Reply Db 1

 

Discussion # 1 Advanced Primary Care of Family

    Shared decision-making leads to better health knowledge among the elderly, children, and veterans. They leave the decision-making to caregivers and practitioners. For children and the elderly, they do not participate in their examination, diagnosis, and treatment options because of their limited literacy. The same impacts how this population responds to the management of chronic illnesses and other aspects of care (Seo et al., 2016). Shared-decision making provides the elderly with an opportunity to ask questions when needed, seek more information about their condition, and communicate their health needs. Through this process, older adults gain an understanding of their health and become experts in the decision-making process.

     Today, best practices of models of care such as patient-centered care enhance communication between practitioners and patients. For instance, allowing a patient to be at the forefront of the medical process is an incentive for self-management (Narva, Norton, & Boulware, 2016). The elderly are particularly vulnerable to illiteracy and will tend to research more when they are perceived as decision-makers. They will be keen on the medical process and gain knowledge as a result. Additionally, motivational interviewing ensures that children and older adults are influential in the decision-making process.

     It breaks the barrier of uncertainty and facilitates curiosity among the elderly, who then learn to decode instructions, and risk asking questions about various aspects of their care (LeDoux & Mann, 2019). It is a strategy that promotes autonomy during the care process, which enhances learning.

References

LeDoux, J., & Mann, C. (2019).Addressing Limitations in Health Literacy: Greater Understanding Promotes Autonomy and Self-Determination. Professional case management24(4), 219-221.

Narva, A. S., Norton, J. M., & Boulware, L. E. (2016). Educating patients about CKD: the path to self-management and patient-centered care. Clinical Journal of the American Society of Nephrology11(4), 694-703.

Seo, J., Goodman, M. S., Politi, M., Blanchard, M., & Kaphingst, K. A. (2016). Effect of health literacy on decision-making preferences among medically underserved patients. Medical Decision Making36(4), 550-556.

 
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Replies W13 Db

1-A.G

Childhood asthma is a frequent clinical occurrence associated with respiratory impairments and airway inflammation, which requires immediate treatment and long-term care. The discussed disorder can considerably worsen overall health conditions, reduce the quality of life, and increase the risk of life-threatening implications. The provided asthma-associated case study can be beneficial for reviewing short-term and long-term treatment options efficient for treating the given patient. Furthermore, one’s potential education can be ultimately useful for achieving sufficient treatment outcomes as well as organizing appropriate preventive and therapeutic actions.  

   The provided clinical case exemplifies moderate persistent asthma that requires immediate intervention. It is evident that short-acting beta2-adrenergic agonists (SABA), systemic and inhaled corticosteroids, as well as anti-inflammatory medications, can provide quick symptomatic relief by reducing such aberrations as wheezing and bronchoconstriction present in the reviewed patient, normalizing respiration, and improving overall health. Furthermore, such drugs as inhaled steroids, leukotriene modifiers, nedocromil, cromolyn sodium, and methylxanthine can assist in providing long-term asthma control, stabilizing respiratory functions, and preventing possible asthma exacerbations and inappropriate lung growth in children (Woo & Robinson, 2015). It is estimated that a combination of SABAs and inhaled corticosteroids is useful for managing acute asthmatic exacerbations and maintaining normal respiratory functions (Arcangelo & Peterson, 2013). The beta2-adrenergic agonists like albuterol and levalbuterol are capable of exerting “their bronchodilatory effects through β2 adrenoceptors (β2ARs) located on airway smooth muscle (ASM) cells” and providing significant airway relaxation by activating the aforementioned receptors, whereas the steroid medications are efficient in decreasing airway inflammation and airway hyperresponsiveness by lessening the number of circulating inflammatory mast cells and eosinophils in the respiratory tract (Billington, Penn, & Hall, 2017, p. 23). Furthermore, the use of inhaled corticosteroids can be also beneficial for relieving airway obstruction, normalizing respiratory functions, asthma control, and minimizing the risk of asthmatic exacerbations. 

