It is anticipated that the initial discussion response should be in the range of 250-300 words. Response posts must demonstrate topic knowledge and scholarly engagement with peers. This is not the only criteria utilized for evaluation; substantive content is imperative. All questions in the topic must be addressed. Please proofread your response carefully for grammar and spelling. Do not upload any attachments. All responses need to be supported by a minimum of one scholarly resource. Journals and websites must be cited appropriately. Citation and reference must adhere to APA format (6th Ed.).

Classroom Participation

Students are expected to initially address the discussion question by Wednesday of each week. Participation in the discussion forums is expected with a minimum total of three (3) substantive postings (this includes your initial posting and posting to two peers) on three (3) different days per week. Substantive means that you add something new to the discussion, you aren’t just agreeing. This is also a time to ask questions or offer information surrounding the topic addressed by your peers. Personal experience is appropriate for a substantive discussion and should be correlated to the literature.

All discussion boards will be evaluated utilizing rubric criterion inclusive of content, analysis, collaboration, writing and APA. If you fail to post an initial discussion you will not receive these points, you may however post to your peers for partial credit following the guidelines above. Due to the nature of this type of assignment and the need for timely responses for initial posts and posting to peers, the Make-Up Coursework Policy (effective July 2017) does not apply to Discussion Board Participation.

Discussion Prompt [Due Wednesday]

Select ONE of the questions listed below and provide a substantive posting by Wednesday. Please include the question number you selected in the title of your post (e.g. Question 1 Painful Menstruation). Respond to a classmate who initially posted to the opposite question. 

1. What clinical information would you obtain from an adolescent or adult female presenting with complaint of painful menstruation? What is your assessment and associated ICD-10 and V code(s) for this condition?  What are your differential diagnoses? What pharmacologic and non-pharmacologic therapies would you recommend?  What follow-up (RTC) timeframe, if any, would you recommend? 
2. Describe the components of the comprehensive, clinically relevant, sexual health, gynecological, and obstetrical history. Identify two health promotion/disease prevention recommendations and anticipatory guidance for the following populations: adolescents, childbearing, perimenopausal, menopausal, and geriatric women.

Estimated time to complete: 3 hours

 

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Discussions (10% of grade): There will 4 discussions during the semester and will be count as participation points.  The discussion board points count towards your final grade. All assigned postings must be completed by the deadline in the schedule for posting AND responding or no credit is given.  Discussions are not just opinion to obtain full points, postings must be based on supported fact, not simply opinion. Posting should be a minimum of one short paragraph and a maximum of two paragraphs.  Word totals for each post should be in the 100-200 words range.  Whether you agree or disagree explain why with supporting evidence and concepts from the readings or a related experience.  Include a reference, link, or citation when appropriate. APA 6th edition format for references as well as in-text citations is expected.

Application of Health Literacy & Motivational Interviewing Concepts to Promote Wellness

Health literacy is not simply the ability to read health information. The National Institutes of Health defines health literacy as the ability to read, comprehend, and analyze information; decode instructions, symbols, charts, and diagrams; weigh risks and benefits; and ultimately make decisions and take action.

After the reading the following HRSA guideline https://www.hrsa.gov/advisorycommittees/bhpradvisory/actpcmd/Reports/twelfthreport.pdf

Discuss how shared decision making , motivational interviewing, and best practices of models of care can improve the health literacy of a especial popualtion ( children ,elderly, veterans)

 

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 reply candace

Rheumatoid arthritis (RA) is an autoimmune disease in which the body’s own immune system attacks the joints on both sides of the body including the hands, wrist and knees. Early stages of RA include:

• Joint pain, tenderness, swelling or stiffness for 6 weeks or longer
• Morning stiffness for 30 minutes or longer
• More than one joint is affected
• Small joints ( wrists, certain joints of the hands and feet) are affected
• The same joints on both side of the body are affected

The history would include complaints of the above systems along with deformities of the affected areas depending on the severity. Rheumatoid nodules are commonly observed over the olecranon process or other extensor surfaces of the limbs and may be tender (Dunphy, Winland-Brown, Porter, & Thomas, 2015). The patient may present with a low grade fever. A thorough history of other systems is elicited because of the involvement of other extra-articular organ systems. Physical exam would include inspection and palpation of the joints on both sides of the body. Passive and active range of motion may be limited due to the swelling and tenderness to the affected area. The initial diagnostic test is the presence of Rheumatoid factor (RF) in the blood. This test alone is not diagnostic and specific test such as circulating anti-CCP autoantibodies. Other test include a ESR, CRP, CBC, platelet count and joint fluid analysis. Studies for a more progressive diagnosis include ANA and comprehensive autoantibody panel. Management of RA progresses from conservative interventions to aggressive symptom management. Initial management would include heat/cold applications, exercise, rest, OT/PT, assistive devices, splints, and weight loss. Subsequent management for a more progressive version of the disease include drug therapies such as NSAIDs, analgesics, corticosteroids and DMARDs.Patient education focuses on medication therapy and control of pain and inflammation. Both primary and secondary medication nonadherence may be affected by low levels of health literacy and patient education (Joplin, Zwan, Joshua, & Wong, 2015). Emotional, spiritual and social education is advised due to disability and pain.

