Category: Nursing

NURS 6053/NURS 6053N/NRSE 6053C/NURS 6053C/NURS 6053A/NRSE 6053A: Interprofessional Organizational and Systems Leadership

National Healthcare Issue/Stressor

A national healthcare issue/stressor affecting healthcare systems across America is disparities in healthcare. The inequalities in healthcare relate to specific ethnic, social, and economic groups. Many of those groups reside in rural and underserved populations where healthcare providers are scarce. Also, chronic diseases disproportionately affect these populations. However, social determinants such as race, socioeconomic status, educational level, and residency are sometimes unchangeable circumstances. Everyone deserves healthcare that is accessible, safe, effective, and affordable. The Triple Aim and Quadruple Aim are initiatives to assist with bridging healthcare gaps and Advance Practice Registered Nurses (APRNs) NURS 6053/NURS 6053N/NRSE 6053C/NURS 6053C/NURS 6053A/NRSE 6053A: Interprofessional Organizational and Systems Leadership.

The Triple Aim and Quadruple Aim relate to essential principles for delivering in the healthcare industry and specifically in individual healthcare organizations. The Triple Aim has three critical components the health of populations, containment cost of healthcare, and improved quality of patient care (Broome & Marshall, 2021). The Quadruple Aim adds another standard that focuses on bettering the work environment of healthcare workers. The addition of the fourth component is paramount in the achievement of the Triple Aim goals. The focal points of my work setting will be improving population health and work enthusiasm.

In correctional nursing, healthcare disparities among the inmate population are more remarkable than that of the general public. According to Nowotny et al. 2017, those incarcerated’ overall health is inadequate and worse than those not in prison, especially chronic conditions. Besides, healthcare worker vacancies are always an issue, and prison positions are hard to fill. Thus, it is difficult to recruit and retain quality healthcare professionals to treat detainees appropriately. The staff has to work additional mandatory hours beyond the 40-hour workweek, which is exhausting. So, the work environment is stressful, and staff burnout is a reality due to staffing shortages.

Response to Healthcare Issue/Stressor in the Work Setting and Changes Implemented

The prison’s answer to reducing health disparities and improving working conditions primary focus is on recruiting and retaining qualified healthcare workers. APRNs are a part of this innovation. Nurse Practitioners play an integral role in providing healthcare in prisons and primary care settings. Besides, there is an increase in APRNs graduating rates compared with physicians, which creates a change in the workforce without compromising patient care quality or a rise in healthcare cost (Auerbach et al., 2018). The Department of Justice offers retention, recruitment, and relocation pay incentives and student loan repayment to nurses and other healthcare professionals (U.S. Department of Justice, 2016). Likewise, at my correctional institution, there is an exercise center and other wellness programs such as health fairs. With all of these initiatives in place, the correctional facility is becoming more competitive, and hiring increases. Staff morale is improving, which decreases burnout and enhances healthcare quality, reducing disparities NURS 6053/NURS 6053N/NRSE 6053C/NURS 6053C/NURS 6053A/NRSE 6053A: Interprofessional Organizational and Systems Leadership.

Conclusion

Health disparities are a significant problem in the private sector and institutionalized places, but with the effect of the Triple/Quadruple Aim and APRNs, the inequalities can decline.

References

Auerbach, D. I., Staiger, D. O., & Buerhaus, P. I. (2018). Growing ranks of advanced practice clinicians-Implications for the physician workforce. 
New England Journal of Medicine
, 
378
(25), 2358–2360. 
https://doi.org/10.1056/NEJMp1801869

Broome, M. E., & Marshall, E. S. (2021). 
Transformational leadership in nursing: From expert clinician to influential leader
 (3rd ed.). New York, NY: Springer.

Nowotny, K. M., Rogers, R. G., & Boardman, J. D. (2017). Racial disparities in health conditions among prisoners compared with the general population. 
ScienceDirect
, 
3
, 487–496. 
https://doi.org/10.1016/j.ssmph.2017.05.011

U.S. Department of Justice. (2016). 
Federal Bureau of Prisons: Program Statement
. Retrieved November 30, 2020, from 
https://www.bop.gov/policy/progstat/3530.02.pdf

Module 1: Healthcare Environment (Weeks 1-2)

Learning Objectives

Students will:

Analyze current national healthcare issues/stressors

Analyze the impact of national healthcare issues/stressors on healthcare organizations

Analyze strategies for addressing national healthcare issues/stressors

 

Due By

Assignment

Week 1, Days 1–2

Read the Learning Resources.

Compose your initial Discussion post.

Week 1, Day 3

Post your initial Discussion post.

Begin to compose your Assignment.

Week 1, Days 4-5

Review peer Discussion posts.

Compose your peer Discussion responses.

Continue to compose your Assignment.

Week 1, Day 6

Post two peer Discussion responses.

Week 2, Days 1–6

Continue to compose your Assignment.

Week 2, Day 7

Deadline to submit your Assignment.

Learning Resources

Required Readings

Broome, M., & Marshall, E. S. (2021).
Transformational leadership in nursing: From expert clinician to influential leader
(3rd ed.). New York, NY: Springer.

Chapter 2, “Transformational Leadership: Complexity, Change, and Strategic Planning” (pp. 34–62)

Chapter 3, “Current Challenges in Complex Health Care Organizations and the Quadruple Aim” (pp. 66–97)

Read any TWO of the following (plus TWO additional readings on your selected issue):

Auerbach, D. I., Staiger, D. O., & Buerhaus, P. I. (2018). Growing ranks of advanced practice clinicians—Implications for the physician workforce.
New England Journal of Medicine, 378
(25), 2358–2360.

Gerardi, T., Farmer, P., & Hoffman, B. (2018). Moving closer to the 2020 BSN-prepared workforce goal. 
American Journal of Nursing, 118
(2), 43–45.

Jacobs, B., McGovern, J., Heinmiller, J., & Drenkard, K. (2018). Engaging employees in well-being: Moving from the Triple Aim to the Quadruple Aim. 
Nursing Administration Quarterly, 42
(3), 231–245.

Norful, A. A., de Jacq, K., Carlino, R., & Poghosyan, L. (2018). Nurse practitioner–physician comanagement: A theoretical model to alleviate primary care strain. 
Annals of Family Medicine, 16
(3), 250–256.

Palumbo, M., Rambur, B., & Hart, V. (2017). Is health care payment reform impacting nurses’ work settings, roles, and education preparation? 
Journal of Professional Nursing, 33
(6), 400–404.

Park, B., Gold, S. B., Bazemore, A., & Liaw, W. (2018). How evolving United States payment models influence primary care and its impact on the Quadruple Aim. 
Journal of the American Board of Family Medicine, 31
(4), 588–604.

Pittman, P., & Scully-Russ, E. (2016). Workforce planning and development in times of delivery system transformation. Human Resources for Health, 14(56), 1–15. doi:10.1186/s12960-016-0154-3. Retrieved from

https://human-resources-health.biomedcentral.com/track/pdf/10.1186/s12960-016-0154-3

Poghosyan, L., Norful, A., & Laugesen, M. (2018). Removing restrictions on nurse practitioners’ scope of practice in New York state: Physicians’ and nurse practitioners’ perspectives. 
Journal of the American Association of Nurse Practitioners, 30
(6), 354–360.

Ricketts, T., & Fraher, E. (2013). Reconfiguring health workforce policy so that education, training, and actual delivery of care are closely connected. 
Health Affairs, 32
(11), 1874–1880.

