This patient is most likely to have plaque psoriasis, the most common form of psoriasis in young adults, with the average age of onset in the early twenties (Dunphy, Winland-Brown, Porter, & Thomas, 2015).)
The risk factors for the development of psoriasis are family history. One-third of all patients with psoriasis have a relative with the disease, as in the case study above. When a parent is affected the children have a tendency for an early onset of the condition. Not only that but when both parents are affected the chance increases to forty-one percent of the children having the condition. This patient had an upper respiratory infection prior to the outbreak of the rash; this predisposes her for an outbreak of psoriasis. Even though there is a genetic disposition of the offspring of the parents having the disease, the exact genetic cause is unknown. Research is ongoing regarding the genetic and environmental influences on the cellular effects of the disease (Dunphy, Winland-Brown, Porter, & Thomas, 2015).
The diagnostic tests to order for this patient are a CBC with differential and serum chemistry profile, serum uric acid level, antinuclear antibody titer, and rheumatoid factor. The serum uric acid level may be elevated. Diagnostic procedures are the Psoriasis Area and Severity Index, which evaluates overall severity and BSA involvement, and the Dermatology Life Quality Index. The top three differentials are seborrheic dermatitis, nummular eczema, and atopic dermatitis (Dominic, Bolder, & Golding, 2019)
The goal of treatment for the condition of Psoriasis is to identify and avoid triggers. If the condition is mild to moderate keeping the skin hydrated with petrolatum ointments is helpful. Topical corticosteroids are also helpful initially in treating the disease and preventing skin atrophy. In the adult, initial therapy should be corticosteroids with varying potencies. These treatments should not be used longer than 4 weeks (Hendriks… et al, 2013).
Follow-ups should be done to measure the body surface area involvement and to see if the therapy is working. If the therapy is not working alternative treatments should be prescribed or the addition of another agent to treat the condition should be done. If the psoriasis is greater than twenty percent of the body surface area, or severe extremity involvement especially of the hands and feet develops, a referral is needed (Menter, Gottlieb, Feldman, Van Voorhees, Leonardi, Gordon, et al…2008).
References
Domino, F., Baldor, R. A., & Golding, J. (2019). The 5-minute clinical consult. (27th
Ed.). [Mobile application software.] Retrieved from http://itunes.apple.com
Dunphy, L.M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2015). Primary
care: the art and science of advanced practice nursing. (4th Ed.). Philadelphia, PA. F. A. Davis Company.
Hendriks, A. G., Keijsers, R. R., de Jong, e. M., Seyger, M. M., van de Kerkof, P. C.
(2013). Efficacy and safety of combinations of first-line topical treatments in chronic plaque psoriasis: a systematic literature review. J Eur Acad Dermatol Venereol. 27(8) 931-951. doi:10.1111/jdv.12058
Menter A, Gottlieb A, Feldman SR, Van Voorhees AS, Leonardi CL, Gordon KB,et al.
(2008). Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol. 58(5):826-50.
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Reply To Angela
/in Uncategorized /by developerThe World Health Organization (2012) developed a report on preterm birth rates and how to prevent them. Born to Soon: The Global Action Report on Preterm Birth includes rates and information from multiple countries and provides guidance and interventions on how to prevent preterm birth. Preconception and interconception times are critical to reducing preterm birth. Per WHO (2012, p 45-57) adolescents is a time that pre and interconception care be introduced, not only with intervention that helps to maintain health and nutrition, but to prevent pregnancy in adolescents.
Prevention of intimate partner violence, providing adequate mental health resources, maintaining chronic health conditions, reducing STI transmission and adequate treatment, reducing obesity, and stopping smoking, alcohol intake or elicit drugs are the other items that can increase preterm birth. Assessing for these should be done in the pre and interconception period to help ensure that a future pregnancy will not have complications (WHO, 2012. p 45-57).
Active family planning in relation to what the women’s goals are should be done as well. Having a woman make a cognizant decision or discussing family planning with women at their healthcare visits will make the issue of conception and health more accessible. WHO (2012, p 49) discussed optimal spacing of pregnancies. This would help to reduce physical and emotional stress that could cause preterm birth. Per WHO (2012, p 49) the optimal spacing between births is 18-24 months.
