Respond to at least two of your colleagues who selected at least one different factor than you in one of the following ways:

Share insights on how the factor your colleague selected impacts the pathophysiology of anaphylactic shock.

Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.

Validate an idea with your own experience and additional research.

                                                        Main Post

 Anaphylactic shock is a widespread hypersensitivity reaction called anaphylaxis (Huether & McCance, 2017).  Anaphylactic shock causes an accelerated allergic reaction that releases large amounts of histamine, which therefore results in vasodilation (Huether & McCance, 2017).  When a sensitized individual is exposed to an allergen it results in an anaphylactic shock which the physiologic alteration is similar to a neurogenic shock (Huether & McCance, 2017).  The physiologic alteration would include vasodilation and relative hypovolemia which then leads to a decreased tissue perfusion and impaired cellular metabolism (Huether & McCance, 2017).  The entire body is affected rapidly when it goes into an anaphylactic shock.

            According to Pistener & Mattey (2017), Anaphylaxis is a life-threatening emergency and in the school setting, school nurses prepare plans to prevent an emergency, educating staff and students on life-threatening allergies. An anaphylactic shock is defined as a sudden onset of one or more allergic reaction symptom lasting less than twenty-four hours; such as wheezing, rash, hives, itching, shortness of breath, angioedema, stridor, nausea, vomiting, dizziness, anxiety or diarrhea (Jacobsen & Gratton, 2011).  If I was the nurse practitioner in the school and the child came in complaining of one or more of the anaphylactic shock’s symptoms, I would first check my anaphylactic shock emergency plan and see if the child is carrying his Epinephrine pen or if the school has it. If the child has the Epinephrine pen or the school has it, I would administer the medication rapidly in order to avoid death. If the child and the school does not have the epinephrine pen, I would call 911 and report my findings and refer the patient to emergency care.  If the child came in complaining of a rash or hives that he/or she has had for a couple days, I would treat them in an outpatient setting and call their parents.

            Genetics is one of the factors I selected for anaphylactic shock due to genetically predisposed individuals, allergens such as shellfish, peanuts, latex, medications, and insect venoms initiate a humoral immune response (type I hypersensitivity reaction) that result in a mass production of immunoglobulin E (IgE) antibodies (Huether & McCance, 2017). The mast cells are de-granulated due to the allergen binding to IgE; thus, a mast cells release vasoactive and inflammatory cytokines in large quantities (Huether & McCance, 2017). The end product is the immune and inflammatory response is triggered causing vasodilation, increased vascular permeability, peripheral pooling, tissue edema, and constriction of extravascular smooth muscle which causes laryngospasm and bronchospasm as well as abdominal cramping (Huether & McCance, 2017).  Lastly, the immune system of a person with an allergy will perceive the allergen as a dangerous body. This would then create an antibody to fight off the foreign body.  This is when the process of an allergic reaction begins (Jacob, 2018).

Behavior is the second factor that impacts anaphylactic shock.  There are times when the patient is not aware of an exposure to allergen. The patient would then have an anaphylactic shock very rapidly which can result into a life-threatening situation. Patients with allergens causing anaphylaxis needs to be educated in carrying an epinephrine pen at all times.  Eating out in restaurants where they cook foods in close proximity, the patients needs to be educated in alarming the waiter that they have a food allergen.

 

References

Huether, S. E., & McCance, K.L. (2017). Understanding pathophysiology (6th ed.). St. Louis, 

MO: Mosby.

 

Jacob, L. M. (2018). Anaphylaxis. Salem Press Encyclopedia of Health. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=ers&AN=87325288&site=eds-live&scope=site

 

Jacobsen, R. C., & Gratton, M. C. (2011). A case of unrecognized prehospital anaphylactic 

shock. Prehospital Emergency Care, 15(1), 61-66. Retrieved from http://m.paems.org/pdfs/online-ce/A-case-of-unrecognized-prehospital-anaphylactic-shock.pdf

 

Pistiner, M., & Mattey, B. (2017). A Universal Anaphylaxis Emergency Care Plan: Introducing the New Allergy and Anaphylaxis Care Plan From the American Academy of Pediatrics. NASN School Nurse (Print), 32(5), 283–286. https://doi-org.ezp.waldenulibrary.org/10.1177/1942602X17713759

 

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Respond  on two different days who selected different disorders or factors than you, in one or more of the following ways:

Share insights on how the factor you selected impacts the pathophysiology of the disorder your colleague selected.

Offer alternative diagnoses and prescription of treatment options for the disorder your colleague selected.

