Respond to at least two of your colleagues who selected a different factor than you, in one of the following ways:

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

Share insights based on your own experience and additional research.

                                                       Main post

Cardiovascular Alterations

It is essential to understand the typical structure and function of the cardiovascular system because alterations occur. Some changes can be pathologic and others not. Alhadheri (2005) states that 50 to 90 percent of children have a benign or functional murmur. In this post, I will explain how I would diagnose and prescribe treatment for the patient in the scenario, including how genetics impacts the diagnosis and treatment.

Diagnosis and Treatment

Making a proper diagnosis is necessary before allowing the teenager to engage in sports. The patient had no significant family history of cardiac death and an unremarkable medical history. The lack of patient medical history leads me to conclude that the problem is not acquired, but congenital. The physical assessment is not enough information to definitively determine the etiology of the murmur. It would be wise to run additional tests to rule out a pathological murmur. Appropriate tests include a chest x-ray, electrocardiogram, blood work, and echocardiogram (Alhadheri, 2005). The patient is asymptomatic, so I would order an echocardiogram looking for structural abnormalities. I suspect that the patient has mitral regurgitation based on the location and description of the sound in the scenario. Hammer and McPhee (2019) state that a murmur can be heard best at the apex of the heart with mitral regurgitation. Another possibility is coarctation of the aorta, but this is unlikely because the patient does not have diminished blood pressure nor pulses in the lower extremities. If mitral regurgitation is the case, the treatment may be surgical intervention. Either way, I would refer the patient for treatment to a pediatric cardiologist knowing that it is outside of my scope. A registered nurse practitioner is required to make a referral to a physician for a patient condition that is beyond their knowledge or experience (Arizona State Board of Nursing, 2018, p. 46).

Genetics

Genetics could impact the diagnosis. There is a high incidence of congenital heart defects with trisomies 13 and 18, Turner syndrome, and Down syndrome (Huether & McCance, 2017). The diagnosis could be a ventricular septal defect instead. However, I do not think the treatment would change if genetics were a factor. Usually, surgery is the intervention when the problem is pathological regardless of origin. 

References

Alhadheri, S. A. (2005). Children with Heart Murmurs…When to be Concerned?. Retrieved from https://apcardio.com/wp-content/themes/advancedpedia/pdf/Heart_Murmurs.pdf

Arizona State Board of Nursing. (2018, May 23). Rules of the State Board of Nursing. Retrieved June 24, 2019, from https://www.azbn.gov/media/2880/ruleseffectivemay232018.pdf

Hammer, G. D., & McPhee, S. J. (2019). Pathophysiology of disease: An introduction to clinical medicine (8th ed.). New York, NY: McGraw-Hill Education.

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

Reply Quote Email Author 

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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

EXAMPLE OF A REFERENCE:

If you cannot locate a doi number, this is how the reference should look: 

Quelly, S. B. (2017). Characteristics Associated with School Nurse Childhood Obesity Prevention Practices. Pediatric Nursing, 43(4). Retrieved from https://www.pediatricnursing.net/issues/17julaug/abstr5.html

                                                     MAIN POST

                               Scholarly Writing and Plagiarism

Learning is a journey and not a destination. A part of this journey was to use Grammarly and SafeAssign. I will discuss my experience with those two platforms as well as my perception of paraphrasing and plagiarism. The internet is full of resources, so I will be sharing an online resource that supports scholarly writing. Finally, I will share two American Psychological Association (APA) formatting rules that I believe are useful for academic writers.

 I have never used Grammarly before, but I like that I can check grammar in real time. I did not know such a tool was in existence and I will be using Grammarly for all my assignments going forward before sending. However, SafeAssign is not a new tool for me. When I went to Western Governors University, I used TurnItIn, which is similar to SafeAssign. It checks how much of your paper matches other known scholarly works. I wrote a sample paragraph with SafeAssign, and it was a 0% match. I like to see my works matching at 5% or less as a matter of philosophy. It is easy to avoid plagiarism if two things are remembered. Use thoughts that originate from your cranium and cite works according to APA rules and Walden University requirements. During this process, my insight was learning how to paraphrase better. Walden University (2012) states that paraphrasing is beyond simply rearranging a sentence and choosing synonyms. I realized paraphrasing is about turning the whole idea into your own words and then citing the author.

