Respond 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
Assessing a patient begins by developing a relationship through effective communication. Gathering details for an accurate history and chief complaint further aids the practitioner in aiding a plan of care. To address the needs of a 54-year-old Caucasian male, that is referred to establish primary care after a recent hospitalization after a seizure related to alcohol withdrawal requires accurate history taking. Additional information includes hypertension with medication use, history of alcohol and cocaine abuse with current abstinence, and homelessness. This male patient reports lack of medication to treat his hypertension and active cigarette smoking.
Some issues that the practitioner would need to be sensitive to when interacting with this patient would be his homelessness and drug and alcohol abuse history. By using cross-cultural communication that is open with respect, the RESPECT Model can help practitioners to remain effective and patient centered during communication with patients. The components of RESPECT are rapport, empathy, support, partnership, explanations, cultural competence, and trust (Ball, Dains, Flynn, Solomon, & Stewart, 2019, p.31). This patient has age and socioeconomical barriers that are affected by his homelessness. Ball, Dains, Flynn, Solomon, & Stewart 2019 note that those in poverty and poorly educated die at higher rates that those who are educated and economically stable. This male patient’s high-risk factors of being homeless and coupled further with smoking and hypertension increase his susceptibility to mortality. It is the responsibility of the practitioner to use appropriate screening tools when assessing a patient with these characteristics. Screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based practice to identify, reduce and prevent alcohol and drug use which is one tool (Acquavita, Van Loon, Smith, Brehm, Diers,…Baker, 2019).
Once the practitioner completes an accurate intact or past medical history (PMH), the chief complaint (CC) is identified to establish care. The patient reports only one medication, amlodipine 10 mg’s, and other medications must be researched and documented. A social history (SH) is gathered to assess all risk factors and specifically for this patient would include the number of cigarettes smoked per day, and length of time smoking. Alcohol and drug abuse are also two risks that patient reports as prior use and knowing when the patient last drank. It is also the responsibility of the practitioner to counsel this patient on risk factors associated with smoking and his hypertension, because if is the practitioner’s responsibility to provide patient education and counseling. The practitioner knows that 70 to 80% that are homeless smoke and are at high risk to smoke because they are exposed to smoking around shelters and feel pressured to smoke which makes it hard to quit (Pratt, Pernat, Kerandi, Kmiecik, Strovel-Ayres, Joseph,…Okuyemi, 2019).
Questions the Practitioner might ask include:
What has contributed to your homelessness and are you engaged in changing your situation?
Whom was treating your hypertension and how long have you had hypertension where you have required medication?
Do you take any other medications?
When is the last time you drank alcohol or used cocaine or any other types of drugs?
Have you participated in any programs to help you not drink alcohol, avoid drug use, or quit smoking?
Do you understand the risk factors of hypertension and smoking?
Developing a plan would be for regular blood pressure monitoring, appropriate medication management, referral to an alcohol and drug treatment program, obtain lab work to evaluate for dyslipidemia, smoking cessation program referral and options for quitting, and the next follow up appointment. Goals to support this patient would be to identify any mental health issues as there is a correlation with mental illness and homelessness. Currently the major reason for homelessness is affordable housing and the reduction in programs to assist (National Homelessness, 2019). Engaging the patient in programs to support his history of alcohol, drug use, and current situation with smoking. Managing his known health condition of hypertension and other associated risk factors with his reported history.
References
Acquavita, S. P., Anne Van Loon, R., Smith, R., Brehm, B., Diers, T., Kim, K., & Baker, A. (2019). The SBIRT Interprofessional Curriculum and Field Model. Journal of Social Work Practice in the Addictions, 19(1/2), 10–25. https://doi-org.ezp.waldenulibrary.org/10.1080/1533256X.2019.1589883 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.National Homelessness.org (2019). National Coalition for the Homeless. Building a movement to end homelessness. Retrieved from: http://nationalhomelss.org/about-homelessnessPratt, R., Pernat, C., Kerandi, L., Kmiecik, A., Strobel-Ayres, C., Joseph, A., … Okuyemi, K. (2019). “It’s a hard thing to manage when you’re homeless”: the impact of the social environment on smoking cessation for smokers experiencing homelessness. BMC Public Health, 19(1), 635. https://doi-org.ezp.waldenulibrary.org/10.1186/s12889-019-6987-7
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Post Lashanda
/in Uncategorized /by developerRespond by providing additional thoughts about competing needs that may impact your colleagues’ selected issues, or additional ideas for applying policy to address the impacts described.
