The treatment of anaphylactic shock varies depending on a patient’s physiological response to the alteration. Immediate medical intervention and emergency room visits are vital for some patients, while others can be treated through basic outpatient care.

Consider the January 2012 report of a 6-year-old girl who went to her school nurse complaining of hives and shortness of breath. Since the school did not have any medication under her name to use for treatment and was not equipped to handle her condition, she was sent to an emergency room where she was pronounced dead. This situation has raised numerous questions about the progression of allergic reactions, how to treat students with severe allergies, how to treat students who develop allergic reactions for the first time, and the availability of epinephrine in schools. If you were the nurse at the girl’s school, how would you have handled the situation? How do you know when it is appropriate to treat patients yourself and when to refer them to emergency care?

To Prepare

· Review “Anaphylactic Shock” in Chapter 24 of the Huether and McCance text, “Distributive Shock” in Chapter 10 of the McPhee and Hammer text, and the Jacobsen and Gratton article in the Learning Resources.

· Identify the multisystem physiologic progression that occurs in anaphylactic shock. Think about how these multisystem events can occur in a very short period of time.

· Consider when you should refer patients to emergency care versus treating as an outpatient.

· Select two patient factors different from the one you selected in this week’s first Discussion: genetics, gender, ethnicity, age, or behavior. Reflect on how the factors you selected might impact the process of anaphylactic shock.

Post an explanation of the physiological progression that occurs in anaphylactic shock. Then, describe the circumstances under which you would refer patients for emergency care versus treating as an outpatient. Finally, explain how the patient factors you selected might impact the process of anaphylactic shock.

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Discussion: Cardiovascular Disorders

Veins and arteries are vital elements of the cardiovascular system. They carry the blood supply through the body and are essential for proper function. Sometimes veins and arteries malfunction, resulting in cardiovascular disorders. Malfunctions of arteries and veins are similar to malfunctions of a water hose. Consider the structure and function of a hose. A tap releases water, which then travels through the hose and comes out the other end. If the hose has been dormant for several months, dirt and rusty particles might build up inside, resulting in a restricted flow of water. Similarly, buildup of plaque inside the coronary arteries restricts blood flow and leads to disorders such as coronary heart disease. This disease is one of the most common cardiovascular disorders, and according to the National Heart, Lung and Blood Institute (2011), is the leading cause of death for men and women in the United States. In this Discussion, you examine the pathophysiology of cardiovascular disorders such as coronary heart disease.

To Prepare

• Review this week’s media presentation on alterations of cardiovascular functions, as well as Chapter 24 in the Huether and McCance text. Identify the pathophysiology of cardiovascular disorders.
• Select one patient factor: genetics, gender, ethnicity, age, or behavior. Consider how the factor you selected might impact the pathophysiology of cardiovascular disorders.
• Select one of the following alterations of cardiovascular disorders: peripheral arterial disease, myocardial infarction, coronary artery disease, congestive heart failure, or dysrhythmia. Think about how hypertension or dyslipidemia can lead to the alteration you selected. 

Post a description of the pathophysiology of cardiovascular disorders, including how the factor you selected might impact the pathophysiology. Then, explain how hypertension or dyslipidemia can lead to the alteration you selected for patients with the factor you identified.

Pick any that you want.

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While arthritis impacts nearly 50 million adults in the United States, it is not a disease that is limited to adulthood. Consider the case of Ashley Russell. At the age of 14 months, Ashley was diagnosed with juvenile rheumatoid arthritis. As a baby, her parents noticed that her knee was always swollen and that she often wanted to be carried instead of walking on her own (Cyr, 2012). After seeking medical care, Ashley’s underlying disorder was discovered. Arthritis in children is not uncommon. According to the CDC (2011), an estimated 294,000 children under age 18 have some form of arthritis or rheumatic condition. Due to the prevalence of the disorder in both children and adults, you must understand the pathophysiology and symptoms of arthritis in order to properly diagnose and prescribe treatment.

To Prepare

· Review Chapter 37 in the Huether and McCance text and Chapter 24 in the McPhee and Hammer text. Identify the pathophysiology of osteoarthritis and rheumatoid arthritis. Consider the similarities and differences of the disorders.

· Select two of the following patient factors: genetics, gender, ethnicity, age, or behavior. Reflect on how the factors you selected might impact the pathophysiology of the disorders, as well as the diagnosis of and treatment for the disorders.

