Reply To Hollie 19138723

The most common sexually transmitted infection is human papillomavirus (Boda et al., 2018). There are over 150 known strains of human papilloma virus (HPV), with approximately 40 known strains that can be passed through sexual activity (Markowitz et al., 2014). HPV has been associated with cervical cancer, penile cancer, anogenital cancer, vulvovaginal cancer, oropharyngeal cancer, and genital warts in both males and female (Markowitz et al., 2014). Studies have shown that women are two times more likely to develop HPV infection than men, with the highest risk of acquiring HPV after becoming sexually active (Boda et al., 2018). More than half of new HPV infections occur in individuals 15 to 24 years of age (Markowitz et al., 2014).

It is estimated that the majority of sexually active individuals contract at least one strain of HPV in their lifetime (Boda et al., 2018). Fortunately, approximately 90% of HPV infections are cleared by the immune system within one to two years of infection (Boda et al., 2018). Treatment for HPV is primarily aimed at prevention (Markowitz et al., 2014). HPV vaccines are available for males and females ages 9 through 26 (Markowitz et al., 2014). It is highly encouraged that males and females begin the vaccine series between the ages of 11 and 12 (Markowitz et al., 2014). Also, safe sexual practices are promoted for prevention, including abstaining from sex, condom use, and/or limiting the number of sexual partners (Markowitz et al., 2014).  Other than prevention, there is no treatment for HPV infections (Markowitz et al., 2014). HPV associated lesions can be treated through various modalities, such as laser or electrosurgical procedures (Markowitz et al., 2014).   

Detection and monitoring for HPV is primarily done through cervical cytology (Markowitz et al., 2014). Current guidelines recommend that cervical cancer screening begin at age 21 and be performed every 3 years until the age of 29 (Markowitz et al., 2014). If abnormal cells are detected, additional testing for HPV may be performed (Markowitz et al., 2014). Routine HPV testing can be performed alongside a pap smear every 5 years for women between the ages of 30 and 65 or women may choose to continue regular pap smears every 3 years (Markowitz et al., 2014). Women that have an abnormal pap smear should be tested more frequently, often every 12 months (Markowitz et al., 2014). Women that test positive for HPV 16 or 18 should be sent for a colposcopy according to current guidelines (Markowitz et al., 2014).

References

Boda, D., Docea, A. O., Calina, D., Ilie, M. A., Caruntu, C., Zurac, S., … Tsatsakis, A. M. (2018). Human papilloma virus: Apprehending the link with carcinogenesis and unveiling new research avenues. International Journal of Oncology, 52(3), 637-655. https://dx.doi.org/10.3892%2Fijo.2018.4256

Markowitz, L., Dunne, E., Saraiya, M., Chesson, H., Curtis, C., Gee, J., … Unger, E. (2014). Human papillomavirus vaccination: Recommendations of the advisory committee on immunization practices. Morbidity and Mortality Weekly Report, 63(1), 1-30. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6305a1.htm

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Reply To Gina Breast

Question 1

Routine Health Periodicity for the Gynecologic and Clinical Breast Exam (CBE)

In order to maintain good reproductive and sexual health, females should visit a gynecologist for an exam about once per year, even if a Pap test isn’t performed. A well-woman visit provides an excellent opportunity to counsel patients about maintaining a healthy lifestyle and minimizing health risks (ACOG, 2017).

The periodic well-woman care visit should include screening, evaluation and counseling, and immunizations based on age and risk factors. Sexually active adolescents shouldn’t wait until age 21 to see a gynecologist for the first time. Recent recommendations state that girls should have their first gynecologic visit between the ages of 13 years and 15 years (ACOG, 2017).

According to the U.S. Preventive Services Task Force (2018) the current evidence is insufficient to assess the balance of benefits and harms of performing screening pelvic examinations in asymptomatic women for the early detection and treatment of a range of gynecologic conditions. The interval for specific individual services may differ for individual patients, and the scope of services provided may vary in different ambulatory care settings (USPSTF, 2018).