References
World Health Organization. (2012). Born to Soon: The Global Action Report on Preterm Birth. Retrieved from https://www.who.int/pmnch/media/news/2012/201204_borntoosoon-report.pdf
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Reply To Cathy Need 2 Current Apa Citations
/in Uncategorized /by developerThis patient is most likely to have plaque psoriasis, the most common form of psoriasis in young adults, with the average age of onset in the early twenties (Dunphy, Winland-Brown, Porter, & Thomas, 2015).)
The risk factors for the development of psoriasis are family history. One-third of all patients with psoriasis have a relative with the disease, as in the case study above. When a parent is affected the children have a tendency for an early onset of the condition. Not only that but when both parents are affected the chance increases to forty-one percent of the children having the condition. This patient had an upper respiratory infection prior to the outbreak of the rash; this predisposes her for an outbreak of psoriasis. Even though there is a genetic disposition of the offspring of the parents having the disease, the exact genetic cause is unknown. Research is ongoing regarding the genetic and environmental influences on the cellular effects of the disease (Dunphy, Winland-Brown, Porter, & Thomas, 2015).
The diagnostic tests to order for this patient are a CBC with differential and serum chemistry profile, serum uric acid level, antinuclear antibody titer, and rheumatoid factor. The serum uric acid level may be elevated. Diagnostic procedures are the Psoriasis Area and Severity Index, which evaluates overall severity and BSA involvement, and the Dermatology Life Quality Index. The top three differentials are seborrheic dermatitis, nummular eczema, and atopic dermatitis (Dominic, Bolder, & Golding, 2019)
The goal of treatment for the condition of Psoriasis is to identify and avoid triggers. If the condition is mild to moderate keeping the skin hydrated with petrolatum ointments is helpful. Topical corticosteroids are also helpful initially in treating the disease and preventing skin atrophy. In the adult, initial therapy should be corticosteroids with varying potencies. These treatments should not be used longer than 4 weeks (Hendriks… et al, 2013).
Follow-ups should be done to measure the body surface area involvement and to see if the therapy is working. If the therapy is not working alternative treatments should be prescribed or the addition of another agent to treat the condition should be done. If the psoriasis is greater than twenty percent of the body surface area, or severe extremity involvement especially of the hands and feet develops, a referral is needed (Menter, Gottlieb, Feldman, Van Voorhees, Leonardi, Gordon, et al…2008).
References
Domino, F., Baldor, R. A., & Golding, J. (2019). The 5-minute clinical consult. (27th
Ed.). [Mobile application software.] Retrieved from http://itunes.apple.com
Dunphy, L.M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2015). Primary
care: the art and science of advanced practice nursing. (4th Ed.). Philadelphia, PA. F. A. Davis Company.
Hendriks, A. G., Keijsers, R. R., de Jong, e. M., Seyger, M. M., van de Kerkof, P. C.
(2013). Efficacy and safety of combinations of first-line topical treatments in chronic plaque psoriasis: a systematic literature review. J Eur Acad Dermatol Venereol. 27(8) 931-951. doi:10.1111/jdv.12058
Menter A, Gottlieb A, Feldman SR, Van Voorhees AS, Leonardi CL, Gordon KB,et al.
(2008). Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol. 58(5):826-50.
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Reply To Cathy
/in Uncategorized /by developerDifferential Diagnosis for Cough
A differential diagnosis for chronic cough is gastroesophageal reflux disease (GERD). This is one of the most common causes of chronic cough in patients. Many respiratory organizations worldwide recommend the evaluation and treatment of GERD for the management of chronic cough (Kakhrilas, Smith, & Dicpinigaitis, 2014).
Presenting Symptoms
Patients normally present with heartburn, dysphagia, acid regurgitation, and an association of cough with a slouched posture. Reflux events that may trigger coughing are microaspiration of refluxate into the airways, extension of reflux into the larynx and pharynx (laryngopharyngeal reflux), or esophageal bronchial reflux (Kakhrilas, Smith & Dicpinigaitis, 2014).
