Discussion 7

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 Discuss a selected chronic illness in relationship to a specific culture (e.g., a Chinese patient with cancer using traditional Eastern medicine, a Hispanic patient with a high probability of contracting adult-onset diabetes being treated by a curandero). 

 
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Discussion 8 18759693

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 Instruction: 

Please look at the American Academy of Gastroenterology Clinical Guidelines for the updated H.Pylori therapy. This is the website and you may copy it and paste it in the internet to get the article journal with the treatment guidelines: 

http://gi.org/wp-content/uploads/2017/02/ACGManagementofHpyloriGuideline2017.pdf

This is an example

 

GI Case Study: H. Pylori infection

Questions: As an NP student, needs to determine the medications for recurrent H. Pylori infection.

According to the ACC/AHA Guidelines, what medication should this patient be prescribed? Write her complete prescriptions using the prescription writing format.

ACC/AHA Guidelines

Chief complaint: “ I have recurrent H. Pylori infection”.

HPI: M.C. a 46-year-old hispanic female presents to the GI clinic for complaint of recurrent H. Pylori infection. She was treated about 2 ½ months ago with H. Pylori triple therapy and failed treatment. She has pmhx of dyspepsia, GERD.

She also indicates that she has noticed that her symptoms of dyspepsia are worsening for past 2 months. She has associated her symptoms with nausea, upset stomach with all foods.

Denies associated symptoms of hematochezia, melena, hemoptysis, abdominal pain, fever, chills, pain or any other symptoms.

PMH:

H. Pylori infection gastritis

Diabetes Mellitus, type 2

Surgeries: None

Allergies: NKDA

Vaccination History:

She receives an annual flu shot. Last flu shot was this year

Social history:

High school graduate, married and no children. He frequently eats out in restaurants. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago.

Family history:

Both parents are alive. Father has history of DM type 2, Tinea Pedis.

mother alive and has history of atopic dermatitis, tinea corporis and tinea pedis.

ROS:

Constitutional: Negative for fever. Negative for chills.

Respiratory: No Shortness of breath. No Orthopnea

Cardiovascular: No edema. No palpitations.

Gastrointestinal: No vomiting. +Dyspepsia. + Nausea. No constipation. No melena. No abdominal pain.

Skin: No lesions. No rash. No itching.

Psychiatric: No anxiety. No depression.

Physical examination:

Vital Signs

Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 110/70 T 98.0 po P 80 R 22, non-labored

HEENT: Normocephalic/Atraumatic, PERRL, EOMI; No teeth loss seen. Gums no redness.

NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.

LUNGS: Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress.

HEART: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. No edema.

ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.

GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred.

MUSCULOSKELETAL: Slow gait but steady. No Kyphosis.

SKIN: Dry. Intact.  

PSYCH: Normal affect. Cooperative.

Labs day of visit:: Hgb 15.2, Hct 40%, K+ 4.0, Na+137, Serum Creatinine normal 1.0, AST/ALT normal. TSH 3.7 normal, glucose 98 normal

A:

Primary Diagnosis: Recurrent H. Pylori infection gastritis

Secondary Diagnoses:

Dyspepsia

Differential Diagnosis:

Peptic Ulcer Disease

Previous medication plan: two months ago and failed.

  1. Clarithromycin 500 mg po BID for 2 weeks
  2. Omeprazole 40 mg po BID for 2 weeks and then po daily.
  3. Cipro 500 mg po BID for 2 weeks

Plan: Tests

Pt had EGD done 2 weeks ago that showed H. Pylori positive gastritis in biopsy results.

Urea breath test 8 weeks after treat with H. Pylori medications. Pt needs to stop PPI’s 2 weeks prior to Urea Breath test.

Labs: No new labs are needed.  

Referrals: may refer based on effect of medication therapy given for 2 weeks.

Follow up: return to office in 8 weeks to reevaluate her symptoms.

 
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Discussion 8 18824913

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What does it take to be an effective health advocate? As a nurse, you have many opportunities to advocate for patients and populations, whether formally or informally. Being an advocate involves more than knowing how to lobby or to whom to write letters. It requires passion and compassion, commitment and courage.

In this Discussion, you will consider the attributes of an effective advocate for population health and/or the nursing profession. You will analyze those attributes that help nurses be a powerful force in improving the quality of health care and in this case especially, the needs of returning veterans and their families.

To prepare:

  • Review the article “On Being a Good Nurse: Reflections on the Past and Preparing for the Future” and “War, its aftermath, and U.S. health policy: Toward a comprehensive health program for America’s military personnel, veterans, and their families” found in this week’s Learning Resources.
  • Consider the multiple health care needs of returning veterans and their families.

