overcome your struggles and how did getting help change you? Did it change the way you understand Statistics? Did it change the way you perceive the struggle in others?

Question 4

One of things I consistently reminded you throughout the semester was the importance of the discussion boards. The discussion boards purpose was to build community, collaboration, and giving and exchanging ideas to learn.  I also am aware that occasionally online learners will collaborate outside of the discussion boards (Pronto, Zoom, Math Center). Discuss how have you improved in your ability to collaborate on difficult problems over the course of the semester.

Here are some questions and ideas that you might help to start you off:

  • Can you describe any problems you worked on or any particularly memorable moments of collaboration with your fellow online learners, either on discussion boards or outside of Canvas?
  • You might discuss how you worked to step outside of your comfort zone and how this impacted you.
  • You might consider some of the difficulties you faced trying to participate in discussions and what you learned from it.
  • Did you ever have to rethink the way you communicate or what words you use to help others make sense of your ideas?
  • What advice and guidance would you communicate to future students?

Question 5

Pretend there were no guidelines in the syllabus for calculating your final grade. Based on the work you have done all semester and our goals for the course; what grade do you think you have earned? Make sure to state why you think you have earned that grade, but keep in mind that learning is not always measured accurately by quizzes and exams. What other evidence is there of your learning? This could include the following: 

  • The number of assignments completed. 
  • A description of your participation in class, both within your group and with the whole class. 
  • Which assessments (quizzes, exams, projects) best reflect what you have learned, and which are outliers that should be ignored. 
  • Additional evidence of your understanding of topics that may not have been accurately captured on assessments.  
  • Your final self-assessment of your understanding of the content. 

Note: Studies show that first generation college students are more likely to grade themselves lower than their instructor does. Please don’t suggest you deserve a lower grade. This is your chance to make an argument for a higher grade. If you are happy with your current grade then give examples of assignments and assessments that show why you deserve that grade. 

WK8 ASSIGN 2 6630

Assignment 2: Assessing and Treating Patients With Sleep/Wake Disorders

Sleep disorders are conditions that result in changes in an individual’s pattern of sleep (Mayo Clinic, 2020). Not surprisingly, a sleep disorder can affect an individual’s overall health, safety, and quality of life. Psychiatric nurse practitioners can treat sleep disorders with psychopharmacologic treatments, however, many of these drugs can have negative effects on other aspects of a patient’s health and well-being. Additionally, while psychopharmacologic treatments may be able to address issues with sleep, they can also exert potential challenges with waking patterns. Thus, it is important for the psychiatric nurse practitioner to carefully evaluate the best psychopharmacologic treatments for patients that present with sleep/wake disorders.

Reference: Mayo Clinic. (2020). Sleep disorders. https://www.mayoclinic.org/diseases-conditions/sleep-disorders/symptoms-causes/syc-20354018

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 patients with sleep/wake disorders.
The Assignment: 5 pages

Examine Case Study: Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult. 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? 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.

Conclusion (1 page)

  • Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.

Reminder : The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.

Learning Resources

Required Readings (click to expand/reduce)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Fernandez-Mendoza, J., & Vgontzas, A. N. (2013). Insomnia and its impact on physical and mental health. Current Psychiatry Reports, 15(12), 418. https://doi.org/10.1007/s11920-012-0418-8

Levenson, J. C., Kay, D. B., & Buysse, D. J. (2015). The pathophysiology of insomnia. Chest, 147(4), 1179–1192. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4388122/

Morgenthaler, T. I., Kapur, V. K., Brown, T. M., Swick, T. J., Alessi, C., Aurora, R. N., Boehlecke, B., Chesson, A. L., Friedman, L., Maganti, R., Owens, J., Pancer, J., & Zak, R. (2007). Practice parameters for the treatment of narcolepsy and other hypersomnias of central origin. SLEEP, 30(12), 1705–1711. https://j2vjt3dnbra3ps7ll1clb4q2-wpengine.netdna-ssl.com/wp-content/uploads/2017/07/PP_Narcolepsy.pdf

Morgenthaler, T. I., Owens, J., Alessi, C., Boehlecke, B, Brown, T. M., Coleman, J., Friedman, L., Kapur, V. K., Lee-Chiong, T., Pancer, J., & Swick, T. J. (2006). Practice parameters for behavioral treatment of bedtime problems and night wakings in infants and young children. SLEEP, 29(1), 1277–1281. https://j2vjt3dnbra3ps7ll1clb4q2-wpengine.netdna-ssl.com/wp-content/uploads/2017/07/PP_NightWakingsChildren.pdf

Sateia, M. J., Buysse, D. J., Krystal, A. D., Neubauer, D. N., & Heald, J. L. (2017). Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: An American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 13(2), 307–349. https://jcsm.aasm.org/doi/pdf/10.5664/jcsm.6470

Winkleman, J. W. (2015). Insomnia disorder. The New England Journal of Medicine, 373(15), 1437–1444. https://doi.org/10.1056/NEJMcp1412740

Medication Resources (click to expand/reduce)

IBM Corporation. (2020). IBM Micromedex. https://www.micromedexsolutions.com/micromedex2/librarian/deeplinkaccess?source=deepLink&institution=SZMC%5ESZMC%5ET43537

Note: To access the following medications, use the IBM Micromedex resource. Type the name of each medication in the keyword search bar. Be sure to read all sections on the left navigation bar related to each medication’s result page, as this information will be helpful for your review in preparation for your Assignments.