Main Post
Addressing the issue of workplace violence (WPV) is a significant concern for organizations. WPV of any form (verbal, physical, psychological) increases the chances that nurses will leave the profession permanently, resulting in nursing workforce retention challenges (Marshall & Broome, 2017). Nurses must maintain environments that allow the profession to be virtuous, allowing for mutual respect, integrity, communication, caring, and benevolence (American Nurses Association (ANA), 2015). Workplace violence does not just include nurses or other healthcare professionals but also patients/ family members being uncivil.
As a new nurse, my preceptor was off the floor for a meeting. The charge nurse did not care for me, and she never had any problems showing it. With two open rooms and already taking care of a DKA patient and prepping another patient for surgery with low hemoglobin. The EMS radio called with a code blue and the eta was 5minutes. There were other rooms and nurses available to take the code, but she placed the patient in my room and offered no assistance, and within minutes of getting the code blue patient she placed yet another patient in the fourth room.
Feeling overwhelmed and very upset; why would she deliberately try to sabotage a new nurse. My preceptor, nurse manager, and I confronted her and asked why she would intentionally risk patient safety and stack patients on one nurse. Her response was “No one told her to stay in the ED, who is she to try to change the way we do things here, I do not agree with having graduate nurses in the ED, she would be better off on one of the inpatient units.”
Workforce resources are competing for needs maintaining and implementing policies to combat such behaviors. The consequences of this situation impacted my other three patients and delayed care; the whole situation created a negative attitude towards the rest of the nursing staff, and trusting anyone and asking for help when my preceptor was not available was out of the question. I felt like this situation needed to happen so that management could see the negative culture/attitudes within the department.
With the looming nursing shortage, leadership may tolerate or entirely ignore WPV. The charge nurse continued to bully other nurses, and the older nurses felt like, the newer nurses were coming in and changing their department. While professional standards appear specific to WPV, an atmosphere of support is essential to reducing the stigma and reoccurrence often associated with those who are victims of bullying. Standards of professional behavior must be developed and implemented with consistent use across all departments (Fink-Samnick,2015).
American Nurses Association. (2015). Code of ethics for nursing with interpretive statements. Silver Springs, MD: Author. Retrieved from: https://www.nursingworld.org/coe-view-only
Fink-Samnick, E. (2015). The New Age of Bullying and Violence in Health Care. Professional Case Management,20(4), 165-174. doi:10.1097/ncm.0000000000000099
Marshall, E., & Broome, M. (2017). Transformational leadership in nursing: From expert clinician to influential leader. New York, NY: Springer Publishing Company.
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Post Linda 19217203
/in Uncategorized /by developerRespond in a positive way(positive comment), to the post bellow, using one or more of the following approaches:
Ask a probing question, substantiated with additional background information, and evidence.
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 review of the literature in the Walden Library.
Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.
Initial Post
The research study’s focus was on the interventions to improve medication adherence in people with multiple chronic conditions. The population of the study consisted of people over 70 years of age and having 3-4 chronic conditions. A well-defined PICOT question helps to identify the best available evidence to influence treatment (Echevarria, 2014). The PICOT question (P) The research study addressed medication adherence of individual over the age of 70, (I) research involving eight studies related to medication nonadherence, (C) Identified effective interventions to improve medication adherence, and (O) evidence-based treatment that assists in medication adherence would delay disease progression.
Design
The design was a systematic review model by Cochrane Collaboration to search, retrieve and appraise the quality and synthesis of the finding of the RCT’s. Out of the 248 abstracts only 97 were selected to be used in full test and after an independent review by two separate reviewers, only eight were chosen. According to Polit, The Consort Checklist was used to obtain the highest scores that could be used to generalize results to similar groups. “Consolidated Standards of Reporting Trials) for reporting information for a randomized controlled trial, including a checklist and flowchart for tracking participants through the trial, from recruitment through data analysis.” (p. 723). The researchers used the Intervention Group, Control Group, and Randomized Control Trials to come up with the results.
