DISCUSSION: NRNP 6675 WEEK 9 PRESCRIBING FOR OLDER ADULTS AND PREGNANT WOMEN

DISCUSSION: NRNP 6675 WEEK 9 PRESCRIBING FOR OLDER ADULTS AND PREGNANT WOMEN

DISCUSSION: NRNP 6675 WEEK 9 PRESCRIBING FOR OLDER ADULTS AND PREGNANT WOMEN

INTRODUCTION

The psychiatric mental health nurse practitioner assumes probably no greater responsibility than the responsibility of prescribing medications. While someone can be harmed by psychotherapy, the level and intensity of the harm generally does not come to the same level of harm that can occur from improper prescribing. The PMHNP must understand his/her responsibility both at a state and federal level when it comes to prescribing medications. It is of critical importance to understand the risks and benefits of the medications prescribed and their varying potential effects on special populations such as children/adolescents, pregnant women, or older adults.

This week, you examine the special considerations when prescribing for pregnant women and older adults.

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LEARNING OBJECTIVES

Students will:

Recommend psychopharmacological and nonpharmacological interventions for older adults and pregnant women in mental health settings

Evaluate the risks and benefits of pharmacological treatment for older adults and pregnant women

Justify clinical decision making related to pharmacological treatment of older adults and pregnant women in mental health settings

PRESCRIBING FOR OLDER ADULTS AND PREGNANT WOMEN

After assessing and diagnosing a patient, PMHNPs must take into consideration special characteristics of the patient before determining an appropriate course of treatment. For pharmacological treatments that are not FDA-approved for a particular use or population, off-label use may be considered when the potential benefits could outweigh the risks.In this Discussion, you will investigate a specific disorder and determine potential appropriate treatments for when it occurs in an older adult or pregnant woman.

RESOURCES

Be sure to review the Learning Resources before completing this activity.

Click the weekly resources link to access the resources.

WEEKLY RESOURCES

TO PREPARE:

Choose one of the two following specific populations: either pregnant women or older adults. Then, select a specific disorder from the DSM-5-TR to use.

Use the Walden Library to research evidence-based treatments for your selected disorder in your selected population (either older adults or pregnant women). You will need to recommend one FDA-approved drug, one non-FDA-approved “off-label” drug, and one nonpharmacological intervention for treating the disorder in that population.

BY DAY 3 OF WEEK 9

Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your chosen disorder in older adults or pregnant women.

Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug?

Explain whether clinical practice guidelines exist for this disorder, and if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration.

Support your reasoning with at least three current, credible scholarly resources, one each on the FDA-approved drug, the off-label, and a nonpharmacological intervention for the disorder.

Read a selection of your colleagues’ responses.

BY DAY 6 OF WEEK 9

Respond to at least two of your colleagues on 2 different days who selected different disorders. Propose an alternative on-label, off-label, or nonpharmacological treatment for the disorders. Justify your suggestions with at least two references to the literature.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!

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LEARNING RESOURCES

Required Readings

American Psychiatric Association. (2016). The American Psychiatric Association practice guideline on the use of antipsychotics to treat agitation or psychosis in patients with dementiaLinks to an external site.. https://doi.org/10.1176/appi.books.9780890426807

Agency for Healthcare Research and Quality. (2019). Maternal and fetal effects of mental health treatments in pregnant and breastfeeding women: A systematic review of pharmacological interventionsLinks to an external site.. https://effectivehealthcare.ahrq.gov/sites/default/files/pdf/protocol-pharm-pregnant-women_0.pdf

Hardy, L. T., & Reichenbacker, O. L. (2019). A practical guide to the use of psychotropic medications during pregnancy and lactationLinks to an external site.. Archives of Psychiatric Nursing, 33(3), 254–266. https://doi.org/10.1016/j.apnu.2019.04.001

National Library of Medicine. (2006–2020). Drugs and lactation databaseLinks to an external site. (LactMed). https://www.ncbi.nlm.nih.gov/books/NBK501922/

The LactMed® database is a peer-reviewed, evidence-based resource on drugs that may be used by breastfeeding mothers. It includes possible effects on nursing infants and offers drug alternatives where possible.

Boland, R. Verdiun, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.

Chapter 1, “Examination and Diagnosis of the Psychiatric Patient”

Section 1.3, “Geriatric Patients” (pp. 87-92)

Chapter 29, “End-of-Life Issues and Palliative Care”

Chapter 31, “Global and Cultural Issues in Psychiatry”

Stewart, J. G., & DeNisco, S. M. (2019). Role development for the nurse practitioner (2nd ed.). Jones & Bartlett Learning.

Chapter 3, “Vulnerable Populations”

Chapter 4, “Mental Health and Primary Care: A Critical Intersection”

Chapter 5, “Cultural Sensitivity and Global Health”

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NRNP_6675_Week9_Discussion_Rubric

