400 word- APA 1 scholarly source referenced

Selected Site is Veterans Community Living Center (nursing home like environment)

1. 1.   Professional Partnership: Discuss the factors and approach you will use to develop a professional partnership with your selected site.
2. 2.   Collaboration: What is the importance of collaborating with other healthcare professionals in order to establish trusting relationships to gain commitment for mobilizing health initiatives? 

 

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 Inflammatory Bowel Disease 

Case Study The patient is an 11-year-old girl who has been complaining of intermittent right lower quadrant pain and diarrhea for the past year. She is small for her age. Her physical examination indicates some mild right lower quadrant tenderness and fullness. Studies Results Hemoglobin (Hgb), 8.6 g/dL (normal: >12 g/dL) Hematocrit (Hct), 28% (normal: 31%-43%) Vitamin B12 level, 68 pg/mL (normal: 100-700 pg/mL) Meckel scan, No evidence of Meckel diverticulum D-Xylose absorption, 60 min: 8 mg/dL (normal: >15-20 mg/dL) 120 min: 6 mg/dL (normal: >20 mg/dL) Lactose tolerance, No change in glucose level (normal: >20 mg/dL rise in glucose) Small bowel series, Constriction of multiple segments of the small intestine Diagnostic Analysis The child’s small bowel series is compatible with Crohn disease of the small intestine. Intestinal absorption is diminished, as indicated by the abnormal D-xylose and lactose tolerance tests. Absorption is so bad that she cannot absorb vitamin B12. As a result, she has vitamin B12 deficiency anemia. She was placed on an aggressive immunosuppressive regimen, and her condition improved significantly. Unfortunately, 2 years later she experienced unremitting obstructive symptoms and required surgery. One year after surgery, her gastrointestinal function was normal, and her anemia had resolved. Her growth status matched her age group. Her absorption tests were normal, as were her B12 levels. Her immunosuppressive drugs were discontinued, and she is doing well. 

Critical Thinking Questions 

1. Why was this patient placed on immunosuppressive therapy? 

2. Why was the Meckel scan ordered for this patient? 

3. What are the clinical differences and treatment options for Ulcerative Colitis and Crohn’s Disease? (always on boards) 

4. What is prognosis for patients with IBD and what are the follow up recommendations for managing disease? 

 

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Mental Health Research Paper –

Student will be provided a Psychiatric/Mental health disorder that they might have encountered or will encounter in nursing practice. Student will write a five (5)-page paper (not including reference or title page) with at least 4 references from a credible source in APA format. Please use LIRN platform for your research. Paper and presentation must include the require elements presented below. 

SCHIZOPHRENIA

Required elements        Points 

Introduction with a full description of the disorder                                         15

(including DSM V criteria and ICD 10 code)       

Cultural Component/History & Background                                                      15

Epidemiology/ Prevalence/Prognosis of the Disorder                                     10

(must include some statistics)                                                                     

Clinical features/ manifestations                                                                         10 

Sub-types of the Disorder / Differential Diagnosis                               10 

Treatment Approaches                                                                                          10

Patient and Family teaching       10

Conclusion/ Summary                      10

Cites four (4) APA format references (at least 5 years old)                             10  

TOTAL                                                   100

 

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Clinical discussion online assignment in class

L.N. is a 49-year-old white woman with a history of type 2 diabetes, obesity, hypertension, and migraine headaches. The patient was diagnosed with type 2 diabetes 9 years ago when she presented with mild polyuria and polydipsia. L.N. is 5′4″ and has always been on the large side, with her weight fluctuating between 165 and 185 lb.

Initial treatment for her diabetes consisted of an oral sulfonylurea with the rapid addition of metformin. Her diabetes has been under fair control with a most recent hemoglobin A1c of 7.4%.

Hypertension was diagnosed 5 years ago when blood pressure (BP) measured in the office was noted to be consistently elevated in the range of 160/90 mmHg on three occasions. L.N. was initially treated with lisinopril, starting at 10 mg daily and increasing to 20 mg daily, yet her BP control has fluctuated.

One year ago, microalbuminuria was detected on an annual urine screen, with 1,943 mg/dl of microalbumin identified on a spot urine sample. L.N. comes into the office today for her usual follow-up visit for diabetes. Physical examination reveals an obese woman with a BP of 154/86 mmHg and a pulse of 78 bpm.

Questions

1. What are the effects of controlling BP in people with diabetes?
2. What is the target BP for patients with diabetes and hypertension?
3. Which antihypertensive agents are recommended for patients with diabetes?

 

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A patient reports having occasional acute constipation with large, hard stools and pain and asks the primary care NP about medication to treat this condition. The NP learns that the patient drinks 1500 mL of water daily; eats fruits, vegetables, and bran; and exercises regularly. How would you address your patient’s concerns?  What medication would you add and why? 

Constipation is among the commonest reason that makes people self medicate (Teri Moser Woo 2016 pp535). It is very common and can be caused by variety of factors ranging from lack of exercise, immobility, neuronal abnormality, iatrogenic causes as well. Appropriate management requires an evaluation for secondary etiologies, such as systemic disorders and drugs. Once secondary causes have been eliminated, idiopathic constipation may be associated with normal or slow colonic transit, defecatory dysfunction (pelvic floor dysfunction), or both. Laboratory work up specifically electrolytes and radiological investigation would be considered for the above mentioned patient. This is after a thorough History and physical exam.

Since the patient above exercises and eats well, I would start with a stimulant Laxative in this case. Stimulant laxatives — Stimulant laxatives such as bisacodyl (e.g., some forms of Dulcolax), Senna (e.g., Senokot), and sodium picosulfate (e.g., Dulcolax drops). According to (Johnson DA, Barkun AN, Cohen LB, et al 2014) A randomized four-week trial of sodium picosulfate (10 mg daily) in 45 patients with chronic constipation demonstrated improved bowel function for those receiving medication compared with placebo

 

                                                                        Senna

Category: Senna is a stimulant laxative, primarily exert their effects via alteration of electrolyte transport by the intestinal mucosa. They also increase intestinal motor activity

Use: Senna is use for constipation, generally causes bowel movement in 6 to 12 hours

Warning and Education: Senna should be used appropriately. Failure to have a bowel movement or occurrence of rectal bleeding after use should be reported to health care provider. It is not recommended for use in patients experiencing stomach pain, nausea, vomiting, or a sudden change in bowel movements which lasts >2 weeks. If constipation did not improve after being on Senna for one week, return to the clinic. Do not use for more than 1 week.

Adverse reaction: Some adverse reaction that can result from Senna use include: abdominal cramps, diarrhea, nausea, vomiting

                                                               

                                                                    References

Anderson PO, Sauberan JB. Modeling drug passage into human milk. Clin Pharmacol Ther. 2016;100(1):42-52. [PubMed 27060684]

Johnson DA, Barkun AN, Cohen LB, et al. Optimizing adequacy of bowel cleansing for colonoscopy: recommendations from the US multi-society task force on colorectal cancer. Am J Gastroenterol, 2014;109(10):1528-1545. [PubMed 25223578]

Woo, T. M. & Robinson, M. V. (2016): Pharmacotherapeutics for Advanced Practice Nurse     

        Prescribers. (4TH ed.). Philadelphia: F. A. Davis Co

Liu Z, Yan S, Wu J, et al. Acupuncture for Chronic Severe Functional Constipation: A Randomized Trial. Ann Intern Med 2016; 165:761.

 

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