Required Media

Laureate Education (Producer). (2015).
Leading in Healthcare Organizations of the Future
[Video file]. Baltimore, MD: AuthorNURS 6053/NURS 6053N/NRSE 6053C/NURS 6053C/NURS 6053A/NRSE 6053A: Interprofessional Organizational and Systems Leadership.

Discussion: Review of Current Healthcare Issues

If you were to ask 10 people what they believe to be the most significant issue facing healthcare today, you might get 10 different answers. Escalating costs? Regulation? Technology disruption?

These and many other topics are worthy of discussion. Not surprisingly, much has been said in the research, within the profession, and in the news about these topics. Whether they are issues of finance, quality, workload, or outcomes, there is no shortage of changes to be addressed.

In this Discussion, you examine a national healthcare issue and consider how that issue may impact your work setting. You also analyze how your organization has responded to this issue.

To Prepare:

Review the Resources and select one current national healthcare issue/stressor to focus on.

Reflect on the current national healthcare issue/stressor you selected and think about how this issue/stressor may be addressed in your work setting.

By Day 3 of Week 1

Post
 a description of the national healthcare issue/stressor you selected for analysis, and explain how the healthcare issue/stressor may impact your work setting. Then, describe how your health system work setting has responded to the healthcare issue/stressor, including a description of what changes may have been implemented. Be specific and provide examples.

Nursing burnout during the COVID-19 pandemic is a national healthcare issue that has had a profound effect on the vast majority of healthcare organizations, with my work setting being no exception.  This issue has significantly raised stress levels for direct care workers due to a number factors, with the primary topic being the risk for exposure.  However, several secondary effects have added to already high levels of concern, which include financial concerns, staffing shortages, and risk of exposing loved ones.

The mental health of healthcare teams with heavy social and work responsibilities is particularly affected in pandemics that affect society both socioeconomically and psychologically (Sayilan, Kulakac, Uzun, 2020).  Frontline healthcare workers that endure the greatest risks via prolonged close contact are expected to be the most at-risk for burnout.  As stress increases and burnout emerges, the risk for sleep deprivation and insomnia begin to form.  Stressful life situations have significant adverse effects on the mental health and psychological functioning of a person and lead to psychological problems such as anxiety, mental confusion, social deprivation, and depression (Yildirim, Solmaz, 2020) NURS 6053/NURS 6053N/NRSE 6053C/NURS 6053C/NURS 6053A/NRSE 6053A: Interprofessional Organizational and Systems Leadership.

My place of work is an acute behavioral health hospital, where for the past four years, I have held the night shift supervisor role.  My organization has been greatly affected by COVID-19, with the most significant area of affect being in staff shortages.  To help combat this issue, the for the time is several years, my hospital has begun to implement registry and traveling nurses.  While this may seem like a fix for our problem, it also opens the door for other potential issues that may affect patient safety due to the lack of familiarity with hospital policy and procedures.  In pandemics, the organization should maintain clear, fluid, and regular communication with the nursing staff, which would help increase staff members’ confidence and sense of control (Garcia, Calvo, 2020).  During these difficult times it is critical that staff feel safe and supported, which significantly boosts overall morale.  Making sure everyone has the tools for success and is up to date on current policies and practice changes, will help to ensure that goal is met.

References.

García, G., Calvo, J. (2020). The threat of COVID‐19 and its influence on nursing staff burnout.
Journal of Advanced Nursing
, 1–13. doi:
https://doi.org/10.1111/jan.14642

Sayilan, A., Kulakaç, N., Uzun, S. (2020). Burnout levels and sleep quality of COVID-19 heroes. 
Perspectives in Psychiatric Care
. doi:10.1111/ppc.12678.

Yıldırım, M. & Solmaz, F. (2020) COVID-19 burnout, COVID-19 stress and resilience: Initial psychometric properties of COVID-19 Burnout Scale. 
Death Studies.
 doi:
10.1080/07481187.2020.1818885

By Day 6 of Week 1

Respond
 to at least 
two
 of your colleagues 
on two different days
 who chose a different national healthcare issue/stressor than you selected. Explain how their chosen national healthcare issue/stressor may also impact your work setting and what (if anything) is being done to address the national healthcare issue/stressor.

 I really enjoyed reading your discussion post. I completely agree that nursing burnout is a prominent national healthcare issue, that has been severely exacerbated by the global pandemic COVID-19. Burnout was first defined by Herbert Freudenberger in 1974 as excessive demands on strength, energy, or resources, resulting in exhaustion in the workplace (Reith, 2018). Symptoms of fatigue, inefficacy, malaise, cynicism, and frustration characterize burnout (Reith, 2018). Healthcare provider burnout is detrimental to patient care (Reith, 2018).

As you mentioned, increased patient acuity, workloads and staffing ratios are some of the mitigating factors behind nursing burnout. One recommendation to decrease nursing burnout is improving nurses’ resilience through on-shift and pre-shift work activities, such as implementing aromatherapy and the use of smartphones (Jones, 2019). This can be viewed as an impractical recommendation for certain clinical settings, such as the one I work in, due to rapidly changing patient acuity and dynamic workloads (Jones, 2019). It is my opinion that better staffing would go a long way towards resolving nursing burnout as this would decrease the workloads and help with patient acuity.

However, as we are encountering a global pandemic, it is understandable that staffing is spread very thin. Do you have any personal recommendations on strategies to effectively cope with nursing burnout?NURS 6053/NURS 6053N/NRSE 6053C/NURS 6053C/NURS 6053A/NRSE 6053A: Interprofessional Organizational and Systems Leadership

References:

Jones, B. (2019). Fifteen minutes may decrease nursing burnout: A discussion paper.

International Journal of Nursing Sciences, 7
(1), 121-123.

https://doi.org/10.1016/j.ijnss.2019.11.004

Reith, T. P. (2018). Burnout in United States healthcare professionals: A narrative review.

Cureus, 10
(12), e3681. 
https://doi.org/10.7759cureus.3681

 

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 1 Discussion Rubric

Post by Day 3 and Respond by Day 6 of Week 1

To participate in this Discussion:

Week 1 Discussion

Assignment: Analysis of a Pertinent Healthcare Issue

The Quadruple Aim provides broad categories of goals to pursue to maintain and improve healthcare. Within each goal are many issues that, if addressed successfully, may have a positive impact on outcomes. For example, healthcare leaders are being tasked to shift from an emphasis on disease management often provided in an acute care setting to health promotion and disease prevention delivered in primary care settings. Efforts in this area can have significant positive impacts by reducing the need for primary healthcare and by reducing the stress on the healthcare system.

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Changes in the industry only serve to stress what has always been true; namely, that the healthcare field has always faced significant challenges, and that goals to improve healthcare will always involve multiple stakeholders. This should not seem surprising given the circumstances. Indeed, when a growing population needs care, there are factors involved such as the demands of providing that care and the rising costs associated with healthcare. Generally, it is not surprising that the field of healthcare is an industry facing multifaceted issues that evolve over time.

In this module’s Discussion, you reviewed some healthcare issues/stressors and selected one for further review. For this Assignment, you will consider in more detail the healthcare issue/stressor you selected. You will also review research that addresses the issue/stressor and write a white paper to your organization’s leadership that addresses the issue/stressor you selected.

To Prepare:

Review the national healthcare issues/stressors presented in the Resources and reflect on the national healthcare issue/stressor you selected for study.