Validate an idea with your own experience and additional research.

                                      Main Post

Reproductive Disorders            

The reproductive system in males and females is an important part of everyday life. Disorders of the reproductive system can cause physical and emotional stress related to symptoms these disorders cause. Polycystic Ovarian Syndrome (PCOS) and Uterine Fibroids are just two of many reproductive disorders that wreak havoc on women. 

Polycystic Ovarian Syndrome

PCOS is a “syndrome,” or group of symptoms that affects the ovaries and ovulation. PCOS causes hormonal imbalances and metabolism problems. PCOS three main features are; cysts in the ovaries, high levels of male hormones, and irregular or skipped periods. PCOS is a hormonal imbalance along with metabolism issues that can affect overall health and appearance. “Between 5% and 10% of women between 15 and 44” (OWH, 2019), have PCOS and usually are diagnoses between their “20s and 30s trying to conceive but PCOS can happen anytime after puberty” (OWH, 2019). Common symptoms can include but not limited are, Irregular periods, heavy menstruation, male pattern baldness, weight gain, acne, and can increase the risk of heart disease. Diagnosis is based on symptoms, blood work, pelvic exam, and ultrasound. Treatment can include weight loss, increased physical activity, medications (metformin and birth control medications), and surgery.              Uterine Fibroids            

“Uterine fibroids are the most common noncancerous tumors in women of childbearing age” (CDC, 2019). “They are made of smooth muscle and other cells that can develop within the uterine wall itself or attach to it and can grow as single tumor or a cluster” (Stoppler, M, Davis, C, n.d.) “Fibroids can occur in up to 50% of all women and are one leading cause of hysterectomy” (Stoppler, M, Davis, C, n.d.). There is no significant reason as to why fibroids develop. Risk factors can include, family history, obesity, nulliparity, early on-set of menstruation, and “women of African descent are two to three times more likely to develop fibroids than women of other races” (Stoppler, M, Davis, C, n.d.). Symptoms can include, increase in menstrual bleeding, pressure in the rectum and bladder, which can cause constipation and frequency in urination, pelvic mass, and increase waist circumference. Diagnosis is based on pelvic ultrasound, endometrial biopsy, hysteroscopy, and laparoscopy. Treatment of fibroids depends on the severity of symptoms, trying to have children, general overall health, and size and location of the fibroids. If medically necessary to treat fibroids, sometimes medications can help, D&C can be an option, and surgery such as a myomectomy, and hysterectomy.

                                        Age as a Factor 

Unfortunately, age can play a role in women diagnoses with PCOS or Uterine fibroids, mainly because of the wanting to have children and the increased risk for cardiovascular disease. PCOS and fibroids usually develop after puberty and are usually diagnosed in childbearing years around 20-30 years of age. It can affect women getting pregnant and make for a difficult road ahead. “Polycystic ovary syndrome puts older women at increased risk of cardiovascular disease and type 2 diabetes following menopause” (Grassi, A, 2014). When a woman has gone through menopause, this causes a decrease in hormones which can decrease the size of fibroids and the development of fibroids. Fibroids need the hormones to develop so without the right number of hormones, fibroids may not develop. 

                                          References

Centers for Disease Control. (2019). Common Reproductive Health Concerns for Women. Retrieved from https://www.cdc.gov/reproductivehealth/womensrh/healthconcerns.html Galan, N. (2017). Fibroids after menopause: What you need to know. Medical News Today. Retrieved from https://www.medicalnewstoday.com/articles/319576.php  Grassi, A. (2014). PCOS in Aging Women — Beyond Hormones and Hot Flashes. Today’s Dietician. Vol. 16 No. 2 P. 40. Retrieved from https://www.todaysdietitian.com/newarchives/020314p40.shtml Stoppler, M, Davis, C, (n.d.). Uterine Fibroids. Retrieved from https://www.emedicinehealth.com/uterine_fibroids/article_em.htm#what_are_uterine_fibroidsOffice of Women’s Health. (2019). Polycystic ovary syndrome. Retrieved from https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome

 

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Respond to this post with a positive response :

Ask a probing question, substantiated with additional background information, evidence or research.

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.

Validate an idea with your own experience and additional research.

Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.

Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.

