DQ2 (COMMENT 1). REFERENCES CITATION NO PLAGIO 150 WORDS
Comparison the physical assessment of a child to that of an adult
(focus should be on what you learned on completing childrens health assessments)
Similarities: Past medical history, current medications, chief complaint, signs and symptoms (OLDCARTS), assessment of systems (neuro, HEENT, respiratory, cardiac, GI, GU, integumentary, musculoskeletal, pain, etc).
Differences: Pain scales are very different, as adults generally use a 0-10 pain scale but children will benefit from a FACES scale or looking at behavioral or physical indicators of pain: grimacing, inconsolability, elevated heart rate, guarding (Andersen et al., 2019).
For an accurate health history, parents will need to be included in the process; without surprise, generally this history will be much shorter than an adult history, unless the child was sickly. Parents may also need to be involved for supplemental information; in our simulation, the child could tell me the cough medicine was a certain color but it was his caregiver that told me what the actual medication was.
Explanation of how the nurse would offer instruction (to children) during the assessment
Children might not respond to the nurse instructing them during the assessment so a doll to puppet to show them what to expect might be helpful (Klossner & Hatfield, 2010). For example, listening to a doll with a stethoscope allows the child to see the stethoscope in use, where it will be touching on their body, and what the nurse will ask them to do while they listen; it might be helpful to let the child touch the stethoscope and listen to the nurse’s chest. With children, some instruction might have to come from the parents or parts of the assessment completed in the arms of the parents so the child feels secure.
Adaption of communication for children of different ages
Infants are easy, nurses will communicate mostly with the parent aside from some baby talk and smiling at the infant. With young children, communication should always be done at eye level, whether that is with the child on the exam table or the nurse sitting at the same level as the child, communication should be slow, clear, calm, and in terms that a child would understand (Klossner & Hatfield, 2010). As children get older, the nurse needs to explain exactly what they will be doing in the assessment, when they are doing it, what to expect and, allowing for questions and answers.
Strategies to encourage children during the assessment
As previously mentioned, a strategy to encourage children during an assessment would include a doll or via puppet might be helpful when communicating with a young child. Always allow children to ask questions and not rush them, they might ask “why” or “what” and require frequent answers and support (Klossner & Hatfield, 2010). Nielson and Reeves make recommendations for nursing care to include, “role-play, simulation, and drama” (2019). Role play would allow the child to wear the stethoscope and listen to the nurse’s or parent’s lungs; simulation would allow the child to see the assessment on the doll (or parent) first; and drama would be puppetry, having a puppet do the assessment or the teaching to the child.
Andersen, R.D., Nakstad, B., Jylli, L., Campbell-Yeo, M., & Anderzen-Carlsson, A. (2019). The complexities of nurses’ pain assessment in hospitalized preverbal children. Pain Management Nursing, 20(4), 337-334. Retrieved from https://www-sciencedirect-com.lopes.idm.oclc.org/science/article/pii/S1524904218301747?via%3Dihub
Klossner, N.J., & Hatfield, N.T. (2010). Introductory Maternity & Pediatric Nursing. PA: Lippincott Williams & Wilkins.
Neilson, S.J., & Reeves, A. (2019). The use of a theatre workshop in developing effective communication in paediatric end of life care, Nurse Education in Practice, 36, 7-12. Retrieved from https://www-sciencedirect-com.lopes.idm.oclc.org/science/article/pii/S1471595318300763?via%3Dihub
DQ2. (COMMENT 2) NO PLAGIO CITATION REFERENCES AND 150 WORDS
There are significant physical and developmental differences between children and adults. Ideally, a physical assessment begins with subjective and objective data where observations and asking of questions are done in the adult population to fulfill the assessment part but in pediatric population, the care giver or parent is the historian in extraction of the required information. This applies to the toddlers and some preschoolers who are still afraid of strangers.
In pediatrics, a nurse could have different patients of entirely different ages. As a nurse this means different reasoning strategies to convince them to take medications, different physical skills based on motor development, different coping abilities to painful or traumatic procedures, different cognitive abilities, different lab values and vital signs normal ranges and so on. This is the most challenging part of dealing with pediatrics – such a wide variety in developmental stages. When dealing with the adult population, majority of them fall within very consistently expected cognitive, physical, emotional and clinical data ranges.
When approaching the pediatrics for explanation about a procedure that is to be done, then a nurse must have caution and use character play to convince them and make them understand. Pictures and diagrams come in handy in getting them to understand. One must take time to win their trust for them to accept and listen to you. This is like learning a different language all together. When discussing a procedure or diagnosis with an adult patient, the nurse uses logical explanations in helping to understand what they expect. This is where the family and relatives come in handy to help the patient understand because they are in distress and there learning capabilities are low.
Dealing with both populations have its own pros and cons, there are tough moments where a nurse caring for adults may encounter temper tantrums, teenage mood swing, uncooperative adult patients and even abusive too and children ever crying until it becomes hard to handle them.
Adults would always have more complicated medical histories unlike children. Quite several ailments may have interconnectedness hence need for a thorough history taking. This comes with histories of allergies and coming with a cocktail of different kinds of medications unlike pediatrics who have fewer or even none. Pediatrics while on care would always crash very easily because they have less reserves and can compensate normal vitals for extended periods before a sudden decline.