Reflect on the feedback you received from your colleagues on your Discussion post for the national healthcare issue/stressor you selected.

Identify and review two additional scholarly resources (not included in the Resources for this module) that focus on change strategies implemented by healthcare organizations to address your selected national healthcare issue/stressor.NURS 6053/ NURS 6053N/NRSE 6053C/NURS 6053C/NURS 6053A/NRSE 6053A: Interprofessional Organizational and Systems Leadership

The Assignment (3-4 Pages):

Analysis of a Pertinent Healthcare Issue

Develop a 3- to 4-page paper, written to your organization’s leadership team, addressing your selected national healthcare issue/stressor and how it is impacting your work setting. Be sure to address the following:

Describe the national healthcare issue/stressor you selected and its impact on your organization. Use organizational data to quantify the impact (if necessary, seek assistance from leadership or appropriate stakeholders in your organization).

Provide a brief summary of the two articles you reviewed from outside resources on the national healthcare issue/stressor. Explain how the healthcare issue/stressor is being addressed in other organizations.

Summarize the strategies used to address the organizational impact of national healthcare issues/stressors presented in the scholarly resources you selected. Explain how they may impact your organization both positively and negatively. Be specific and provide examples.

Looking Ahead

The paper you develop in Module 1 will be revisited and revised in Module 2. Review the Assignment instructions for Module 2 to prepare for your revised paper.

By Day 7 of Week 2

Submit
 your paper.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

Please save your Assignment using the naming convention “WK2Assgn+last name+first initial.(extension)” as the name.

Click the 
Week 2 Assignment Rubric 
to review the Grading Criteria for the Assignment.

Click the 
Week 2 Assignment 
link. You will also be able to “View Rubric” for grading criteria from this area.

Next, from the Attach File area, click on the 
Browse My Computer
 button. Find the document you saved as “WK2Assgn+last name+first initial.(extension)” and click 
Open
.

If applicable: From the Plagiarism Tools area, click the checkbox for 
I agree to submit my paper(s) to the Global Reference Database
.

Click on the 
Submit
 button to complete your submission.

Due to the nature of this assignment, your instructor may require more than 
7
days to provide you with quality feedback NURS 6053/NURS 6053N/NRSE 6053C/NURS 6053C/NURS 6053A/NRSE 6053A: Interprofessional Organizational and Systems Leadership.

Grading Criteria

To access your rubric:

Week 2 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment Draft for Authenticity:

Submit your Week 2  Assignment draft and review the originality report

Submit Your Assignment by Day 7 of Week 2

To participate in this Assignment:

Week 2 Assignment

Next Module

To go to the next module:

Module 2

Module 1 Week 1 Main Discussion Post

One health care issue that has been in the news nationally all this year, besides Covid19 that is, is the rising issue of people having to ration their insulin related to increased cost and/or lack of insurance coverage to pay for insulin.  As we all already know, diabetes is one of the predominate health issues facing our society today and the problem is compounded when people cannot afford the increase cost of the life saving insulin or their insurance will not pay these increased costs.  I have firsthand experience with this, as my own father had stop taking his Victoza (not exactly insulin, but still related to diabetes) in October of this year because his insurance coverage would not pay out on it anymore this year.  He was not able buy it on his own because it is insultingly expensive, and instead will have to use less effective oral medications to control his blood sugars for the rest of this year.

There is significant scholarly evidence that this really is a national problem and is effecting patient outcomes negatively.  Fralick discusses why this may be happening, postulating that there are no laws in the United States prohibiting pharmaceutical companies from over pricing and raising the price of their drugs in combination with a lack of competition in the market as most insulin in the US is made by 3 companies (2019).  Fralick also points out the irony of the fact that a drug discovered in the 1920s and universally identified as the ONLY way—at the time—to treat the nearly 100% fatal disease is now today being exploited by pharmaceutical companies for profit (2019) NURS 6053/NURS 6053N/NRSE 6053C/NURS 6053C/NURS 6053A/NRSE 6053A: Interprofessional Organizational and Systems Leadership.

How bad is the problem?  Hart identifies in her research that the cost of insulins has tripled from 2002 to 2013 and then doubled again from that already inflated cost from 2012 to 2016 (2020).  This drastically outpaces any positive change in income most people might experience and can be compounded by a lack of insurance coverage or coverage (such as in my father case) that will not pay for all of the needed and life saving medications.  Pharmaceutical companies are being allowed to place their profit over the lives of the patients their medications are intended to help save.  Heng Nhoung sites that the problem is additionally compounded in cases in which food insecurity, which is defined as lack of consistent access to necessary nutrients, causes the diabetic to engage in the dangerous practice of rationing insulins while also contending with not having enough money for food (2020).  As you can imagine, that is a recipe for disaster.

At my workplace, patients are committed and cannot leave of their own accord.  This means that compared to other patients, or even their own situations when not in the facility, are actually better off.  The State of Minnesota purchases the necessary insulins for our patients regardless of cost.  However, that does not mean adjustments have not been made.  We have now switched to Semglee instead of Lantus.  Semglee is chemical similar to Lantus and nearly identical in function, but significantly less expensive.  My parents have been told by their Medicare Part-D provider that regular insulins will changed with respect to their Medicare coverage and they will no longer have to pay as much for the insulins they need.  However, this change in coverage does not apply to my father’s Victoza.  It is unclear if this change in coverage is limited to just the Part-D supplemental coverage or if Medicare as a whole will have better coverage on insulin.  Somehow, I fear this is NOT the case and probably means that low income diabetic patients who cannot afford Part-D supplemental coverage will continue to be in life threatening trouble NURS 6053/NURS 6053N/NRSE 6053C/NURS 6053C/NURS 6053A/NRSE 6053A: Interprofessional Organizational and Systems Leadership.

References

Fralick, M., & Kesselheim, A. S. (2019). The U.S. Insulin Crisis – Rationing a Lifesaving Medication Discovered in the 1920s. 
The New England Journal of Medicine
, 
19
, 1793.

Hart, L. (2020). Insulin Rationing. 
The Journal for Nurse Practitioners
, 
16
(3), 213–217. 
https://doi-org.ezp.waldenulibrary.org/10.1016/j.nurpra.2019.10.023

Heng Ky Nhoung, Goyal, M., Cacciapuoti, M., Day, H., Hashemzadeh, T., Magee, M., & Jarris, Y. S. (2020). Food Insecurity and Insulin Use in Hyperglycemic Patients Presenting to the Emergency Department. 
Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
, 
21
(4), 959–963. https://doi-org.ezp.waldenulibrary.org/10.5811/westjem.2020.4.45918

response

Diabetes is a disease that affects millions of people worldwide. Global health leaders identify diabetes as a non-communicable disease (NCDs). According to NCD Alliance (2017), in 2014, there were 387 million people with diabetes and is expected to rise to 592 million by 2035 without effective prevention and treatment. The U.S. has 30 million Americans with diabetes, and almost 25% or 7.4 million Americans need insulin (Rajkumar, 2020).

The United States is one of the priciest countries for prescription medications. Insulin is an example. Insulin is a 20
th
-century wonder drug that modernized diabetes from a fatal disease into a controllable condition (Luo et al., 2019). Yet, the cost of insulin is ten times more in the U.S. than in any other developed nation (Rajkumar, 2020). A reason for the high price is because insulin is a biological product and considered a biosimilar drug. Biosimilar drugs’ production and marketing are monopolized by three pharmaceutical companies: Novo Nordisk, Sanofi-Aventis, and Eli Lilly (Rajkumar, 2020).