Scholarly writing is a term that can be confusing for many students. I had no idea what it meant until I researched the topic. According to Jackson State University (2015), scholarly writing is structured and seeks feedback from the audience. It would seem that this is the purpose of using discussion boards in an online learning environment. I believe that this online resource is useful, and I plan on adding it as a bookmark as a reminder of the essentials of scholarly writing.

As previously mentioned, proper APA style and formatting is essential in scholarly writing. A rule that I was not versed in was related to in-text citations with more than five authors. The APA Manual states, “when a work has six or more authors, cite only the surname of the first author followed by et al” (American Psychological Association, 2010, p. 175). Also, I did not know that the following rule existed. According to the American Psychological Association (2010, p. 170), presenting your existing work as new when it is not is the definition of self-plagiarism. I found this to be an interesting rule that I had not considered before and will make sure I never do.

                                             References

American Psychological Association. (2010). Publication Manual of the American Psychological Association (6th ed.). Washington, DC: American Psychological Association.

Jackson State University. (2015). What Is “Scholarly Writing”? Retrieved from http://www.jsums.edu/wrightcenter/2015/04/29/what-is-scholarly-writing/

Walden University. (2012). Walden University: Proofreading and revising. Retrieved from http://writingcenter.waldenu.edu/872.htm

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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

EXAMPLE OF A REFERENCE:

If you cannot locate a doi number, this is how the reference should look: 

Quelly, S. B. (2017). Characteristics Associated with School Nurse Childhood Obesity Prevention Practices. Pediatric Nursing, 43(4). Retrieved from https://www.pediatricnursing.net/issues/17julaug/abstr5.html

                                             MAIN POST

Scholarly Writing and Plagiarism

                Learning is a journey and not a destination. A part of this journey was to use Grammarly and SafeAssign. I will discuss my experience with those two platforms as well as my perception of paraphrasing and plagiarism. The internet is full of resources, so I will be sharing an online resource that supports scholarly writing. Finally, I will share two American Psychological Association (APA) formatting rules that I believe are useful for academic writers.

                I have never used Grammarly before, but I like that I can check grammar in real time. I did not know such a tool was in existence and I will be using Grammarly for all my assignments going forward before sending. However, SafeAssign is not a new tool for me. When I went to Western Governors University, I used TurnItIn, which is similar to SafeAssign. It checks how much of your paper matches other known scholarly works. I wrote a sample paragraph with SafeAssign, and it was a 0% match. I like to see my works matching at 5% or less as a matter of philosophy. It is easy to avoid plagiarism if two things are remembered. Use thoughts that originate from your cranium and cite works according to APA rules and Walden University requirements. During this process, my insight was learning how to paraphrase better. Walden University (2012) states that paraphrasing is beyond simply rearranging a sentence and choosing synonyms. I realized paraphrasing is about turning the whole idea into your own words and then citing the author.

                Scholarly writing is a term that can be confusing for many students. I had no idea what it meant until I researched the topic. According to Jackson State University (2015), scholarly writing is structured and seeks feedback from the audience. It would seem that this is the purpose of using discussion boards in an online learning environment. I believe that this online resource is useful, and I plan on adding it as a bookmark as a reminder of the essentials of scholarly writing.

                As previously mentioned, proper APA style and formatting is essential in scholarly writing. A rule that I was not versed in was related to in-text citations with more than five authors. The APA Manual states, “when a work has six or more authors, cite only the surname of the first author followed by et al” (American Psychological Association, 2010, p. 175). Also, I did not know that the following rule existed. According to the American Psychological Association (2010, p. 170), presenting your existing work as new when it is not is the definition of self-plagiarism. I found this to be an interesting rule that I had not considered before and will make sure I never do.