   Patient education is important for achieving sufficient treatment outcomes. Patients, as well as their caregivers, have to be aware that adherence to the prescribed treatment regimen and recommendations, reporting adverse effects, and regular physical evaluation along with cooperative communication with a physician can assist in stabilizing the patient’s condition and preventing asthma progression. Therefore, asthma is a severe acute or chronic respiratory abnormality that requires competent treatment and care. It is estimated that inhaled SABA, as well as inhaled and systemic corticosteroids, are efficient for achieving short-term therapy goals, whereas leukotriene modifiers, methylxanthines, and anti-inflammatory agents demonstrate normal heir efficacy in providing long-term asthma control and maintaining normal respiratory functioning. Lastly, a patient’s teaching is a critical component of successful medication. 

2-michael V.

The short-term option for this child diagnosed with asthma will be bronchodilators to quickly relieve his symptoms by opening swollen airways that are limiting breathing (Saglani, Fleming, Sonnappa, & Bush, 2019).  Long-term options include Inhaled corticosteroids, Leukotriene modifiers, Long-acting beta agonists, and Combination inhalers. Corticosteroids are the first line of treatment for severe acute asthma, because of the inflammatory process.  Steroids control airway inflammation through a number of mechanisms, such as reducing the number and activation of lymphocytes, eosinophils, mast cells, and macrophages; suppressing the production of cytokines, tumor necrosis factor-α, granulocyte-macrophage colony-stimulating factor, adhesion molecules, and inducible enzymes, including nitric oxide synthase and cyclooxygenase-2.  The step-up approach involves beginning with low-dose treatment and increasing intensity at subsequent visits if control is not achieved (Bateman et al., 2019). When selecting the medication and dosage, the provider must take into account the risk to the patient, severity of disease, and potential for impairment.

The goal of asthma treatment is to decrease symptoms and reduce airway inflammation and hyperreactivity.  Healthcare provider should develop written asthma action plan with the patient and his mother for self-management, so they know how to recognize the severity of its symptoms (peak flow) and what to do (Bateman et al., 2019).  Patient should be educated on ways to control exposures to allergens.  An allergy test will be a good plan to identify the patient’s allergy (Bateman et al., 2019).  The patient may need a referral to a pulmonologist if symptoms are uncontrolled with the current regiment.  Pulmonary function testing may be necessary in this child’s case.

References

Bat

 
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Replies Research Db 6 W12

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Replies Research Db 6 W12 19176169

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Replies Db5 Theory Week 8

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Replies Db Breast

 Reply Cathy

Asking the patient about any breast changes including size change, dimpling, or nipple discharge would be helpful (Centers for Disease Control and Prevention, 2018). In addition, asking the patient about any family history of breast cancer and her menstrual cycle timing could be helpful. A  breast exam would be appropriate during this patient’s physical exam. The patient reported feeling a lump in the shower. By the provider doing their own exam, the patient’s technique and lump placement could be verified (Centers for Disease Control and Prevention, 2018). 

       Some possible differential diagnosis for this patient include breast cancer, a cyst, fibroadenoma, lipoma, mastitis, and breast injury (Mayo Clinic, 2018). Getting a full health history and ordering tests would be needed to know for sure. Some tests that may be ordered include imaging to see what the potential lump looks like and placement.  A mammogram is commonly used along with a biopsy to test the breast tissue cells to determine if they could be cancerous (Mayo Clinic, 2018).  

       Based on the results for this patient, it is possible that a referral could be necessary. This patient may need to see an oncologist or even a surgeon. If this patient has cancer, radiation or chemotherapy may be an necessary intervention (Mayo Clinic, 2018). Making sure this patient has access to information and support is also important when considering management of care.  

Reference
 

Centers for Disease Control and Prevention. (2018). “What Are the Symptoms of Breast Cancer”. Retrieved from:  (Links to an external site.)Links to an external site.https://www.cdc.gov/cancer/breast/basic_info/symptoms.htm
 

Mayo Clinic. (2018). Breast lumps. Retrieved from https://www.mayoclinic.org/symptoms/breast-lumps/basics/causes/sym-20050619 (Links to an external site.)Links to an external site. 

