WK9 DISCUSSUION NRNP 6675

Week 9: Special Considerations Related to Vulnerable Populations

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. 

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

Learning Resources

Required Readings (click to expand/reduce)

American Psychiatric Association. (2016). The American Psychiatric Association practice guideline on the use of antipsychotics to treat agitation or psychosis in patients with dementia. 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 interventions. 

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 lactation. 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 database (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. 

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.

· Chapter 27, “Psychiatry and Reproductive Medicine”

· Chapter 33, “Geriatric 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”

Required Media (click to expand/reduce)

American Psychiatric Association. (2020). Geriatric telepsychiatry [Video].  https://www.psychiatry.org/psychiatrists/practice/telepsychiatry/toolkit/geriatric-telepsychiatry

Discussion: 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. 

Photo Credit: Getty Images/Blend Images

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.

Rubric Detail

 

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Name: NRNP_6675_Week9_Discussion_Rubric

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Main 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.–

Excellent

90%–100% 40 (40%) – 44 (44%)

Good

80%–89% 35 (35%) – 39 (39%)

Fair

70%–79% 31 (31%) – 34 (34%)

Poor

0%–69% 0 (0%) – 30 (30%)

Main Posting:

Writing–

Excellent

90%–100% 6 (6%) – 6 (6%)

Good

80%–89% 5 (5%) – 5 (5%)

Fair

70%–79% 4 (4%) – 4 (4%)

Poor

0%–69% 0 (0%) – 3 (3%)

Main Posting:

Timely and full participation–

Excellent

90%–100% 9 (9%) – 10 (10%)

Good

80%–89% 8 (8%) – 8 (8%)

Fair

70%–79% 7 (7%) – 7 (7%)

Poor

0%–69% 0 (0%) – 6 (6%)

First Response:

Post to colleague’s main post that is reflective and justified with credible sources–

Excellent

90%–100% 9 (9%) – 9 (9%)

Good

80%–89% 8 (8%) – 8 (8%)

Fair

70%–79% 7 (7%) – 7 (7%)

Poor

0%–69% 0 (0%) – 6 (6%)

First Response:

Writing

—

Excellent

90%–100% 6 (6%) – 6 (6%)

Good

80%–89% 5 (5%) – 5 (5%)

Fair

70%–79% 4 (4%) – 4 (4%)

Poor

0%–69% 0 (0%) – 3 (3%)

First Response:

Timely and full participation

—

Excellent

90%–100% 5 (5%) – 5 (5%)

Good

80%–89% 4 (4%) – 4 (4%)

Fair

70%–79% 3 (3%) – 3 (3%)

Poor

0%–69% 0 (0%) – 2 (2%)

Second Response:

Post to colleague’s main post that is reflective and justified with credible sources

—

Excellent

90%–100% 9 (9%) – 9 (9%)

Good

80%–89% 8 (8%) – 8 (8%)

Fair

70%–79% 7 (7%) – 7 (7%)

Poor

0%–69% 0 (0%) – 6 (6%)

Second Response:

Writing

—

Excellent

90%–100% 6 (6%) – 6 (6%)

Good

80%–89% 5 (5%) – 5 (5%)

Fair

70%–79% 4 (4%) – 4 (4%)

Poor

0%–69% 0 (0%) – 3 (3%)

Second Response:

Timely and full participation

—

Excellent

90%–100% 5 (5%) – 5 (5%)

Good

80%–89% 4 (4%) – 4 (4%)

Fair

70%–79% 3 (3%) – 3 (3%)

Poor

0%–69% 0 (0%) – 2 (2%)

Total Points: 100

Name: NRNP_6675_Week9_Discussion_Rubric