Diagnostic Testing
A diagnostic test to confirm the diagnosis is an initial therapeutic trial of double-strength proton pump inhibitors (PPIs) for 8 weeks: This may require 8 weeks of double strength PPI therapy for alleviation of symptoms. This trial should not be stopped before 8 weeks and could take up to 3 months. Another test to consider is a 24-hour esophageal pH monitoring with a pH<4 that coincides with the chronic cough and is consistent with pathologic acid exposure. (Epocrates, 2019).
Treatments
Standard treatments for the cough associated with GERD are proton pump inhibitor for 8 weeks initially and can become an ongoing therapy. In addition, patients with GERD may benefit by avoiding alcohol, caffeine, nicotine, citrus, tomatoes, chocolate, and fatty foods (Domino, 2019).
References
Domino, F., Baldor, R. A., & Golding, J. (2019). The 5-minute clinical consult. (27th
Ed.). [Mobile application software.] Retrieved from http://itunes.apple.com (Links to an external site.)Links to an external site.
Epocrates. (2019). Epocrates plus. (Version 18.11). [Mobile application software].
Retrieved from http://itunes.apple.com (Links to an external site.)Links to an external site.
Kahrilas, P. J., Smith, J. A., & Dicpinigaitis, P. V. (2014). A causal relationship between
cough and gastro esophageal reflux disease (GERD) has been established: A Pro/Con debate. Lung, 192(1),
39-46. doi:http://dx.doi.org/10.1007/s00408-013-9528-7
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Reply To Discussion Board By Amanda
/in Uncategorized /by developerThe word metaphor I chose for this scenario is “actuality”, because a similar scenario likely unfolds in primary care offices around the country on a daily basis. During my most recent clinical rotation, it was expected that all providers schedule a patient every 15 minutes, and remain timely. This is common practice throughout primary care in the United States. Primary care institutions across the U.S strive to create value for their consumers (Budrevičiūtė et al, 2018), but at what cost? During my rotation, I struggled to identify what needs of the patient were most important to them. Often, I felt as though the patients could benefit from a little extra time with the provider.
As nurses, it is engrained in our being to put the patient first, and address all needs. Being a nurse practitioner does not change our inherent desire to fix all of our patient’s problems. However, this does set us aside from other providers such as MDs, DOs, and PAs. From the time we are in nursing school to now – we are taught to address the whole patient. So, how I would address this issue? I would prioritize the patient’s most pressing health-care needs. I would follow this patient on a regular basis, even weekly if needed to put him on the right track.
Budrevičiūtė, A., ⨯ Ramunė Kalėdienė, & Petrauskienė, J. (2018). Priorities in effective management of primary health care institutions in lithuania: Perspectives of managers of public and private primary health care institutions.PLoS One, 13(12) doi:http://dx.doi.org/10.1371/journal.pone.0209816
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Reply To Hollie Discussion
/in Uncategorized /by developerThe physical examination should include components that are relevant to the patient’s complaint and with the patient’s history in mind. Thyroid palpation and an abdominal assessment are appropriate for all individuals with complaints of painful menstruation. A pelvic examination and bimanual exam are appropriate tests for sexually active individuals (Osavande & Mehulic, 2014). Adolescents that are not sexually active with histories consistent with primary dysmenorrhea do not need to have a pelvic examination (Osavande & Mehulic, 2014). Laboratory tests may be used pending the relevance determined by the provider. Laboratory tests may include: pregnancy test, CBC, thyroid function tests, vaginal and endocervical swabs, erythrocyte sedimentation rate, and urinalysis (Osayande & Mehulic, 2014). Additional tests may be ordered as necessary.
Diagnosis and Differentials
Without more information, the initial diagnosis in this case would be unspecified dysmenorrhea (ICD-10: N94.6). Further information and evaluations may be needed to rule out secondary causes of dysmenorrhea, if clinical findings are suspicious for secondary dysmenorrhea. Differential diagnoses may be: primary dysmenorrhea, endometriosis, pelvic inflammatory disease, fibroids, or uterine cancer (Hackley & Kriebs, 2017).
