Respond to this post with a positive response :

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

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

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

Validate an idea with your own experience and additional research.

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

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

Use  references

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The behavioral risk factor that I selected from the Healthy People 2020 objectives is overweight and obesity among children and adolescents (ages 6 through 19), which has increased significantly over the last three decades (Knickman & Kovner, 2015). Currently, only 36% of Floridians are at healthy weight, and if we stay on our current trend, by 2030, almost 60% will be obese (Florida Health, 2017). Additionally, six out of ten children born today will be obese by the time they graduate from high school (Florida Health, 2017). Five areas in which reform is critically needed in order to prevent obesity are creating safe environments for physical activity, healthy food and beverage choices, message environments, and health care, work and school environments (Knickman & Kovner, 2015). The population-based intervention model describes downstream, midstream and upstream interventions for preventing overweight and obesity among children and adolescents (Knickman & Kovner, 2015).

A downstream health prevention program focuses on changing behaviors at an individual level, rather than preventing risk behaviors (Knickman & Kovner, 2015). Given parents’ influence and control over their children’s diet, physical activity, media use, and sleep, family interventions are a key strategy in the effort to eliminate childhood obesity (Ash, Agaronov, Young, Aftosmes-Tobio & Davison, 2017). An example of a downstream intervention that would be effective is to provide a hand-out for parents and children through the school with helpful tips on reducing screen time, suggestions for healthy food swaps (having an apple instead of chips after school) and suggestions for easy ways to incorporate exercise into your day, such as go for a walk as a family for 20-30 minutes after school each day.

A midstream health prevention program focuses on changing behaviors at a community level, with health promotion programs that are targeted at populations to change or prevent risk factors (Knickman & Kovner, 2015). An example of a midstream intervention that would be effective is to provide school-based sports and physical activity to children each day. Two main individual behavior determinants of health are diet and physical activity (ODPHP, 2018). The school would provide coaches and equipment for children to participate in sports who may not have the ability to otherwise in their home environment.

An upstream health prevention program focuses on developing policies at state and national levels in order to reduce the promotion of unhealthy products and behaviors (Knickman & Kovner, 2015). An example of an effective upstream intervention is the great efforts made in the public-school system to improve the quality of food provided in school lunches, and to eliminate the availability of junk-food to kids. In April 2014, the US Department of Agriculture (USDA) issued new regulations, which took effect in July 2014, banning the sale of all junk-food in schools (Ballaro & Griswold, 2018). The regulations stated that only fruits, vegetables, dairy products, lean-protein foods, and whole-grain items could be sold in cafeterias or vending machines, limiting the maximum calorie count of 200 for snacks and 350 for entrées (Ballaro & Griswold, 2018). Foods containing trans-fats could not be sold, and drinks could contain no more than 35% sugar or fat, and must be limited to water, low- or no-fat milk, and 100% fruit or vegetable juice (Ballaro & Griswold, 2018).

References

Ash, T., Agaronov, A., Young, T., Aftosmes-Tobio, A., & Davison, K. (2017). Family-based childhood obesity prevention interventions: a systematic review and quantitative content analysis. International Journal of Behavioral Nutrition & Physical Activity, 14(1), 1-12. doi:10.1186/s12966-017-0571-2

Ballaro, B., & Griswold, A. (2018). Junk food in schools. Salem Press Encyclopedia. Retrieved from https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ers&AN=89158234&site=eds-live&scope=site

Florida Health. (2017). Healthy weight. Retrieved from http://www.floridahealth.gov/programs-and-services/prevention/healthy-weight/index.html

Knickman, J. R., & Kovner, A. R. (Eds.). (2015). Health care delivery in the united states (11th ed.). New York, NY: Springer Publishing.

Office of Disease Prevention and Health Promotion. (2018). Determinants of health. Retrieved from https://www.healthypeople.gov/2020/about/foundation-health-measures/Determinants-of-Health

 

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Respond to at least two of your colleagues on two different days by sharing ideas for how shortcomings discovered in their evaluations and/or their examples of incivility could have been managed more effectively.

                                                   

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Workplace civility is linked to organizational excellence and creates an environment where employees respect and value one another through cooperation, fair resolution of disputes, teamwork, and non-discriminatory behavior (Department of Veteran Affairs, 2017). Organizational leaders and managers must create an environment that is respectful and inclusive of all people (Clark, 2015; Marshall & Broome, 2017).

Work Environment Assessment

According to the Clark Healthy Workplace Inventory results, my organization is a moderately healthy environment. Why my workplace is civil? The VA understands that civility is a significant determinant not only to employee outcomes ( job satisfaction, stress levels) but also to higher level outcomes directly connected to the organizational mission (quality of patient care, operational costs, ability to retain quality workforce ). The organization continues to create a healthy work environment and measures civility annually through the All Employee Survey (Department of Veteran Affairs, 2017).

Incidence of Incivility

A physician assistant (PA) ordered Versed, and  I was not comfortable giving this medication to my patient. I asked him to explain his rationale for ordering the medication because I knew this drug was not part of the ACLS chest pain protocol and although in pain morphine was the better drug of choice.  The PA pretending to understood my concern and contacted his pharmacist friend who works in our department, but was off duty. The pharmacist became enraged and began to text me with vulgar language and statements, feeling under attack, I  stood up for myself told the pharmacist and the PA I would not be bullied into unsafe practice, and it was my responsibility to advocate appropriately. I shared the messages with the supervising physician, management, and union representative. The pharmacist and PA both issued a formal apology and suspended for two weeks.

Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10(11), 18–23. Retrieved from https://www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdf

Department of Veteran Affairs. (2017). Civility, respect, and engagement in the workplace (crew). Retrieved from https://www.va.gov/ncod/crew.asp

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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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.

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

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

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

Validate an idea with your own experience and additional research.

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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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Read 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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