I believe that the U.S. federal government needs to step in to regulate or amend laws to restrict the inflation of insulin prices or any prescription medication. People should not have to make life-altering decisions to forgo their insulin over food and shelter.

I hope your father finds a solution to get the treatment he needs and deserves.

References

Luo, J., Gonsalves, G., & Greene, J. (2019). Insulin for all: treatment activism and the global diabetes crisis. 
Lancet (London, England)
, 
393
(10186), 2116–2117. 
https://doi-org.ezp.waldenulibrary.org/10.1016/S0140-6736(19)31090-6

NCD Alliance. (2017). 
Diabetes
. https://ncdalliance.org/diabetes

Rajkumar, S. V. (2020). The High Cost of Insulin in the United States: An Urgent Call to Action. 
Mayo Clinic Proceedings
, 
1
, 22. https://doi-org.ezp.waldenulibrary.org/10.1016/j.mayocp.2019.11.013 NURS 6053/NURS 6053N/NRSE 6053C/NURS 6053C/NURS 6053A/NRSE 6053A: Interprofessional Organizational and Systems Leadership

Discussion: Review of Current Healthcare Issues

If you were to ask 10 people what they believe to be the most significant issue facing healthcare today, you might get 10 different answers. Escalating costs? Regulation? Technology disruption?

These and many other topics are worthy of discussion. Not surprisingly, much has been said in the research, within the profession, and in the news about these topics. Whether they are issues of finance, quality, workload, or outcomes, there is no shortage of changes to be addressed.

In this Discussion, you examine a national healthcare issue and consider how that issue may impact your work setting. You also analyze how your organization has responded to this issue Discussion: Review of Current Healthcare Issues.

To Prepare:

Review the Resources and select one current national healthcare issue/stressor to focus on.

Reflect on the current national healthcare issue/stressor you selected and think about how this issue/stressor may be addressed in your work setting.

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By Day 3 of Week 1

Post
 a description of the national healthcare issue/stressor you selected for analysis, and explain how the healthcare issue/stressor may impact your work setting. Then, describe how your health system work setting has responded to the healthcare issue/stressor, including a description of what changes may have been implemented. Be specific and provide examples.

By Day 6 of Week 1

Respond
 to at least 
two
 of your colleagues 
on two different days
who chose a different national healthcare issue/stressor than you selected. Explain how their chosen national healthcare issue/stressor may also impact your work setting and what (if anything) is being done to address the national healthcare issue/stressor Discussion: Review of Current Healthcare Issues

NRS-429 VN Topic 2 DQ 2 -Family health promotion strategies

Re: Topic 2 DQ 2

The concept of family health is important in society as individual in each family affect each other and plays a role in helping each other to achieve optimal healt. Families have a connectedness with everyone in the unit and it enables for changes to occur. Families love, trust, and support each other during times of distress. It’s important to determine in health promotion who the family unit is for a patient so that they are engaged in family education to promote positive behavioral changes NRS-429 VN Topic 2 DQ 2 -Family health promotion strategies.

There are various strategies to promote health but as mentioned in the article, “5 Health Promotion Action Areas Every Nurse Should Know,” there are three key strategies to create effective health promotion, Health Communication, Health Education and Policy, Systems and Environmental changes. In health communication the goal is to promote health literacy, discuss health screenings, educate the patient and families regarding their health issues. Health Education promotes preventive health, daily choices a person makes to improve their health, to lead a healthy lifestyle. In an example given by the article was, for poor communities to have access to a Nutritionist to combat diabetes. The other strategy is for Policy systems and Environmental changes, creating policies that enable a person to have access to healthcare for instance and environment is the environmental changes within a community that inhibits their health outcomes, for example people that live in communities that high pollution.

The Nurse can determine which strategies will be best to enable individuals or families by assessing the socioeconomic, financial, and 
family structure
of the family to improve their health. To promote health changes within the family the Nurse also needs to determine what the barriers are to promoting those changes in the family. For instance, as mentioned in previous discussion in our forum with Maslow’s Hierarchy of needs a family with a low socioeconomic background is unable to focus on education when their focus is daily life is to meet their physical needs first. Assessing the family unit will enable to the nurse to develop a health promotion health plan based on their needs NRS-429 VN Topic 2 DQ 2 -Family health promotion strategies.

References

Anonymous (2020). Environment Health. Goal: Promote Healthier environments to promote health. 
Healthy People 2030
. Retrieved from 
www.health.gov

Anonymous (2020). University of Maine Fort Kent. 5 Health Promotion Action Areas Every Nurse Should Know. Retrieved from https://www.online.umfk.edu

 

Why is the concept of family health important? Consider the various strategies for health promotion. How does a nurse determine which strategy would best enable the targeted individuals to gain more control over, and improve, their health?

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Re: Topic 2 DQ 2

The concept of family health is important because a family health history can identify people with a higher-than-usual chance of having common disorders, such as heart disease, high blood pressure, stroke, certain cancers, type 2 diabetes as well as possible mental health issues. These complex disorders are influenced by a combination of genetic factors, environmental conditions, and lifestyle choices. understanding these preexisting factors within the family dynamic help nurses formulate better treatment plans. Strategies that would be effective for health promotion when dealing with family health are assessing education level, family structure, inquiring about previous encounters with healthcare professionals and health concerns. Deciding which strategy to use in order to help a patient gain control over and improve their health can be tricky. The best approach in my opinion is to use the person’s own motivations and goals towards health as well as educating the family so the environment can be supportive, this will make behavioral changes that will positively affect the patients’ health a lot easier for the patient to stick to over time which will in turn produce better health outcomes NRS-429 VN Topic 2 DQ 2 -Family health promotion strategies.

References

https://medlineplus.gov/genetics/understanding/inheritance/familyhistory/ May 12, 2021

5 Health promotion Action Areas Every Nurse Should Know February 7, 2020 https://online.umfk.edu/articles/rnbsn/health-promotion-action-areas-every-nurse.aspx

 

sample 3

Topic 2 DQ 2

Family health is important because the family is there every day to help each other survive. Knowing the needs of the patient and the family will help ensure their health promotion on target with goals that are given. There are many different strategies the nurse can use to target the family. Doing a complete assessment of the patient and family will help determine which path to take. Making sure the patient has control over their own needs is important, but what is the family able to do to help and what are their barriers as well. Being sure the family’s overall health is important so that they can continue to help each other and care for one another. As a nurse it is our duty to help find ways to ease the stress of the patient and their family to help them in their healthcare journey. If the patient’s financial situation is not that great, knowing the local tools to help like shelters, food banks, churches and other programs that are available in the community can be a huge help to them. When working with families it is important to always use “an accepting, nonjudgmental approach that can enhance collaborative efforts from the family members.” (Green, S. 2018) Knowing the patient and family’s strengths and weaknesses will help determine what their needs will be and what services to provide.

Below are some core concepts I thought were interesting!

“Core Concepts of Patient- and Family-Centered Care

Dignity and Respect. Health care practitioners listen to and honor patient and family perspectives and choices. Patient and family knowledge, values, beliefs and cultural backgrounds are incorporated into the planning and delivery of care.

Information Sharing. Health care practitioners communicate and share complete and unbiased information with patients and families in ways that are affirming and useful. Patients and families receive timely, complete and accurate information in order to effectively participate in care and decision-making NRS-429 VN Topic 2 DQ 2 -Family health promotion strategies.