Pediatrics won’t talk and this then calls for thorough and keen assessment skills and reliance on intuition. Children would always code starting with respiratory arrest unlike adults who in most cases start with cardiac arrest. Its easier discussing living will and medical decisions with an adult patient unlike in pediatrics where you discuss with the parents who are legally responsible. This can cause ethical dilemmas for nurses at times if a child disagrees with the treatment the guardian consents to.
References.
How are Children Different from Adults? | CDC (2019) retrieved from
https://www.cdc.gov/childrenindisasters/differences.html
Falkner, A. (2018) Health Assessment: Foundations for Effective Practice retrieved from
https://www.gcumedia.com/digital-resources/grand-canyon-university/2018/health-assessment_foundations-for-effective-practice_1e.php
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2 Case Study
/in Uncategorized /by developerCase Study 1 (Inflammatory Bowel Disease)
The patient is an 11-year-old girl who has been complaining of intermittent right lower quadrant pain and diarrhea for the past year. She is small for her age. Her physical examination indicates some mild right lower quadrant tenderness and fullness.
Studies and Results:
Hemoglobin (Hgb): 8.6 g/dL (normal: >12 g/dL)
Hematocrit (Hct): 28% (normal: 31%-43%)
Vitamin B12 level: 68 pg/mL (normal: 100-700 pg/mL)
Meckel scan: No evidence of Meckel diverticulum
D-Xylose absorption: 60 min: 8 mg/dL (normal: >15-20 mg/dL)
120 min: 6 mg/dL (normal: >20 mg/dL)
Lactose tolerance: No change in glucose level (normal: >20 mg/dL rise in glucose) Small bowel series: Constriction of multiple segments of the small intestine
Diagnostic Analysis
The child’s small bowel series is compatible with Crohn disease of the small intestine. Intestinal absorption is diminished, as indicated by the abnormal D-xylose and lactose tolerance tests. Absorption is so bad that she cannot absorb vitamin B12. As a result, she has vitamin B12 deficiency anemia. She was placed on an aggressive immunosuppressive regimen, and her condition improved significantly. Unfortunately, 2 years later she experienced unremitting obstructive symptoms and required surgery. One year after surgery, her gastrointestinal function was normal, and her anemia had resolved. Her growth status matched her age group. Her absorption tests were normal, as were her B12 levels. Her immunosuppressive drugs were discontinued, and she is doing well.
Critical Thinking Questions:
1. Why was this patient placed on immunosuppressive therapy?
2. Why was the Meckel scan ordered for this patient?
3. What are the clinical differences and treatment options for Ulcerative Colitis and Crohn’s Disease? (always on boards)
4. What is prognosis for patients with IBD and what are the follow up recommendations for managing disease?
Case Studies 2 (Urinary Obstruction )
The 57-year-old patient noted urinary hesitancy and a decrease in the force of his urinary stream for several months. Both had progressively become worse. His physical examination was essentially negative except for an enlarged prostate, which was bulky and soft.
Studies and Results
Intravenous pyelogram (IVP): Mild indentation of the interior aspect of the bladder, indicating an enlarged prostate.
Uroflowmetry with total voided flow of 225 mL: 8 mL/sec (normal: >12 mL/sec) Cystometry: Resting bladder pressure: 35 cm H2O (normal: <40 cm H2O) Peak bladder pressure: 50 cm H2O (normal: 40-90 cm H2O).
Electromyography of the pelvic sphincter muscle: Normal resting bladder with a positive tonus limb .
Cystoscopy: Benign prostatic hypertrophy (BPH)
Prostatic acid phosphatase (PAP): 0.5 units/L (normal: 0.11-0.60 units/L)
Prostate specific antigen (PSA): 1.0 ng/mL (normal: <4 ng/mL)
Prostate ultrasound: Diffusely enlarged prostate; no localized tumor
Diagnostic Analysis
Because of the patient’s symptoms, bladder outlet obstruction was highly suspected. Physical examination indicated an enlarged prostate. IVP studies corroborated that finding. The reduced urine flow rate indicated an obstruction distal to the urinary bladder. Because the patient was found to have a normal total voided volume, one could not say that the reduced flow rate was the result of an inadequately distended bladder. Rather, the bladder was appropriately distended, yet the flow rate was decreased. This indicated outlet obstruction. The cystogram indicated that the bladder was capable of mounting an effective pressure and was not an atonic bladder compatible with neurologic disease. The tonus limb again indicated the bladder was able to contract. The peak bladder pressure of 50 cm H2O was normal, again indicating appropriate muscular function of the bladder. Based on these studies, the patient was diagnosed with a urinary outlet obstruction. The PAP and PSA indicated benign prostatic hypertrophy (BPH). The ultrasound supported that diagnosis. Cystoscopy documented that finding, and the patient was appropriately treated by transurethral resection of the prostate (TURP). This patient did well postoperatively and had no major problems.