References

American Psychological Association. (2010). Publication Manual of the American Psychological Association (6th ed.). Washington, DC: American Psychological Association.

Jackson State University. (2015). What Is “Scholarly Writing”? Retrieved from http://www.jsums.edu/wrightcenter/2015/04/29/what-is-scholarly-writing/

Walden University. (2012). Walden University: Proofreading and revising. Retrieved from http://writingcenter.waldenu.edu/872.htm

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Respond  in one or more of the following ways:

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.

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

                                                              Main Post

When conducting research, it is necessary that the researcher not only know how to find the sources needed to answer the question that they have created but also how to analyze that information to understand which research design was used. Doing so will allow the researcher to provide the evidence needed to support or reject the question being asked. Quantitative research is the investigation of phenomena that lends themselves to precise measurement and quantification, often involving a controlled design (Polit & Beck, 2017). This discussion will look at two different quantitative studies and the qualities that make them so. 

Sleep Apnea Study Number One

 This study by Boulos et al.(2017) looks at the effectiveness of using home sleep apnea testing (HSAT) as a means of detecting obstructive sleep apnea (OSA)  in stroke or transient ischemic attack (TIA) inpatients and outpatients. OSA can negatively impact poststroke functional recovery and by using HSAT these patients can be screened and diagnosed for OSA sooner and improve their poststroke functional and motor recovery (Boulos et al., 2017).

The question being asked is therapeutic in nature. The design of the study is listed under the methods section as a single-center prospective observational study. An observational study means that the researchers do not intervene by manipulating the independent variable  (Polit & Beck, 2017). The independent variable within this study would be that all participants have had a stroke or TIA. Prospective designs are studies that begin with a presumed cause and look forward in time for its effect (Polit & Beck, 2017). Within this study, OSA was the presumed cause in a delay of functional and motor recovery for those patients who suffered a stroke or TIA. This design method was appropriate for the group being used. A control group would not have helped to validate the use of HSAT in stroke recovery since those within that group would not be suffering from the same effects. The use of t-tests, Wilcoxon rank sum-test, and multivariate logistic regression were used to analyze the data (Boulos et al., 2017). The results demonstrated that the use of HSAT in the poststroke or TIA population was effective at expediting the diagnosis and treatment of OSA (Boulos et al., 2017). 

Sleep Apnea Study Number Two

The second study is similar to the first in that it evaluated patients with acute ischemic stroke for the prevalence of sleep apnea and compared the functional outcomes of patients with and without sleep apnea at the 3rd month after an acute ischemic stroke (Nair et al., 2019). The type of question being asked is an etiology in that it looks to see if OSA is a risk factor for stroke. The design of the study is under the methodology section and is listed as a prospective observational study. This type of study is also known as a cohort design and as stated by Polit & Beck (2017), it is the strongest design for etiology questions when randomization is impossible. This method study is appropriate in that no manipulation was done to the independent variable (stroke). Randomization would not be appropriate for this particular study as the only treatment option would be the use of Continuous Positive Airway Pressure (CPAP) and the use of such treatment was not evaluated.

Questionnaires such as the sleep disordered Questionnaire, Berlin Questionnaire, and Epworth sleepiness scale were used to diagnose sleep apnea in the patients being evaluated and the results divided the group into those who had sleep apnea and those who did not. The two groups were then compared using Barthel scores at baseline and at 3 months. Using repeated measure of ANOVA, the results showed a significant difference with an improved functional gain in patients in the no sleep apnea group demonstrating that sleep apnea is associated with an increased risk of ischemic stroke and poor functional outcome (Nair et al., 2019).  

Conclusion

  For researchers, understanding which design method to use when creating a research study can be a great asset to promoting the change that they wish to bring about. Utilizing the wrong research design may diminish the quality of the results and may create doubt about the study overall. Understanding that quantitative studies aim to explain cause-and-effect relationships will help to guide the researcher to design their research to demonstrate causality and bring attention to the problem that they are determined to address (Polit & Beck, 2017).

References

Boulos, M. I., Elias, S., Wan, A., Im, J., Frankul, F., Atalla, M., … Murray, B. J. (2017). 