Participation. Patients and families are encouraged and supported in participating in care and decision-making at the level they choose.

Collaboration. Patients, families, health care practitioners, and health care leaders collaborate in policy and program development, implementation, and evaluation; in facility design; in professional education; and in research; as well as in the delivery of care.”

References:

Green, S. (2018). 
CCC Web Books by AWS & CDD
. Gcumedia.com. 
https://lc.gcumedia.com/nrs429vn/health-promotion-health-and-wellness-across-the-continuum/v1.1/#/chapter/4

https://www.ipfcc.org/about/pfcc.html NRS-429 VN Topic 2 DQ 2 -Family health promotion strategies

COVID-19 Current Healthcare Issues discussion essay

COVID-19 infection is one of the most current global healthcare issues. The United States is one of the worst-hit countries globally, with over 152,000 new cases and a total of more than 13 million cases currently leading to the death of over 263,000 Americans (Center for Disease Control and Prevention [CDC], 2020). Due to the increase in the infection rate of COVID-19 during the 2020 winter season, schools, businesses, and public activities are being shut down or scaled-down to the barest minimum to curb the transmission rates. The COVID-19 shutdown has enormous adverse economic and psychosocial effects on the American population while the government struggles to provide relief for individuals and businesses to survive the resultant hardship (Hughes, 2020) COVID-19 Current Healthcare Issues discussion essay.

Besides, the recent upsurge in the COVID-19 infection rate in the United States has occasioned many challenges on the country’s healthcare system due to an increase in hospitalizations across the country. Hospitals are running out of available bed spaces, personal protective equipment, and medical staff (McKinsey Insights, N.PAG., 2020). Most importantly, there is an increasing demand for healthcare workers all over the country following the COVID-19 crisis. Hence, in this period, more than ever before, the frontline workers’ well-being is paramount to sustaining the workforce needed in this pandemic era. Adopting the quadruple aim approach for patient care will improve patient care outcomes and experience and reduce hospital stay and cost (Jacobs et al., 2018). The quadruple aim takes cognizances of healthcare workers’ well-being by actively engaging them while improving the work environment. Healthcare workers, especially the nursing staff, are more productive and resilient when their welfare and work environmental stressors, are eliminated (Gallup, 2017).

Furthermore, the healthcare system is passing through a lot of transformation since the inception of the Affordable Care Act (ACA) which is currently compounded by the emergence of the Coronavirus pandemic (Pittman & Scully-Russ, 2016). It is essential to enhance healthcare workers’ skills and capabilities, especially the nursing staff, to deal with the current challenges occasioned by the pandemic. The inclusion of worker-friendly policies and development plans by healthcare employers and the government will ensure the healthcare workforce’s sustenance through the Coronavirus pandemic’s difficulties (Pittman & Scully-Russ, 2016). The education/training of staff and the adequate supply of PPEs and deliveries needed for caring for hospitalized patients are essential to ensure healthcare staff’s safety (Ricketts & Fraher, 2013). Increasing free testing sites and providing safe vaccines to vulnerable populations and frontline workers is the government and policymakers’ fundamental responsibility in combating the incidence of the COVID-19 virus COVID-19 Current Healthcare Issues discussion essay.

In conclusion, the COVID-19 pandemic has imposed enormous challenges on the healthcare system of the United States. The frontline workers experience stress and burnout by the increased hospitalization and infection rate in the country. Adopting the quadruple aim will go a long way to alleviating the stress and burnout of healthcare workers, especially the nursing staff. The healthcare administrators and the government should adopt plans and policies that address the healthcare workforce’s demands and needs in this current era of the COVID-19 pandemic through staff training, education, and career advancement programs.

References

Center for Disease Control and Prevention. (2020). CDC COVID Data Tracker. Retrieved on December 2, 2020, from 
https://covid.cdc.gov/covid-data-tracker/#cases_casesper100klast7days
.

Gallup. (2017). State of the American Workplace Report. Retrieved on December 2, 2020, from https://www.gallup.com/workplace/238085/state-american-workplace-report-2017.aspx

Hughes, J. S. (2020). The Coronavirus Aid, Relief, and Economic Security (CARES) Act–Tax Relief for Individuals and Businesses. 
Congressional Research Service: Report, 1–17
.

Jacobs, B., McGovern, J., Heinmiller, J., & Drenkard, K. (2018). Engaging employees in well-being: Moving from the Triple Aim to the Quadruple Aim. 
Nursing Administration Quarterly, 42(3),
 231–245.

McKinsey Insights, N.PAG. (2020). Challenges Emerge for the US Healthcare System as COVID-19 Cases Rise.

Pittman, P., & Scully-Russ, E. (2016). Workforce Planning and Development in Times of Delivery System Transformation. Human Resources for Health, 14(56), 1–15. doi:10.1186/s12960-016-0154-3. Retrieved from 
https://human-resources-health.biomedcentral.com/track/pdf/10.1186/s12960-016-0154-3

Ricketts, T., & Fraher, E. (2013). Reconfiguring Health Workforce Policy So That Education, Training and Actual Delivery of Care are Closely Connected. 
Health Affairs, 32
(11), 1874–1880 COVID-19 Current Healthcare Issues discussion essay.

response

I enjoyed your thoughts on the current state of the healthcare arena.  You expertly touched on many current issues that we are experiencing.  I agree with your thoughts on the importance of the adoption of the Quadruple Aim.  The more I learn about the Quadruple Aim, the more I wonder why the well-being of healthcare providers has not been on the priority list for healthcare organizations sooner.  According to Epperson et al., (2019), The Triple Aim addresses payers, organizations, and payments in its ideology; I cannot help but wonder how the providers of the healthcare services were left out of the equation, given that any of the other three would not exist without those individuals providing the services.

COVID-19 has given us a big reason to regret not adopting Quadruple Aim sooner.  The psychological toll is arguably comparable to what is experienced by military personnel in battlefield conditions (Albott et al, 2020).  We are now at a point where it is critical organizations provide resiliency training and opportunities that promote debriefing of stressed-out staff all while continuing to provide for the care of the huge numbers of critically ill COVID-19 patients.  The stress is palpable to those of us on the outside as well; much of my time now is spent educating about inaccuracies of ineffectiveness of masks and social distancing on social media.  Most of the exchanges are friendly, or at least, I try to keep them that way (you get more flies with honey than you do with vinegar, right?).  Unfortunately, these exchanges continue to occur, and I expect they will increase as discussions about the safety and efficacy of the vaccine become more frequent.  Still, I will continue to try, as I recognize that as a nurse, I am perceived as a credible and reliable source of information, and I feel it is my responsibility to do what I can to assist in the fight against this deadly virus COVID-19 Current Healthcare Issues discussion essay.

Leslie

References

Albott, C. S., Wozniak, J. R., McGlinch, B. P., Wall, M. H., Gold, B. S., & Vinogradov, S. (2020). Battle buddies. 
Anesthesia & Analgesia
, 
Publish Ahead of Print
. 
https://doi.org/10.1213/ane.0000000000004912

Epperson, W. J., Childs, S. F., S., & Wilhoit, G. (2019). Provider burnout and patient engagement: The quadruple and quintuple aims. Www.Physicianleaders.org. 
https://www.physicianleaders.org/news/provider-burnout-patient-engagement

Discussion: Review of Current Healthcare Issues

If you were to ask 10 people what they believe to be the most significant issue facing healthcare today, you might get 10 different answers. Escalating costs? Regulation? Technology disruption?