Results
The researchers came to their conclusion after conducting a quality assessment of the randomized, control trials examining medication adherence using the CONSORT Group. The research study did identify weaknesses in the study. Several RTC’s had methodological problems, did not identify all medical conditions, explanation of interventions used (William, 2008).
Alternate Conclusion
There was a wealth of data in this research study that could be used to explore several different issues related to medication adherence. Researchers could have drawn a conclusion based on the data they identified, what chronic conditions are individual most like or less likely to be compliant with their medications. They did find that further research is needed on this subject.
References
Echevarria, I. &. (2014, February). To make your case, start with a PICOT question. Retrieved from OVID: https://ovidsp-tx-ovid-com.ezp.waldenulibrary.org/sp-3.33.0b/ovidweb.cgi?WebLinkFrameset=1&S=NAAIFPMHKIDDHDBONCDKIAJCHHLHAA00&returnUrl=ovidweb.cgi%3f%26Titles%3dS.sh.22%257c1%257c10%26FORMAT%3dtitle%26FIELDS%3dTITLES%26S%3dNAAIFPMHKIDDHDBONCDKIAJCHHLHAA0
Polit, D. F. (2017). Nursing Research: Generating and Assessing Evidence for Nursing Practice. Philadelphia: Wolters Kluwer Health.
William, A. M. (2008, July 4). Intervention to improve medication adherence in people with multiple chronic conditions: a systematic review. Retrieved from Wiley Library Online: Retrieved From: https://onlinelibrary-wiley-com.ezp.waldenulibrary.org/doi/full/10.1111/j.1365-2648.2008.04656.x
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Post Linda 19335609
/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
Assessing a patient begins by developing a relationship through effective communication. Gathering details for an accurate history and chief complaint further aids the practitioner in aiding a plan of care. To address the needs of a 54-year-old Caucasian male, that is referred to establish primary care after a recent hospitalization after a seizure related to alcohol withdrawal requires accurate history taking. Additional information includes hypertension with medication use, history of alcohol and cocaine abuse with current abstinence, and homelessness. This male patient reports lack of medication to treat his hypertension and active cigarette smoking.
Some issues that the practitioner would need to be sensitive to when interacting with this patient would be his homelessness and drug and alcohol abuse history. By using cross-cultural communication that is open with respect, the RESPECT Model can help practitioners to remain effective and patient centered during communication with patients. The components of RESPECT are rapport, empathy, support, partnership, explanations, cultural competence, and trust (Ball, Dains, Flynn, Solomon, & Stewart, 2019, p.31). This patient has age and socioeconomical barriers that are affected by his homelessness. Ball, Dains, Flynn, Solomon, & Stewart 2019 note that those in poverty and poorly educated die at higher rates that those who are educated and economically stable. This male patient’s high-risk factors of being homeless and coupled further with smoking and hypertension increase his susceptibility to mortality. It is the responsibility of the practitioner to use appropriate screening tools when assessing a patient with these characteristics. Screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based practice to identify, reduce and prevent alcohol and drug use which is one tool (Acquavita, Van Loon, Smith, Brehm, Diers,…Baker, 2019).
Once the practitioner completes an accurate intact or past medical history (PMH), the chief complaint (CC) is identified to establish care. The patient reports only one medication, amlodipine 10 mg’s, and other medications must be researched and documented. A social history (SH) is gathered to assess all risk factors and specifically for this patient would include the number of cigarettes smoked per day, and length of time smoking. Alcohol and drug abuse are also two risks that patient reports as prior use and knowing when the patient last drank. It is also the responsibility of the practitioner to counsel this patient on risk factors associated with smoking and his hypertension, because if is the practitioner’s responsibility to provide patient education and counseling. The practitioner knows that 70 to 80% that are homeless smoke and are at high risk to smoke because they are exposed to smoking around shelters and feel pressured to smoke which makes it hard to quit (Pratt, Pernat, Kerandi, Kmiecik, Strovel-Ayres, Joseph,…Okuyemi, 2019).
Questions the Practitioner might ask include:
What has contributed to your homelessness and are you engaged in changing your situation?