Post a description of the pathophysiology of osteoarthritis and rheumatoid arthritis, including the similarities and differences between the disorders. Then explain how the factors you selected might impact the pathophysiology of the disorders, as well as the diagnosis of treatment for the disorders. 

Pick any 2

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In clinical settings, some of the most common questions that patients ask are Why do I have this? What caused this disorder? Will it ever go away? These emotional questions can be difficult to ask and to answer. However, for patients to come to terms with their diagnoses and adhere to treatment plans, they must have an understanding of factors that might have caused, or continue to impact, their disorders. As an advanced practice nurse, it is important that you are able to explain disorders, associated alterations and symptoms, and changes that might occur within your patients’ bodies.

To Prepare

• Review this week’s media presentation with Dr. Terry Buttaro. Reflect on the importance of developing an in-depth understanding of pathophysiology.
• Select a disorder from the following list:
  • Adrenal insufficiency (Addison’s disease)
  • Atherosclerosis
  • Cholelithiasis (gallstones)
  • Colon cancer
  • Cystic fibrosis
  • Hemophilia
  • Nephrolithiasis (kidney stones)
  • Osteoporosis
  • Parkinson’s disease
  • Tuberculosis
• Select one of the following patient factors: genetics, gender, ethnicity, age, or behavior. Reflect on how that factor might impact your selected disorder, as well as potential associated alterations and symptoms.
• Identify the pathophysiology of the associated alterations, including the normal and altered cellular function. Consider both intra- and extra-cellular changes that occur.

Post a brief description of a patient scenario involving the disorder and the factor you selected. Explain how the factor might impact your selected disorder, as well as potential associated alterations and symptoms. Finally, explain the pathophysiology of the associated alterations, including changes in cellular function.

 Please do colon cancer 

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Discussion: Assessment Tools and Diagnostic Tests in Adults and Children

When seeking to identify a patient’s health condition, advanced practice nurses can use a diverse selection of diagnostic tests and assessment tools; however, different factors affect the validity and reliability of the results produced by these tests or tools. Nurses must be aware of these factors in order to select the most appropriate test or tool and to accurately interpret the results.

Not only do these diagnostic tests affect adults, body measurements can provide a general picture of whether a child is receiving adequate nutrition or is at risk for health issues. These data, however, are just one aspect to be considered. Lifestyle, family history, and culture-among other factors-are also relevant. That said, gathering and communicating this information can be a delicate process.

In this Discussion, you will consider the validity and reliability of different assessment tools and diagnostic tests. You will explore issues such as sensitivity, specificity, and positive and negative predictive values. You will also consider examples of children with various weight issues. You will explore how you could effectively gather information and encourage parents and caregivers to be proactive about their children’s health and weight.

To prepare:

· Review this week’s learning resources and consider factors that impact the validity and reliability of various assessment tools and diagnostic tests. We will also review examples of pediatric patients and their families as it relates to BMI.

· This week you will be assigned one of the following DB by your instructor.

1. Select one of the following assessment tools or diagnostic tests to explore for the purposes of this Discussion:

§ Mammogram

§ Prostate-specific antigen (PSA) test

§ Body-mass index (BMI) using waist circumference for adults

2. Select one of the examples on which to focus for this Discussion. What health issues and risks may be relevant to the child you selected?

§ Overweight 5-year-old boy with overweight parents

§ 5-year-old girl of normal weight with obese parents

§ Severely underweight 12-year-old girl with underweight parents

· Search the Walden Library and credible sources for resources explaining the tool or test you selected. What is its purpose, how is it conducted, and what information does it gather?

· What does the literature discuss regarding the validity, reliability, and are there any issues with sensitivity, specificity, predictive values, ethical dilemmas, and controversies related to the test or tool?

· Based on the risks you identified, consider what further information you would need to gain a full understanding of the child’s health. Think about how you could gather this information in a sensitive fashion.

· Consider how you could encourage parents or caregivers to be proactive toward the child’s health.

Post a description of how the assessment tool or diagnostic test you selected is used in health care. Based on your research, evaluate the test or the tool’s validity and reliability, and explain any issues with sensitivity, reliability, and predictive values. Include references in appropriate APA formatting.

OR

Post an explanation of the health issues and risks that are relevant to the child you selected. Describe additional information you would need in order to further assess his or her weight-related health. Taking into account the parents’ and caregivers’ potential sensitivities, list at least three specific questions you would ask about the child to gather more information. Provide at least two strategies you could employ to encourage the parents or caregivers to be proactive about their child’s health and weight.

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