Critical Thinking Questions
1. Does BPH predispose this patient to cancer?
2. Why are patients with BPH at increased risk for urinary tract infections?
3. What would you expect the patient’s PSA level to be after surgery?
4. What is the recommended screening guidelines and treatment for BPH?
5. What are some alternative treatments / natural homeopathic options for treatment?
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2 Coments Each One 150 Words Citation And Reference 19491453
/in Uncategorized /by developer(1) 150 words citation references
Nola Pender’s health promotion model is used to promote health behaviors by observing the family dynamics and promoting interventions that affect the family unit. The model has three main concepts. The first is that people are basically a sum of their parts, their individual biological makeup and their past experiences. Second, they have developed beliefs and characteristics based upon their interpersonal environment. The final concept is the goal, which is health promotion. The nurse is a part of the interpersonal experience, as well as the family. The individual’s perception of self-efficacy can be based on emotions related to past success or failures, the presence or absence of positive role models, and the presence of health disparities that can compete with the behavior change (Nursing Theories, 2011).
Pender’s model can help in teaching behavioral change, because it considers the multitude of dynamic forces at work in an individual’s life. According to the theorist, when a person’s interpersonal environment becomes supportive and positive, there is a greater chance of patient compliance. For incidence, if the person is a new onset diabetic and their family is not supportive with diet changes and do not modify the family meals, the patient is less likely to be compliant with their new diet.
Disparities such as age, socioeconomic status, educational level, disability, race, culture, or religious beliefs can affect a patient’ ability to learn. These factors can compete with the patient’s ability to participate in health promoting behaviors or limit access to health promotion resources. For instance, a person with limited English speaking ability may not have health promotion resources available in their native language (Whitney, 2018).
According to the transtheoretical model, change is based upon a person working through six stages. Change occurs when a person has had time to contemplate and make up their mind to take action (Whitney, 2018). People can be unwilling to change for many reasons. They might not be cognitively capable, physically ready, or psychologically ready (Ashton & Oermann, 2014). For example, newly diagnosed patients are often in denial or have not accepted the diagnosis, so they may not be willing to intitally learn about their condition or their care. Another example, is when a parent of a child with a TBI is still grieving and may leave the room when their child needs to be cathed, toileted, or connected to a feeding pump. In this case, patient teaching that includes the parent’s active participation in their child’s care is not the focus.
Ashton, K., & Oermann, M.(2014). Patient education in home care: strategies for success. Home Healthcare Now,32(5),288-294. Retrieved from https://www.nursingcenter.com/journalarticle?Article_ID=2460148&Journal_ID=2695880&Issue_ID=2460020
Nursing Theories. (2011). Health promotion model. Retrieved from http://currentnursing.com/nursing_theory/health_promotion_model.html
Whitney, S. (2018) Teaching and learning styles. In Grand Canyon University (Eds.), Health promotion: health & wellness across the continuum. Retrieved from https://lc.gcumedia.com/nrs429vn/health-promotion-health-and-wellness-across-the-continuum/v1.1/#/chapter/1
(2) citation references 150 words
Bandura’s Self efficiency theory of behavior change is a health promotion model that was made the model by Albert Bandura. This model focused on the feelings of self-efficacy can lead to competency (Whitney, 2018). Bandura believed that patients/individuals have the power to bring their own outcomes to fruition. Its stated that there are three factors influence self-efficacy which are behaviors, environment, and personal/cognitive factors. The theory focuses on “…how learning is influenced by repetition, reinforcement, and symbolic modeling.” (Whitney, 2018). This model helps by giving power to the patient in changing their outcomes and behaviors.
Some barriers that effect a patient’s ability to earn and language, environment, socioeconomic status, illness and the patient’s readiness to learn. Language is an obvious barrier to learning, if a patients first language isn’t English and the nurse who is caring for said patient only speaks English there is going to be an inability to teach/learn. In this situation the use of translators and informational and educational packets/ videos in the patients preferred language are helpful and overcoming this barrier. The environment in which learning or teaching is done is also very important. If the environmental is full of distraction, loud noises, family members and nurses in and out or even a roommate it can cause the patient to ot focused on the teaching that is taking place. Nurse must ensure that before teaching is done that the environment is prepared. This involves elimination of all distractions, turning of the tv, having family members and staff exit the room and so on.
If a patient isn’t ready to learn or change the teaching is useless. Attitude and behaviors are one of the biggest factors in not just healing but learning as well. When patients aren’t ready or willing, the information they receive won’t be absorbed or it will be ignored which will lead to possible worsening of the patient’s illness and negative outcome. A Nurse has to ensure the patient is in the right mindset to learn, receive information and change. This can be done be a simple readiness to learn assessment by the nurse.