Whom was treating your hypertension and how long have you had hypertension where you have required medication?
Do you take any other medications?
When is the last time you drank alcohol or used cocaine or any other types of drugs?
Have you participated in any programs to help you not drink alcohol, avoid drug use, or quit smoking?
Do you understand the risk factors of hypertension and smoking?
Developing a plan would be for regular blood pressure monitoring, appropriate medication management, referral to an alcohol and drug treatment program, obtain lab work to evaluate for dyslipidemia, smoking cessation program referral and options for quitting, and the next follow up appointment. Goals to support this patient would be to identify any mental health issues as there is a correlation with mental illness and homelessness. Currently the major reason for homelessness is affordable housing and the reduction in programs to assist (National Homelessness, 2019). Engaging the patient in programs to support his history of alcohol, drug use, and current situation with smoking. Managing his known health condition of hypertension and other associated risk factors with his reported history.
References
Acquavita, S. P., Anne Van Loon, R., Smith, R., Brehm, B., Diers, T., Kim, K., & Baker, A. (2019). The SBIRT Interprofessional Curriculum and Field Model. Journal of Social Work Practice in the Addictions, 19(1/2), 10–25. https://doi-org.ezp.waldenulibrary.org/10.1080/1533256X.2019.1589883 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.National Homelessness.org (2019). National Coalition for the Homeless. Building a movement to end homelessness. Retrieved from: http://nationalhomelss.org/about-homelessnessPratt, R., Pernat, C., Kerandi, L., Kmiecik, A., Strobel-Ayres, C., Joseph, A., … Okuyemi, K. (2019). “It’s a hard thing to manage when you’re homeless”: the impact of the social environment on smoking cessation for smokers experiencing homelessness. BMC Public Health, 19(1), 635. https://doi-org.ezp.waldenulibrary.org/10.1186/s12889-019-6987-7
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Post Linda
/in Uncategorized /by developerRespond to the post bellow, using one or more of the following approaches:
Ask a probing question, substantiated with additional background information, and evidence.
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 review of the literature in the Walden Library.
Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.
Initial Post
The research study’s focus was on the interventions to improve medication adherence in people with multiple chronic conditions. The population of the study consisted of people over 70 years of age and having 3-4 chronic conditions. A well-defined PICOT question helps to identify the best available evidence to influence treatment (Echevarria, 2014). The PICOT question (P) The research study addressed medication adherence of individual over the age of 70, (I) research involving eight studies related to medication nonadherence, (C) Identified effective interventions to improve medication adherence, and (O) evidence-based treatment that assists in medication adherence would delay disease progression.
Design
The design was a systematic review model by Cochrane Collaboration to search, retrieve and appraise the quality and synthesis of the finding of the RCT’s. Out of the 248 abstracts only 97 were selected to be used in full test and after an independent review by two separate reviewers, only eight were chosen. According to Polit, The Consort Checklist was used to obtain the highest scores that could be used to generalize results to similar groups. “Consolidated Standards of Reporting Trials) for reporting information for a randomized controlled trial, including a checklist and flowchart for tracking participants through the trial, from recruitment through data analysis.” (p. 723). The researchers used the Intervention Group, Control Group, and Randomized Control Trials to come up with the results.
Results
The researchers came to their conclusion after conducting a quality assessment of the randomized, control trials examining medication adherence using the CONSORT Group. The research study did identify weaknesses in the study. Several RTC’s had methodological problems, did not identify all medical conditions, explanation of interventions used (William, 2008).
Alternate Conclusion
There was a wealth of data in this research study that could be used to explore several different issues related to medication adherence. Researchers could have drawn a conclusion based on the data they identified, what chronic conditions are individual most like or less likely to be compliant with their medications. They did find that further research is needed on this subject.
References
Echevarria, I. &. (2014, February). To make your case, start with a PICOT question. Retrieved from OVID: https://ovidsp-tx-ovid-com.ezp.waldenulibrary.org/sp-3.33.0b/ovidweb.cgi?WebLinkFrameset=1&S=NAAIFPMHKIDDHDBONCDKIAJCHHLHAA00&returnUrl=ovidweb.cgi%3f%26Titles%3dS.sh.22%257c1%257c10%26FORMAT%3dtitle%26FIELDS%3dTITLES%26S%3dNAAIFPMHKIDDHDBONCDKIAJCHHLHAA0
Polit, D. F. (2017). Nursing Research: Generating and Assessing Evidence for Nursing Practice. Philadelphia: Wolters Kluwer Health.