Use  references

                                                       Initial Post

My program is Nurse Educator and to do research on anything to do with this is a little difficult as there is not much information on it. I decided to do two types of searches based on how I might go with my master’s degree. The first search was nurse educators and what came up was an article on how to become a better nurse educator to nursing students. The most interesting statement made in this article hit close to home for me. “Teaching student nurses’ critical thinking and the ability to apply clinical reasoning skills remains a challenge in nursing education” (Wyngaarden, 2018). Being a nursing student is stressful but having to think outside the box but quickly can be even more difficult at times. Teachers are having a hard time connecting with students because not only is there a huge age gap between the student population but so many different learning barriers and language barriers they are trying to work around. 

The second search I did was nurse educators to patients. I research this as well because I have also thought about being an educator to patients to have one-to-one conversations about their illness. I feel as though patients might listen and understand better if they are working with someone one-on-one rather than a different nurse/doctor every other day while in the hospital. While I was working for Shands, they had a diabetic nurse educator who would not only do education with the patients during their hospital stay, but she would go to the clinic and speak with patients. Once a month she would hold a newly diagnosed diabetes class for patients and then once a week she would hold classes on how to continue to control your diabetes. She would charge $5 for the continuing education class. The money that she would make from this would go to buying supplies to hand out to patients who did not have any or could not afford it. 

For both searches, I used the Walden Library and found it to be the easiest way to look for my information. The Walden Library has a variety of articles/books/online journals to choose from. I will always recommend using the Walden Library for any type of research as this provides information from all over as well as the information is current. 

 

References

 

Walden Library. Accessed December 16, 2018, from     https://class.waldenu.edu/bbcswebdav/library

Flanders, S. A. (2018, January-February). Effective Patient Education: Evidence and Common Sense. MedSurg Nursing, 27(1), 55-58. Retrieved December 16, 2018, from https://eds-b-ebscohost-com.ezp.waldenulibrary.org/eds/pdfviewer/pdfviewer?vid=2&sid=17e9bf97-558e-4e18-8a46-a242c62be6ab%40pdc-v-sessmgr02

Wyngaarden, A. V. (2018). ASSESSING THE VALUE OF ACTION RESEARCH. South African Journal of Higher Education, 32(6), 519-531. doi:http://dx.doi.org/10.20853/32-6-2974

     

 

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Respond  on two different days by explaining how the leadership skills they described may impact your organization or your personal leadership, or by identifying challenges you see in applying the skills described.

                                                                     Main Post

The leadership of any given workplace sets the tone for the entire operation. One key factor of this was presented by Anyati, Sudiro, Hadiwidjaja and Noermijati in their article addressing ethical leadership and its effect on the workplace. Their study found that an ethical leaderships system results in an ethical climate and prevents what they describe as “deviant behavior’ in the workplace” (2018). Leaders that use unethical means to enforce their policies will likely be met with undesirable actions from their employees. Leaders that create an ethical work environment and preform under their own ethical scrutiny are, likewise, met with ethical and pleasing behavoir in the workplace.  

     An example of this in my workplace from our Chief Operations Officer at Grand Peaks Medical. She conducts herself in an ethical way in all instances. When she has a child that needs to be seen for an illness, she calls and makes an appointment, sits in the waiting room and insists that regular operations and flow continue despite the fact that she is our boss, she could easily have her child seen first. This in turn has created an atmosphere of ethics in our office. We all have followed suit with scheduling ourselves and our family members. It has also deterred staff and doctors from giving important members of the community preferential treatment over another patient because of their social status. Our patients are all treated ethically regardless of financial, insurance or social status. We also all feel that we can go to her with concerns, because we know that she will handle them ethically, maintaining confidentiality, and will get back to us will answers in a timely manner.  

     A type of Transformational Leadership, known as inspirational, has been shown to be the one of the most effective in producing outcomes and a happy and healthy work environment. The Inspirational leader sets organizational goals and although he or she has high expectations of his or her employees, the leader is supportive and positive (Zindeldin, 2017). I found this type of leadership a key factor in good leadership because I feel it makes the organization feel like they are working as a team to achieve the same goal.  

     An example of this was my manager when I worked on Labor and Delivery. Our Nurse Manager was this type of manager and ran a very effective team. Each nurse meeting was organized to develop a team goal to improve patient safety. Sometimes this meant improving medication error rates or decreasing the call to cut time for a cesarean section. Not only did she give us helpful ideas on how to improve, she would spend time on the floor, working with us, taking care of patients. This gave her to opportunity to see what was hindering the goal, and to see what could be improved in way of policy that would help us meet that goal. We felt supported and felt that our manager truly cared for each of us.  

