Respond on two different days who selected different treatments and factors than you, in the following ways:
Offer alternative common treatments for the disorders.
Share insight on how the factor you selected impacts the treatment of alterations of digestive function.
Main Post
Many patients will present with disease processes that have the same or similar symptoms, and it will be the responsibility of the practitioner to diagnose and provide treatment accurately. The gastrointestinal tract is one area where misdiagnoses occur due to the common signs and symptoms. Inflammatory bowel disease and irritable bowel syndrome are two common misdiagnosed disorders that will be explored, the pathophysiology explained, proper treatment, and the effects gender has on these diseases.
Pathophysiology of Inflammatory Bowel Disease and Irritable Bowel Syndrome
Inflammatory bowel disease (IBD) comprises three key disorders; Crohn’s disease (CD), ulcerative colitis (UC), and microscopic colitis all attributed to an inflammation process but each affects the body differently. Research by El-Salhy and Hausken (2016) explains that the inflammation in Crohn’s disease is transmural in nature and occurs in any part of the gastrointestinal tract, while the inflammation in ulcerative colitis is more superficial and affects the rectocolonic mucosa, and the inflammation in microscopic manifests as mucosal and submucosal infiltration of immune cells without ulcerations or crypt abscesses and occurs in the colon.
Irritable bowel syndrome (IBS) is a common disease, although the pathophysiology is still not fully understood. Combination of low-grade mucosal inflammation with visceral hypersensitivity and impaired bowel motility could be the underlying etiology for IBS pathogenesis (Chong et al., 2019). Alterations in the gut microbiota and dietary choices play a central role in disease development. According to O’Malley (2019), IBS is complex multifactorial pathophysiology, that involves dysfunction of the bi-directional signaling axis between the brain and the gut, this axis incorporates efferent and afferent branches of the autonomic nervous system, circulating endocrine hormones and immune factors, local paracrine and neurocrine factors and microbial metabolites.
Treatments for Inflammatory Bowel Disease and Irritable Bowel Syndrome
Treatment for IBS and IBD focuses on treating not only the symptoms but the underlying cause of the disease. Treatment for IBS includes; dietary interventions, probiotics, prebiotics, synbiotics, non-absorbable antibiotics, mixed μ-opioid receptor agonist–δ-opioid receptor antagonist and κ-opioid receptor agonist, Serum-derived bovine immunoglobulin (SBI), and fecal microbiota transplantation (FMT). Treatment for IBD is more complex due to IBD being composed of three different diseases, each requires different treatment plans, but there is some crossover. Corticosteroids, probiotics, immunomodulatory drugs, immunosuppressants, antitumor necrosis factor therapy, anti-interleukin 12/23 antibody drugs, janus kinase (JAK) inhibitor, SMAD 7 inhibitor, and FMT are treatments available for IBD. 5-aminosalicylates (5-ASAs) are the first-line therapy for induction and maintenance of remission in patients with UC (Su et al., 2019). Anti-tumor necrosis factor (TNF) therapy works well on both UC and CD, JAK inhibitor works for UC and not CD, SMAD 7 inhibitor works for CD but not UC.
Gender’s Affect on Inflammatory Bowel Disease and Irritable Bowel Syndrome
Research conducted by Kosako, Akiho, Miwa, Kanazawa, and Fukudo (2018) acknowledges that the higher prevalence of IBS in women compared with men may be associated with sex hormone fluctuations, which reportedly affect IBS symptoms, with symptoms appearing stronger before menstruation. Women may also receive a delay in treatment to both IBD and IBS due to the perceived perception of pain being misdiagnosed by the primary care practitioner.
Conclusion
The gastrointestinal tract has many disorders where the signs and symptoms are the same. It is imperative that the practitioner distinguishes between diseases as the therapies can become complicated. The practitioner must do a comprehensive physical exam, as well as a health history with the patient to determine the path towards diagnosis. Laboratory data and imaging can also play a key role in determining the proper treatment plan and diagnosis. Unsuccessful medical treatment will warrant more invasive procedures in an attempt to visualize the underlying issue.
References
Chong, P. P., Chin, V. K., Looi, C. Y., Wong, W. F., Madhavan, P., & Yong, V. C. (2019). The Microbiome and Irritable Bowel Syndrome–A Review on the Pathophysiology, Current Research and Future Therapy. Frontiers in Microbiology, 10, 1136.. https://doi-org.ezp.waldenulibrary.org/10.3389/fmicb.2019.01136
El-Salhy, M., & Hausken, T. (2016). The role of the neuropeptide Y (NPY) family in the pathophysiology of inflammatory bowel disease (IBD). Neuropeptides, 55, 137–144. https://doi-org.ezp.waldenulibrary.org/10.1016/j.npep.2015.09.005
Kosako, M., Akiho, H., Miwa, H., Kanazawa, M., & Fukudo, S. (2018). Impact of symptoms by gender and age in Japanese subjects with irritable bowel syndrome with constipation (IBS-C): A large population-based internet survey. BioPsychoSocial Medicine, 12(1). https://doi-org.ezp.waldenulibrary.org/10.1186/s13030-018-0131-2
O’Malley, D. (2019). Endocrine regulation of gut function – a role for glucagon‐like peptide‐1 in the pathophysiology of irritable bowel syndrome. Experimental Physiology, 104(1), 3–10. https://doi-org.ezp.waldenulibrary.org/10.1113/EP087443
Su, H.-J., Chiu, Y.-T., Chiu, C.-T., Lin, Y.-C., Wang, C.-Y., Hsieh, J.-Y., & Wei, S.-C. (2019). Inflammatory bowel disease and its treatment in 2018: Global and Taiwanese status updates. Journal of the Formosan Medical Association, 118(7), 1083–1092. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jfma.2018.07.005Many patients will present with disease processes that have the same or similar symptoms, and it will be the responsibility of the practitioner to diagnose and provide treatment accurately. The gastrointestinal tract is one area where misdiagnoses occur due to the common signs and symptoms. Inflammatory bowel disease and irritable bowel syndrome are two common misdiagnosed disorders that will be explored, the pathophysiology explained, proper treatment, and the effects gender has on these diseases.
Pathophysiology of Inflammatory Bowel Disease and Irritable Bowel Syndrome
Inflammatory bowel disease (IBD) comprises three key disorders; Crohn’s disease (CD), ulcerative colitis (UC), and microscopic colitis all attributed to an inflammation process but each affects the body differently. Research by El-Salhy and Hausken (2016) explains that the inflammation in Crohn’s disease is transmural in nature and occurs in any part of the gastrointestinal tract, while the inflammation in ulcerative colitis is more superficial and affects the rectocolonic mucosa, and the inflammation in microscopic manifests as mucosal and submucosal infiltration of immune cells without ulcerations or crypt abscesses and occurs in the colon.
Irritable bowel syndrome (IBS) is a common disease, although the pathophysiology is still not fully understood. Combination of low-grade mucosal inflammation with visceral hypersensitivity and impaired bowel motility could be the underlying etiology for IBS pathogenesis (Chong et al., 2019). Alterations in the gut microbiota and dietary choices play a central role in disease development. According to O’Malley (2019), IBS is complex multifactorial pathophysiology, that involves dysfunction of the bi-directional signaling axis between the brain and the gut, this axis incorporates efferent and afferent branches of the autonomic nervous system, circulating endocrine hormones and immune factors, local paracrine and neurocrine factors and microbial metabolites.
Treatments for Inflammatory Bowel Disease and Irritable Bowel Syndrome
Treatment for IBS and IBD focuses on treating not only the symptoms but the underlying cause of the disease. Treatment for IBS includes; dietary interventions, probiotics, prebiotics, synbiotics, non-absorbable antibiotics, mixed μ-opioid receptor agonist–δ-opioid receptor antagonist and κ-opioid receptor agonist, Serum-derived bovine immunoglobulin (SBI), and fecal microbiota transplantation (FMT). Treatment for IBD is more complex due to IBD being composed of three different diseases, each requires different treatment plans, but there is some crossover. Corticosteroids, probiotics, immunomodulatory drugs, immunosuppressants, antitumor necrosis factor therapy, anti-interleukin 12/23 antibody drugs, janus kinase (JAK) inhibitor, SMAD 7 inhibitor, and FMT are treatments available for IBD. 5-aminosalicylates (5-ASAs) are the first-line therapy for induction and maintenance of remission in patients with UC (Su et al., 2019). Anti-tumor necrosis factor (TNF) therapy works well on both UC and CD, JAK inhibitor works for UC and not CD, SMAD 7 inhibitor works for CD but not UC.
