Nurs 683
Discussion response 1
Angelica Llamas
Dopamine is a neurotransmitter produced in the brain and serves as a messenger to communicate between nerve cells in the brain and the rest of the body. According to Stahls et al., 2023, Dopamine is a volume neurotransmitter with action in the prefrontal cortes of the brain; when dopamine neurotransmission happens at a synapse in the prefrontal cortex, dopamine spills over from that synapse and spreads to neighboring dopamine receptors to stimulate them.
Dopamine agonist drugs (such as Mirapex and ropinirole) imitate the natural neurotransmitter dopamine by binding to and activate the dopamine receptors on nerve cells in the brain leading to a reaction the same way as they would with natural dopamine. Dopamine agonists have two subclasses: Ergoline and Non-Ergoline Agonist. Both subclasses target dopamine D2type receptors. Types of Ergoline agonist are: Cabergoline & Bromocriptine. Types of Non-Ergoline Agonist are: Pramipexole, ropinirole and rotigotine.
Expected outcomes: Lack of dopamine can cause major disruptions between the brain and the body- Dopamine agonist Activate dopamine receptors, treat movement disorders and other control processes related to the heart, kidneys, pancreas, pituitary gland, endocrine system, GI systema and reproductive system. There are some potential risks and side effects from taking dopamine agonist including constipation, dizziness, headaches, indigestion, irregular heart rhythms, nausea and vomiting, orthostatic hypotension, and uncontrolled chorea like muscle movements. long term use of dopamine agonist can lead to mental health behavior changes such as confusion, depression, manias and psychosis. Condition that Dopamine agonist would be considered for the treatment plan include Parkinsons disease, restless legs syndrome, high prolactin levels and neuroleptic malignant syndrome (Mayo Clinic n.d.)
GABA is an inhibitory neurotransmitter. It decreases a nerve cells ability to communicate with other nerve cells. It slows down the brain by blocking signals. It controls hyperactivity, anxiety, fear and leads to a calming effect.
Gaba receptors such as Benzodiazepines slow down the nervous system by activating the brain to release GABA neurotransmitters. There are 2 types of benzodiazepines, by strength: Some are stronger than others (though potency can vary from person to person) and by duration: Some are short-acting and last only several hours, some are long-acting and last several days (Mayo Clinic n.d.). Stahls et al., 2023 explain that drug-induced changes in signal transduction from ionotropic receptors can have profound actions on psychiatric symptoms. Most psychotropic drugs currently utilized including many drugs for the treatment of anxiety and insomnia such as benzodiazepines act as these inotropic receptors, acting immediately and having an almost immediate effect. While there are benefits there are potential risks such as for misuse and overdose, habit forming, they can interact dangerously with alcohol and certain drugs. affect ability to drive and other tasks. Conditions associated with GABA imbalances include Anxiety and mood disorders, schizophrenia, autism spectrum disorders, depression, epilepsy, seizures among others (Mayo Clinic n.d.)
Discussion response 2
Rocio Reyes Echemendia
Serotonin and melatonin are neurotransmitters that play crucial roles in the central nervous system and are associated with various physiological processes. The pharmacology action of serotonin, also known as 5-hydroxytryptamine (5-HT), is that regulates mood, appetite, sleep, and various other functions (De Deurwaerdère & Di Giovanni, 2020). It is synthesized in nerve cells and released into the synaptic cleft, where it binds to receptors on the postsynaptic neuron (Bamalan et al., 2023). The drug class it is most closely linked is selective serotonin reuptake inhibitors (De Deurwaerdère & Di Giovanni, 2020). Some expected outcomes are the improvement of mood and alleviation of symptoms such as anxiety and insomnia, among others (De Deurwaerdère & Di Giovanni, 2020). In addition, common side effects of SSRIs may include nausea, insomnia, headache, and sexual dysfunction (Bamalan et al., 2023). In some cases, there may be more serious side effects, such as serotonin syndrome, which can occur when there is an excess of serotonin in the body (Bamalan et al., 2023).
On the other hand, the pharmacologic action of melatonin is that regulates the sleep-wake cycle (circadian rhythm). Melatonin agonists are medications that mimic the action of melatonin and are often used to treat sleep disorders (Savage et al., 2022). An expected outcome is the relief of sleep disorders, such as insomnia or circadian rhythm disorders. Additionally, common side effects of melatonin may include dizziness, headache, and fatigue (Savage et al., 2022).
Finally, if a patient presents with symptoms of depression, anxiety, or obsessive-compulsive disorder, and the primary issue is believed to be related to serotonin imbalance, medications targeting serotonin receptors (such as SSRIs) may be considered. On the other hand, if the primary concern is related to sleep disorders, especially difficulties falling asleep or regulating the sleep-wake cycle, melatonin or melatonin agonists may be more appropriate.
NURS682
Discussion response 1
Monica Sanchez
The four advanced practice registered nurse roles include Certified Nurse Practitioner, clinical nurse specialist, certified registered nurse anesthetist, and certified nurse midwife (The 4 Advanced Practice (APRN) Careers in Nursing, n.d.). The historical development of accredited nurse practitioners started in 1965 (Juda, 2014). Loretta Ford partnered with Henry Silver, MD, and created the first nurse practitioner program (Juda, 2014). The program at the University of Colorado focused on family health, disease prevention, and health promotion (Juda, 2014).
The role of an NP is to implement disease prevention, diagnose and treat chronic and acute issues, health management, and health maintenance (Nurse Practitioner (8212) – CalHR, n.d.). Certified Nurse Anesthetists prepare for anesthesia, implement assessments, provide preoperative teaching, administer anesthesia to patients, maintain anesthesia during an operation, and manage anesthesia recovery (Nurse et al.). The Certified Nurse Midwife confirms pregnancy, provides prenatal/postpartum care, monitors childbirth, manages complications, performs episiotomies, and delivers the newborn/placenta (Science, n.d.). Clinical Nurse Specialists assess patients, analyze patient data/outcomes, develop healthcare policies, collaborate with other healthcare members, and improve patient satisfaction (Clinical et al., 2016).