NRNP_6675_Week9_Discussion_Rubric

Criteria	Ratings	Pts
This criterion is linked to a Learning OutcomeMain Posting:Response to the Discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.	44 to >39.0 ptsExcellent 90%–100% Thoroughly responds to the Discussion question(s)… Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources… No less than 75% of post has exceptional depth and breadth… Supported by at least three current credible sources 39 to >34.0 ptsGood 80%–89% Responds to most of the Discussion question(s)… Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module… 50% of the post has exceptional depth and breadth… Supported by at least three credible references 34 to >30.0 ptsFair 70%–79% Responds to some of the Discussion question(s)… One to two criteria are not addressed or are superficially addressed… Is somewhat lacking reflection and critical analysis and synthesis… Somewhat represents knowledge gained from the course readings for the module… Post is supported by fewer than two credible references 30 to >0 ptsPoor 0%–69% Does not respond to the Discussion question(s)… Lacks depth or superficially addresses criteria… Lacks reflection and critical analysis and synthesis… Does not represent knowledge gained from the course readings for the module… Contains only one or no credible references	44 pts
This criterion is linked to a Learning OutcomeMain Posting:Writing	6 to >5.0 ptsExcellent 90%–100% Written clearly and concisely… Contains no grammatical or spelling errors… Adheres to current APA manual writing rules and style 5 to >4.0 ptsGood 80%–89% Written concisely… May contain one to two grammatical or spelling errors… Adheres to current APA manual writing rules and style with minor errors 4 to >3.0 ptsFair 70%–79% Written somewhat concisely… May contain more than two spelling or grammatical errors… Contains some APA formatting errors 3 to >0 ptsPoor 0%–69% Not written clearly or concisely… Contains more than two spelling or grammatical errors… Does not adhere to current APA manual writing rules and style	6 pts
This criterion is linked to a Learning OutcomeMain Posting:Timely and full participation	10 to >8.0 ptsExcellent 90%–100% Meets requirements for timely, full, and active participation… Posts main Discussion by due date 8 to >7.0 ptsGood 80%–89% Posts main Discussion by due date… Meets requirements for full participation 7 to >6.0 ptsFair 70%–79% Posts main Discussion by due date 6 to >0 ptsPoor 0%–69% Does not meet requirements for full participation… Does not post main Discussion by due date	10 pts
This criterion is linked to a Learning OutcomeFirst Response:Post to colleague’s main post that is reflective and justified with credible sources	9 to >8.0 ptsExcellent 90%–100% Response exhibits critical thinking and application to practice settings… Responds to questions posed by faculty… The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives. 8 to >7.0 ptsGood 80%–89% Response has some depth and may exhibit critical thinking or application to practice setting. 7 to >6.0 ptsFair 70%–79% Response is on topic, may have some depth. 6 to >0 ptsPoor 0%–69% Response may not be on topic, lacks depth.	9 pts
This criterion is linked to a Learning OutcomeFirst Response:Writing	6 to >5.0 ptsExcellent 90%–100% Communication is professional and respectful to colleagues…. Response to faculty questions are fully answered, if posed…. Provides clear, concise opinions and ideas that are supported by two or more credible sources… Response is effectively written in standard, edited English. 5 to >4.0 ptsGood 80%–89% Communication is mostly professional and respectful to colleagues…. Response to faculty questions are mostly answered, if posed…. Provides opinions and ideas that are supported by few credible sources… Response is written in standard, edited English. 4 to >3.0 ptsFair 70%–79% Response posted in the Discussion may lack effective professional communication…. Response to faculty questions are somewhat answered, if posed…. Few or no credible sources are cited. 3 to >0 ptsPoor 0%–69% Responses posted in the Discussion lack effective communication…. Responses to faculty questions are missing…. No credible sources are cited.	6 pts
This criterion is linked to a Learning OutcomeFirst Response:Timely and full participation	5 to >4.0 ptsExcellent 90%–100% Meets requirements for timely, full, and active participation… Posts by due date 4 to >3.0 ptsGood 80%–89% Meets requirements for full participation… Posts by due date 3 to >2.0 ptsFair 70%–79% Posts by due date 2 to >0 ptsPoor 0%–69% Does not meet requirements for full participation… Does not post by due date	5 pts
This criterion is linked to a Learning OutcomeSecond Response:Post to colleague’s main post that is reflective and justified with credible sources	9 to >8.0 ptsExcellent 90%–100% Response exhibits critical thinking and application to practice settings…. Responds to questions posed by faculty… The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives. 8 to >7.0 ptsGood 80%–89% Response has some depth and may exhibit critical thinking or application to practice setting. 7 to >6.0 ptsFair 70%–79% Response is on topic, may have some depth. 6 to >0 ptsPoor 0%–69% Response may not be on topic, lacks depth.	9 pts
This criterion is linked to a Learning OutcomeSecond Response:Writing	6 to >5.0 ptsExcellent 90%–100% Communication is professional and respectful to colleagues…. Response to faculty questions are fully answered, if posed…. Provides clear, concise opinions and ideas that are supported by two or more credible sources… Response is effectively written in standard, edited English. 5 to >4.0 ptsGood 80%–89% Communication is mostly professional and respectful to colleagues…. Response to faculty questions are mostly answered, if posed…. Provides opinions and ideas that are supported by few credible sources… Response is written in standard, edited English. 4 to >3.0 ptsFair 70%–79% Response posed in the Discussion may lack effective professional communication…. Response to faculty questions are somewhat answered, if posed…. Few or no credible sources are cited. 3 to >0 ptsPoor 0%–69% Responses posted in the Discussion lack effective communication…. Responses to faculty questions are missing…. No credible sources are cited.	6 pts
This criterion is linked to a Learning OutcomeSecond Response:Timely and full participation	5 to >4.0 ptsExcellent 90%–100% Meets requirements for timely, full, and active participation… Posts by due date 4 to >3.0 ptsGood 80%–89% Meets requirements for full participation… Posts by due date 3 to >2.0 ptsFair 70%–79% Posts by due date 2 to >0 ptsPoor 0%–69% Does not meet requirements for full participation… Does not post by due date	5 pts