The field of long-term care has gone through and is still experiencing, a time of great change. It has been, as such times tend to be, both trying and exciting. It has presented challenges to providers, consumers, payers, and regulators alike. Some of these challenges have been met, at least in part. Others have not. The desire of consumers to receive care in the most appropriate setting and the desire for a high quality of life have led to development of more and better alternative services such as hospice and adult day care. They have also stimulated more home- and community-based care. This has improved access to care for many.

Reference

Pratt, J. R. (2010). Long-term care: Managing across the continuum (3rd ed.). Sudbury, MA: Jones and Bartlett

1. What are the major challenges that have faced the long-term care system in recent years?
2. What are the most likely ethical challenges to be faced in the near future?

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Provide a critique Kristen Swanson’s Theory of Caring, making sure to identify benefits, consequences and feasibility of application in clinical practice as a family nurse practitioner. Provide evidence using 2 (two) scholarly articles in order to support your critique.

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In clinical settings, advanced practice nurses often encounter patients with blood disorders such as anemia. Consider the case of a 17-year-old girl who is rushed to the emergency room after suddenly fainting. The girl’s mother reports that her daughter has had difficulty concentrating for the past week, frequently becomes dizzy, and has not been eating normally due to digestion problems. The mother also informs the nurse that their family has a history of anemia. With the family history of anemia, it appears that this is the likely diagnosis. However, in order to properly diagnose and treat the patient, not only must her symptoms and family history be considered, but also factors such as gender, ethnicity, age, and behavior. This poses the question: How do patient factors impact the incidence and prevalence of different types of anemia?

To Prepare

• Review Chapter 21 in the Huether and McCance text. Reflect on the pathophysiological mechanisms of iron deficiency anemia.
• Select one of the following types of anemia: pernicious anemia, folate deficiency anemia, sideroblastic anemia, chronic inflammation anemia, or post-hemorrhagic anemia. Identify the pathophysiological mechanisms of the anemia you selected.
• Consider the similarities and differences between iron deficiency anemia and the type of anemia you selected.
• Reflect on how patient factors such as genetics, gender, ethnicity, age, and behavior might impact these anemic disorders.

Post an explanation of the pathophysiological mechanisms of iron deficiency anemia and the anemia you selected. Compare these two types of anemia, as well as their potential causes. Finally, explain how genetics, gender, ethnicity, age, and behavior might impact the anemic disorders you selected.

4 references

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APRNs are licensed registered nurses who have earned a graduate degree at the master’s or doctorate level and achieved national advanced practice certification for their specific practice area. The APRN designation includes Nurse Practitioners, Certified Registered Nurse Anesthetists, Certified Nurse Midwives, Psychiatric Certified Nurse Practitioners and Clinical Nurse Specialists. Florida law requires APRNs to practice within a collaboration protocol with a physician or dentist.

        State laws regulating nurse practitioners in Florida are among the strictest in the nation. Florida law requires that nurse practitioners are supervised by physicians. While the supervising physician does not need to be available to the NP in person he/she must be available by phone for consultation. State law also requires that patients be notified when the physician will and will not be present in the clinic.  (Practitioners, 2015). These hours must be conspicuously posted in each office staffed by nurse practitioners and supervised by a physician so patients are aware when the MD will be on site.  There is no minimum amount of time the physician must be present in the clinic, they must simply alert patients if the supervising MD is off site. Rules for specialty clinics are even stricter in Florida.  Physicians in specialty practice may supervise nurse practitioners at only one location in addition to their primary practice and these clinics must be no more than 75 miles apart. Rules for specialty clinics are even stricter in Florida.  Physicians in specialty practice may supervise nurse practitioners at only one location in addition to their primary practice and these clinics must be no more than 75 miles apart.

        APRNs are proven to provide effective and high-quality patient care. A review of studies published over the past 18 years demonstrate comparable performance between nurse practitioners and primary care physicians on clinical outcomes, including reduction of symptoms and overall health improvement. Patients seen by nurse practitioners also report higher rates of satisfaction. In addition, APRNs are more readily recruited to states that authorize full practice. Full scope of practice regulation is associated with a higher supply of nurse practitioners in rural areas and counties facing health-professional shortages. (Practitioners, 2015)

References

Practitioners, A. A. (2015, October 09). Scope of Practice for Nurse Practitioners . Retrieved from AANP American Association of Nurse Practitioners: https://www.aanp.org/advocacy/advocacy-resource/position-statements/scope-of-practice-for-nurse-practitioners

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Answer to this discussion post with a minimum of 200 words. cited and references, APA style. 

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Screening is an essential step as it helps clinical officers in the diagnosis of diseases. It helps to identify the cause of specific symptoms that a patient has. It is also helpful in the early detection and diagnosis of a disease, and therefore, it can be treated early. Many screening tools are normally used as the most important being population and risk assessment. When it comes to these two variables, the USPSTF recommends that the when it is screening for the women to check if they may be having diseases such as cancers, the care providers should screen all the population that have family members with that type of cancer. The example given is the case of breast cancer. In this case the whole population that is all women related to the one having breast cancer, ovarian, peritoneal or even tubal cancer should be screened. The screening should use one of the several tools that are designed for screening. This is aimed at ensuring that the increased risk of harmful mutation in breast cancer susceptibility genes is identified. The genes in question in this question are BRCA1 and BRCA2. Upon the screening, women with positive screening results should be given proper counselling on genetics in the event they are indeed confirmed to test positive for BRCA. 

Moreover, it is also essential to assess the risks that might be associated with certain diseases or disorders. This is important because it helps to create awareness on the risks and to identify who is more at risk of contracting it (Moyer, 2014). Thus, the people who are more at risk can take necessary caution and care to manage the risk. For example, according to the guide to preventive services 2014, older people, African Americans, and people with a family history of glaucoma are more at risk of having glaucoma. Therefore, they should be screened regularly (Force, 2014).

References:

Force, U. P. T. (2014). Guide to clinical preventive services. Available from https://www.ahrq.gov/sites/default/files/publications/files/cpsguide.pdf  [accessed on 14/6/2019]

Moyer, V. A. (2014). Screening for lung cancer: US Preventive Services Task Force recommendation statement. Annals of internal medicine, 160(5), 330-338.

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