 Reply Quiana

A 35-y.o. woman is seen in the office with a chief complaint of a breast mass. She states she found the lump when she was in the shower, and she is quite visibly distressed. Her medical history is unremarkable, although she reports that she has not had a mammogram. She takes no prescription medications.

What additional questions should you ask the patient and why?

  • Additional questions to ask this patient would be if the lump is painful, pain in fibrocystic disease is bilateral and increases before the monthly menstruation.
  • Has the lump changed in size or remained the same, has she ever noticed a lump before, is she menstruating. Cyst gets smaller and pain decreases when the menstrual cycle starts. If the patient is menstruating it is important to have her come back at the end of her menstrual period. This is because the breast cysts can fluctuate during the menstrual cycle (So you found a lump, now what? 2015).
  • Does she have a nipple discharge? A nipple discharge that is unilateral, pink or bloody, non-milky or associated with a mass is an indicator of breast cancer.
  • Ask at what age did she begin menstruating because early menarche increases the risk of breast cancer.
  • Does she have a family history of breast cancer? If a mother or sister had breast cancer there is twice the risk and if both have it there is three times the risk of developing breast cancer.
  • Does she have any children? Null parity increases your risk of breast cancer (Seller, & Symons, 2018).

What should be included in the physical examination at this visit?

            A complete breast exam should be included in this visit. The breast lump should be assessed to determine if it is firm, with indistinct borders and if it is attached to the skin. Assessment should include if there is any dimpling or nipple retraction, and unilateral nipple discharge, all of which are a signs of breast cancer. Benign lumps usually have well-defined borders and are mobile (Sellers, & Symons, 2018).

Possible differential diagnoses at this time are as follows:

  • Breast cancerPatients that develop breast cancer with no family history are normally older than 40 years.
  • Fibrocystic breast disease-Patients have cyclic bilateral breast pain, especially near and during menstruation. The pain and tenderness worsen before menstruation.
  • Fibroadenoma- Usually presents in patients 20-40 years. Usually, a solitary lump that is firm, mobile, smooth, and rubbery (Seller, & Symons, 2018).

What tests should you order and why?

            A mammogram is the first test to order. If the mammogram is inconclusive or the breast has dense tissue then a breast ultrasound should be ordered to differentiate between a cystic mass and a solid mass. If needed a needle aspiration breast biopsy should be ordered. In some cases an MRI can be ordered, especially in high-risk patients (Sellers, & Symons, 2018).

How should this patient be managed?

            If it is fibrocystic breast disease the patient should be advised to wear a firm bra even at night. Dietary restrictions will include coffee, chocolate, and tea. The patient should also take 400 IU of vitamin E daily. If the patient is experiencing pain or moderate to severe fibrocystic breast disease, the therapeutics to prescribe are oral contraceptives, NSAIDs and/or progestin. The patient should also be educated on the importance of conducting breast self-exams monthly even though the breasts may be lumpy (Dunphy, Winland-Brown, Porter, & Thomas, 2015).

References

Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. A. (2015). Primary

care. The art and science of advanced practice nursing. (4th Ed.). Philadelphia, PA. F. A. Davis Company.

Seller, R. H., & Symons, A. B. (2018). Differential diagnosis of common complaints. (7th Ed.). Philadelphia, PA. Elsevier, Inc.

 
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Replies 19460303

1-AG 

                                                    Process and Regulations of Fast Track

    New pharmacological agents go a long way in clinical trials and approvals from the Food and Drug Administration before entering a wide market and becoming available to needy patients in the United States. At the same time, for promising drugs that can significantly improve the results of existing therapy or fill a missing niche, this process can be accelerated using the Fast Track protocol (Woo & Robinson, 2015). The latter provides for the filing of a special application by a pharmacological company at the FDA office, which the latter examine within 60 days. If the medicine acquires Fast Track status, manufacturers receive a number of concessions, such as the right to more frequent correspondence and meetings with representatives of this state regulatory body and the possibility of cooperation in conducting a clinical trial. If convincing positive results are obtained, it is possible to obtain FDA approval after a single phase 2 clinical trial (Papadimitriou & Butler, 2017). In addition, the verification process of such a pharmacological agent is significantly reduced from 10 to 6 months.