Unattended Hospital and Home Sleep Apnea Testing Following Cerebrovascular Events. Journal of Stroke & Cerebrovascular Diseases, 26(1), 143–149. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jstrokecerebrovasdis.2016.09.001

Nair, R., Radhakrishnan, K., Chatterjee, A., Gorthi, S. P., & Prabhu, V. A. (2019). Sleep 

Apnea-Predictor of Functional Outcome in Acute Ischemic Stroke. Journal of Stroke & Cerebrovascular Diseases, 28(3), 807–814. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jstrokecerebrovasdis.2018.11.030

Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for 

nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.

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Respond  on 2 different days who were assigned different case studies than you. Analyze the possible conditions from your colleagues’ differential diagnoses. Determine which of the conditions you would reject and why. Identify the most likely condition, and justify your reasoning.

                                            Main Post

Knee Pain SOAP Note  

Patient Information:SJ, 15-year-old WM

S.

CC– Pain in both knees.

HPI: 15-year-old white male presents with pain in bilateral knees.  Pain onset was 1 week ago after football practice.  Pain is described as “dull”.  Associated s/s include clicking in one or both knees and a catching sensation under the patella. SJ describes pain as dull and constant, pain rated at 3 on a scale of 0-10. Pain is exacerbated by movement and relieved by rest.  

Current Medications: No medications, no OTC medications or vitamins.

Allergies: seasonal allergies only

PMHx: Immunizations current, flu shot received from PCP 10/5/19.  No previous injuries, hospitalizations, or surgeries.

Soc Hx: 10th grade student, on high school football team (offensive lineman), has played football since age 6.  Denies alcohol use, denies tobacco use, Denies use of illicit drugs.  Honor student, popular in school with many friends. Lives at home with dad and two younger sisters.  Mom is active duty/deployed currently.  Currently learning to drive in driver’s education at school.

Fam Hx: No significant medical history in parents. Maternal grandmother died at 80 of lung cancer, grandfather at 81 of MI.  Paternal grandmother has osteoarthritis, grandfather has DM.  

ROS: GENERAL:  Denies weight loss, fever, chills, weakness or fatigue.

HEENT:  Head: denies headache, 

Eyes: Denies visual loss, blurred vision, or double vision, denies hearing loss, nasal dysfunction or sore throat.

SKIN:  denies rash or puritis.

CARDIOVASCULAR:  Denies chest pain, chest pressure or chest discomfort. Denies palpitations or edema.

RESPIRATORY:  Denies shortness of breath, cough or sputum.

NEUROLOGICAL:  Denies headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. Denies change in bowel or bladder control.

MUSCULOSKELETAL:  Knee pain, with clicking and catching sensation under the patella. Denies back pain, stiffness.

HEMATOLOGIC:  Denies anemia, bleeding or bruising.PSYCHIATRIC:  Denies depression or anxiety.

ALLERGIES:  Denies food or drug allergies, allergy to pollen.

O.

VS: BP 123/68; P 89; RR 18; T 97.6; O2 98%; Wt 179; BMI 25.68

General– AOx4. Pt appears healthy and well nourished, athletic build.  Well groomed, no acute distress noted.

Cardiovascular- Regular rate/rhythm. S1/S2 heard, no murmurs, gallops, or rubs noted.   

Respiratory– RR even and unlabored. Clear to auscultation bilaterally with no wheezing, rales, rhonchi, or crackles.

Musculoskeletal- joint stability normal in upper extremities, no tenderness to palpation.  Lower bilateral popliteal tenderness upon palpation, Rt quadricep angle 18 degrees, Lt quadricep angle 20 degrees.  Bilateral inflammation present in the distal extensors.

Diagnostic results: CBC: WBC-5.9 Hgb- 16.1  Hct- 49 Platelet count- 210, X-ray McMurry test negative, Lachman test negative, MRI- negative for meniscus tear, negative for ACL tear, negative for CP.