The Centers for Disease Control and Prevention (2018), states that the best way to find breast cancer is with a mammogram; having a CBE or a BSE has not been found to decrease the risk of dying from breast cancer. Even if the patient chooses to have annual CBEs and to perform regularly BSEs, it is essential to also get mammograms regularly. The USPSTF recommended that women begin mammograms at age 50, not 40, and decrease the frequency thereafter. The USPSTF stated that current evidence is insufficient on the additional benefits versus harms of CBE beyond screening mammogram in women older than 40 years (USPSTF, 2018).

Health Factors Utilized to Determine the Need for a Pap Test

The need for a PAP test depends on factors such as a woman’s age, health history, recent Pap test results, and whether or not she has had HPV. The American Cancer Society (ACS) and the USPSTF both recommend that women get their first Pap test at age 21. Co-testing with Pap and HPV begins at age 30 years. Current interim guidance for stand-alone HPV primary screening begins at age 25 years. Most women between age 21 and age 30 should have a Pap test every three years, assuming their previous Pap test results were normal (Carcio and Secor, 2015).

Women who are Pap/negative and HPV/positive should perform Pap and HPV in 12 months. HIV-infected women should have biannual Pap tests in the first year of diagnosis and then may reduce frequency to annual Pap tests based on the results. A woman who has been vaccinated against HPV should still follow the screening recommendations for her age group (Carcio and Secor, 2015).

When is the Pap test no longer necessary?

The PAP test is no longer necessary in women who have had a total hysterectomy, but if the hysterectomy was done because of cervical cancer or precancerous cell changes, she may still need Pap tests. Also, after age 65, most women may no longer need Pap tests if their last three Pap tests were normal, they are not at high risk for cervical cancer, and they have gone 10 years without an abnormal test (HHS.gov, 2019).

                                                          References

Carcio, H. & Secor, M.C. (2015). Advanced health assessment of women: Clinical skills and procedure. 3rd ed. New York: Springer.

Center for Disease Control and Prevention (2018). What are benefits and riskd of screening. Retrieved from https://www.cdc.gov/cancer/breast/basic_info/benefits-risks.htm

The American College of Obstetricians and Gynecologists (2017). First Gynocologic exam. Retrieved from https://www.acog.org/Patients/FAQs/Your-First-Gynecologic-Visit-Especially-for-Teens

U.S. Preventive Services Task Force (2018). Final recommendation Statement. Ginecological conditions. Retrieved from https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/gynecological-conditions-screening-with-the-pelvic-examination

US Department of Health and Human Services (2019). Cervical Cancer Screening (Pap Test). Retrieved from https://www.hhs.gov/opa/reproductive-health/fact-sheets/pap-test/index.html

 
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Research 18675587

Read a qualitative nursing study. If a different investigator had gone into the field to study the same problem, how likely is it that the conclusions would have been the same? How transferable are the research’s findings?

I need at least 2 references included this book:

Polit, D. &. (2011). Nursing Research. Generating and Assesing Evidence for Nursing Practice. (9th ed.). Lippincott Williams & Wilkins; Ninth, North American Edition (Aug 16, 2011).

 
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Reply To Db Vivian Adult

Patient Questions 

      I would want to know if this patient has ever had this before and when the patient first noticed her symptoms. Physical exam would include looking at the patient’s sores in her mouth and two-point discrimination could be helpful. I would also auscultate and palpate the patient’s abdomen.  

Differential Diagnose 

      Some differential diagnose could include celiac disease, appendicitis, ulcer, and GERD. This patient most likely is suffering from celiac disease. Commons symptoms with this include mouth sores, fatigue, tingling or numbness, and bloating (Beyond Celiac, 2019).  Testing to help diagnose celiac include a blood test that looks for certain antibodies. Genetic testing is also an option, this test looks for HLA-DQ2 and HLA-DQ8, which are human leukocyte antigens (Mayo Clinic, 2018).  

Management of Condition 

      If a patient has celiac disease, there are different management options. A common and somewhat simple lifestyle change includes going gluten-free. Besides cutting out wheat, this patient may also want to cut out barley, rye, malt, and other foods that have gluten. Taking extra vitamins or minerals is another great addition to the diet. This patient will also need follow-up care to manage their condition and may need medication to help decrease any inflammation of the intestines (Mayo Clinic, 2018).  