Gender’s Affect on Inflammatory Bowel Disease and Irritable Bowel Syndrome
Research conducted by Kosako, Akiho, Miwa, Kanazawa, and Fukudo (2018) acknowledges that the higher prevalence of IBS in women compared with men may be associated with sex hormone fluctuations, which reportedly affect IBS symptoms, with symptoms appearing stronger before menstruation. Women may also receive a delay in treatment to both IBD and IBS due to the perceived perception of pain being misdiagnosed by the primary care practitioner.
Conclusion
The gastrointestinal tract has many disorders where the signs and symptoms are the same. It is imperative that the practitioner distinguishes between diseases as the therapies can become complicated. The practitioner must do a comprehensive physical exam, as well as a health history with the patient to determine the path towards diagnosis. Laboratory data and imaging can also play a key role in determining the proper treatment plan and diagnosis. Unsuccessful medical treatment will warrant more invasive procedures in an attempt to visualize the underlying issue.
References
Chong, P. P., Chin, V. K., Looi, C. Y., Wong, W. F., Madhavan, P., & Yong, V. C. (2019). The Microbiome and Irritable Bowel Syndrome–A Review on the Pathophysiology, Current Research and Future Therapy. Frontiers in Microbiology, 10, 1136.. https://doi-org.ezp.waldenulibrary.org/10.3389/fmicb.2019.01136
El-Salhy, M., & Hausken, T. (2016). The role of the neuropeptide Y (NPY) family in the pathophysiology of inflammatory bowel disease (IBD). Neuropeptides, 55, 137–144. https://doi-org.ezp.waldenulibrary.org/10.1016/j.npep.2015.09.005
Kosako, M., Akiho, H., Miwa, H., Kanazawa, M., & Fukudo, S. (2018). Impact of symptoms by gender and age in Japanese subjects with irritable bowel syndrome with constipation (IBS-C): A large population-based internet survey. BioPsychoSocial Medicine, 12(1). https://doi-org.ezp.waldenulibrary.org/10.1186/s13030-018-0131-2
O’Malley, D. (2019). Endocrine regulation of gut function – a role for glucagon‐like peptide‐1 in the pathophysiology of irritable bowel syndrome. Experimental Physiology, 104(1), 3–10. https://doi-org.ezp.waldenulibrary.org/10.1113/EP087443
Su, H.-J., Chiu, Y.-T., Chiu, C.-T., Lin, Y.-C., Wang, C.-Y., Hsieh, J.-Y., & Wei, S.-C. (2019). Inflammatory bowel disease and its treatment in 2018: Global and Taiwanese status updates. Journal of the Formosan Medical Association, 118(7), 1083–1092. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jfma.2018.07.005
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Post Casey 19490227
/in Uncategorized /by developerRespond to at least two of your colleagues who were assigned to a different case than you. Explain how you might apply knowledge gained from your colleagues’ case studies to you own practice in clinical settings.
NOTE: Positive Comment
Main Post
Case #13 the 8-year-old girl who was naughty
This case study will examine an 8-year-old girl who initially presents to the pediatrician’s office with complaints of a fever and sore throat. After further examination, the client is diagnosed with attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD). According to Ghosh, Ray, & Basu (2017), characteristics of ODD include persistent anger or irritable mood, argumentativeness, defiance, and vindictiveness for at least 6 months. ADHD is characterized by a pattern of inattention, hyperactivity, and impulsivity that interferes with daily functioning or development (American Psychiatric Association, 2013).
3 Additional Assessment Questions for the Client:
1. I would ask the client and her mother how often her daughter displays symptoms that are congruent with ODD and? According to the authors Ghosh, Ray, & Basu (2017), the occurrence of ODD symptoms must be disproportionate to the child’s developmental stage and age.
2. I would ask the client if she had trouble learning in class when she was younger. The onset of ADHD symptoms usually occurs before a child reaches age 12, and in some children, these symptoms are noticeable at age 3 (Sibley, Rohde, & Swanson, 2017).
3. A final question that I would ask the client is if she interrupts her classmates when they are speaking. Children suffering from ADHD feel the need to be constantly active and struggle with controlling impulsive behaviors (American Psychiatric Association, 2013).
Feedback From the Client’s Loved Ones
The first person in this client’s life that I would like to further interview is the client’s mother. According to Stahl (2019), the client’s mother is 26 years old and is a single parent of two children, ages 8 and 6. I would want to ask the client’s mother more about her daughter’s academic performance in earlier grades. Identifying the precise onset of the client’s ADHD symptoms will assist the provider in creating the most appropriate treatment for the client (Stahl, 2014). I would also like to interview the client’s teacher in order to gain another perspective on the client’s behavior in the classroom. The client’s teacher did use an ADHD rating scale, but scales of that nature are very broad and do not elaborate on the child’s specific classroom behaviors. A third person that I would interview is the client’s 6-year-old sister. According to Stahl (2019), the client began displaying signs of anger and resentfulness when her sister was born. I would ask the client’s sister if she felt safe at home and if she and her sister fought often, in order to determine if the home environment is safe for both children.
Physical Exams and Diagnostic Tests
The physical assessment of the client is essential for developing an appropriate diagnosis and treatment plan. Visual assessment of the client’s behaviors during the physical assessment will be extremely useful to the provider. The provider would also want to obtain and review the client’s report cards along with any behavior reports, and attendance records from the client’s school (Adesman, 2011). The healthcare provider should also review the client’s pediatric health records to see if her symptoms are congruent with a learning disability, auditory processing disorder, signs of language delay, spacial orientation confusion, and complete a more thorough family history involving learning disabilities (Adesman, 2011). A complete blood count should be down to rule out physical illness as a causetive factor for the client’s ODD symptoms. The client is currently suffering from a fever and sore throat, which could be an indicator of PANDAS (pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections). Since the client does have a current sore throat, a rapid strep test should be ordered. If the client does test positive for strep, it could explain the client’s symptomologies impulsivity, temper tantrums, and aggressiveness.
Differential Diagnoses
Autism Spectrum Disorder: there are deficits in social-emotional reciprocity, ranging from an abnormal social approach and failure to communicate in a standard back-and-forth conversation (American Psychiatric Association, 2013). There is also a reduced sharing of interests, emotions, or affect, along with a failure of the patient to initiate or respond during social interactions (American Psychiatric Association, 2013). The client’s history does not show any indication of impaired communication.
Conduct Disorder: characterized by behavior that violates either the rights of others or major societal norms, the symptoms must be present for at least 3 months with one symptom having been present in the past 6 months. The symptoms of conduct disorder must cause significant impairment in social, academic or occupational functioning (American Psychiatric Association, 2013). Per the client’s medical record, her symptoms fit the time frame for conduct disorder, however, her behavior is not this severe in nature.
ADHD with Co-occurring ODD: The authors Ghosh, Ray, & Basu (2017), describe the characteristics of ODD as persistent anger or irritable mood, argumentativeness, defiance, and vindictiveness for at least 6 months. ADHD is characterized by a pattern of inattention, hyperactivity, and impulsivity that interferes with daily functioning or development (American Psychiatric Association, 2013). The client’s behavior is congruent with ADHD with co-occurring ODD.
Pharmacological Agents for ADHD/ODD Therapy:
Risperdal is the first pharmacological agent that I would choose for this client. This medication is not listed on the suggested medication list of the case study, however, the medication list does list “other” as a possible choice. According to Stahl (2014), Risperidone is also used to treat behavior problems such as aggression, self-injury, and sudden mood changes in teenagers and children 5 to 16 years of age. Risperidone is in a class of medications called atypical antipsychotics. It works by changing the activity of certain natural substances in the brain. The second medication that was chosen for this client is Vyvanse. Vyvanse increases norepinephrine and dopamine actions by blocking their reuptake and creating an environment that allows their release (Stahl, 2013). Vyvanse also causes an enhancement of dopamine and norepinephrine in specific areas of the brain that may improve attention, concentration, executive dysfunction, and wakefulness (Stahl, 2013). According to Stahl (2014), it is thought that the increased dopamine action caused by Vyvanse, may help with hyperactivity. I would initially start this client on Vyvanse due to its efficacy in treating symptoms of ADHD. If the child’s academic performance and classroom behavior improve, perhaps ODD symptoms will improve.