Therapies
Pharmacological therapies for primary dysmenorrhea include NSAIDs or oral contraceptives (Osavande & Mehulic, 2014). Strong evidence supports the use of NSAIDs as the first line treatment for primary dysmenorrhea (Osavande & Mehulic, 2014). The choice of NSAID should be made on an individual basis, though over-the-counter ibuprofen, Aleve, or Midol are popular and effective choices (Osavande & Mehulic, 2014). The decision to use oral contraceptives should be made by the patient after thorough education and risks are explained to the patient.
The most effective non-pharmacological therapy used to treat primary dysmenorrhea is the topical application of heat (Osavande & Mehulic, 2014). Some dietary supplements, such as omega 3 fatty acids and B vitamins, have shown mixed effectiveness for controlling menstrual pain (Osavande & Mehulic, 2014). Lifestyle modifications can also assist in decreasing painful menstruation. Some evidence suggests low fat or vegetarian diets can decrease intensity and duration of menstrual cramps (Alsaleem, 2018). Obesity and smoking are other factors that can be modified to improve menstrual cramps, through weight loss and smoking cessation, respectfully (Hackley & Kriebs, 2017). Stress reduction techniques may also improve symptoms in stressed individuals (Osavande & Mehulic, 2014).
Follow-Up
If symptoms of primary dysmenorrhea improve with the pharmacological adjustments and non-pharmacological interventions, Osavande and Mehulic (2014) recommend continuing treatment and reassessing every six months. If symptoms are not relieved, the patient should return to the clinic for further evaluation after menstruation.
References
Alsaleem M. A. (2018). Dysmenorrhea, associated symptoms, and management among students at King Khalid University, Saudi Arabia: An exploratory study. Journal of Family Medicine and Primary Care, 7(4), 769-774. https://dx.doi.org/10.4103%2Fjfmpc.jfmpc_113_18
Hackley, B. & Kriebs, J. (2017). Primary care of women. Burlington, MA: Jones & Bartlett Learning.
Osayande, A. & Mehulic, S. (2014). Diagnosis and initial management of dysmenorrhea. American Family Physician, 89(5), 341-346. Retrieved from https://www.aafp.org/afp/2014/0301/p341.html
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Reply To Hollie
/in Uncategorized /by developerQuestion 1—Preconception Counseling
Preconception care has been around since the 1980s, however, a recent push across many nationally recognized professional practices, including the American Academy of Family Physicians (AAFP), has been occurring (AAFP, 2015). This is largely due to the high rate of infant mortality, premature births, birth defects, and maternal deaths in the United States (AAFP, 2015). Preconception care refers is defined as: “individualized care for men and women that is focused on reducing maternal and fetal morbidity and mortality, increasing the chances of conception when pregnancy is desired, and providing contraceptive counseling to help prevent unintended pregnancies” (AAFP, 2015, para. 1). The AAFP is pushing for family practice health care providers to play a larger role in preconception care to help improve the current statistics.
As a future family nurse practitioner, I do not anticipate seeing a large population of women seeking maternity care; however, as the AAFP points out, family practice providers are the most frequent providers of ambulatory primary care services to women aged 18 to 44 (AAFP, 2015). This puts family care providers in a prime position to do the majority of the preconception interventions. Preconception interventions can occur during routine well-woman examinations and should include identifying childbearing goals, screening for risks that can impact pregnancies, and assisting women in making healthy changes before becoming pregnant.