References

Joplin, S., Zwan, R., Joshua, F., & Wong, P. (2015). Medication adherence in patients with rheumatoid

arthritis: the effect of patient education, health literacy, and musculoskeletal ultrasound. BioMed

Research International, 2015, 10. 

Dunphy, L., Brown, J., Porter, B., & Thomas, D. (2015). Primary Care: The Art and Science of

Advanced Practice Nursing. Philadelphia: F.A. Davis Company.

 reply vivian

Rheumatoid arthritis is a condition that is chronic and consists of inflammation to different joints. RA in the hands is very common. This condition is related to an autoimmune response where the patient’s immune system ends up attacking its own body tissues. This condition can be very painful and requires certain testing for diagnoses and treatment (Mayo Clinic, 2018).  

       I would get a health history on this patient to determine if she has RA and what she has done for treatment of it. If this patient has a “flare up” then this patient most likely is educated and familiar with her condition. Risk factors for this condition include being female, age 40-60, having a family history of RA, smoking or other environment exposures like asbestos, and being obese (Mayo Clinic, 2018).  

       Some testing for this patient would include a blood test looking for elevated erythrocyte sedimentation rate or C-reactive protein. Imaging could be helpful to see how this condition is progressing for the patient. Medication to help include NSAIDs, steroids, antirheumatic drugs, and biological agents. The goal is to decrease inflammation and slow the progression of the disease. Physical therapy is also an option to help the patient maintain joint flexibility (Mayo Clinic, 2018).  

       For patient education, it could be helpful to make sure the patient has signs to be aware of a flare up starting. It can be easier to prevent flare ups than treat them. Some signs of a flare up include an increased stiffness to the joints, entire body pain, swelling that may cause shoes not to fit, a change in fatigue that is intense, and even flu-like symptoms. Some foods or medications could be the cause of a flare up and this is something for the patient to be aware of (Healthline, 2019).  

Reference 

Healthline. (2019). Signs of rheumatoid arthritis exacerbations and how to prevent them. Retrieved from https://www.healthline.com/health/rheumatoid-arthritis-exacerbations 

 Mayo Clinic. (2018). Rheumatoid arthritis. Retrieved from https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648 (Links to an external site.)Links to an external site. 

 

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Reply Hollie 

Although there are still many things we do not understand about sleep, it is well known that there are numerous health concerns that can result from inadequate sleep (Hackley & Kriebs, 2017). Both short-term and long-term consequences can result from sleep disturbances. Short-term consequences of inadequate sleep include: increased stress response, headaches, abdominal pain, mood disorders, fatigue, and decreased cognitive performance (Medic, Wille, & Hemels, 2017). Women with sleep issues during perimenopause and menopause are likely to suffer sleep disturbances for an extended period of time due to hot flashes, night sweats, and other factors (Hackley & Kriebs, 2017). These extended episodes of poor sleep may increase the risk of developing long-term consequences. One long term consequence of inadequate sleep is cardiovascular disease (Medic et al., 2017). Long-term sleep issues are associated with hypertension, higher cholesterol levels, increased atherosclerosis risk, and increased risk of myocardial infarction (Medic et al., 2017). Metabolic issues are also associated with long-term sleep disturbances (Medic et al., 2017). Sleep loss is known to affect energy metabolism, which can ultimately impair insulin sensitivity and increase food intake (Medic et al., 2017). These factors are known to contribute to type 2 diabetes and obesity (Medic et al., 2017). A third health concern of long-term sleep disturbance is the development of different types of cancers (Medic et al., 2017). Melatonin, an important hormone involved in the circadian rhythm and in sleep, has numerous important properties including DNA repair, inhibition of tumor growth, and scavenging free radicals (Medic et al., 2017). During clinic visits, it is always important to take the time to revisit healthy bedtime habits. It is always my goal to avoid medication unless absolutely necessary. Sometimes by revisiting healthy routines or discussing nonpharmacological interventions, patients can see great improvement in their sleep. Some basic sleep hygiene interventions include: having a consistent bed time; choosing relaxing activities before bed; avoiding alcohol, coffee, tea, or other stimulants 4 to 6 hours before bed; avoiding smoking before bed; avoiding heavy meals or spicy foods before bed; increasing daytime physical activity; and creating a comfortable sleeping environment (Santos et al., 2018). Patient should be encouraged to read or journal before bed instead of using electronic devices (Santos et al., 2018). Cognitive behavioral therapy has also been proven effective for treating insomnia (Santos et al., 2018).

References

Hackley, B. K., & Kriebs, J. M. (2017). Primary care of women(2nd ed.). Burlington, MA: Jones & Bartlett Learning.Medic, G., Wille, M., & Hemels, M. E. (2017). Short- and long-term health consequences of sleep disruption. Nature and science of sleep, 9, 151–161. doi:10.2147/NSS.S134864

Santos, M., Conceição, A., Ferretti-Rebustini, R., Ciol, M. A., Heithkemper, M. M., & Cruz, D. (2018). Non-pharmacological interventions for sleep and quality of life: A randomized pilot study. Revista Latino-Americana de Enfermagem, 26, e3079. doi:10.1590/1518-8345.2598.3079

Reply Hollie 

Women experiencing perimenopause and menopause often report sleep disturbances. Identify three health concerns related to inadequate sleep and clinically relevant interventions to address these concerns.