References
Whitney, S. (2018) Health Promotion: Health & Wellness Across the Continuum. Grand Canyon University. https://lc.gcumedia.com/nrs429vn/health-promotion-health-and-wellness-across-the-continuum/v1.1/#/chapter/1
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2 Coments Each One 150 Words Citation And Reference 19492927
/in Uncategorized /by developer1 reply 150 words citation reference
The aim of health promotion is to improve the health of not only individuals but also populations through health education. One among other models that ensures health promotion is the Ponder’s health promotion model. This model was developed when Nola Pender noticed that health care professionals only paid attention to treating diseases but didn’t recognize the need for promotion of healthy lifestyles. In 1982 therefore, this model came into existence to provide a framework that helps to understand health promotion behaviors by recognizing the family as the unit of assessment and intervention. Through identification of available resources and fostering resilience among individual family members this theory encouraged behavioral changes that led to promotion of health among family members. The other components of this model that influences behavioral change include; recognizing experiences and characteristics of individuals, understanding behavior-specific cognition and affect and implementing behavioral outcomes (Kwong & Kwan, 2007)
As important as health teaching seems, nurses should also be aware of other variables that are likely to affects patient’s ability to learn. Such variables include; race, ethnicity, disability, sex, sex orientation, environmental threats, poverty levels, access to health care and lack of education. Other factors such as cultural, socio-economic and socio-political influences affect the patient’s experiences while other components like stereotype, biases and other forms of discrimination can limit the healthcare providers’ ability to share relevant health information. Being able to self-analyze and analyze their target populations, health providers can effectively eliminate these barriers to safeguard health promotion strategies (Whitney, 2018)
Through the transtheoretical model, health providers are able to assess the patient’s readiness to change. The different stages involved include; precontemplation, contemplation, planning, action, maintenance and termination. As the providers work with patients through this model, they are able to note any positiveness or unwillingness depending on their participation. If patients turn out to be positive, they are more actively involved in the decision making of their specific tailored care plans and this ultimately leads to effective learning outcomes as they continue in healthy living behaviors (Whitney, 2018)
References.
Whitney, S. (2018) Health Promotion: Health & Wellness Across the Continuum. Grand Canyon University. Retrieved from https://lc.gcumedia.com/nrs429vn/health-promotion-health-and-wellness-across-the-continuum/v1.1/#/chapter/1
Kwong, E. W., & Kwan, A. Y. (2007). Participation in health-promoting behavior: Influences on community-dwelling older Chinese people. Journal of Advanced Nursing, 57(5), 522-534.
2 reply 150 words citation references
Bandura’s self-efficacy theory of behavior change is a model developed by Albert Bandura that is used to initiate behavioral changes. Whitney (2018) states “He believed that feelings of self-efficacy can lead to competency; in other words, he believed that individuals have the ability to bring about their own outcomes” (Whitney, 2018, para. 30). This model emphasizes the importance of the patient feeling that he/she is capable of making changes that will lead to the desired outcomes. The patient must feel confident in their own abilities to bring about postive outcomes.
Bandura’s model helps in teaching behavioral changes by giving the patients the knowledge needed so that they can feel confident in themselves. Whitney (2018) states “This conceptual theory explains how learning is influenced by repetition, reinforcement, and symbolic modeling.learning” (Whitney, 2018, para. 30). When patients are in doubt of their own capabilities it makes it hard for them to believe that they are capable of attaining the outcome that is desired for them. However, when patients are taught through repetition and reinforcement, they gain confidence in their own abilities and that is what is needed to bring about the desired outcome.
There are many barriers that may affect a patient’s ability to learn. According to Whitney (2018) “Patients’ physical condition, including limited vision and auditory function, mobility, alertness, mental capacity, or high levels of physical pain, may impede learning capability” (Whitney, 2018, para. 18). All of these physical conditions can negatively affect the patient’s ability to learn. There are other barriers, such as language barriers, that can make it a difficult for a patient to learn, so it is imperative that there is a translator available when needed to be certain that the patient understands what is being taught.
It is important for the nurse to assess the patient to identify their readiness to learn. If a patient is not willing and ready to learn or willing to make the needed changes then the learning outcomes will be negatively affected. The learning outcomes will be positively affected by the patient that is ready and willing to make changes. The patient must be ready to learn and change for the teaching to be successful.
Reference
Whitney, S. (2018). Grand Canyon University (Ed). Health promotion: Health & wellness across the continuum. Retrieved from https://lc.gcumedia.com/nrs429vn/health-promotion-health-and-wellness-across-the-continuum/v1.1/#/chapter/1
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2 Coments Each One 150 Words Citation And Reference By122
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2 Comments 150 Words Citation And References
/in Uncategorized /by developerComent (1). 150 words citation and references
Culture
19 years old female of the Hindu faith
Considerations
Health care providers should incorporate cultural competence in their services as a result of the increasing religious and cultural diversity. For both patients and health professionals to ensure quality health services, they need to consider cultural barriers. Evidence shows that there is a connection between poor cultural competence and low-quality health outcomes in health care practice. In this case, the client is a teenage girl who is admitted to the hospital with fevers (Gopalkrishnan, 2018).When dealing with teenagers, one should consider the legal requirements to maintain confidentiality, obtain consent, and language assistance services especially if the client is not a proficient English speaker. When interviewing her, the nurse should also consider her level of openness, special distance, taboo subjects, and eye contact.