Discussion response 2
Michaela Parker-Leone
Historically, the advanced specialization of nurses has been associated with innovative risk-takers and critical events (Blair, 2019). The term “advanced practice registered nurse” (APRN) became the common umbrella term for describing four specialties of nurses with formal postbaccalaureate preparation: certified nurse midwives (CNMs), certified registered nurse anesthetists (CRNAs), nurse practitioners (NPs), and clinical nurse specialists (CNSs).
Over a century ago, nurse anesthetists and nurse-midwives developed national standards for education, professional organizations, and certification. Recent decades have seen a gradual standardization of the preparation of NPs and CNSs, as well as certificates and licenses. Nursing leaders considered several factors to define these four APRN roles (Blair, 2019). In addition to obtaining legal status for direct reimbursement, nurses had to obtain federal and state legislation allowing them to be reimbursed for their nursing services, which was achieved first for nurse-midwives over 35 years ago. Regulations and laws governing reimbursement require that nursing specify specific qualifications for reimbursable APRNs, contributing to the standardization of titles, education, and certification (Blair, 2019). Another factor contributing to the delineation of APRN roles was public protection. Over time, all states have implemented laws and regulations to ensure that nurses in all four roles possess the necessary expertise and skills mandated by state legislatures. Some states have accomplished this by instituting a second-level licensing process. The practice of APRNs in other states is governed by state law governing title protection and scope of practice. According to Blair (2019), in 2008, APRNs reached an agreement defining a desired national regulatory model.
In many cases, APRNs are primary care providers who offer preventative health services to the public. APRNs must earn a master’s degree or higher and complete a graduate-level curriculum that includes advanced coursework in pathophysiology, pharmacology, and advanced clinical practice. They also receive clinical training through supervised practice hours, must pass a licensing exam, and must continue their education through ongoing professional development to stay updated on the latest advancements in healthcare (Blair, 2019).
The role of Nurse Practitioners (NPs) is to provide advanced primary and specialty nursing care to patients. Assessing patient health, developing health-promoting plans, and establishing health-promoting habits are all part of the job (Berg, 2020). Nurse Practitioners are crucial in disease prevention and management by educating patients and their families on healthy lifestyle choices, promoting health-promoting habits, and identifying risk factors. They assess patient health, develop personalized care plans, and guide preventive measures such as vaccinations, regular exercise, a balanced diet, and stress management. Additionally, NPs monitor patient progress, identify early signs of potential health issues, and collaborate with healthcare professionals to ensure timely diagnosis and treatment (Berg, 2020).
A clinical nurse specialist specializes in advanced patient care and consulting (Fischer-Cartlidge et al., 2020). Some specific specialized nursing activities performed by clinical nurse specialists include diagnosing and treating acute and chronic illnesses, providing patient education and counseling, coordinating patient care across multiple healthcare settings, implementing and assessing treatment plans, collaborating with other healthcare professionals, conducting clinical research, and advocating for patients and their families. They also play a crucial role in policy development, quality improvement initiatives, and continuing education for nurses within their healthcare organization(Fischer-Cartlidge et al., 2020). They consult with patient care supervisors before administering medicine, identify and facilitate training needs for nursing students and staff, and ensure that people and resources are placed where needed. In addition to providing diagnosis and treatment, patients and their families are counseled on managing their diseases appropriately. They are researching and keeping up with the latest developments in nursing (Fischer-Cartlidge et al., 2020).
Under the direct supervision of an anesthesiologist, a CRNA (Certified Registered Nurse Anesthetist) works as an Assistant and Instructor in a highly specialized area of nursing (Orser & Wilson, 2020). While both CRNAs and anesthesiologists are responsible for administering anesthesia, CRNAs are typically supervised by anesthesiologists and work under their direction. CRNAs have more autonomy in their work than student nurse anesthetists, who are directed, supervised, and evaluated by an anesthesiologist. Additionally, anesthesiologists have more education and training than CRNAs, often taking on leadership roles in the anesthesia department (Orser & Wilson, 2020). CRNAs are responsible for evaluating and assessing patients before surgery, determining the appropriate type and dosage of anesthesia, and administering the anesthesia during surgery. They also monitor the patient’s vital signs, respiratory status, and level of consciousness during surgery and provide post-operative care and pain management. CRNAs work closely with anesthesiologists and regularly consult with them regarding patient care decisions (Orser & Wilson, 2020).
A certified nurse-midwife (CNM) is a healthcare provider who specializes in gynecological care, reproductive health, labor and delivery, and postpartum care (Emeis et al., 2021). CNMs work in various settings and are advanced practice registered nurses (APRNs), meaning they have a broader range of tasks than registered nurses. Their role includes providing prenatal and postpartum care, assisting with childbirth, managing complications during pregnancy and labor, and offering education and support to patients and their families. CNMs collaborate with obstetricians and refer to them when necessary to ensure comprehensive patient care (Emeis et al., 2021). In addition to providing gynecological and reproductive health services, certified nurse-midwives (CNMs) are responsible for conducting prenatal visits and monitoring the health of both the mother and the baby (Emeis et al., 2021). They also educate patients and their families on pregnancy, labor, and postpartum care and provide emotional support throughout these processes. CNMs assist in vaginal deliveries and may also offer cesarean delivery assistance if needed. Furthermore, they effectively manage common complications during pregnancy and labor and collaborate with other healthcare professionals to ensure comprehensive patient care (Emeis et al., 2021).