CheckPoints:
According to Stahl (2019), the closest child psychotherapist is an hour away, therefore the client did not receive therapy. I would refer the client and her mother to case management in order to connect the client with resources that are closer to her home. I would also ask the client’s school what type of resources are available in terms of psychotherapy.
Lessons Learned:
Through this case study I have learned that co-occurring childhood disorders can be difficult to treat. Pediatric clients can respond differently to medication dosages than adults, so careful dose titration is essential. Pediatric clients also rely on their parents or caregivers to provide them with their prescribed medications and transportation to medical appointments. It is essential that the healthcare provider conveys how important treatment regime compliance is to both the client and their caregiver.
Adesman, A. R. (2011). The Diagnosis and Management of Attention-Deficit/Hyperactivity Disorder in
Pediatric Patients. Primary care companion to the Journal of clinical psychiatry, 3(2), 66-77.
https://doi.org/10.4088/pcc.v03n0204
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.). Washington, DC: Author.
Ghosh, A., Ray, A., & Basu, A. (2017). Oppositional defiant disorder: current insight. Psychology
research and behavior management, 10, 353-367. https://doi.org/10.2147/PRBM.S120582
Sibley, M. H., Rohde, L. A., & Swanson, J. M. (2017). Late-Onset ADHD Reconsidered with
Comprehensive Repeated Assessments between Ages 10 and 25. American journal of psychiatry,
175(2), 140-149. https://doi.org/10.1176/appi.ajp.2017.17030298
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (fourth ed.). New York, NY: Cambridge University Press.
Stahl, S. M. (2014). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
Stahl Online. (2019). Volume 1 case #5: The sleepy woman with anxiety. (PDF file).
Retrievedfrom http://stahlonline.cambridge.org.ezp.waldenulibrary.org/viewPdf?p
age=csEP_05.pdf
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Post Casey
/in Uncategorized /by developerRespond by offering additional thoughts regarding the examples shared, Systems Development Life Cycle SDLC-related issues, and ideas on how the inclusion of nurses might have impacted the example described by your colleagues.
Initial Post
Consequences of a Healthcare Organization not Involving Nurses
Nurses are the backbone of healthcare and when they are not involved in the design and decision-making processes of the Systems Development Life Cycle the results can be catastrophic. According to the authors Powell-Cope & Nelson (2008), nurses are the frontline and chief users of electronic health record (EHR) systems, it only makes sense they’d have a major say in EHR design and upgrades. Unfortunately, however, in many facilities, EHR design is left primarily to IT and only minor input is taken into consideration from the nursing staff. When subject matter experts, such as nurses, don’t have autonomy and responsibility within the design process, implementing and utilizing an EHR can take longer because providers are distanced from the outcomes (Powell-Cope & Nelson, 2008).
Inclusion of Nurses in EHR Design
When nurses are included in technology design, it enables and enhances safety (Hamer & Cipriano, 2013). A study was done in 2009 on early nursing involvement during the implementation of a Bar Code Medication Administration (BCMA) system. The authors of this study describe how nurses participated in the early design, planning, implementation, and evaluation phases of the BCMA. The study found that the benefits of early nursing involvement in each phase of BCMA technology greatly outweigh the problems that can arise from early nursing involvement (Weckman & Jansen, 2009). This study found that in order to find success when implementing new technologies, it is essential that nurses be involved throughout all phases of the process. Comments and feedback from nurses provide the necessary clues that are needed to resolve underlying systemic issues and can offer possible resolutions.
My Personal Input
My current healthcare facility is changing its EHR system to Epic. They have selected a specific team of nurses and nurse informaticists that are currently part of their healthcare team, to design and adapt the Epic program to meet the institution’s requirements. My facility has named their adaptation of the Epic EHR to Elle. The entire healthcare team has been invited to monthly townhouse meetings which involve disclosing the most recent updates made to Elle and team members are also encouraged to provide input on any modifications they would like to add to Elle. As critical nurses, we are excited that we will finally have a charting system that downloads our vital signs electronically. Before Elle, we had to write our vital signs every 15 minutes on each of our two patients. It might not seem like a big deal, but writing vital signs for two patients can take up a considerable amount of time, especially when a patient is unstable and on multiple drips. If nurses were not involved in the EHR design, downloading vital signs might be something that was overlooked again.
References
Hamer, S., & Cipriano, P. (2013). Involving nurses in developing new technology. Nursing Times, 109(47). Powell-Cope, G., Nelson, A. L., & Patterson, E. S. (2008). Patient Care Technology and Safety. Retrieved April 22, 2019, from https://www.ncbi.nlm.nih.gov/books/NBK2686/ Weckman, H. N., & Jansen, S. K. (2009). The Critical Nature of Early Nursing Involvement for Introducing New Technologies. The Online Journal of Nursing Issues, 14(2).
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Post Chrismene
/in Uncategorized /by developerRespond to at least two of your colleagues who were assigned a different patient than you. Critique your colleague’s targeted questions, and explain how the patient might interpret these questions. Explain whether any of the questions would apply to your patient, and why.
Main Post
CASE STUDY 2
AG is a 54-year-old Caucasian male who was referred to the clinic to establish care after a recent hospitalization after having a seizure related to alcohol withdrawal. He has hypertension and a history of alcohol and cocaine abuse. He is homeless and is currently living at a local homeless shelter. He reports that he is out of his amlodipine 10 mg which he takes for hypertension. He reports he is abstaining from alcohol and cocaine but needs to smoke cigarettes to calm down since he is not drinking anymore.
The Communication Techniques
A nurse practitioner chooses to use the RESPECT Modell to communicate with the patient to stay productive and patient-centered in all her communication with the patient. RESPECTS stand for (Rapport, Empathy, Support, Partnership, Explanation, Cultural Competence, and Trust) (Ball, Dains, Flynn, Solomon, & Stewart, 2019). The nurse practitioner establishes rapport by seeking the patient’s point of view to avoid being judgmental. She asked the question of how the patient wanted to be addressed. The nurse practitioner shows empathy by asking the patient how he becomes homeless to understand how she can help him get his life back in order. The nurse practitioner supports the patient by asking him about his financial situation to direct him to the proper agency. The patient is at risk for cardiac diseases, lung cancer, and stroke, so the nurse practitioner partnered with the patient to help him stop smoking (Ball et al., 2019).The nurse practitioner needs to explain to the patient to know what cigarette smoking does to the body. Nicotine is a sympathomimetic medicine that releases catecholamines, increases heart rate and cardiac contractility, constricts cutaneous, and coronary blood vessels, and rapidly increases blood pressure (Benowitz, 2009). It is crucial to present the patient with evidence-based practice to address health risks across cultures, and it is essential to assure the patient that what he said will be kept confidential to establish trust (Ball et al., 2019).
The Risk Assessment Instrument
The CAGE questionnaire is a precise tool that has been used for many years to screen patients for addictive behaviors. The GAGE questions have been modified to apply to smoke behavior. The CAGE questions are as following: 1) Have you ever felt the necessity to cut down or control your smoking, but had trouble doing so? 2) Do you ever get angry or annoyed with people who criticize your smoking or demanding you quit smoking? 3) Do you feel guilty regarding your smoking or about something you did while smoking? And 4) Do you ever smoke within half an hour of waking up (Eye-opened)? The patient is screen positive to two yes responses. The CAGE instrument is used because it is nonthreatening. A study showed that the CAGE questionnaire was used in a medical outpatient embedded in a self-administered questionnaire regarding health habits. Most of the patients did not know that they were filling out an assessment for addictions. The patient must be willing to stop smoking for treatment to be effective (American Family Physician, 2000).
Targeted Questions
1) How do you want to be addressed?