William, A. M. (2008, July 4). Intervention to improve medication adherence in people with multiple chronic conditions: a systematic review. Retrieved from Wiley Library Online: Retrieved From: https://onlinelibrary-wiley-com.ezp.waldenulibrary.org/doi/full/10.1111/j.1365-2648.2008.04656.x
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Post Logan 19257129
/in Uncategorized /by developerRespond by providing additional thoughts about competing needs that may impact your colleagues’ selected issues, or additional ideas for applying policy to address the impacts described.
Main Post
Organization Policies and Practices to Support Healthcare Issues
Competing needs of the workforce may have an impact on the development of organization policy. A shortage of providers may institute organizational or legislative change to increase workforce capacity. In this post, I will discuss how the need of the workforce impacts policy as it relates to the national issue of the scope of practice for the nurse practitioner (NP).
Estimates project that two-thirds of new practitioners added to the workforce will be NPs between 2016 and 2030 (Auerbach, Staiger, & Buerhaus, 2018). This information shifts the conversation towards the NP workforce and the policies that affect it. Poghosyan, Liu, Shang, D’Aunno (2017) found that NPs were more likely to be satisfied with their jobs and less likely to have the intent to leave if their organization supported NP practice. This finding could have a direct impact on workforce capacity and patient care as a result. Organizations located in areas where the effect of a deficit is minimal tend to restrict NPs using policy, and this may be affecting their internal workforce. Organizations must adopt a plan that is supportive NPs in their daily practice. Ricketts & Fraher (2013) highlight that workforce policy is a result of the demands of different professions and not about the needs of patients. A vital obligation of a healthcare institution is to ensure patients receive the care they need. Outdated policy or one that is non-reflective of the needs of the community does not meet this obligation. New York is an example of government policy that is not beneficial to the residents of the state via the NP scope of practice. NPs must work under the supervision of a physician, which inhibits how many patients they can manage as well as the physicians patient load. I imagine this is an example of professions shaping policy versus patient needs. Changes in policy can have a dramatic impact on workforce capacity and patient care.
References
Auerbach, D. I., Staiger, D. O., & Buerhaus, P. I. (2018). Growing ranks of advanced practice clinicians—Implications for the physician workforce. New England Journal of Medicine, 378(25), 2358–2360. doi:10.1056/NEJMp1801869
Poghosyan, L., Liu, J., Shang, J., & D’Aunno, T. (2017). Practice environments and job satisfaction and turnover intentions of nurse practitioners: Implications for primary care workforce capacity. Health Care Management Review, 42(2), 162–171. Retrieved from https://doi org.ezp.waldenulibrary.org/10.1097/HMR.0000000000000094
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Post Logan 19282707
/in Uncategorized /by developerRespond on two different days who selected different types of anemia than you, in the following ways:
Share insights on how the anemia you selected is similar to or different from the one your colleague selected.
Discuss how genetic, gender, ethnic, age, and behavioral factors impact the diagnosis and prescription of treatment for anemic patients.
Main Post
Anemia
Anemia is an insufficient amount of red blood cells that carry vital oxygen to the tissues. There are different types of anemia with unique pathological processes. This post will explore the pathophysiology of iron deficiency and folate deficiency anemia, including the impact of behavior on these disorders.
Iron deficiency anemia is like it sounds. The body has a deficiency of iron and cannot produce enough hemoglobin to oxygenate the tissues properly. The heme molecules that constitute hemoglobin need iron as it attracts oxygen to attach to the red blood cell (erythrocyte). When it is not available, hematopoiesis (red blood cell formation) cannot occur. The body has some reserves of iron, but it does not last because hematopoiesis happens throughout life. Red blood cells die or are lost through bleeding and need replacement. The causes of iron deficiency include inadequate dietary intake, chronic blood loss, and metabolic disorders via insufficient delivery or absorption. In all types of anemia, patients present with classic symptoms of weakness, fatigue, dyspnea, and paleness (Hammer & McPhee, 2019). Obtaining a serum ferritin level is the best way to measure iron deficiency as the iron binds to ferritin. Treatment includes increasing dietary intake of iron or giving supplemental iron after ruling out a chronic bleed (most often the gastrointestinal tract). If there is bleeding, this needs correction to resolve the anemia.