Post two types of health needs returning veterans and their families might need. How might you advocate for the needs of this population. What type of advocacy skills would you need and how could you develop them. What responsibility does a nurse have to be an advocate? Give specific examples.

 
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Discussion 8 19264827

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Discuss the pros or cons of using hormone-regulating medications to treat Diabetes Mellitus.

Only two Paragraphs

 
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Discussion 8 Concepts

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THIS CLASS IS ABOUT NURSING THEORISTS

Consider your learning in the course. How have you met the course objectives listed in the syllabus? Has the material in the course changed your professional practice? How might nursing theory influence your professional practice?

Your initial posting should be at least 400 words in length and utilize at least one scholarly source other than the textbook

 
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Discussion 8 Week 14 Nursing Theory

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

 
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Discussion 9 18835053

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As emphasized in this week’s media presentation, all nurses need to be familiar with the laws and regulations that govern their practice: their state’s Nurse Practice Act, ANA’s Nursing: Scope and Standards of Practice, specialty group standards of practice, etc. In addition, basic ethical principles guide nurses’ decision-making process every day. ANA’s Code of Ethics and ANA’s Social Policy Statement are two important documents that outline nurses’ ethical responsibilities to their patients, themselves, and their profession. This said, there is a dilemma: The laws are not always compatible with the ethical positions nurses sometimes take. This week’s Discussion focuses on such a dilemma.

To prepare:

  • Review this week’s Learning Resources, focusing on the information in the media presentation about the relationship between the law and ethics.
  • Consider the ethical responsibility of nurses in ensuring patient autonomy, beneficence, non-malfeasance, and justice.
  • Read the following scenario:

    Lena is a community health care nurse who works exclusively with HIV-positive and AIDS patients. As a part of her job, she evaluates new cases and reviews confidential information about these patients. In the course of one of these reviews, Lena learns that her sister’s boyfriend has tested HIV positive. Lena would like to protect her sister from harm and begins to consider how her sister can find out about her boyfriend’s health status.

  • Consult at least two resources to help you establish Lena’s legal and ethical position. These resources might include your state’s Nurse Practice Act, the ANA’s Code of Ethics, ANA’s Nursing: Scope and Standards of Practice, and internal or external standards of care.
  • Consider what action you would take if you were Lena and why. 
  • Determine whether the law and the ANA’s standards support or conflict with that action.

Post a description of the actions you would take in this situation, and why. Justify these actions by referencing appropriate laws, ethical standards, and professional guidelines.

Links:

https://www.nap.edu/read/11623/chapter/4

 
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Discussion Advanced Clinical Inquiry And Pico T

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Discussion: Searching Databases

When you decide to purchase a new car, you first decide what is important to you. If mileage and dependability are the important factors, you will search for data focused more on these factors and less on color options and sound systems.

The same holds true when searching for research evidence to guide your clinical inquiry and professional decisions. Developing a formula for an answerable, researchable question that addresses your need will make the search process much more effective. One such formula is the PICO(T) format.

In this Discussion, you will transform a clinical inquiry into a searchable question in PICO(T) format, so you can search the electronic databases more effectively and efficiently. You will share this PICO(T) question and examine strategies you might use to increase the rigor and effectiveness of a database search on your PICO(T) question.

To Prepare:

  • Review the materials offering guidance on using databases, performing keyword searches, and developing PICO(T) questions provided in the Resources.
  • Review the Resources for guidance and develop a PICO(T) question of interest to you for further study.
By Day 3 of Week 4

Post your PICO(T) question, the search terms used, and the names of at least two databases used for your PICO(T) question. Then, describe your search results in terms of the number of articles returned on original research and how this changed as you added search terms using your Boolean operators. Finally, explain strategies you might make to increase the rigor and effectiveness of a database search on your PICO(T) question. Be specific and provide examples.

 
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Discussion Anemia 19470695

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

To Prepare

  • Review Chapter 21 in the Huether and McCance text. Reflect on the pathophysiological mechanisms of iron deficiency anemia.
  • Select one of the following types of anemia: pernicious anemia, folate deficiency anemia, sideroblastic anemia, chronic inflammation anemia, or post-hemorrhagic anemia. Identify the pathophysiological mechanisms of the anemia you selected.
  • Consider the similarities and differences between iron deficiency anemia and the type of anemia you selected.
  • Reflect on how patient factors such as genetics, gender, ethnicity, age, and behavior might impact these anemic disorders.
  • APA citation 3 to 4 references within 5 years
 
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Discussion Anemia 19474837

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

To Prepare

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

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

4 references

 
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