2) How are you feeling?
3) How may we help you?
4) How do you become homeless and tell us about your financial situation?
5) Do you need help getting your prescription refill?
6) When was the last time you drink alcohol or use cocaine?
7) When was the last time you check your blood pressure and take your amlodipine medication?
8) When was the last time you had a seizure episode?
9) When do you start smoking and how many packs do you smoke a day?
10) How can we help you to stop smoking?
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.Benowitz, N. L. (2009). Pharmacology of nicotine: addiction, smoking-induced disease, and therapeutics. Annual review of pharmacology and toxicology, 49, 57–71. doi:10.1146/annurev.pharmtox.48.113006.094742American Family Physician. (2000). Assessing Nicotine Dependence. Retrieved from https://www.aafp.org/afp/2000/0801/p579.html
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Post Cristopher
/in Uncategorized /by developerRespond on two different days by making recommendations for how they might strengthen the leadership behaviors profiled in their StrengthsFinder assessment, or by commenting on lessons to be learned from the results that can be applied to personal leadership philosophies and behaviors.
Main Post
Through this week’s resources, we have learned what a leader is. Last week we focused on theories and examples of leaders we have witnessed firsthand. This week we are focusing on ourselves individually. After taking Gallup’s Strengths Finder assessment, I was given five signature themes.
My Signature Themes
Before going over my specific themes, I must first explain the domain’s they rest under. My themes were either under the executing or the relationship builder domains (Strengths Finder, 2018). The executing domain is about knowing, “how to make things happen” (Strengths Finder, 2018, para. 3). The relationship domain encompasses themes that are involved with providing, “the essential glue to hold a team together” (2018, para. 1). The themes that I had under the executing domain were restorative and consistency. These themes are defined as being able to deal with problems and treating people with equality, respectively. The themes I had under the relationship domain were developer, empathy, and harmony. Developers, “cultivate the potential in others” (Strengths Finder 2018, para. 2). Empathy is focused on sensing other’s feelings and harmony is focused on looking for consensus (2018).
Room for growth
After reviewing the Strengths Finder assessment, now I will point out a few areas for improvement. Starting with values, I have chosen courage and service as two values I would like to improve (MasonLeads, 2019). None of the themes I had were under the domain of influencing (StrengthsFinder, 2018). I believe with more courage this would change. Two potential strengths I would improve would be activator and analytical. People who are adept at activating, “can make things happen by turning thoughts into action” (2018, para. 1). It is also under the influence domain. Another domain I didn’t exemplify with strategic thinking. The analytical theme is under this domain and people who demonstrate this, “search for reasons and causes” (StrengthsFinder, 2018, para. 1). Two characteristics I would like to improve are the ability to self-manage and to make difficult decisions (Yscouts.com, 2019). Nowhere in my results was there any mention of self-management skills or the ability to make tough decisions. These two characteristics are crucial to be a transformational leader.
The Strengths Finder assessment was an eye-opening tool. I learned my strengths, but, more importantly, I learned my weaknesses. Being able to improve upon my weaknesses will bring me one step closer to a transformational leader.
References
MasonLeads. (2019). Core Leadership Values. Retrieved from https://masonleads.gmu.edu/about-us/core-leadership-values/
Strengths Finder: Gallup. (2018). Retrieved from https://walden.gallup.com
Strengths Finder: Gallup. (2018). Retrieved from https://walden.gallup.com/application/strengthsquest#domain
Yscouts. (2019). 10 Transformational Leadership Characteristics. Retrieved from https://yscouts.com/10-transformational-leadership-characteristics/
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Post David
/in Uncategorized /by developerRespond on to two different days who selected different immune disorders and/or factors than you, in the following ways:
Share insights on how the factor you selected impacts the pathophysiology of the immune disorder your colleague selected.
Expand on your colleague’s posting by providing additional insights or contrasting perspectives based on readings and evidence.
Main Post
Irritable Bowel Syndrome (IBS):
Irritable bowel syndrome is a problem of a bowel function of the gastrointestinal tract. IBS is one of the most common reasons for gastroenterologist consultation (Hammer & McPhee, 2019). Irritable bowel syndrome symptoms are persistent abdominal pain, gas, bloating and with bowel disturbance; there are four subtypes of IBS: constipation (IBS-C), diarrhea (IBS-D), mixed (IBS-M), or unsubtyped IBS (IBS-U) (Kosako et al., 2018). The incidence of IBS is higher in women; it is 1.5 to 3 times higher than men; with greater incidence in youth and middle age (Huether & McCance, 2017).
There is no known pathophysiology of irritable bowel syndrome and no specific biomarker for the disease (Huether & McCance, 2017). Increasing evidence showed due to the different types of symptoms presentation of IBS that there are possibilities of correlation to altered gut microflora, gut immune responses, neuroendocrine cell function, the brain-gut axis, genetic predisposition and epigenetic factor (Huether & McCance, 2017). Despite the global frequency and disease burden of IBS, its underlying pathophysiology remains unclear (Ng QX et al., 2018). Inflammation may provide a pathogenic role in IBS; research has shown the occurrence of mucosal irritation at the microscopic and molecular degree in IBS (Ng QX et al., 2018). It also been reported that considerable overlaps between IBS and inflammatory bowel disease (Ng QX, et al., 2018).
Psoriasis:
Psoriasis is one of the common issues of chronic skin inflammation. The prevalence of psoriasis affects both sexes and in most ethnic groups (Huether & McCance, 2017). Most common occurrences are in people in their 30s, but it can also happen soon after birth (Hammer & McPhee, 2019). Familial history of psoriasis is common, and the genetic process is complicated (Huether & McCance, 2017).
The inflammatory dynamic of psoriasis involves the multifaceted interaction between macrophages, fibroblasts, dendritic cells, natural killer cells, T helper cells, and regulatory T cells. The influence of these immune cells can signal the secretion of multiple inflammatory mediators such as interferon, tumor necrosis factor-alpha, and various cytokines including interleukin 12, 23 and 17 (Huether & McCance, 2017).
Maladaptive consequences of IBS and psoriasis:
Skin diseases, including psoriasis, appeared to impact a substantial adverse effect on patients’ health-related quality of life (Jung et al., 2018). Individuals with psoriasis report that the illness has various physical and mental implications, such as social isolation and stress, depression, shame, and anxiety (Jung et al., 2018).
Patients with irritable bowel syndrome (IBS) have been found to have a significant reduction in quality of life (Arluwaili, et al., 2018). People with IBS report that the disease broth substantial psychosocial consequences such as social lifestyle and activities, emotional, food, and diet interest (Arluwaili, et al., 2018).
Refences
Alruwaili, A. M. M., Albalawi, K. S. A., Alfuhigi, F. R. D., Alruwaili, A. F., Altaleb, B. A. A., & Aljarid, J. S. (2018). Effects of Irritable Bowel Syndrome (IBS) on the health-related quality of Life among Saudi Males at Al-Jouf, Kingdom of Saudi Arabia. Egyptian Journal of Hospital Medicine, 73(4), 6581–6585. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=a9h&AN=132302964&site=eds-live&scope=site
Hammer, G. D., & McPhee, S. J. (2019). Pathophysiology of disease: An introduction to clinical medicine (8th ed.). New York, NY: McGraw-Hill Education.
Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.
Jung, S., Lee, S.-M., Suh, D., Shin, H. T., & Suh, D.-C. (2018). The association of socioeconomic and clinical characteristics with health-related quality of life in patients with psoriasis: a cross-sectional study. Health And Quality Of Life Outcomes, 16(1), 180. https://doi-org.ezp.waldenulibrary.org/10.1186/s12955-018-1007-7
Kosako, M., Akiho, H., Miwa, H., Kanazawa, M., & Fukudo, S. (2018). Impact of symptoms by gender and age in Japanese subjects with irritable bowel syndrome with constipation (IBS-C): A large population-based internet survey. BioPsychoSocial Medicine, 12. https://doi-org.ezp.waldenulibrary.org/10.1186/s13030-018-0131-2
Ng QX, Soh AYS, Loke W, Lim DY, & Yeo WS. (2018). The role of inflammation in irritable bowel syndrome (IBS). Journal of Inflammation Research, 345. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=edsdoj&AN=edsdoj.4b6f79137ef348099ec9533069da7bbb&site=eds-live&scope=site
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Post Douglas 19256625
/in Uncategorized /by developerRespond on two different days who selected different factors than you, in the following ways:
Share insights on how your colleague’s factors impact the pathophysiology of pain.