Reference 

Beyond Celiac. (2019). Celiac disease symptoms list. Retrieved from https://www.beyondceliac.org/celiac-disease/symptoms/ (Links to an external site.)Links to an external site. 

Mayo Clinic. (2018). Celiac disease. Retrieved from https://www.mayoclinic.org/diseases-conditions/celiac-disease/diagnosis-treatment/drc-20352225

 
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Research 18642203

In your opinion which of the following topics is best suited to a phenomenological inquiry? To a ethnography? To a grounded theory study? Provide a rational for each response.  

a-The passage through menarche among Hatian refugee  

b-The process of coping among AIDS patients  

c-The experience of having a child with leukemia  

d-Rituals relating to dying among nursing home residents  

e-Decision making processes among nurses regarding do-not-resucitate orders

I need at least 3 references for this 

 
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Reply To Candace Db

Abdominal bloating can be the result of many different ailments. Several questions can help the provider find the cause of the symptoms. The first question you can ask is when did she notice the bloating? This will help give some direction of how long the complaint has been going on and what may have caused it. If there is any associated pain and if so when was the onset, duration, frequency and relationship can help eliminate causes and questions such as: Does it get better or worse when you eat certain foods? Does movement or rest alleviate symptoms? Where is the bloating feeling exactly? Location can provide clue regarding the mechanism of the bloating. Has she has had any nausea or vomiting? Although the patient has passed gas, this writer would ask when was the last bowel movement because the patient could also be constipated. 

The physical examinations should include vitals and assessment of the abdomen (inspection, auscultation, percussion, and palpation). Included in the physical exam of this visit will be an oral exam making sure to thoroughly exam the teeth and the mucosa for sores, noting the teeth and mucosal colors. A musculoskeletal exam would also be performed noting any muscle weakness, fatigue, joint pain, numbness or tingling. Generalized skin exam noting skin color, lesions, or rashes. Neurological examination for headaches, migraines, or confusion. Psychosocial for any anxiety or depression. Social habits for any drug or alcohol abuse. There are tons of differential diagnoses that comes along with abdominal pain since this area can reciprocate pain from other areas in the body. Differential diagnosis can include constipation, bowel obstruction, Chrons, food allergies, enteritis, irritable bowel syndrome or celiac disease.

Test should be ordered and performed along the history and physical to help assist diagnosing. A complete blood count, serum chemistries, liver function tests, urinalysis, pregnancy test, and abdominal films will help determine the acuity of the problem (Dunphy, Winland-Brown, Porter, & Thomas, 2015). Antibody levels that are elevated indicate an immune reaction to gluten. Genetic testing could also be an option, and might include antigens that are used to rule out celiac (Bascunan, Vespa & Araya, 2017). A kidney, utter, and bladder (KUB) x-ray may also be ordered to asses organs, structures, causes of the bloating. Further testing may include endoscopes and possible biopsy to rule out other gastrointestinal (GI) conditions. 

The main thing about managing any disease is diet, education, and pharmacological and nonpharmacological interventions. This is most true for IBS. If gluten is the issue, the patient must have a strict diet that includes avoiding wheat, barley, rye, malt, and more. Education is key. In doing so, this promotes decreased inflammation and intestinal healing (Mayo Clinic, 2018). Crohn’s disease can also be treated with latter. It is mostly treated with immunosuppressant drugs. Medical follow-up is also necessary to ensure a healthy body response to the new changes. If unresponsive to this surgical interventions are required. 

References

Bascuñán, K., Vespa, M. & Araya, M. (2017). Celiac disease: Understanding the gluten-free diet. European 

Journal of Nutrition, 56(2), 449–459. doi: https://doi-org.wgu.idm.oclc.org/10.1007/s00394-016-1238-5.

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

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

Mayo Clinic (2018). Celiac Disease. Retrieved from https://www.mayoclinic.org/diseases-conditions/celiac- (Links to an external site.)Links to an external site.

disease/diagnosis-treatment/drc-20352225 (Links to an external site.)Links to an external site..