Folate deficiency anemia is an insufficient amount of folic acid. Folic acid is necessary for RNA and DNA synthesis in erythrocytes (Huether & McCance, 2017). Folate deficiency occurs more often in alcoholics or malnourished individuals. Symptoms that can present with this type of anemia include watery diarrhea, stomatitis, burning mouth syndrome, and ulcers in the mouth to name a few. Treatment requires an oral supplement of folic acid until blood levels rise to adequate levels. Although different in their pathology, both types of anemia effect hematopoiesis, and this is critical for oxygen delivery to the tissues.
Behavior
Adequate dietary intake of iron and folate can reduce these types of anemia. However, as mentioned above, with iron deficiency anemia, it is essential to determine the cause because it could be from bleeding. Odewole et al. (2013) conducted a study of folate deficiency anemia after the mandatory enrichment of folic acid into cereal grains in the United States. The researchers found only two individuals out of over 1500 surveyed, suggesting that this type of anemia is nearly nonexistent in the United States. (Odewole et al., 2013).
References
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. (2012). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.
Odewole, O. A., Williamson, R. S., Zakai, N. A., Berry, R. J., Judd, S. E., Qi, Y., … Oakley Jr., G. P. (2013). Near-elimination of folate-deficiency anemia by mandatory folic acid fortification in older US adults: Reasons for Geographic and Racial Differences in Stroke study 2003-2007. The American Journal of Clinical Nutrition, 98(4), 1042–1047. Retrieved from https://doi-org.ezp.waldenulibrary.org/10.3945/ajcn.113.059683
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Post Logan 19311767
/in Uncategorized /by developerRespond 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
Disorders of the Reproductive Systems
The reproductive system is essential to the continuation of the human race. Proper functioning is necessary for optimal physical and psychosocial well being. This post will explore two reproductive disorders, including similarities and differences and the impact of behavior on the conditions. Phimosis is a disorder of the male reproductive system that prevents retraction of the foreskin over the glans penis. It is a non-issue in males under the age of three, as the glans and foreskin are one under normal physiological conditions (Huether & McCance, 2017). After age three, the foreskin begins to separate from the glans penis naturally. Phimosis can happen at any age in uncircumcised males. It often occurs as a result of chronic infection, but treatment is unnecessary unless balanitis or posthitis occur. Common symptoms include tenderness, edema, erythema, or purulent discharge. If the condition is pathological, treatment includes circumcision or a preputioplasty which widens the hole for the glans to pass through properly preserving the foreskin (McPhee & McKay, 2019).Paraphimosis is a disorder of the male reproductive system where the foreskin becomes trapped behind the corona of the glans. This condition is considered a urologic emergency and requires rapid treatment. If left untreated, the glans becomes strangulated, leading to vascular compromise, edema, and necrosis (Bragg & Leslie, 2019). Paraphimosis often occurs when retracting the foreskin for cleaning, physical examination, or placement of a catheter. Common symptoms include erythema, swelling, and pain. Treatment for uncomplicated paraphimosis includes manual reduction using a small amount of lubricant and moderate pressure to advanced the foreskin back over the glans. Complicated paraphimosis requires analgesia and surgical incision to correct.
Similarities and Differences
One similarity between the two disorders is the involvement of the foreskin. In one condition, the foreskin does not retract, and in the other, it does not return to cover the glans penis. One difference is that paraphimosis is most common in adolescents, while phimosis can happen at any age. Also, paraphimosis can occur in circumcised males too if there is enough skin present after a circumcision.
Behavior
Cleanliness is essential in the prevention of phimosis. Regular hygiene prevents many cases of this condition. Self-inflicted injuries are a significant cause for paraphimosis. However, merely retracting the foreskin can trigger the problem
References
Bragg, B. N., & Leslie, S. W. (2019). Paraphimosis. In StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books /NBK448067/ Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.McPhee, A. S., & McKay, A. C. (2019). Phimosis. In StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books /NBK448067/
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Post Logan 19329077
/in Uncategorized /by developerRespond to at least two of your colleagues on two different days by suggesting additional patient factors that might have interfered with the pharmacokinetic and pharmacodynamic processes of the patients they described.