Dealing with a female teenager of the Hindu faith requires one to have adequate knowledge of their beliefs and faith. According to the Hindu religion, all individuals are free to practice their religion the way they see fit. Besides, Hindus have a strong belief in karma, which is the law of cause and effect. They believe that each action, thought, and word makes up karma and affects their future and current lives. The nurse should consider this fact when interviewing the young girl as it may affect the decision-making process (Zavos, 2015). Also, Hindus believe that serious illnesses and other occurrences in their lives balance their lives and help them become better people. Hindus embrace the use of western medicine among many other options for treatments.
Resources
The United States provides health resources that help in effective communication among health care providers and Indian patients, which include the ward communication tool, language identification card, among others. Also, some Hindus may prefer fasting while in hospital, which may affect their wellness (Zavos, 2015). The nurse should ensure that the teenager is aware of the dangers of fasting when sick, while still considering the requirements of the Hindu religion.
References
Gopalkrishnan, N. (2018). Cultural Diversity and Mental Health: Considerations for Policy and Practice. Frontiers In Public Health, 6. doi: 10.3389/fpubh.2018.00179
Zavos, J. (2015). Digital media and networks of Hindu activism in the UK. Culture And Religion, 16(1), 17-34. doi: 10.1080/14755610.2015.1023814
Comment (2). 150 words citation and references
Culture
Scenario: Admitting a 19-year-old female college student for fevers. Patient has immigrated from Russia to complete her education.
Considerations
When interviewing this patient, it is okay to shake her hand and make direct eye contact. As healthcare is not very accessible in Russia, it is safe to assume the patient has not had much experience being in a hospital, so it is important to make her feel comfortable. Explain your role thoroughly prior to conducting the interview. When obtaining a history of medication, be sure to ask about homeopathic remedies the patient might have used. When asking about mental health history, avoid using the word “mental” as it is taboo for this culture (Stratis Health, 2020). Instead, words such as depression or anxiety can be replaced. Russians are very hesistant to admit mental health problems or familial history of mental health problems. When assessing patient, always explain what you are going to do prior to doing it and why. Russian culture is very dependent on the family unit, so when delivering diagnoses, it may be wise to ask the patient if she has any family with her. Ask her who she would like to be involved in her medical decisions. Russians believe that if bad medical news is shared with the patient, it will only make them sicker (University of Washington Medical Center, 2007). It is important to know what your patient believes and if she wants the family to make decisions for her or if she wants to make them for herself. When considering the cause of the illness, take into consideration the lack of access to healthcare in Russia. Russians are not as likely to be vaccinated as U.S. citizens, so it is important to know the patient’s vaccination status. There is also a higher prevalence of TB and HIV in Russia. At this age, it is important to assess patient’s sexual activities. When assessing the patient’s sexual history, do so privately. Also, stress the importance of honesty in her answers. Patient may feel more comfortable with a nurse of the same sex, but if a male nurse were assigned to her, he can just ask her if she is okay with him taking care of her. The author was unable to find healthcare support systems that are specific to the Russian culture that are targeted for this patient, both locally and nationally.
Resources
Falkner, A., & Green, S. Z. (2018). Adult Health Assessment. Retrieved from Health Assessment Foundations for Effective Practice: https://lc.gcumedia.com/nrs434vn/health-assessment-foundations-for-effective-practice/v1.1/#/chapter/4
Stratis Health. (2020). Russians in Minnesota. Retrieved from Culture Care Connection: http://culturecareconnection.org/matters/diversity/russian.html
University of Washington Medical Center. (2007). Communicating With Your Russian Patient. Retrieved from Culture Cues: http://depts.washington.edu/pfes/PDFs/RussianCultureClue.pdf
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2 Comments 150 Words Each One Citation Reference No Plagio 19471633
/in Uncategorized /by developerReply 1
External stressors unique to teens
According to Faulkner, teenagers mee the definition of a “vulnerable population.” Like children, imprisoned inmates, and cognitively impaired individuals, teenagers may not be able to advocate for themselves to maintain their own health and safety (Faulkner, A. 2018). One external stressor that teenagers may suffer is the impact of online bullying (cyberbullying). As teens grow into new bodies and deeper, more complicated relationships with friends and peers, bullying can have a dramatic effect on a teenager’s self-esteem. With the advent of social media, a new platform has been created where bullied teens can be attacked in the comfort of their own home, not just at school.
A second stressor unique to teens is dating violence. As teenagers navigate the unfamiliar waters of intimate partner relationships, they can be especially vulnerable to the toxic behaviors associated with dating violence. Some signs of dating violence include physical abuse, seclusion from friends and family, decline in academic performance, and use of emotional control/abuse tactics (Faulkner, A. 2018).
Risk taking behavior related to stressors
As a result of these stressors, teens who fall victim to cyberbullying or dating violence may engage in risky behaviors. These individuals may turn to drug or alcohol abuse. Teens in unhealthy relationships may be pressured into unwanted or unsafe sexual encounters. They also may become at risk for depression or suicide, which are further issues teens need to be screened and monitored for (Faulkner, A. 2018).
Coping mechanisms and support
Support is available for these teenagers. For teens who have falling into physically or emotionally abusive relationships, many public-school programs have been created to educate students and their families about signs of dating violence and how to address it. School nurses head this education in many facilities to create a culture of awareness (Faulkner, A. 2018). Help is also available for teens victimized by bullying who have fallen into depression or are at risk for suicide. Programs like Lifelines Curriculum and Coping and Support Training (CAST) have been instituted to promote systems for identifying students who are at risk and supplying support resources like professional and peer-based counseling to these teens (Faulkner, A. 2018).