Suggest alternative diagnoses and treatment options for acute, chronic, and referred pain.
Main Post
Pain is both an easy and complex symptom to diagnose and treat due to its subjective nature. As future practitioners, we are diagnosing pain in the era of the opioid crisis will only add to the complexity of analyzing all of the signs and symptoms while trying to provide comfort to our patients. Pain confronts us with basic questions such as the tension between an objective and a subjective approach, the concept of brain disease, human consciousness, and the relationship between body and mind (Dekkers, 2017).
Pain
According to the National Library of Medicine (2018), pain is a signal activated within the nervous system signaling to an individual that something may be wrong; it is an unpleasant feeling that can be described as burning, stinging, aching, tingling, etc. It ranges from dull to severe, can be treated in a variety of ways, or can dissipate on its own. Every individual reacts differently to pain; pain can present differently in genders despite being the same disease process.
Acute Pain
Acute pain is brief and can last several seconds or up to three months; acute pain occurs in an attempt to protect the body from harm by causing withdrawal from painful stimuli and encourages individuals to avoid painful stimuli in the future (Huether & McCance, 2017). The damage to the tissue is usually easily seen, with the naked eye or imaging that can reveal the source. Acute pain also involves biological functions that protect against further injury. For example, pain produces protective reflexes, including an unconscious withdrawal from the noxious stimulus, muscle spasms, and other autonomic reactions such as flight (Rodriguez, 2015). Noxious stimulation in the periphery leads to activation of nociceptors and the transmission of signals to the central nervous system, which will lead to the perception of acute pain (Berger & Zelman, 2016).
Chronic Pain
Chronic pain persists for at least three months or greater, despite intervention to relieve the injury, surgical, holistic, or medicinal, when the treatment does not control the original issue. Chronic pain is disruptive to sleep patterns and activities of daily living, and as a pain syndrome, it serves no protective or adaptive function (Rodriguez, 2015). Anwar (2016) acknowledges that there are three ascending pathways: the first-order neuron; start from the periphery (skin, bone, ligaments, muscles, and other viscera) travels through the peripheral nerve reaches the dorsal horn of the spinal cord, second-order neuron: start at the dorsal horn cross over to the contralateral side and then ascend in the spinal cord to the thalamus, and other brain areas like dorsolateral pons and third order neuron: starts at the thalamus and then terminates in the cerebral cortex. The descending pathway begins in multiple areas of the brain, sending signals across nerve fibers.
Referred Pain
Referred pain is felt in an area removed or distant from its point of origin-the area of referred pain is supplied by the same spinal segment as the actual site of pain (Huether & McCance, 2017). Making the diagnosis difficult for practitioners, referred pain also presents differently in men and women. It is fairly common in some conditions, such as heart attacks and osteoarthritis (Ungvarsky, 2019). Impulses from many cutaneous and visceral neurons converge on the same ascending neuron, and the brain cannot distinguish between the different sources of pain (Huether & McCance, 2017).
Impact of Gender and Age on Pain
Focusing on the factors of age and gender and the effects on the experience of pain showed the importance of understanding different factors relating to pain. Persistent pain affects the elderly disproportionally, occurring in 50 % of elderly community-dwelling patients and 80 % of aged care residents (Veal & Peterson, 2015). In the United States, the fastest growing population is the baby boomers generation, and in ten years they will represent one out of five citizens. Pain is also increasingly difficult to manage in the elderly patient population as drug interactions, absorption rates and drug clearances begin varying as a result of the aging process. With the opportunity of placing a high fall risk population in even more danger, dosing for the elderly population can become difficult for a practitioner. Petrini, Matthiesen, and Arendt-Nielsen (2015) acknowledged that the experience of pain in the elderly may differ from the experience in younger populations on multiple dimensions (sensory, affective, and cognitive). As the body physically wears down, so does the nervous system. In many patients seeking pain relief, the number of neurotransmitter cell receptors decreases with age-associated cortical and subcortical atrophy of brain tissue (Kaye et al., 2014). The practitioner must take into account all of the aging population’s comorbidities plus, fully assess the patient to determine if they are accurately representing their pain description.
Females have always been associated with a higher threshold for pain, and I can attest to this as I would gladly take an open heart female patient over a male patient but, this is not fair to assume those female patients have a higher tolerance for pain. Practitioners must still assess their patients, monitor their vital signs, and ask questions that can reveal answers that patient may not know themselves until the question is asked. Women do have more difficulty when attempting to have their pain managed. The tendency to underdiagnose and undertreat the pain of certain groups of patients, especially women, is greater when patients present with symptoms that are less objective and more grounded in complaints of pain (coronary artery disease, collagen vascular disease, nonspecific abdominal or pelvic pain) (Becker & Mcgregor, 2017). While pain does not differentiate between genders, male masculinity has taught generations of men to accept pain as normal while at the same time, women who complain of pain are frequently underdiagnosed.
Conclusion
Pain can be acute or chronic, and it can be referred or direct, practitioners must take into account all the factors that can mask or enhance the pain experience of their patients. Understanding the role the pain experience has can vary due to age or gender and pain is whatever the individual states it is or in some cases, fail to state. High-quality physical assessments and asking the appropriate questions can help practitioners manage their pain, taking into account the aging process and comorbidities that present throughout life.
References
Anwar, K. (2016). Pathophysiology of pain. Disease-a-Month, 62(9), 324–329. https://doi-org.ezp.waldenulibrary.org/10.1016/j.disamonth.2016.05.015
Becker, B., & Mcgregor, A. J. (2017). Article Commentary: Men, Women, and Pain. Gender and the Genome, 1(1), 46-50. https://doi-org.ezp.waldenulibrary.org/10.1089/gg.2017.0002
Dekkers, W. (2017). Pain as a Subjective and Objective Phenomenon. Handbook of the Philosophy of Medicine, 1-15. doi:10.1007/978-94-017-8706-2_8-1
Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.
Kaye, A. D., Baluch, A. R., Kaye, R. J., Niaz, R. S., Kaye, A. J., Liu, H., & Fox, C. J. (2014). Geriatric pain management, pharmacological and nonpharmacological considerations. Psychology & Neuroscience, 7(1), 15–26. https://doi-org.ezp.waldenulibrary.org/10.3922/j.psns.2014.1.04
National Library of Medicine – National Institutes of Health. (2018). Retrieved June 7, 2019, from https://www.nlm.nih.gov/
Petrini, L., Matthiesen, S. T., & Arendt-Nielsen, L. (2015). The Effect of Age and Gender on Pressure Pain Thresholds and Suprathreshold Stimuli. Perception, 44(5), 587–596. https://doi-org.ezp.waldenulibrary.org/10.1068/p7847
Rodriguez, L. (2015). Pathophysiology of Pain: Implications for Perioperative Nursing. AORN Journal, 101(3), 338–344. https://doi-org.ezp.waldenulibrary.org/10.1016/j.aorn.2014.12.008
Ungvarsky, J. (2019). Referred pain (reflective pain). Salem Press Encyclopedia of Health. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=ers&AN=133861288&site=eds-live&scope=site
Veal, F., & Peterson, G. (2015). Pain in the Frail or Elderly Patient: Does Tapentadol Have a Role? Drugs & Aging, 32(6), 419–426. https://doi-org.ezp.waldenulibrary.org/10.1007/s40266-015-0268-7
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Post Douglas 19263659
/in Uncategorized /by developerRespond on two different days who selected different alterations and factors than you, in one or more of the following ways:
Share insights on how the factor you selected impacts the cardiovascular alteration your colleague selected.
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
The purpose of this paper is to explore coronary artery disease (CAD), the roles of hypertension and dyslipidemia affect CAD, and exploring if genetics is a factor in CAD. The progression of CAD can lead to myocardial ischemia, infarction, and even death if left untreated. Heart disease remains the number one cause of death in the United States, and understanding these factors plays a continued role in developing strategies, both preventive and treatment efforts.