In addition, suggest how the personalized plan of care might change if the age of the patient were different and/or if the patient had a comorbid condition, such as renal failure, heart failure, or liver failure.
Main Post
Pharmacokinetics and Pharmacodynamics
A solid understanding of how drugs impact the body is essential. Pharmacokinetics explains how the body metabolizes drugs, and pharmacodynamics describes the effect of the drug on the body. This post will explore a patient case, including factors that might have altered the patient response to medication therapy and a discussion of a personalized plan of care for the above patient.The case is about an adverse drug reaction (ADR).
According to Rosenthal and Burchum (2018), there has been a dramatic increase in ADRs despite efforts to reduce them. Although many of these events are preventable with careful prescribing, some are not. About two years ago, I went to work and received morning report for my patients. One particular patient stood out. He was an otherwise healthy 19-year-old with no known medication allergies, no active home medications, or medical conditions. The prior evening, he had become agitated because he wanted to leave the hospital and received Haldol 5 mg, Ativan 2 mg, and Benadryl 50 mg. I went to assess him and saw him unresponsive to his environment, standing at the wall, facing it, and mumbling. He was not alert to person, place, time, nor situation. I immediately suspected rhabdomyolysis and alerted the provider. The provider looked at him and stated: “he is just crazy.” I explained the patient history and demanded an order to send the patient to the emergency department (ED), which occurred. Later on, I called the ED, and the diagnosis was indeed rhabdomyolysis. It would be too easy to state that the scenario above was merely an unfortunate adverse event. Dr. Buttaro had it correct when she mentioned in the video that prescribing is about ensuring the right drug, right patient, right time, and the right dose (Laureate Education, 2019). I believe that a different medication choice in the scenario would have prevented rhabdomyolysis or lower doses.
The most likely etiology of the rhabdomyolysis was the administration of these medications. I do not think genetics, sex, age, ethnicity, or existing disease impacted this scenario. All three drugs increase the risk of developing rhabdomyolysis, especially for someone who had never taken antipsychotics or benzodiazepines (Stanley & Adigun, 2018). My plan of care for the patient would include verbal de-escalation as the first line of treatment and a low dose of hydroxyzine for agitation if needed. This medication choice would most likely be sufficient for someone who does not take medications at all. A safe rule for a prescriber is to go low and slow when prescribing drugs and monitor responses to therapy accordingly.
References
Laureate Education, Inc. (Executive Producer). (2019). Introduction to Advanced Pharmacology. Baltimore, MD: Author.Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.Stanley, M., & Adigun, R. (2018). Rhabdomyolysis. In StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK448168/
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Post Logan 19360823
/in Uncategorized /by developerRead a selection of your colleagues’ responses and respond on two different days who selected a different type of diabetes than you did. Provide recommendations for alternative drug treatments and patient education strategies for treatment and management.
Main Post
Diabetes is an all too common endocrine disorder. Creating an effective treatment plan is essential to delay long term effects of the disease. This post explores the differences between types of diabetes with a focus on details of type two diabetes, one drug used to treat it, dietary considerations, and short-term and long-term impact.
There are several types of diabetes include type two, gestational, juvenile, and type two. This list is not all-inclusive, but for purposes of simplicity, I will focus on these four. Type one diabetes is related to an autoimmune response that destroys the beta cells in the pancreas. The beta cells produce insulin for the body, and insulin is a hormone that draws glucose into the cells for fuel. When the beta cells no longer exist, no insulin production occurs, and the glucose remains in the bloodstream leading to hyperglycemia and cell starvation. Juvenile diabetes is the old name for type one diabetes and received the name because it often appeared during this time in the life span. Gestational diabetes appears in a pregnant patient and subsides quickly after delivery of the child. Type two diabetes is the most prevalent form as 90 to 95 percent of diabetics have this type (Rosenthal & Burchum, 2018). It is insidious and often appears after age 40. Type two is related to inappropriate production of insulin and insulin resistance. The cells become intolerant to insulin and do not uptake it, or the beta cells do not produce enough insulin, rendering it ineffective to control blood sugar. There is a familial association which suggests it is hereditary, but the etiology remains unknown.