                                                                    Medical Conditions

    In order to be able to obtain faster approval via the Fast Track protocol, the drug agent must meet a number of requirements. Specific medical conditions are not indicated, but it is prescribed that the effect of the drug should be aimed at treating a life-threatening or dangerous disease, such as heart failure (Papadimitriou & Butler, 2017). A prerequisite is either to improve the outcome of existing treatment, such as a reduction in mortality or disability, or a significant reduction in the toxicity of therapy (Woo & Robinson, 2015). In addition, medical conditions that do not have developed a pharmacological treatment, such as some rare and orphan diseases, are also eligible for faster approval from the FDA via the Fast Track protocol. Therefore, due to this possibility, patients will more quickly gain access to the most modern therapy and increase the chances of a more favorable outcome of treatment.                                                   

                                                                           References

Papadimitriou, L., & Butler, J. (2017). “Fast Track” Development and Approval Process for Heart Failure Therapeutics. Clinical Pharmacology & Therapeutics, 102(2), 184-186.

Woo, T. M., & Robinson, M. V. (2015). Pharmacotherapeutics for advanced practice nurse prescribers. FA Davis.

2-MV

The FDA made it possible for critically needed medications to be introduced to the US market promptly using the “Fast Track” procedure.  “Fast Track” is a process designed to facilitate the development and expedite the review of drugs to treat serious conditions and fill an unmet medical need (Vaggelas & Seimetz, 2019).  With fast track, FDA is required by the statute to decide within 60 days of receipt of the request whether the conditions for fast track designation have been met (Vaggelas & Seimetz, 2019).  To be eligible for the fast track program, an applicant must submit a request with supporting documentation for fast track designation for the product and its proposed use (Darrow, Avorn, & Kesselheim, 2018).

The medical conditions that warrant “Fast Track” drugs are serious or life-threatening conditions and those conditions that result in unmet medical needs (Darrow et al., 2018).  Determining whether a condition is serious is a matter of judgment, but generally is based on whether the drug will have an impact on such factors as survival, day-to-day functioning, or the likelihood that the condition, if left untreated, will progress from a less severe condition to a more serious one.  Stroke, epilepsy, brain disorders, depression, AIDS, Alzheimer’s, heart failure, diabetes, and cancer are examples of serious conditions.  Filling an unmet medical need is defined as providing a therapy where none exists or providing a therapy which may be potentially better than available therapy (Darrow et al., 2018).

References

Darrow, J. J., Avorn, J., & Kesselheim, A. S. (2018). The FDA breakthrough-drug designation-four years of experience. N Engl J Med, 378(15), 1444-1453.

Vaggelas, A., & Seimetz, D. (2019). Expediting drug development: FDA’s new regenerative medicine advanced therapy designation. Therapeutic Innovation & Regulatory Science, 53(3), 364-373. doi: 10.1177/2168479018779373

 
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Reply This Discussion

 Please,reply this post

 The difference between research utilization and evidence-based practice

            Research utilization is basically conducted to process the research and to obtain more data for the research that was conducted earlier. It is a method of incorporating and applying research based intervention practically. Results of a certain study are implemented into a practice that are not related to the study, this is referred to as research utilization. It focuses specifically on applying scientific research findings in nursing practices. Research utilization is used to alter the impact on the practice of nursing. It includes application of opinions from the experts and patients’ reports, which can be applied in the treatment process (Schaffer, Sandau & Diedrick, 2014).

Evidence based practice involves the practice and performance of care and the treatment process which has already been implemented successfully or given positive results. Evidence based practice enhances the nursing practices in healthcare and ensures the quality of the care given to the patients is improved. Hence, implementing evidence based research in nursing practices helps to increase knowledge and elevate the nursing care standards. Evidence based practice implements the best current evidences to come up with better decisions on health care. It is very useful to researches related to nursing since it supports the hypothesis of the nursing research and scientific literature, which helps in the clinical trials (LoBiondo-Wood & Haber, 2017).