There are a number of important topics to discuss during preconception counseling. I will utilize the most current, evidence-based guidelines available when providing preconception counseling to a woman who is planning a pregnancy. At this time, I would plan to discuss the following: reproductive and pregnancy goals; nutrition (especially folic acid); contraception; weight concerns; family and genetic history; management of chronic diseases; medication use; smoking cessation; avoiding alcohol; avoiding other drugs; eliminating toxin exposures; updating immunizations if needed; screening for sexually transmitted infections; and screening for abuse (Fowler & Jack, 2018). These are all important topics to discuss, because they have an impact on fetal and maternal health. For women in the interconception phase, it is important that they be counseled on healthy pregnancy intervals (Fowler & Jack, 2018). For instance, short interval pregnancies of less than 18 months are associated with high rates of preterm births, premature rupture of membranes, maternal morbidity and mortality, third trimester bleeding, anemia, and myometritis (Fowler & Jack, 2018).
References
American Academy of Family Physicians. (2015). Preconception care. Retrieved from https://www.aafp.org/about/policies/all/preconception-care.html
Fowler, J., & Jack, B. (2018). Preconception counseling. Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK441880/
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Reply To Jennifer 2 Apa Citations Current Due In 6 Hours
/in Uncategorized /by developerUnintended pregnancy is something I know very much about, I had an unintended pregnancy at the age of 19. Never in my wildest dream did I think it would happen to me, I knew the consequences of an intimate relationship, but at my age, I was invincible. While I was sitting with my OB/GYN my options were discussed, and at that time there weren’t all these different ways to deal with an unintended pregnancy, you either had the baby or had an abortion, but abortions were not as “easy” as they are today. Pills were not given and 10 minute procedures were not around, there was intense bleeding and pain and there was a very real chance that the reproductive organs could be damaged and the patient could never have children later in life. I chose to have my child and I bless each day that I have her, but not all young women can easily make that decision and with advances in medicine they have more options than ever before. I was amazed over this past week when I went to Planned Parenthood with a staff member, who is alone, we went over the many options that she had and she was educated in the different ways she could choose her way. I am not saying that I agree with her choice or the choices of the other women that were in the waiting room, but the idea that they had many options is what I was impressed with. The contraceptives offered to young adults, presently allow for options based on what fits their needs. Teen pregnancy is prevalent in the nation and with recently approved long acting contraceptives for adolescents there are ways to help teens be more responsible with intimate relationships. Intrauterine devices and implants are the choice for the main line of contraception for all women including the young adults. Currently prescriptions for contraceptives show that the main choice is pills for young adults, some feel it is due to barriers of knowledge and cost (K. McKellen, 2018). Nurse practitioners will be at the forefront of providing education to their patients, helping reduce the number of teen pregnancies and ensuring that all their patients have access to them. According to a 2015 survey, only 3.3% of adolescents are using LARC’s for their last sexual encounter. What has been found through this study was that the type of contraceptive chosen by the patient was directly based on the type of provider they see (S. Dixon, 2018). Again, this is where nurse practitioners will be vital in aiding how teens and their parents view the use of LARC’s. How do you personally feel about youth and LARC’s?ReferencesMcKellen, e. a. (2018). The Latest in Teen Pregnancy Prevention: Long-Acting Reversible Contraception. The Journal of Pediatric Medicine, e91-e97.Dixon, e. a. (2018). What Do Parents Know and Believe About LARC Use in Teens? Journal of Adolescent Health, S37-S140.
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Reply To Jennifer
/in Uncategorized /by developerComprehensive exams in women’s health need to
As with any assessment, the chief complain is often what drives what our questions are and what clinical pathways we explore. With women’s health that approach is not any different, as we need to explore the “what was”, “what is” and “what will be” for the patient. The comprehensive assessment is one that is longer in nature and normally saved for the first visit, as if this patient will be a returning patient a more focused examine comes during their following appointments. The follow is a “blanket” comprehensive assessment that can be tweaked for any patient (Elson, 2008);
18.Health Maintenance
Health maintenance is very important for all ages when related to women’s health. The following are some ideas of health maintenance for each age group (Well-Woman Recommendations, 2018);
Elson, N. B. (2008, July). The Gynecologic History and Examination. Retrieved from The Global Library of Womens Health: https://www.glowm.com/section_view/heading/TheGynecologicHistoryandExamination/item/3#3521
Well-Woman Recommendations. (2018, January 5). Retrieved from The American College of Obstetricians and Gynecologists: https://www.acog.org/About-ACOG/ACOG-Departments/Annual-Womens-Health-Care/Well-Woman-Recommendations?IsMobileSet=false
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Reply To Samantha
/in Uncategorized /by developer“Vertigo is defined as a hallucination of motion of the body or the environment and may be rotatory or linear… it is a cardinal symptom of vestibular system disease” (Smouha, 2013, pp. 456). The most common causes of vertigo include benign paroxysmal positional vertigo (BPPV), Meniere’s disease, inner ear infections and/or vestibular neuritis. When treating vertigo, the provider will focus on the cause rather than the symptoms. For example, if a patient has Meniere’s disease, then the provider may prescribe them a diuretic or recommend a low sodium diet to help reduce the amount of fluid pressure on the inner ear. If the patient is experiencing BPPV, then they are usually treated with exercises, physical therapy and slow-positioning maneuvers.