I chose Metformin as it is appropriate for the initial treatment of type two diabetes. It is a biguanide that works by decreasing glucose production in the liver and increasing tissue response to insulin. This mechanism of action is essential to understand because it prevents a sharp increase in blood sugar after a meal but does not actively control blood sugar. The provider should order Metformin at 500 mg twice a day with meals as the initial starting dose (Epocrates, 2019). There is no particular food to avoid with Metformin, and common side effects include gastrointestinal disturbances. The recommended diet should be low in carbohydrates, including sugar, low in fried foods, low in salt, and high in protein (National Insititute of Diabetes and Digestive and Kidney Diseases, 2016).
Lastly, the short-term effects of diabetes include medication, diet changes, adding exercise, and routine follow-up with the provider. The long-term effects include all of the above as well as retinopathy, nephropathy, peripheral neuropathy, and shorter life span related to these long-term effects of the disease. Metformin is relatively safe but can cause vitamin B12 and folic acid deficiencies and lactic acidosis, which is rare.
References
Epocrates. (2019). Metformin Adult Dosing. Retrieved from https://online.epocrates.com/drugs/787/metformin
National Institute of Diabetes and Digestive and Kidney Diseases. (2016). Diabetes Diet, Eating, & Physical Activity.
Retrieved from https://www.niddk.nih.gov/health-information/diabetes/overview/diet-eating-physical-activity
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO:
Elsevier.
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/in Uncategorized /by developerRead a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who were assigned a different patient case study, and provide recommendations for alternative drug treatments to address the patient’s pathophysiology. Be specific and provide examples.
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Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders
Patients today are much sicker than they used to be. The advanced practice nurse needs to manage all comorbidities in the plan of care. In this post, I will discuss the patient’s health care needs and a recommended treatment plan, including pharmacotherapeutic choices. Also, I will present an education strategy to assist the patient in managing their disease conditions. The patient has a history of hypertension, myocardial infarction, hyperlipidemia angina, and diabetes type two. Her needs center around the management of these comorbidities. Also, I noticed that her serum creatinine is on the high end of the range if not outside of it. This fact is not surprising considering her diabetes. The case reports that she was doing well until about a month ago. It was tempting to consider adding another medication to the regimen. However, I believe that either the metoprolol is not high enough to manage her current disease state or she has been missing doses, and I am leaning toward the latter. If withdrawn suddenly, the drug can increase the incidence and intensity of anginal attacks. Metoprolol is the first-line drug for stable angina and should be working (Rosenthal & Burchum, 2018).
A review of her current drug therapy appears appropriate. Aspirin, simvastatin, and metformin are competent choices, and the doses are adequate. My plan would include an assessment of how she takes medication at home and manages them before making any changes. If this were in order, I would increase the metoprolol to 75 mg twice a day and set a follow-up appointment in two weeks. I prefer to increase the dose of metoprolol first before adding any new drug because of polypharmacy considerations, and the drug does not require renal adjustment (Epocrates, 2019). This fact is beneficial to consider because she has diabetes. Assuming that the patient has missed doses over the last month, the priority is to determine why. Costa et al. (2015) recommend explaining how to take medication, discussing reluctance to take drugs, and a conversation about the patient’s beliefs and knowledge about their health and treatment. I believe that this is a great strategy to use with the patient. Medication adherence is troubling and particularly so with the elderly who have multiple medications and conditions. I think it is essential for the patient and provider to be partners in the plan of care. The patient must agree to it and fully understand their conditions and the purpose of each medication.
References
Costa, E., Giardini, A., Savin, M., Menditto, E., Lehane, E., Laosa, O., … Marengoni, A. (2015). Interventional tools to improve medication adherence: review of literature. Patient Preference And Adherence, 9, 1303–1314. doi:10.2147/PPA.S87551Epocrates. (2019). Metoprolol Tartrate Adult Dosing. Retrieved from https://online.epocrates.com/drugs/25501/metoprolol- tartrate/Adult-DosingRosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.
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