A.Patellar tendinitis- This overuse syndrome is characterized by inflammation in the distal extensors of the knee joint (Dains, Baumann, & Scheibel, 2019). Patellar tendinitis is more common in athletes who habitually place excessive strain on their knees from jumping or running (Dains, Baumann, & Scheibel, 2019). Determine the quadriceps angle by measuring the angle between the center of the patella to the anterior superior iliac spine and from the center patella to the tibial tubercle (Dains, Baumann, & Scheibel, 2019). An angle greater than 10 degrees in males and 15 degrees in females suggests patellar tendinitis (Dains, Baumann, & Scheibel, 2019). People affected complain of dull, achy knee pain that may have associated clicking or popping (Dains, Baumann, & Scheibel, 2019).

Medial meniscus tear- clinically examined with McMurray’s test and joint line tenderness for clinical diagnosis of medial meniscus tear (Gupta, Mahara & Lamichhane, 2016). The presence of pain and/or click/snap/clunk/thud was considered positive for the McMurray’s test. Joint line tenderness was tested in 90 degree of knee flexion (Gupta, Mahara & Lamichhane, 2016).Anterior cruciate ligament tear- Patients with ACL tears typically present with acute injury, sometimes with an associated “pop,” a sensation of tearing, the immediate onset of effusion, or any combination thereof.  Better tests are the Lachman test and the pivot-shift test, which have reported respective sensitivities of 0.87 and 0.49 and specificities of 0.97 and 0.98 (Volker & Karlsson, 2019). The pivot-shift test is a dynamic test of the rotatory laxity of the knee that produces subluxation and reduction (felt as a “clunk”) of the lateral tibial plateau (Volker & Karlsson, 2019). Although plain radiography is often the first diagnostic step after the physical examination to rule out fracture, dislocation, or both, magnetic resonance imaging (MRI) is strongly recommended as part of the diagnostic evaluation, given its reported high sensitivity and specificity (97% and 100%, respectively) for the detection of ACL injury (Volker & Karlsson, 2019).

Acute leukemia- Leukemia is the most common cancer in children, and bone and joint pain is the most common presenting complaint (Dains, Baumann, & Scheibel, 2019). The bone pain is diffuse and nonspecific and may extend to adjacent joints (Dains, Baumann, & Scheibel, 2019). Laboratory findings may show the WBC count as elevated, depressed, or normal; severe anemia is common, as is a depressed platelet count (Dains, Baumann, & Scheibel, 2019). Radiographs of the limb at the distal end of the femur and the proximal end of the tibia show abnormal areas of radiolucency (Dains, Baumann, & Scheibel, 2019). 

Chondromalacia Patellae- Chondromalacia patellae (CP) represents a spectrum of abnormalities, including softening, swelling, fraying and erosion of the hyaline cartilage overlying the patellae and sclerosis of underlying bone (Harman et al., 2003). Patients with CP experience pain as the articular cartilage begins to degenerate and abnormal stresses are transferred from the elastic, shock-absorbing cartilage to the subchondral bone (Harman et al., 2003).  MRI, with its multiplanar capabilities, excellent soft tissue resolution and noninvasive nature, has been studied in the evaluation and staging of chondral lesion in the knee (Harman et al., 2003)

P. This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

                                              References

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care(6th ed.). St. Louis, MO: Elsevier Mosby. Gupta, Y., Mahara, D., & Lamichhane, A. (2016). McMurray’s Test and Joint Line Tenderness for Medial Meniscus Tear: Are They Accurate? Ethiopian Journal of Health Sciences, 26(6), 567–572. https://doi-org.ezp.waldenulibrary.org/10.4314/ejhs.v26i6.10Harman, M., Ipeksoy, U., Dogan, A., Arslan, H., & Etlik, O. (2003). MR arthrography in chondromalacia patellae diagnosis on a low-field open magnet system.Clinical Imaging, 27(3), 194-9. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1016/S0899-7071(02)00521-1 Volker, M., & Karlsson, J. (2019). Anterior cruciate ligament tear. The New England Journal of Medicine, 380(24), 2341-2348. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1056/NEJMcp1805931

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