These and many other topics are worthy of discussion. Not surprisingly, much has been said in the research, within the profession, and in the news about these topics. Whether they are issues of finance, quality, workload, or outcomes, there is no shortage of changes to be addressed.

In this Discussion, you examine a national healthcare issue and consider how that issue may impact your work setting. You also analyze how your organization has responded to this issue.

To Prepare:

Review the Resources and select one current national healthcare issue/stressor to focus on.

Reflect on the current national healthcare issue/stressor you selected and think about how this issue/stressor may be addressed in your work setting.

By Day 3 of Week 1

Post
 a description of the national healthcare issue/stressor you selected for analysis, and explain how the healthcare issue/stressor may impact your work setting. Then, describe how your health system work setting has responded to the healthcare issue/stressor, including a description of what changes may have been implemented. Be specific and provide examples.

By Day 6 of Week 1

Respond
 to at least 
two
 of your colleagues 
on two different days
 who chose a different national healthcare issue/stressor than you selected. Explain how their chosen national healthcare issue/stressor may also impact your work setting and what (if anything) is being done to address the national healthcare issue/stressor.

It goes without saying—this has been a rough year—arguably, the roughest many of us will face in our entire career.  Most, if not all, of us were blindsided by the arrival of the COVID-19 pandemic.  In a complex occupation that has inherent risks to our own balance and personal well-being, many of us have inadvertently been responding reactively to stress rather than proactively preparing for it (Abram & Jacobowitz, 2020).  This style of coping, when combined with the arrival of the COVID-19 pandemic, is a recipe for disaster; a true sink or swim situation where we find ourselves on our own grasping for a lifeline to safety, yet feeling like it is out of reach .  But there is a quality within all of us that when properly maintained can be our own lifeline—resilience—the ability to thrive despite adversity.  Healthcare organizations that prioritize resiliency training and maintenance benefit in many ways from their investment, including quality of the care provided and retention of highly skilled staff COVID-19 Current Healthcare Issues discussion essay.

We all possess the capacity for resilience, but many of us have not nurtured it within ourselves enough along the way to feel we can depend on it to be our lifeline.  Resilience is the ability to adapt to and persevere through stressful and challenging situations and achieving personal growth in the process (American Psychological Association, 2012).  I personally experienced a glitch in my resilience early on in the pandemic and found that my organization was not prepared to help me determine ways that I could cope more effectively.  This situation led me to quit my prn clinic job at a clinic that I loved, and although my position was not critical in the organization, it was something that meant a lot to me and was extremely distressing to me that I found myself floundering.

Through my studies, I have learned that the transformation in healthcare we have known as the Triple Aim was inherently lacking in an area that was key to the success of such an initiative—the well-being of the healthcare workers themselves (Broome & Marshall, 2021).  The Triple Aim focuses on quality and cost as they relate to the patient and the payor, but it does not address they quality of the experience of the healthcare worker or the cost that the healthcare worker will pay in the process.  Enter the Quadruple Aim—the addition of the idea that the well-being of those providing the care is directly related to the success of the components of the Triple Aim (Broome & Marshall, 2021).

I worked for my former employer for over 30 years, and I was described as a “team player” and one who “embraces change” on more than one occasion.  Yet when the real stress arrived with the COVID-19 pandemic, I felt as if I had been left to fend for myself, and it was then that I considered that perhaps my organization was less concerned about the resiliency of the employees, and that being the case, I was not willing to allow myself to go down with the ship.  In light of my experience, I have chosen to focus on resiliency development and maintenance in the healthcare occupational settings.  Our patients look to us for strength and guidance, which as healthcare workers, we are more than willing to share; however, we must also recognize that it is crucial that we identify and nurture our own coping strategies, and learn how to employ them in the context of our own situations COVID-19 Current Healthcare Issues discussion essay.

References

Abram, M. D., & Jacobowitz, W. (2020). Resilience and burnout in healthcare students and inpatient psychiatric nurses: a between-groups study of two populations. 
Archives of Psychiatric Nursing
. 
https://doi.org/10.1016/j.apnu.2020.10.008

American Psychological Association. (2012). Building your resilience. 
https://www.Apa.org
. 
https://www.apa.org/topics/resilience

Broome, M., & Marshall, E. S. (2021). 
Transformational leadership in nursing: From expert clinician to influential leader
 (3rd ed.). New York, NY: Springer.

sample post 3

Week 1 Discussion

Burnout in healthcare has long been an issue many nurses face as they give their all when caring for patients. Burnout is described as a long-term outcome related to excessive exposure demands of the job and results when the employee can no longer endure the stress (Algunmeeyn et al., 2020). The recent COVID-19 Pandemic has exacerbated this long-held state of burnout, causing nurses to walk off the job or not show up for work. Previously dedicated employees are now no-call no-shows because they are physically and mentally exhausted fighting both a Pandemic and misinformation. The World Health Organization Director declared that the COVID-19 pandemic is going through an ‘infodemic’ (information epidemic) of misinformation (Barua et al., 2020). Fighting both a pandemic and infodemic increases the stress nurses already face.

Not only are nurses dealing with normal burnout, we are now having to fight misinformation. Facebook reported warning labels were placed on about 90 million pieces of content related to covid-19 misinformation in two months at the beginning like false cures, anti-vaccination propaganda, and conspiracy theories (Barua et al., 2020). This can be a daunting task to keep the public educated on science-based theory and approaches to COVID-19. Misinformation about the global health crisis COVID-19 pandemic generates a severe risk to public health (Barua et al., 2020). It is our job as nurses to continue to educate our patients and the population on fact and science-based evidence COVID-19 Current Healthcare Issues discussion essay.

The most significant resources to explain burnout include autonomy, social support at work, and available resources (Manzano García & Ayala Calvo, 2020). Short staffing contributes to increased burnout. Burnout in hand leads to increased sick days, decreased job satisfaction, and a decrease in health and well-being. In the workplace, this may mean mandatory overtime may need to take place, making it more difficult to balance family and work. At the state of MN, mandatory overtime occurs frequently and is used for routine staffing. What is seen is a higher call-in rate with those caring for the most mentally ill in the state.

Trying to plan to avoid burnout is key. Managers need to make an effort to reduce stress in the job, reinforce resources for covid-19 treatment, and promote support from upper management (Algunmeeyn et al., 2020). Scheduling extra staff members is a great solution, but only happens on a rare occasion. Implementing 10-hour shifts at my facility allowed for an overlap of nurses mid-day. It felt as though the staffing ratio had increased, though it had not. The mere hours the nurses worked changed so more were present during the busiest times of the day. This is a good solution to reduce burnout. A lot of hospitals are moving towards 12 hour shifts. The addition of 12- hour shifts would allow for less travel time and transitions from work and home life, increasing employee satisfaction. Self-care is another area that employers need to focus on and encourage to avoid burnout.

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Burnout in healthcare has been seen everywhere over the years. It is important for management to listen and support its staff, encourage self-care, and offering additional staffing when able. Involvement of upper management will allow for the additional support staff that is needed to decrease stress in the nursing force that is dealing with not only a pandemic, but an infodemic as well COVID-19 Current Healthcare Issues discussion essay.