References
Faulkner, A. (2018). Adolescent assessment . In Health Assessment Foundations for effective practice . http://dx.doi.org/https://lc.gcumedia.com/nrs434vn/health-assessment-foundations-for-effective-practice/v1.1/#/chapter/3
Reply 2
Stress is how the body and brain respond to a demand. Human body is meant to handle small amounts of stress, but too much can take a toll on one’s mental and physical health. This means that we should device ways of coping with stress when identified. While every teen faces a unique challenge and different life event, some circumstances are common to most teens.
Relationships and violence are some of the external stressors encountered by teens. Healthy dating relationships and relationship abuse among teens have led to formation of programs to educate them on components of healthy dating relationships. Such programs are initiated in schools and should involve educating teachers and parents regarding warning signs of relationship violence (Fry et al., 2014). Teens would always start feeling new romantic or sexual draw to people. Its normal but can be stressful and confusing. They feel some self- doubt or lack of confidence. This adds stress to them if they face questions about gender identity or sexual orientation. At times teens feel stressed about the right way to respond to friends’ needs. It becomes hard to set boundaries on how their hardships affect own lives. Teenagers should be informed regarding resources if they feel pressured to have sex or are being abused in a relationship, whether sexually, verbally, or physically (Howarth et al., 2015).
Bullying and friendships are considered as external stressors in teenagers. At one point or the other, everyone must admit having been part of this vice in childhood. Within the adolescent community bullying is a concern, affecting nearly 20-30% of students who admit being the perpetrator or victim of such harassment (Jantzer, Haffner, Parzer, Resch, & Kaess, 2015). Bullying is “an aggressive behavior that is intentional, repeated, and involves a power imbalance” (Sampasa- Kanyinga, Roumeliotis, & Xu, 2014).
These stressors may result in suicidal ideations and even committing suicide itself. Some may start indulging in alcoholism, end up with depression, physical illness and poor coping skills as drugs. Teen suicide could result from unresolved crisis from stressors, teenage suicide and teenage depression have increased (Bratsis, 2014), suicide is the second leading cause of death among 10-24 years of age (Lamis, Underwood, & D’ Amore, 2017, p.89).
Nurses direct victims to support groups. This groups offer support and protection of victims and put them through programs for behavior change with psychotherapy. Some involved in drugs are taken to rehabilitation camps and go through behavior change with help of medications.
References
Falkner, A. (2018) Health Assessment: Foundations for Effective Practice retrieved from
https://www.gcumedia.com/digital-resources/grand-canyon-university/2018/health-assessment_foundations-for-effective-practice_1e.php
Break the Silence: Stop the Violence,” by the Centers for Disease Control and Prevention (CDC) retrieved from
http://www.cdc.gov/cdctv/injuryviolenceandsafety/break-silence-stop-violence.html
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2 Comments 150 Words Each One Citation Reference No Plagio
/in Uncategorized /by developerDQ2 (COMMENT 1). REFERENCES CITATION NO PLAGIO 150 WORDS
Comparison the physical assessment of a child to that of an adult
(focus should be on what you learned on completing childrens health assessments)
Similarities: Past medical history, current medications, chief complaint, signs and symptoms (OLDCARTS), assessment of systems (neuro, HEENT, respiratory, cardiac, GI, GU, integumentary, musculoskeletal, pain, etc).
Differences: Pain scales are very different, as adults generally use a 0-10 pain scale but children will benefit from a FACES scale or looking at behavioral or physical indicators of pain: grimacing, inconsolability, elevated heart rate, guarding (Andersen et al., 2019).
For an accurate health history, parents will need to be included in the process; without surprise, generally this history will be much shorter than an adult history, unless the child was sickly. Parents may also need to be involved for supplemental information; in our simulation, the child could tell me the cough medicine was a certain color but it was his caregiver that told me what the actual medication was.
Explanation of how the nurse would offer instruction (to children) during the assessment
Children might not respond to the nurse instructing them during the assessment so a doll to puppet to show them what to expect might be helpful (Klossner & Hatfield, 2010). For example, listening to a doll with a stethoscope allows the child to see the stethoscope in use, where it will be touching on their body, and what the nurse will ask them to do while they listen; it might be helpful to let the child touch the stethoscope and listen to the nurse’s chest. With children, some instruction might have to come from the parents or parts of the assessment completed in the arms of the parents so the child feels secure.
Adaption of communication for children of different ages
Infants are easy, nurses will communicate mostly with the parent aside from some baby talk and smiling at the infant. With young children, communication should always be done at eye level, whether that is with the child on the exam table or the nurse sitting at the same level as the child, communication should be slow, clear, calm, and in terms that a child would understand (Klossner & Hatfield, 2010). As children get older, the nurse needs to explain exactly what they will be doing in the assessment, when they are doing it, what to expect and, allowing for questions and answers.