Coronary Artery Disease
CAD is normally the result of atherosclerosis, the build-up of plaque due to damaged endothelium that allows fat to accumulate and decrease the diameter of the vessel. The decrease in vessel size allows for blockage and decreased blood flow to the coronary vessel; this leads to ischemia, where the cells are deprived of blood and begin the process of dying if left untreated. Persistent ischemia or the complete occlusion of a coronary artery causes the acute coronary syndromes, including infarction, or irreversible myocardial damage (Huether & McCance, 2017). Also, known as a heart attack or myocardial infarction (MI). Fortunately, the incidence and mortality statistics for CAD have been decreasing over the past 15 years because of more aggressive recognition, prevention, and treatment (Huether & McCance, 2017).
Hypertension’s Role in Coronary Artery Disease
Hypertension is a consistent elevation of systemic arterial blood pressure (Huether & McCance, 2017). Fortunately, hypertension a key factor in CAD is modifiable and can be monitored closely to prevent further disease progression. Hypertension is common; it ranks as the number one primary diagnosis in America. Pathophysiological mechanisms of blood pressure as a risk factor for CAD are complex and include the influence of blood pressure as a physical force on the development of the atherosclerotic plaque, and the relationship between pulsatile hemodynamics/arterial stiffness and coronary perfusion (Weber et al., 2016). The presence of hypertension further increases the risk of CAD and may explain why some individuals are more predisposed than others to developing coronary events (Rosendorff et al., 2015). Pathophysiological mechanisms of blood pressure as a risk factor for CAD are complex and include the influence of blood pressure as a physical force on the development of the atherosclerotic plaque, and the relationship between pulsatile hemodynamics/arterial stiffness and coronary perfusion (Weber et al., 2016). Hypertension, when diagnosed early, can be treated accordingly, decreasing the opportunity for the role of exacerbation of CAD.
Dyslipidemia’s Role in Coronary Artery Disease
Huether & McCance (2017) define dyslipidemia as an abnormal concentration of serum lipoproteins, the result of genetic and dietary factors. The hardening aspect of this disease is the result of cholesterol deposits in the vessel, which decrease elasticity and make the vessel wall stiff (Marsh & Rizzo, 2019). The elevation of lipoproteins creates a narrowing of the vessel diameter, which in turn decreases blood flow to arteries. When dyslipidemia occurs in the coronary arteries, the decreased blood flow can lead to ischemia or infarct, depending on the size of the blockage. Controlling the progression of the disease is important, modifying lifestyle habits; diet and physical activity can help to prevent further complications. Medications are also available to keep lipid levels balanced.
Genetics Affects of Risk Factors in Coronary Artery Disease
Dyslipidemia is known as a heritable risk factor for CAD; patients with a family history should inform their practitioner to manage the disease process in the early state. Plasma lipids and lipoproteins are heritable risk factors for CAD, with heritability estimates ranging from 40% to 60% (Tada, Kawashiri, & Yamagishi, 2017). The best treatment is prevention, knowing a patient’s family history is paramount in controlling the lipid levels and keeping them at rates that will prevent CAD. Monitoring labs and dietary modifications assist those with family history and can avoid the progression of CAD.
Conclusion
Cardiovascular disease is still the leading cause of premature death world-wide with factors like abdominal obesity, hypertension and dyslipidemia being central risk factors in the etiology (Lidin, Hellénius, Rydell-Karlsson, & Ekblom-Bak, 2018). Hypertension and dyslipidemia both can accelerate the development of CAD. Fortunately, both factors are modifiable and are manageable by lifestyle modifications. Genetics plays a role in both hypertension and dyslipidemia; obtaining an accurate family history allows for early monitoring and controlling the modifiable factors, diet, and physical activity can keep both hypertension and dyslipidemia well controlled.
References
Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.
Lidin, M., Hellénius, M.-L., Rydell-Karlsson, M., & Ekblom-Bak, E. (2018). Long-term effects on cardiovascular risk of a structured multidisciplinary lifestyle program in clinical practice. BMC Cardiovascular Disorders, 18(1), 59. https://doi-org.ezp.waldenulibrary.org/10.1186/s12872-018-0792-6
Marsh, C. C. . P. D., & Rizzo, C., MD. (2019). Hypertension. Magill’s Medical Guide (Online Edition). Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=ers&AN=89093446&site=eds-live&scope=site
Rosendorff, C., Lackland, D. T., Allison, M., Aronow, W. S., Black, H. R., Blumenthal, R. S., … White, W. B. (2015). Treatment of hypertension in patients with coronary artery disease: A scientific statement from the American Heart Association, American College of Cardiology, and American Society of Hypertension. Journal of the American Society of Hypertension, 9(6), 453–498. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jash.2015.03.002
Tada, H., Kawashiri, M., & Yamagishi, M. (2017). Clinical Perspectives of Genetic Analyses on Dyslipidemia and Coronary Artery Disease. Journal of Atherosclerosis and Thrombosis, 24(5), 452-461. https://doi-org.ezp.waldenulibrary.org/10.5551/jat.RV17002
Weber, T., Lang, I., Zweiker, R., Horn, S., Wenzel, R. R., Watschinger, B., . . . Metzler, B. (2016). Hypertension and coronary artery disease: Epidemiology, physiology, effects of treatment, and recommendations. Wiener Klinische Wochenschrift, 128(13-14), 467-479. doi:10.1007/s00508-016-0998-5
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Post Douglas 19276313
/in Uncategorized /by developerRespond on two different days who selected a different scenario than you, in one or more of the following ways:
Share insights on how the factor you selected impacts the disorder your colleague identified.
Ask a probing question regarding the disorder that your colleague identified.
Suggest an alternative disorder for the scenario your colleague selected.
Main Post
Respiratory Alterations
Windell (2018) acknowledges the clinical name for croup is laryngotracheobronchitis, which reveals that it is an inflammation of the larynx, trachea, and bronchi caused by a viral infection that mostly affects children between the ages of six months and three years. The incomplete immunization history could explain the croup in an older child. The low-grade temperature also guides in the diagnosis of viral croup. According to Henningfeld (2019), viral croup is often accompanied by a low-grade fever and is responsible for 70 to 75 percent of croup cases.
Pathophysiology of Croup
The pathophysiology of croup stems from the infection; the infection causes the immune system to respond. The virus that causes croup inflames the windpipe and voice box, and this swelling means they become narrowed (Windell, 2018). This narrowing causes the barking cough that is associated with croup. The mucous membranes of the larynx are tightly adherent to the underlying cartilage, whereas those of the subglottic space are looser and thus allow accumulation of mucosal and sub-mucosal edema (Huether & McCance, 2017). The edema, the mucous, and swelling make croup a life-threatening disease, children’s airways are smaller than adults and time is valuable.
Factors of Genetics and Gender
For gender, croup is more prevalent in males than females by a 5:1 ratio. Huether and McCance (2017) report that approximately 15% of children who experience croup have a family history of the disease.
Conclusion
Respiratory alterations or disease processes can turn into life-threatening moments quickly, it is important that the practitioner be able to differentiate and diagnose the disease to begin the treatment process. A thorough physical examination coupled with an active interview with both patient and parents can guide the practitioner towards the correct diagnosis.
References
Henningfeld, D. A. P. D. (2019). Croup. Magill’s Medical Guide (Online Edition). Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=ers&AN=86194029&site=eds-live&scope=site
Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.
Windell, J. (2018). Coping with Croup. Community Practitioner, 91(8), 22–24. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=rzh&AN=132575714&site=eds-live&scope=site
Week 6 Discussion Post .doc (56.5 KB)
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Post Douglas 19290355
/in Uncategorized /by developerRespond on two different days who selected different treatments and factors than you, in the following ways:
Offer alternative common treatments for the disorders.
Share insight on how the factor you selected impacts the treatment of alterations of digestive function.
Main Post
Many patients will present with disease processes that have the same or similar symptoms, and it will be the responsibility of the practitioner to diagnose and provide treatment accurately. The gastrointestinal tract is one area where misdiagnoses occur due to the common signs and symptoms. Inflammatory bowel disease and irritable bowel syndrome are two common misdiagnosed disorders that will be explored, the pathophysiology explained, proper treatment, and the effects gender has on these diseases.