References

Algunmeeyn, A., El-Dahiyat, F., Altakhineh, M., Azab, M., & Babar, Z.-U. (2020). Understanding the factors influencing healthcare providers’ burnout during the outbreak of covid-19 in jordanian hospitals. 
Journal of Pharmaceutical Policy and Practice
, 
13
(1). Retrieved December 2, 2020, from 
https://doi.org/10.1186/s40545-020-00262-y

Barua, Z., Barua, S., Aktar, S., Kabir, N., & Li, M. (2020). Effects of misinformation on covid-19 individual responses and recommendations for resilience of disastrous consequences of misinformation. 
Progress in Disaster Science
, 
8
, 100119. Retrieved December 2, 2020, from 
https://doi.org/10.1016/j.pdisas.2020.100119

Broome, M. E., & Marshall, E. S. (2020). 
Transformational leadership in nursing
 (3rd ed.) [E-book]. Springer. 
https://doi.org/https://mbsdirect.vitalsource.com/#/books/9780826135056/

Jacobs, B., McGovern, J., Heinmiller, J., & Drenkard, K. (2018). Engaging employees in well-being. 
Nursing Administration Quarterly
, 
42
(3), 231–245. Retrieved December 2, 2020, from 
https://doi.org/10.1097/naq.0000000000000303

Laureate Education (Producer). (2015). 
Leading in Healthcare Organizations of the Future
 [Video]. 
https://class.content.laureate.net/bff323eadbbca206b96404db9ab32968.html

Manzano García, G., & Ayala Calvo, J. (2020). The threat of covid‐19 and its influence on nursing staff burnout. 
Journal of Advanced Nursing
. Retrieved December 2, 2020, from 
https://doi.org/10.1111/jan.14642

response

Excellent post.  Certainly, burnout is a real issue that faces nurses in the workforce today.  I also, as you already know, work with the State of MN and have experienced the burnout issues that you described.  It would seem that an inability to keep consistent staffing which leads to significant mandatory overtime is a major problem at the state hospital.  And as you mentioned, when the issue begins to peak at any given time, it certainly significantly effects a nurse’s job satisfaction.  This decreased satisfaction and mandatory overtime leads to more sick calls, which only worsens the problem.  It’s a bit of a vicious cycle COVID-19 Current Healthcare Issues discussion essay.

Chang et al. notes that there is evidence decreased job satisfaction caused by burnout directly lessens a nursing professional’s professional commitment (2017).  The authors go on to define this professional commitment as in effect professional integrity, meaning a nurse’s desire and ability to follow best practices even in the face of adversity or increased stress (Chang et al., 2017).  I have witnessed this firsthand, in where burnout is so significant, good and capable nurses feel forced to make less than ideal choices in order to lessen the burden they feel on themselves through the shift and the workweek.

Jones suggests that nurses develop a regimen at least weekly of devoting a minimum of 15 minutes to the practices of mindfulness of the situation and relaxing the mind from it’s stress (2019).  Certainly, this is good advice for nurses to take time to relax and focus their mind on their own time, I believe another component is a commitment from the health care organization to addressing the underlying issues that contribute to or may be the primary cause of the increased burnout COVID-19 Current Healthcare Issues discussion essay.

References

Chang, H., Shyu, Y. L., Wong, M., Chu, T., Lo, Y., & Teng, C. (2017). How does burnout impact the three components of nursing professional commitment? 
Scandinavian Journal of Caring Sciences
, 
31
(4), 1003–1011. 
https://doi-org.ezp.waldenulibrary.org/10.1111/scs.12425

Jones, B. (2019). Fifteen minutes may decrease nursing burnout: A discussion paper. 
International Journal of Nursing Sciences
, 
7
(1), 121–123. 
https://doi-org.ezp.waldenulibrary.org/10.1016/j.ijnss.2019.11.004

response 2

Nurse burnout seems to be a problem that nurses have faced for many years. During the COVID-19 pandemic, burnout has become an even bigger problem. Prolonged stress at work can lead to burnout (Soto-Rubio et al., 2020). Increased stress at healthcare facilities was inevitable. Like you said, the amount of misinformation, conspiracy theories, and the changing protocols created stress among providers and all other healthcare workers.  The prevalence of burnout among RN’s in the US ranges from 35-45%, where nurses had twice the rate of depression compared to other healthcare professionals (Janeway, 2020). Those statistics are alarming, especially with the unknown of how long the pandemic will continue. It would be interesting to see what hospitals across the country are doing for their nurses to help reduce burnout. Our hospital provides stress management tips and peer support. However, burnout is high as staffing is often low resulting in nurses being asked to pick up multiple shifts COVID-19 Current Healthcare Issues discussion essay.

Great post Joy, I enjoyed reading your discussion.

References

Janeway, D. (2020). The Role of Psychiatry in Treating Burnout Among Nurses During the Covid-19 Pandemic. Journal of Radiology Nursing, 39(3), 176–178. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jradnu.2020.06.004

Soto-Rubio, A., Giménez-Espert, M. D. C., & Prado-Gascó, V. (2020). Effect of Emotional Intelligence and Psychosocial Risks on Burnout, Job Satisfaction, and Nurses’ Health during the COVID-19 Pandemic. International Journal of Environmental Research and Public Health, 17(21). https://doi-org.ezp.waldenulibrary.org/10.3390/ijerph17217998 COVID-19 Current Healthcare Issues discussion essay

NRS-429VN Topic 2 DQ 1 family structures discussion essay

Re: Topic 2 DQ 1

What is a definition of family that encompasses the different family structures prevalent today?

The definition of a family that encompasses the different family structures in modern times is the family of choice. According to Green (2018), this type of family is unique in that the individual chooses the individual to care, love and trust for them rather than their family or origin.

Discuss the importance of acknowledging nontraditional family structures.

It’s important for the nurse to acknowledge the non- traditional family structure so that health promotion can be implemented according to their family structure. The concerns of a nontraditional family might be different than a traditional family unit. As mentioned in the chapter on health promotion, for the nurse to understand what “family,” is, it’s important to assess so that proper interventions can be placed (Green, 2018). Proper assessment of the family structure of the individual will aid the nurse to promote health and behavioral changes. It’s also important to note that an individual’s illness affects the family’s health as well. The family unit can have a negative or positive impact on each other NRS-429VN Topic 2 DQ 1 family structures discussion essay.

Explain how family systems theory can be used to better understand the interactions of a modern family (traditional or nontraditional)

The family systems theory can be used when interacting with any type of family whether traditional or non-traditional as the approach is the same. In family systems theory, the family is a whole and each member of the unit affect each other. The family member is independent, has personal goals, roles, functions, and individual characteristic, but is interdependent of the family unit. Understanding the importance of each person in the patient’s family unit is crucial to engage the family in promoting changes to improve health outcomes. The family systems theory helps to aid the Nurse in health promotion to understanding the patient’s behaviors. Among family systems theories the main theme is that they all empower the individual to make decisions that will make them feel valued, loved, and accepted. Individual want others attention, approval, and support as well as feel connected to their family unit. The family unit is an emotional unit that is very emotionally connected (Devlin, 2021).

References

Devlin, K. (2021). Family Systems Theory Definition & What is it? Retrieved October 11, 2021from 
https://www.regain.us

Green, S.Z. (2018). 
Health Promotion: Health and Wellness Across the Continuum. 
Retrieved from NRS-429VN Topic 2 DQ 1 family structures discussion essay

URL:
https://www.gcumedia.com/digital-resources/grand-canyon-university/2018/health-promotion_health-and-wellness-across-the-continuum_1e.php

 

What is a definition of family that encompasses the different family structures prevalent today? Discuss the importance of acknowledging nontraditional family structures. Explain how family systems theory can be used to better understand the interactions of a modern family (traditional or nontraditional). 