Strategies to encourage children during the assessment
As previously mentioned, a strategy to encourage children during an assessment would include a doll or via puppet might be helpful when communicating with a young child. Always allow children to ask questions and not rush them, they might ask “why” or “what” and require frequent answers and support (Klossner & Hatfield, 2010). Nielson and Reeves make recommendations for nursing care to include, “role-play, simulation, and drama” (2019). Role play would allow the child to wear the stethoscope and listen to the nurse’s or parent’s lungs; simulation would allow the child to see the assessment on the doll (or parent) first; and drama would be puppetry, having a puppet do the assessment or the teaching to the child.
Andersen, R.D., Nakstad, B., Jylli, L., Campbell-Yeo, M., & Anderzen-Carlsson, A. (2019). The complexities of nurses’ pain assessment in hospitalized preverbal children. Pain Management Nursing, 20(4), 337-334. Retrieved from https://www-sciencedirect-com.lopes.idm.oclc.org/science/article/pii/S1524904218301747?via%3Dihub
Klossner, N.J., & Hatfield, N.T. (2010). Introductory Maternity & Pediatric Nursing. PA: Lippincott Williams & Wilkins.
Neilson, S.J., & Reeves, A. (2019). The use of a theatre workshop in developing effective communication in paediatric end of life care, Nurse Education in Practice, 36, 7-12. Retrieved from https://www-sciencedirect-com.lopes.idm.oclc.org/science/article/pii/S1471595318300763?via%3Dihub
DQ2. (COMMENT 2) NO PLAGIO CITATION REFERENCES AND 150 WORDS
There are significant physical and developmental differences between children and adults. Ideally, a physical assessment begins with subjective and objective data where observations and asking of questions are done in the adult population to fulfill the assessment part but in pediatric population, the care giver or parent is the historian in extraction of the required information. This applies to the toddlers and some preschoolers who are still afraid of strangers.
In pediatrics, a nurse could have different patients of entirely different ages. As a nurse this means different reasoning strategies to convince them to take medications, different physical skills based on motor development, different coping abilities to painful or traumatic procedures, different cognitive abilities, different lab values and vital signs normal ranges and so on. This is the most challenging part of dealing with pediatrics – such a wide variety in developmental stages. When dealing with the adult population, majority of them fall within very consistently expected cognitive, physical, emotional and clinical data ranges.
When approaching the pediatrics for explanation about a procedure that is to be done, then a nurse must have caution and use character play to convince them and make them understand. Pictures and diagrams come in handy in getting them to understand. One must take time to win their trust for them to accept and listen to you. This is like learning a different language all together. When discussing a procedure or diagnosis with an adult patient, the nurse uses logical explanations in helping to understand what they expect. This is where the family and relatives come in handy to help the patient understand because they are in distress and there learning capabilities are low.
Dealing with both populations have its own pros and cons, there are tough moments where a nurse caring for adults may encounter temper tantrums, teenage mood swing, uncooperative adult patients and even abusive too and children ever crying until it becomes hard to handle them.
Adults would always have more complicated medical histories unlike children. Quite several ailments may have interconnectedness hence need for a thorough history taking. This comes with histories of allergies and coming with a cocktail of different kinds of medications unlike pediatrics who have fewer or even none. Pediatrics while on care would always crash very easily because they have less reserves and can compensate normal vitals for extended periods before a sudden decline.
Pediatrics won’t talk and this then calls for thorough and keen assessment skills and reliance on intuition. Children would always code starting with respiratory arrest unlike adults who in most cases start with cardiac arrest. Its easier discussing living will and medical decisions with an adult patient unlike in pediatrics where you discuss with the parents who are legally responsible. This can cause ethical dilemmas for nurses at times if a child disagrees with the treatment the guardian consents to.
References.
How are Children Different from Adults? | CDC (2019) retrieved from
https://www.cdc.gov/childrenindisasters/differences.html
Falkner, A. (2018) Health Assessment: Foundations for Effective Practice retrieved from
https://www.gcumedia.com/digital-resources/grand-canyon-university/2018/health-assessment_foundations-for-effective-practice_1e.php
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2 Comments References And Citation Each One 150 Words
/in Uncategorized /by developerComment (1) 150 words references and citation
Health Issues of Middle Age that Exercise can Prevent
Prevalence of the Problem in the US
Health promotion measures you would introduce/ physical exercise you would suggest/ Approach to gain cooperation
Obesity- Obesity is defined by the CDC as having a body mass index of 30 or more. Those with a body mass index of 25.0 to <30 are considered overweight and at-risk for obesity (CDC, 2019).
42.8% of middle-aged adults in the U.S. are obese.
For patients who are already obese, the likelihood that they are getting enough physical activity is low. When developing a health promotion plan, the nurse should include the patient in formulating that plan. Activities should be based upon patient’s current level of fitness. It is not realistic that someone who is already obese would be able to go out and run a mile every day. The Physical Activity Guidelines for Americans recommends starting with low expectations and slowly increasing physical activity as tolerance is built (Department of Health and Human Services, 2018). Activities such as swimming, biking, walking, playing sports and even gardening are good ways to start. If someone’s current health state or physical fitness does not allow for much exercise, it is important to remind them that any activity is better than none. They can start as low as they need to, once their small goals are attained, they move on to bigger ones. They should continue doing this until they can meet the recommendations for physical activity. 150 minutes per week of moderate-intensity aerobic activity is the recommended amount of physical activity for adults (CDC, 2020). Moderate-intensity aerobic activity is any activity that causes an increase in heart rate. Allowing for patient to slowly increase activity over time is a good approach to increase their cooperation.