Evidence based practice is research utilization that employs other considerations specific to the problem that is being solved. Evidence based practice uses the present evidences to make better decisions regarding the patients while research utilization aims to put in practice the implementation of the research study.

 
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Replies 19460301

1-AG 

                                                    Process and Regulations of Fast Track

    New pharmacological agents go a long way in clinical trials and approvals from the Food and Drug Administration before entering a wide market and becoming available to needy patients in the United States. At the same time, for promising drugs that can significantly improve the results of existing therapy or fill a missing niche, this process can be accelerated using the Fast Track protocol (Woo & Robinson, 2015). The latter provides for the filing of a special application by a pharmacological company at the FDA office, which the latter examine within 60 days. If the medicine acquires Fast Track status, manufacturers receive a number of concessions, such as the right to more frequent correspondence and meetings with representatives of this state regulatory body and the possibility of cooperation in conducting a clinical trial. If convincing positive results are obtained, it is possible to obtain FDA approval after a single phase 2 clinical trial (Papadimitriou & Butler, 2017). In addition, the verification process of such a pharmacological agent is significantly reduced from 10 to 6 months.

                                                                    Medical Conditions

    In order to be able to obtain faster approval via the Fast Track protocol, the drug agent must meet a number of requirements. Specific medical conditions are not indicated, but it is prescribed that the effect of the drug should be aimed at treating a life-threatening or dangerous disease, such as heart failure (Papadimitriou & Butler, 2017). A prerequisite is either to improve the outcome of existing treatment, such as a reduction in mortality or disability, or a significant reduction in the toxicity of therapy (Woo & Robinson, 2015). In addition, medical conditions that do not have developed a pharmacological treatment, such as some rare and orphan diseases, are also eligible for faster approval from the FDA via the Fast Track protocol. Therefore, due to this possibility, patients will more quickly gain access to the most modern therapy and increase the chances of a more favorable outcome of treatment.                                                   

                                                                           References

Papadimitriou, L., & Butler, J. (2017). “Fast Track” Development and Approval Process for Heart Failure Therapeutics. Clinical Pharmacology & Therapeutics, 102(2), 184-186.

Woo, T. M., & Robinson, M. V. (2015). Pharmacotherapeutics for advanced practice nurse prescribers. FA Davis.

2-MV

The FDA made it possible for critically needed medications to be introduced to the US market promptly using the “Fast Track” procedure.  “Fast Track” is a process designed to facilitate the development and expedite the review of drugs to treat serious conditions and fill an unmet medical need (Vaggelas & Seimetz, 2019).  With fast track, FDA is required by the statute to decide within 60 days of receipt of the request whether the conditions for fast track designation have been met (Vaggelas & Seimetz, 2019).  To be eligible for the fast track program, an applicant must submit a request with supporting documentation for fast track designation for the product and its proposed use (Darrow, Avorn, & Kesselheim, 2018).

The medical conditions that warrant “Fast Track” drugs are serious or life-threatening conditions and those conditions that result in unmet medical needs (Darrow et al., 2018).  Determining whether a condition is serious is a matter of judgment, but generally is based on whether the drug will have an impact on such factors as survival, day-to-day functioning, or the likelihood that the condition, if left untreated, will progress from a less severe condition to a more serious one.  Stroke, epilepsy, brain disorders, depression, AIDS, Alzheimer’s, heart failure, diabetes, and cancer are examples of serious conditions.  Filling an unmet medical need is defined as providing a therapy where none exists or providing a therapy which may be potentially better than available therapy (Darrow et al., 2018).

References

Darrow, J. J., Avorn, J., & Kesselheim, A. S. (2018). The FDA breakthrough-drug designation-four years of experience. N Engl J Med, 378(15), 1444-1453.

Vaggelas, A., & Seimetz, D. (2019). Expediting drug development: FDA’s new regenerative medicine advanced therapy designation. Therapeutic Innovation & Regulatory Science, 53(3), 364-373. doi: 10.1177/2168479018779373

 
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Reply Theory Db4 Week 7

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