     Both of these leaders made a decision, as descried in chapter 7 of the course text, to be influential leaders. They both genuinely care about the staff and maintain a level of credibility among staff that provides them with a high level of respect from their employees. Being a leader is a selfless endeavor, and the best leaders aim to improve the lives of others not to improve their own status (Mashall & Broome, 2017).  

 References

Aryati, A. S., Sudiro, A., Hadiwidjaja, D., & Noermijati, N. (2018). The influence of ethical leadership to deviant workplace behavior mediated by ethical climate and organizational commitment. International Journal of Law & Management, 60(2), 233–249. https://doi-org.ezp.waldenulibrary.org/10.1108/IJLMA-03-2017-0053 

Marshall, E., & Broome, M. (2017). Transformational leadership in nursing: From expert clinician to influential leader (2nd ed.). New York, NY: Springer. 

Zineldin, M. (2017). Transformational leadership behavior, emotions, and outcomes: Health psychology perspective in the workplace. Journal of Workplace Behavioral Health, 32(1), 14–25. https://doi-org.ezp.waldenulibrary.org/10.1080/15555240.2016.1273782 

 

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Respond  by offering one or more additional mitigation strategies or further insight into your colleagues’ assessment of big data opportunities and risks.

                                                                  

                                                                 Main Post 

      Big data provides knowledge, insight, ideas and the potential to expand opportunities within an organization (McGonigle & Mastrian, 2018, p. 478).  Considerable amounts of data have been collected through the EMR over the past decade creating a challenge for nurse scientist to find nuggets of information in tsunami of data (Gephart, Davis, & Shea, 2017). The amount if big data can be difficult for those required to examine and retrieve information. Despite the overwhelming amounts of big data, it does come with benefits, challenges and risk associated with its use.

     A benefit to using big data is the ability to communicate with a large group of patients at one time. For instance, a physician can send a message out to a large group of patients in a short period of time with the use of big data (Laurete Education, 2018).  A physician’s office can remind large group of patients of appointment reminders, lab appointments or alert them to call the md office with abnormal lab results.  This cost effective and convenient as it allows consistent measures to monitor the practice.

     A potential challenge of using big data is the fine line of deciding who owns and who can use the data (Shanthagiri, 2014). For example, the data sources include the patient’s private health information which could now be potentially shared with labs, pharmacies, social media in addition to their physician (Shanthagiri, 2014).  The enforcement of privacy of PHI and HIPPA is strict. The potential for error with big data is a high risk.

     Working with the VA medical center, I observe strict monitoring and firewalls ensuring safety of patient’s PHI. The vulnerability of exposure of personal health information to social media or social networks is a constant threat.  The EMR not only stores health data but also houses the patient’s personal information such as social security numbers, addresses, and birthdays. A strategy to combat this potential problem is a strong malware and security system monitored 24 hours a day 7 days a week. The VA medical center monitors all information going in and going out of the EMR with it’s own security department specific for data protection.  Each user is tagged to this information and can be traced.  The VA will immediately terminate privileges should a user of the EMR violate any firewall in the system. They monitor everything as they should.

      As a bedside nurse I am aware of my contribution to this data however, I am not exposed to the cumbersome job of disentangling this information or protecting it. I know the potential benefit of collecting this information is to provide information as it relates to quantifying and qualifying illness, providing evidence for practice.  That being said, big data will continue to grow as we knowledge workers continue to contribute and technology advances.

References

Gephart, S., Davis, M., & Shea, K. (2017, December 13, 2017). Perspectives on Policy and the Value of Nursing Science in a Big Data Era. SAGE Journals.         https://doi.org/https://doi-org.ezp.waldenulibrary.org/10.1177/0894318417741122

Laurete Education. (2018).  Health Informatics and Population Health: Analyzing Data for Clinical Success [Video file]. Retrieved from                                       https://class.waldenu.edu/bbcswebdav/institution/USW1/201950_27/MS_NURS/NURS_5051_WC/USW1_NURS_5051_module03.html?course_uid=USW1.1425.201950&service_url=https://class.waldenu.edu/webapps/bbgs-deep-links-BBLEARN/app/wslinks&b2Uri=https%3A%2F%2Fclass.waldenu.edu%2Fwebapps%2Fbbgs-deep-links-BBLEARN#resources

McGonigle, D., & Mastrian, K. G. (2018). Nursing Informatics and the Foundation of Knowledge (4 ed.). Burlington, MA: Jones & Bartlett Learning.

Shanthagiri, V. (2014). Big Data in Health Informatics [Video file]. Retrieved from https://www.youtube.com/watch?v=4W6zGmH_pOw

 

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