Pathophysiology of Inflammatory Bowel Disease and Irritable Bowel Syndrome
Inflammatory bowel disease (IBD) comprises three key disorders; Crohn’s disease (CD), ulcerative colitis (UC), and microscopic colitis all attributed to an inflammation process but each affects the body differently. Research by El-Salhy and Hausken (2016) explains that the inflammation in Crohn’s disease is transmural in nature and occurs in any part of the gastrointestinal tract, while the inflammation in ulcerative colitis is more superficial and affects the rectocolonic mucosa, and the inflammation in microscopic manifests as mucosal and submucosal infiltration of immune cells without ulcerations or crypt abscesses and occurs in the colon.
Irritable bowel syndrome (IBS) is a common disease, although the pathophysiology is still not fully understood. Combination of low-grade mucosal inflammation with visceral hypersensitivity and impaired bowel motility could be the underlying etiology for IBS pathogenesis (Chong et al., 2019). Alterations in the gut microbiota and dietary choices play a central role in disease development. According to O’Malley (2019), IBS is complex multifactorial pathophysiology, that involves dysfunction of the bi-directional signaling axis between the brain and the gut, this axis incorporates efferent and afferent branches of the autonomic nervous system, circulating endocrine hormones and immune factors, local paracrine and neurocrine factors and microbial metabolites.
Treatments for Inflammatory Bowel Disease and Irritable Bowel Syndrome
Treatment for IBS and IBD focuses on treating not only the symptoms but the underlying cause of the disease. Treatment for IBS includes; dietary interventions, probiotics, prebiotics, synbiotics, non-absorbable antibiotics, mixed μ-opioid receptor agonist–δ-opioid receptor antagonist and κ-opioid receptor agonist, Serum-derived bovine immunoglobulin (SBI), and fecal microbiota transplantation (FMT). Treatment for IBD is more complex due to IBD being composed of three different diseases, each requires different treatment plans, but there is some crossover. Corticosteroids, probiotics, immunomodulatory drugs, immunosuppressants, antitumor necrosis factor therapy, anti-interleukin 12/23 antibody drugs, janus kinase (JAK) inhibitor, SMAD 7 inhibitor, and FMT are treatments available for IBD. 5-aminosalicylates (5-ASAs) are the first-line therapy for induction and maintenance of remission in patients with UC (Su et al., 2019). Anti-tumor necrosis factor (TNF) therapy works well on both UC and CD, JAK inhibitor works for UC and not CD, SMAD 7 inhibitor works for CD but not UC.
Gender’s Affect on Inflammatory Bowel Disease and Irritable Bowel Syndrome
Research conducted by Kosako, Akiho, Miwa, Kanazawa, and Fukudo (2018) acknowledges that the higher prevalence of IBS in women compared with men may be associated with sex hormone fluctuations, which reportedly affect IBS symptoms, with symptoms appearing stronger before menstruation. Women may also receive a delay in treatment to both IBD and IBS due to the perceived perception of pain being misdiagnosed by the primary care practitioner.
Conclusion
The gastrointestinal tract has many disorders where the signs and symptoms are the same. It is imperative that the practitioner distinguishes between diseases as the therapies can become complicated. The practitioner must do a comprehensive physical exam, as well as a health history with the patient to determine the path towards diagnosis. Laboratory data and imaging can also play a key role in determining the proper treatment plan and diagnosis. Unsuccessful medical treatment will warrant more invasive procedures in an attempt to visualize the underlying issue.
References
Chong, P. P., Chin, V. K., Looi, C. Y., Wong, W. F., Madhavan, P., & Yong, V. C. (2019). The Microbiome and Irritable Bowel Syndrome–A Review on the Pathophysiology, Current Research and Future Therapy. Frontiers in Microbiology, 10, 1136.. https://doi-org.ezp.waldenulibrary.org/10.3389/fmicb.2019.01136
El-Salhy, M., & Hausken, T. (2016). The role of the neuropeptide Y (NPY) family in the pathophysiology of inflammatory bowel disease (IBD). Neuropeptides, 55, 137–144. https://doi-org.ezp.waldenulibrary.org/10.1016/j.npep.2015.09.005
Kosako, M., Akiho, H., Miwa, H., Kanazawa, M., & Fukudo, S. (2018). Impact of symptoms by gender and age in Japanese subjects with irritable bowel syndrome with constipation (IBS-C): A large population-based internet survey. BioPsychoSocial Medicine, 12(1). https://doi-org.ezp.waldenulibrary.org/10.1186/s13030-018-0131-2
O’Malley, D. (2019). Endocrine regulation of gut function – a role for glucagon‐like peptide‐1 in the pathophysiology of irritable bowel syndrome. Experimental Physiology, 104(1), 3–10. https://doi-org.ezp.waldenulibrary.org/10.1113/EP087443
Su, H.-J., Chiu, Y.-T., Chiu, C.-T., Lin, Y.-C., Wang, C.-Y., Hsieh, J.-Y., & Wei, S.-C. (2019). Inflammatory bowel disease and its treatment in 2018: Global and Taiwanese status updates. Journal of the Formosan Medical Association, 118(7), 1083–1092. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jfma.2018.07.005Many patients will present with disease processes that have the same or similar symptoms, and it will be the responsibility of the practitioner to diagnose and provide treatment accurately. The gastrointestinal tract is one area where misdiagnoses occur due to the common signs and symptoms. Inflammatory bowel disease and irritable bowel syndrome are two common misdiagnosed disorders that will be explored, the pathophysiology explained, proper treatment, and the effects gender has on these diseases.
Pathophysiology of Inflammatory Bowel Disease and Irritable Bowel Syndrome
Inflammatory bowel disease (IBD) comprises three key disorders; Crohn’s disease (CD), ulcerative colitis (UC), and microscopic colitis all attributed to an inflammation process but each affects the body differently. Research by El-Salhy and Hausken (2016) explains that the inflammation in Crohn’s disease is transmural in nature and occurs in any part of the gastrointestinal tract, while the inflammation in ulcerative colitis is more superficial and affects the rectocolonic mucosa, and the inflammation in microscopic manifests as mucosal and submucosal infiltration of immune cells without ulcerations or crypt abscesses and occurs in the colon.
Irritable bowel syndrome (IBS) is a common disease, although the pathophysiology is still not fully understood. Combination of low-grade mucosal inflammation with visceral hypersensitivity and impaired bowel motility could be the underlying etiology for IBS pathogenesis (Chong et al., 2019). Alterations in the gut microbiota and dietary choices play a central role in disease development. According to O’Malley (2019), IBS is complex multifactorial pathophysiology, that involves dysfunction of the bi-directional signaling axis between the brain and the gut, this axis incorporates efferent and afferent branches of the autonomic nervous system, circulating endocrine hormones and immune factors, local paracrine and neurocrine factors and microbial metabolites.
Treatments for Inflammatory Bowel Disease and Irritable Bowel Syndrome
Treatment for IBS and IBD focuses on treating not only the symptoms but the underlying cause of the disease. Treatment for IBS includes; dietary interventions, probiotics, prebiotics, synbiotics, non-absorbable antibiotics, mixed μ-opioid receptor agonist–δ-opioid receptor antagonist and κ-opioid receptor agonist, Serum-derived bovine immunoglobulin (SBI), and fecal microbiota transplantation (FMT). Treatment for IBD is more complex due to IBD being composed of three different diseases, each requires different treatment plans, but there is some crossover. Corticosteroids, probiotics, immunomodulatory drugs, immunosuppressants, antitumor necrosis factor therapy, anti-interleukin 12/23 antibody drugs, janus kinase (JAK) inhibitor, SMAD 7 inhibitor, and FMT are treatments available for IBD. 5-aminosalicylates (5-ASAs) are the first-line therapy for induction and maintenance of remission in patients with UC (Su et al., 2019). Anti-tumor necrosis factor (TNF) therapy works well on both UC and CD, JAK inhibitor works for UC and not CD, SMAD 7 inhibitor works for CD but not UC.