Lightheadedness
“Lightheadedness (syncope or near-syncope) is cardiovascular or cerebrovascular in origin, or occasionally metabolic (e.g., hypoglycemia), but almost never vestibular” (Smouha, 2013, pp. 456). The most common causes of lightheadedness include orthostatic hypotension (sudden drop in blood pressure when a patient stands up), illnesses (cold, flu, allergies, etc.), certain medications, arrhythmia, anxiety stroke, anemia and/or neurological conditions. Treating lightheadedness is like treating vertigo even though it is not the same causes – you would treat a patient that is lightheaded with potential medications, head position maneuvers, balance therapy or psychotherapy for something caused by an anxiety disorder.
Referral
With treating an individual with either vertigo or lightheadedness, a referral to Ear, Nose and Throat (ENT) should be recommended when the patient is experiencing reoccurring episodes – regardless of the cause because there may be an underlying condition that should be further evaluated by a specialist.
Reference
Smouha, E. (2013). Inner ear disorders. NeuroRehabilitation, 32(3), 455–462.
https://doi.org/10.3233/NRE-130868 (Links to an external site.)Links to an external site.
and Communication, 11, 191-197. DOI: 10.3109/21695717.2013.835090
10:28am
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Reply To Vivian Db
/in Uncategorized /by developerVertigo is a sensation that comes on suddenly and makes the patient feel like they are spinning or that the inside of their head is spinning. Some other symptoms associated with this condition include dizziness, loss of balance, nausea, and vomiting (Mayo Clinic, 2018).
The cause for this condition may be unknown. Possible causes of this condition could be related to a blow to the head, damage to the inner ear, or an association to migraines. If this condition has a severe headache, vision changes, a fever, extremity weakness, or trouble speaking with it, seeking medical attention is warranted. If the patient mentions these other symptoms, a referral would be appropriate (Mayo Clinic, 2018).
Some treatment options for vertigo include canalith repositioning and surgical interventions, Canalith repositioning is the process of slowly positioning the head in different ways. The hope of this process is to help loose particles return to the semicircular canals of the inner ear. Surgery could be used to add a bone plug to the inner ear where the dizziness is originating (Mayo Clinic, 2018).
Lightheadedness
Feeling lightheaded differs from vertigo in that lightheadedness is more a feeling of being dizzy or that one might faint. If someone has this feeling mixed with severe headache, vision changes, slurred speech, seizures, chest pain, or extremity numbness or weakness, seeing a provider is necessary. The causes of dizziness range from inner ear troubles, to medication reactions, possible cardiac conditions, infection, or even blood sugar related issues. Determining the cause of dizziness is needed in order to determine the best possible treatment needed. Treatment could be related to medication education or alteration, treating blood sugar, or treating something else (Mayo Clinic, 2018).
Reference
Mayo Clinic. (2018). Dizziness. Retrieved from https://www.mayoclinic.org/diseases-conditions/dizziness/symptoms-causes/syc-20371787
Mayo Clinic. (2018). Vertigo. Retrieved from
https://www.mayoclinic.org/diseases-conditions/vertigo/symptoms-causes/syc-20370055
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