     

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Research 18630615

The purpose of this assignment is to familiarize students with health reform strategies adopted by states. Students will select a state health policy reform innovation and describe the rationale, how it was adopted (e.g., federal waivers, passage by state legislature), the funding structure, and (to the extent statistical data are available) its impact. Students should summarize their findings in a 1-2 page, single-spaced memo due Sunday, October 8th. Examples of state innovations include Maryland’s hospital rate setting, Vermont’s single payer system, Massachusetts’ health reforms, Florida’s Medicaid program, and Kentucky’s Medicaid healthcare program. Assignment Rubric Rationale/Adoption 30 points Funding Structure 30 points Impact on Healthcare 30 points APA Format 10 points 

 
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Reply To Amanda

Question #1 Georgia Reporting Laws

“New CDC data for three nationally reported STDs – chlamydia, gonorrhea, and syphilis—reveal more than 2 million cases were diagnosed in 2016. CDC estimates that closer to 20 million infections occur annually”(CDC, 2017).  These are the highest numbers ever.  As healthcare providers it is important for us to be aware of reporting laws and just trends in our areas.   Georgia has different reporting laws for different STD’s.  Syphilis in adults and syphilis in pregnancy must be reported immediately.  The healthcare provider is to call the District Health Office.  Other cases are to be reported within seven days.  This are to be reported electronically through the State Electronic Notifiable Disease Surveillance. Chlamydia trachomatis, hepatitis B -acute hepatitis B -newly identified HBsAg+ carriers** -HBsAg+ pregnant women hepatitis C virus infection (past or present) (genital infection), gonorrhea HIVinfection and Perinatal HIV exposure*, or AIDS all have to be reported within seven days.  “According to Georgia’s law notifiable disease reporting, healthcare facilitites providing HIV/AIDS care and testing should report any new patients to their facility (including referrals), any current/previous patient updates (change of address, name, pregnancy status, and or gender), and any new clinical status’ (new AIDS status or AIDS defining illnesses) within seven (7) days”(DPH, 2019). Adult (>13 years of age) cases can be reported electronically through the secure disease reporting system called SENDSS (State Electronic Notifiable Disease Surveillance System) using an electronic Adult Case Report Form (eACRF)”(DPH, 2019).  When looking into reportable diseases, I also found some very disturbing news about Georgia.  “According to the 2016 report, Georgia had some of the highest rates of reported chlamydia, gonorrhea and primary and secondary syphilis cases in the country”(CDC, 2017).  I was unaware that Clamydia and gonorrhea had to be reported so this was a very informational discussion for me.

CDC. (2017). 2016 STD Surveillance Report. Retrieved on February 16, 2019 from https://www.cdc.gov/nchhstp/newsroom/2017/2016-STD-Surveillance-Report.html#Graphics

Georgia Department of Public Health. (2019).  Disease Reporting.  Retrieved on February 16, 2019 from https://dph.georgia.gov/disease-reporting

 
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Reseach Encounter Role Play Presentation

Follow up attached instruction 

 
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Reply To A Discussion Answer

Provide a 3-4 sentence reply to the below discussion question answer in apa format with in-text citations and references

Answer: In last weeks discussion question, I had mentioned that the culture of the institution can be a barrier, and in addition to this,the lack of leadership support, education and time can compound the problem. It takes support from management as well as from fellow personnel (nurses, ancillary staff) to initiate, promote and maintain EBP in an organization. According to Polit & Beck, (2018),”Although many organizations support the idea of EBP in theory, they do not always provide the necessary supports in terms of staff release time and provisions of resources”. There are ways to address this particular barrier:

Organizing a staff meeting and explaining the value of implementing the EBP method

Explanations (posters on walls in break room, bathrooms,pamphlets) on how this new EBP method will bring quality care to the patient or improve a system within the organization helps staff become more receptive to new information.The staff has to see EBP as valuable and feasible.

Schedule monthly forums or meetings, enlist the aid of different staff members(on a rotation basis) and make them accountable to finish the task (making it count towards the annual evaluation). At my organization, extra duty tasks are included as favorable in the yearly evaluation. The incentive is pay increases, bonuses, time off awards.

Encourage online research. In the hospital that I work at there is a library (in the basement) but it is underutilized by everyone.Keep the staff informed as to when the library is open and provide administrative time off the floor for continued education, (Jennifer, 2017).  

Original Question: Consider an obstacle or barrier to the implementation of evidence-based practice you identified in last week’s discussion. What are two ways to address this problem?

 
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