  • alprazolam
  • amitriptyline
  • amoxapine
  • amphetamine
  • desipramine
  • diazepam
  • doxepin
  • eszopiclone
  • flunitrazepam
  • flurazepam
  • hydroxyzine
  •  imipramine
  • lemborexant
  • lorazepam
  • melatonin
  • methylphenedate
  • modafinil
  • armodafinil
  • carnitine
  • clomipramine
  • clonazepam
  • nortriptyline
  • pitolisant
  • ramelteon
  • sodium oxybate
  • solriamfetol
  • SSRI’s
  • temazepam
  • trazodone
  • triazolam
  • trimipramine
  • wellbutrin
  • zaleplon
  • zolpidem

Insomnia
31-year-old Male

76-year-old Iranian Male

BACKGROUND

This week, we examine a 31-year-old male who presents to the office with a chief complaint of insomnia.

SUBJECTIVE

Patient is a 31-year-old male. He states that his insomnia has gotten progressively worse over the past 6 months. Per the patient, he has never been a “great sleeper” but is now having difficulty both falling asleep and staying asleep at night. The problem began approximately 6 months ago after the sudden loss of his fiancé. The patient states this is affecting his ability to perform his job, which is a forklift operator at a local chemical company. The patient states he has used diphenhydramine in the past to sleep but does not like the way it makes him feel the morning after. He states he has fallen asleep on the job due to lack of sleep from the night before. The patient’s medical record from his previous physician states that he has a history of opiate abuse, which began after he broke his ankle in a skiing accident and was prescribed hydrocodone/apap (acetaminophen) for acute pain management. The patient has not received a prescription for an opiate analgesic in 4 years. The patient states recently he has been using alcohol to help him fall asleep, approximately four beers prior to bed.

MENTAL STATUS EXAM

The patient is alert and oriented to person, place, time, event. He makes good eye contact and is dressed appropriately for time of year. He denies auditory/visual hallucinations. Judgement, insight, and reality contact are all intact. Patient denies suicidal/homicidal ideation, and is future oriented.

Decision Point One

Select what you should do:

Zolpidem: 10 mg daily at bedtimeTrazodone: 50–100 mg daily at bedtimeHydroxyzine: 50 mg daily at bedtime

Insomnia
31-year-old Male

31-year-old Male

Decision Point One

Zolpidem: 10 mg daily at bedtime

RESULTS OF DECISION POINT ONE

  • Patient returns to clinic in 2 weeks.
  • Patient states the medication “knocked him out” but felt he slept well.
  • His new girlfriend was concerned as he woke up in the middle of the night and cooked breakfast, yet the patient has no recollection of the occurrence.
  • Patient states that the medication helps him sleep especially well when taken with a beer right before bedtime. Patient denies auditory/visual hallucinations and is future oriented.

Decision Point Two

Decrease zolpidem to 5 mg daily at bedtime

RESULTS OF DECISION POINT TWO

  • Patient returns to clinic in 2 weeks.
  • Patient states his episodes of “nighttime activity” has greatly decreased.
  • His girlfriend told him that one time in the 2 weeks he got up and was getting ready to go for a drive.
  • Patient denies auditory/visual hallucinations and is future oriented.
  • Patient states that he likes the way the zolpidem helps him sleep and “is good with continuing to take it if most of the time I sleep through the night undisturbed.”

Decision Point Three

Select what you should do next:

Maintain dose. Patient to return in 4 weeks for follow up appointmentDiscontinue zolpidem 5 mg tablets. Initiate therapy with Intermezzo 5 mg sublingual tablet nightly at bedtime, as needed. Follow up in 4 weeksDiscontinue zolpidem. Initiate therapy with trazodone 50 mg nightly at bedtime. Instruct patient he may take up to 100 mg if 50 mg is ineffective. Follow up in 4 weeks

Insomnia
31-year-old Male

31-year-old Male

Decision Point One

Zolpidem: 10 mg daily at bedtime

RESULTS OF DECISION POINT ONE

  • Patient returns to clinic in 2 weeks.
  • Patient states the medication “knocked him out” but felt he slept well.
  • His new girlfriend was concerned as he woke up in the middle of the night and cooked breakfast, yet the patient has no recollection of the occurrence.
  • Patient states that the medication helps him sleep especially well when taken with a beer right before bedtime. Patient denies auditory/visual hallucinations and is future oriented.

Decision Point Two

Decrease zolpidem to 5 mg daily at bedtime

RESULTS OF DECISION POINT TWO

  • Patient returns to clinic in 2 weeks.
  • Patient states his episodes of “nighttime activity” has greatly decreased.
  • His girlfriend told him that one time in the 2 weeks he got up and was getting ready to go for a drive.
  • Patient denies auditory/visual hallucinations and is future oriented.
  • Patient states that he likes the way the zolpidem helps him sleep and “is good with continuing to take it if most of the time I sleep through the night undisturbed.”

Decision Point Three

Maintain dose. Patient to return in 4 weeks for follow up appointment

Guidance to Student
Zolpidem is a medication that has a host of negative side effects. It should not be the first choice of therapy due to these side effects. Caution must be exercised if prescribing this medication to a patient. The patient should be instructed not to mix the medication with alcohol or any other medication unless first speaking with their provider.
In this case, the patient is experiencing complex sleep behavior. It is prudent as the patient’s healthcare provider to discontinue this medication and prescribe something different.
Trazodone is a selective serotonin reuptake inhibitor that is a much safer choice. In adults you will want to start with 50mg at bedtime and titrate up as needed.

USE 6 RESOURCES FROM SCHOOL RESOURCES