Gender’s Affect on Inflammatory Bowel Disease and Irritable Bowel Syndrome
Research conducted by Kosako, Akiho, Miwa, Kanazawa, and Fukudo (2018) acknowledges that the higher prevalence of IBS in women compared with men may be associated with sex hormone fluctuations, which reportedly affect IBS symptoms, with symptoms appearing stronger before menstruation. Women may also receive a delay in treatment to both IBD and IBS due to the perceived perception of pain being misdiagnosed by the primary care practitioner.
Conclusion
The gastrointestinal tract has many disorders where the signs and symptoms are the same. It is imperative that the practitioner distinguishes between diseases as the therapies can become complicated. The practitioner must do a comprehensive physical exam, as well as a health history with the patient to determine the path towards diagnosis. Laboratory data and imaging can also play a key role in determining the proper treatment plan and diagnosis. Unsuccessful medical treatment will warrant more invasive procedures in an attempt to visualize the underlying issue.
References
Chong, P. P., Chin, V. K., Looi, C. Y., Wong, W. F., Madhavan, P., & Yong, V. C. (2019). The Microbiome and Irritable Bowel Syndrome–A Review on the Pathophysiology, Current Research and Future Therapy. Frontiers in Microbiology, 10, 1136.. https://doi-org.ezp.waldenulibrary.org/10.3389/fmicb.2019.01136
El-Salhy, M., & Hausken, T. (2016). The role of the neuropeptide Y (NPY) family in the pathophysiology of inflammatory bowel disease (IBD). Neuropeptides, 55, 137–144. https://doi-org.ezp.waldenulibrary.org/10.1016/j.npep.2015.09.005
Kosako, M., Akiho, H., Miwa, H., Kanazawa, M., & Fukudo, S. (2018). Impact of symptoms by gender and age in Japanese subjects with irritable bowel syndrome with constipation (IBS-C): A large population-based internet survey. BioPsychoSocial Medicine, 12(1). https://doi-org.ezp.waldenulibrary.org/10.1186/s13030-018-0131-2
O’Malley, D. (2019). Endocrine regulation of gut function – a role for glucagon‐like peptide‐1 in the pathophysiology of irritable bowel syndrome. Experimental Physiology, 104(1), 3–10. https://doi-org.ezp.waldenulibrary.org/10.1113/EP087443
Su, H.-J., Chiu, Y.-T., Chiu, C.-T., Lin, Y.-C., Wang, C.-Y., Hsieh, J.-Y., & Wei, S.-C. (2019). Inflammatory bowel disease and its treatment in 2018: Global and Taiwanese status updates. Journal of the Formosan Medical Association, 118(7), 1083–1092. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jfma.2018.07.005
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Post Douglas 19297077
/in Uncategorized /by developerRespond on two different days who selected different factors than you, in one or more of the following ways:
Share insights on how the factor you selected impacts the pathophysiology of diabetes mellitus and diabetes insipidus.
Offer alternative diagnoses and prescription of treatment options for diabetes mellitus and diabetes insipidus.
Validate an idea with your own experience and additional research.
Main post
Diabetes affects millions of Americans and the cost of diabetes is a constant healthcare stressor as Insulin costs continue to rise. Diabetes mellitus is separated into three classes; Type 1, the pancreas fails to produce enough insulin to meet the body’s demand and Type 2, where the body’s cells do not respond to the insulin production and can be managed with lifestyle modifications, and gestational diabetes. Diabetes insipidus is not as common as diabetes mellitus but can have a severe effect on the human body due to the fluid imbalance that is created. It is important for the practitioner to understand the pathophysiologies and the roles behavior and ethnicity play in the diagnosis and treatment.
Pathophysiology of Diabetes Mellitus
Type 1 diabetes mellitus is an autoimmune disease that results from beta-cell destruction in pancreatic islets. Beta-cell death via virus directed or physiological mechanisms induces the release of antigens and initiation of immune responses against other beta-cells (Saberzadeh-Ardestani et al., 2018). Type 2 diabetes also has beta-cell destruction more but, more variable different degrees of beta-cell failure relative to varying degrees of insulin resistance. Kumar et al. (2018) acknowledge that insulin resistance impairs the ability of muscle cells to take up and store glucose and triglycerides, which results in high levels of glucose and triglycerides circulating in the blood. Type 2 diabetes can be managed with diet and exercise; like these, both can improve insulin resistance and delay the long-term complications associated with diabetes mellitus.
Pathophysiology of Diabetes Insipidus
Diabetes insipidus is separated into four classifications; central, nephrogenic, dipsogenic, and gestational. The results are that the body excretes an abundance of urine, causing the patient to have an unquenchable thirst. Kalra et al. (2016) describe central diabetes insipidus due to impaired secretion of arginine vasopressin could result from traumatic brain injury, surgery, or tumors whereas nephrogenic diabetes insipidus due to failure of the kidney to respond to arginine vasopressin is usually inherited.
Differences and Similarities of Hormonal Regulation
Despite sharing a name, the differences between diabetes mellitus and diabetes insipidus are great, from the pathophysiology to the treatment. Similarities between diabetes insipidus and diabetes mellitus due to hormonal changes lie within the symptoms that the patient is experiencing. Diabetes mellitus involves blood sugar levels and insulin resistance; diabetes insipidus, it isn’t blood sugar that is the problem, but blood water levels. The similarities of these diseases lie within the signs and symptoms that the patients may be present. Diabetes insipidus, excessive fatigue occurs because of an overall lack of hydration or an electrolyte imbalance. For diabetes mellitus, excessive fatigue generally occurs because blood sugar levels are too low or too high. Excessive thirst occurs in diabetes insipidus because the body senses a lack of Vasopressin, and so it demands more fluids because it thinks it needs them. For diabetes mellitus, excessive thirst occurs because of excessive glucose levels that need to be expelled from the body.
Ethnicity and Behavior’s Impact
Research by Saberzadeh-Ardestani et al. (2018) shows environmental factors include reduction in gut microbiota, obesity, early introduction to fruit or cow milk during childhood, gluten, toxins, lack of vitamins, and viruses play a role in the development of diabetes mellitus type 1; while previously most prevalent in Europeans, it is becoming more common in other ethnic groups. Diet and exercise can help delay diabetes mellitus type 2 from other disease processes related to diabetes mellitus. Diabetes insipidus is common when a traumatic brain injury (TBI) occurs, wearing seatbelts when driving and helmets when participating in cycling or sporting events can decrease the opportunity for diabetes insipidus to occur.
Conclusion
It is important for a practitioner to distinguish between the multiple types of diabetes that patients may present with, although signs and symptoms may be similar, the diagnosis and treatments are completely different. Patient education for each disease is also important because diabetes mellitus type 1 cannot be managed with diet and exercise alone. Diabetes insipidus can occur, but the underlying cause must be singled out to classify and treat. Central diabetes insipidus may require long term treatment depending on the extent of trauma, whereas gestational diabetes insipidus is usually a short term treatment, but the treatments remain the same.
References
Kalra, S., Zargar, A. H., Jain, S. M., Sethi, B., Chowdhury, S., Singh, A. K., … Malve, H. (2016). Diabetes insipidus: The other diabetes. Indian Journal of Endocrinology & Metabolism, 20(1), 9–21. https://doi-org.ezp.waldenulibrary.org/10.4103/2230-8210.172273Kumar, A. S., Maiya, A. G., Shastry, B. A., Vaishali, K., Ravishankar, N., Hazari, A., … & Jadhav, R. (2018). Exercise and insulin resistance in type 2 diabetes mellitus: A systematic review and meta-analysis. Annals of physical and rehabilitation medicine. https://doi-org.ezp.waldenulibrary.org/10.1016/j.rehab.2018.11.001Saberzadeh-Ardestani, B., Karamzadeh, R., Basiri, M., Hajizadeh-Saffar, E., Farhadi, A., Shapiro, A. M. J., … Baharvand, H. (2018). Type 1 Diabetes Mellitus: Cellular and Molecular Pathophysiology at A Glance. Cell Journal (Yakhteh), 20(3), 294–301. https://doi-org.ezp.waldenulibrary.org/10.22074/cellj.2018.5513
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