Diabetes Mellitus Type II- Diabetes is a chronic disease in which your body either does not produce enough insulin which is Type I, or your body’s cells have become resistant to insulin which is Type II. The most common form of Diabetes is Type II. 90-95% of Diabetics are Type II (CDC, 2019).
9.4% of people in the U.S. have Diabetes, 33.9% have prediabetes.
One of the leading risk factors for Type II Diabetes is Obesity. Given that, recommendations the nurse should make for activity to prevent Diabetes Type II are the same as those to someone who is obese. One difference would be the education needed regarding blood sugars. Patient’s with diabetes need to be educated on the effects exercise can have on blood sugar levels and the need to monitor levels more closely when increasing activity levels in order to prevent hypoglycemic episodes. This is extremely important if the patient is utilizing insulin. They may need to plan to exercise during specific times of day depending on how it effects their blood sugar levels (Colberg, 2008).
References
Centers for Disease Control (CDC). (2019, December 23). Diabetes. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/diabetes/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fdiabetes%2Findex.htm
Centers for Disease Control and Prevention (CDC). (2019, November 21). Overweight and Obesity. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/obesity/index.html
Centers for Disease Control and Prevention (CDC). (2020, January 9). Physical Activity. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/physicalactivity/basics/adults/index.htm
Colberg, S. (2008, December 30). Timing of Exercise and Your Insulin Levels. Retrieved from Diabetes in Control: http://www.diabetesincontrol.com/timing-of-exercise-and-your-insulin-levels/
Department of Health and Human Services. (2018). Physical Activity Guidelines for Americans. Retrieved from Department of Health and Human Services: https://health.gov/paguidelines/second-edition/pdf/Physical_Activity_Guidelines_2nd_edition.pdf
comment (2) 150 words references citation
Health Issues of Middle Age that Exercise can Prevent
Prevalence of the Problem in the US
Health promotion measures you would introduce/ physical exercise you would suggest/ Approach to gain cooperation
Type 2 Diabetes Diabetes have increased as well. In 2017, the CDC reported that more than 100 million Americans have diabetes (CDC, 2017d).
Type 2 diabetes can be reversed with weight loss and diet modification.
Develop a healthy eating and activity plan
Drinking more water and fewer sugary drinks
Eating more fruits and vegetables
Making favorite foods healthier
Making physical activity more fun
Hypertension (HTN)Per centre of disease control the prevalence of hypertension has been increased in middle age from 18 to 39 from 7.2% to 33.2%, also the report says that 74 millian people is suffering from hypertension (2020), it is overall 54% that means 1 out of 3 adult does hav HTN
For health promotion and prevention of hypertension i will suggesst my patient that High blood pressure increases your risk for heart disease and stroke, two leading causes of death in the United States. No matter your age, you can take steps each day to keep your blood pressure in a healthy range.
By living a healthy lifestyle, you can help keep your blood pressure in a healthy range and lower your risk for heart disease and stroke. A healthy lifestyle includes:
Eating a healthy diet.
Maintaining a healthy weight.
Getting enough physical activity.
Not smoking.
Limiting alcohol use.
As an example of health eating habit considers prevent salt on top of the food, try to follow ‘ B ‘ diet that mean baked, boiled, broiled, Also help to eucatate the patient by adding green vegetable, fruit, fibers,in regular basis
we sould encourage patients to maintain healthy weight by having a healthy choice in eating, early habits of eating, avoid junk food, soda, sweets, oily food.
I would also introduce to manage or prevent HTN is 30-60 minutes of aerobic activity, specifically a brisk walk, 3-4 times a week with a long-term goal of 60 minutes, four time a week.start going to the gym do cardio exercise, running.
quit smoking is also very healpfull in decreasing hypertension rate
Referance
Centers for Disease Control and Prevention. (2017d). New CDC report: More than 100 million Americans have diabetes or prediabetes. Retrieved from https://www.cdc.gov/media/releases/2017/p0718-diabetes-report.html
center of disease contro and prevention(october 2018) nach data
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2 Db Family Practicum
/in Uncategorized /by developerThe U.S. Department of Health & Human Services released a comprehensive Clinical Practice Guideline for Treating Tobacco Use and Dependence–2008 Update
https://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/tobacco/clinicians/update/index.html
The goal of these recommendations is that clinicians strongly recommend the use of effective tobacco dependence counseling and medication treatments to their patients who use tobacco, and that health systems, insurers, and purchasers assist clinicians in making such effective treatments available.
After reading these recommendations answer the following questions.
1. what are the clinical interventions for patients unwilling to quit cigarette smoking?
2. According to the best practices what are the best strategies to help your clients quit smoking?
3. are there any specific smoking cessation recommendations for especial populations such as teenagers or the elderly?
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