Perimenopause                  As a 54-year-old woman currently in perimenopause, I can attest to sleep disturbances. For about a month this past year, I had hot flashes and insomnia. It miraculously all went away, I’m hoping for good. Getting a full night’s rest is so wonderful when you have experienced the opposite. As I’ve learned from my preceptor, you have to have 1 full year with absolutely no bleeding before considered in full menopause; a chapter that I’m sure is in my future.

Inadequate sleep Depression and Anxiety Baker, Zambotti, Colrain, and Bei, (2018) discuss the relationship between sleep problems with menopausal women and depression. In general, depression increases in menopausal women but the tendency is more with women who are sleep deprived (Baker, Zambotti, Colrain, & Bei, 2018). Once study showed that women who have difficulty getting to sleep have more problems with anxiety and those who have their sleep interrupted have problems with depression (Baker, Zambotti, Colrain, & Bei, 2018). The authors discuss the fact that the circadian rhythm, interrupted during sleep deprivation, plays a role in depression in anxiety (Baker, Zambotti, Colrain, & Bei, 2018).To treat insomnia and depressive symptoms during menopause, there are a few options. Hormone replacement therapy (HRT), serotonin reuptake inhibitors, and behavioral therapy have been investigated (Baker, Zambotti, Colrain, & Bei, 2018). Supplements such as soy isoflavones have assisted in reducing menopausal symptoms including sleep deprivation in some women (Baker, Zambotti, Colrain, & Bei, 2018).

Cardiovascular challengesSleep problems interrupt the efficient automaticity of the cardiovascular system and cardiovascular recovery (Baker, Zambotti, Colrain, & Bei, 2018). Insomnia, specifically the shortened amount of sleep has been associated with coronary heart disease, heart failure, hypertension, and acute coronary syndrome (Javaheri & Redline, 2017). Cardiovascular problems are more prevalent when insomnia is chronic; lasting more than three months (Javaheri & Redline, 2017).Behavioral therapy has been known to not only assist with insomnia but with corresponding cardiovascular disease as well (Baker, Zambotti, Colrain, & Bei, 2018).

Physiologic changes in Inflammation and Immune FunctionAukley (2018) discusses the relationship between sleep deprivation and immune function. In studies involving animal models there was shown to be a link between impaired immune function and a loss of sleep (Aukley, 2018). Asif, Iqbal, and Nazir (2017) inform us that wakefulness, rapid eye movement and non-rapid eye movement regulate the immune response. Inflammatory mediators increase in response to sleep loss (Asif, Iqbal, & Nazir, 2017).In addition to regulation of sleep, melatonin, a pineal hormone plays a role in immune system regulation (Jehan et al., 2017). Melatonin has been known to assist with sleep deprivation and related immune challenges (Jehan et al., 2017)

.References

Asif, N., Iqbal, R., & Nazir, C. F. (2017). Human immune system during sleep. American journal of clinical and experimental immunology, 6(6), 92–96.Aukley, D. (2018). Poor sleep in the hospital: Contributing factors and interventions. Retrieved from https://www.uptodate.com/contents/poor-sleep-in-the-hospital-contributing-factors-and-interventions?search=inadequate sleep&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2Baker, 

F. C., de Zambotti, M., Colrain, I. M., & Bei, B. (2018). Sleep problems during the menopausal transition: prevalence, impact, and management challenges. Nature and science of sleep, 10, 73–95. doi:10.2147/NSS.S125807Javaheri, S., & Redline, S. (2017). Insomnia and Risk of Cardiovascular Disease. Chest, 152(2), 435–444. doi:10.1016/j.chest.2017.01.026Jehan, 

S., Jean-Louis, G., Zizi, F., Auguste, E., Pandi-Perumal, S. R., Gupta, R., … Brzezinski, A. (2017). Sleep, Melatonin, and the Menopausal Transition: What Are the Links?. Sleep science (Sao Paulo, Brazil), 10(1), 11–18. doi:10.5935/1984-0063.20170003

 

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Mrs. Cason brings her 10-year-old child to the clinic stating my son “just isn’t breathing right, he doesn’t want to play, he just sits on my lap or lays on the couch, and this  happens all the time.” Appearance of both mother and child is disheveled. The child’s wheezing can be heard across the room. When asked if her son is better at any certain time of the day the mother responds: “It’s like this all the time and has been for the past year, we just don’t come to the doctor because we don’t have any money.”

Mrs. Cason’s son was diagnosed of asthma.

Discuss short and long term treatment options for this child, inhaled beta2-adrenergic agonists. Include rationale for your recommendations.

What is your educational plan for the child?

All posts must be supported by peer-reviewed references within 5 years of publication. 

Thanks,

 

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