 

response

it is important for a nurse to understand the family system theory. That way, she knows to include the family in the decision-making and care of the patient. because any decision taken on the patient indirectly affects the entire family.

 

response 2

That is so well written you discussed the family structure and the use of the Family Systems Theory. The system created by these individuals influences values and morals.

 

 

sample 2

Re: Topic 2 DQ 1

After attempting several times to find a more modern definition of family, I was honestly surprised that I really could not find one that I felt really encompassed the different family structures of the present day. I have combined multiple definitions to create what I believe to be the most suitable, A family is a group of one or more parents/guardians and their children who may or may not be descendants of a common ancestor, living together as a unit. The nuclear family, elementary family or conjugal family are family groups consisting of only parents and their children. These types of families still exist but are no longer the majority. We now have family structures that include Grand Parents, Aunts, Uncles, and cousins all who live under the same roof and operate successfully as a family unit. The nontraditional family structure has become normal. According to the U.S. Census Bureau, in 2020 married couples made up 48% of U.S. households, down from 71% in 1970. Over this same period, non-traditional households increased from just 29% in 1970 to 52% today. Acknowledgment of the nontraditional family is a must in order to provide effective care and teaching of both patients and students in the nursing field.Family Systems Theory is a theory introduced by Dr. Murray Bowen that suggests that individuals cannot be understood in isolation from one another, but rather as a part of their family, as the family is an emotional unit. This theory can be used to understand the interactions between the modern family in a few ways. By understanding the roles each individual plays in the nontraditional family, we can breakdown their interactions and how we should interact with them as well NRS-429VN Topic 2 DQ 1 family structures discussion essay. With the ever-changing family structure, we must remain flexible and open-minded about what a family truly is.References
https://www.putnam.com/literature/pdf/II916.pdf
 May 2021

https://genopro.com/genogram/family-systems-theory/December 2020

sample 2

Topic 2 DQ 1

The definition of family ranges from country to country, and has many interworking differences that include religion, culture, and socioeconomic status. Time has changed repeatedly, changing the way families survive. At one time family meant there was a father, mother and children. Today, the family could mean two fathers and children, 2 mothers and children, no parents with grandparents raising the children. It can also include other relatives, friends and much more.It is important to know about nontraditional family structures, because in today’s world, traditional is not the norm. Blended families are everywhere, and each is unique. Household’s include parents, biological children, foster, children, adopted children, stepchildren and so on. Nontraditional also means different religion practices, hierarchy of kinship and who is the head of household.

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“Because of the multitude of definitions of “family” and the changing realities of the current times, there is a felt need for redefining the family and the common types, for the purpose of study of the family as a factor in health and other variables of interest. The following definition of a “family” is hence proposed. People related by marriage, birth, consanguinity or legal adoption, who share a common kitchen and financial resources on a regular basis.” (NCBI 2013)

There are eight concepts using the family systems theory and they include:

Differentiation of self

Emotional triangle

Family projection process

Multigenerational transmission process

Emotional cutoff

Sibling position

Societal emotional process

Nuclear family emotional process. (Goodtherapy 2018)

Being able to respond to anxiety, separating thoughts from feelings, and being able to cope with the many changes in life successfully is being able to differentiate yourself. The emotional triangle means that there are always two sides to emotions. The triangle includes harmony and conflict, and they are a constant balance. Knowing when projecting on family members is key to help prevent having a negative impact NRS-429VN Topic 2 DQ 1 family structures discussion essay. As generations continue to pass on, differentiation can lower and eventually break the pattern if the individuals find partners with similar or lower levels. Knowing when to be able to distance yourself emotionally will not only be helpful to you but family members as well depending on the situation. Siblings and their ranking in the family have their own roles. Older children have a duty to help and be role models for younger children. Society always plays an important role in the family. It can affect the household in many ways, good and bad, causing even more stress. The nuclear process is always a high anxious and high energy family. Constant fighting, arguments and criticism passing on more stress and anguish to the family dynamics.

Regardless of the family, it is important to know how it works to be able to help each family in the household thrive, especially with their healthcare. Achieving good outcomes at home, most likely the family will be participating and knowing how they work can get the right tools and people in place to be successful.

References:

https://www.goodtherapy.org/learn-about-therapy/types/family-systems-therapy

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4649868/NRS-429VN Topic 2 DQ 1 family structures discussion essay

COVID-19 pandemic and Nursing Burnout discussion essay

The national healthcare issue that has affected many facilities worldwide in this time is the nursing shortage. According to the Journal on Nursing Education, “Beyond the obvious and most discussed risks of prematurely ending social distancing restrictions, such as a second and third wave of infections, more illness and deaths, and more long-term damage to the economy, an equally important risk to public health has not received the media attention it deserves: an acute and perhaps dramatic escalation of the national nursing shortage” (Spurlock, 2020). Nurses play a vital and centralized role in the healthcare system. The same article projects that the national nursing shortage will remain in effect well into the year 2030. The COVID-19 pandemic hit the healthcare system with a devastating blow. Hospitals were not prepared for the impact it would have on nursing personnel as well as supply. Working in a high acuity Emergency Department during this time in a considered “hot zone” was difficult and proved that the nursing shortage was real, and the surge of patients was overwhelming COVID-19 pandemic and Nursing Burnout discussion essay.

The healthcare organization that I am employed saw the ugly face of this pandemic up close and personal. Staffing ratios were inadequate at most times and the already minimal critical care beds remained occupied with patients who had contracted the virus. We brought in travelers to help and offered extra shift bonuses for staff to stay over or come in extra just to be able to keep up with the surge. However, inevitably the more staff were there the more staff got sick and were out of work. In order to keep up with he amount of tests that were being done, the hospital followed suit with many of the other healthcare organizations throughout the country and opened drive-thru testing centers for those whose symptoms did not pose an immediate emergency. This lessened the surge and workload on the already overworked staff in the Emergency Department. However, along with the rest of the country ideas to deal with this pandemic were being thought of on a reactive basis instead of a proactive approach.

The nursing shortage became even more prevalent after subsequent waves of the pandemic and nurses and hospital personnel were provided inadequate personal protective equipment resulting in higher numbers of nurses testing positive for the virus. According to the Center for Infectious Disease Research and Policy, “COVID-19–related shortages of personal protective equipment and drugs continue to plague the US healthcare system, but now in the third US pandemic wave, nursing and other staffing shortages are sweeping the country” (McLernon, 2020). To deal with these nursing shortages some states have begun to allow asymptomatic nurses who are positive for COVID-19 to take care of COVID patients. Though the healthcare facility I am employed has not implemented this practice and I hope they do not, it is safe to say that these are trying times and whatever the response for the further nursing shortage is it will most likely not be ideal for this worsening healthcare issue and the increase in burnout and mental health concerns for this profession will be seen for years to come COVID-19 pandemic and Nursing Burnout discussion essay.

References:

Spurlock, D. (2020). The nursing shortage and the future of nursing education is in our hands.

Journal of Nursing Education, 59
(6), 303-304. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.3928/01484834-20200520-01

Lianna Matt McLernon | News Writer | CIDRAP News  | Nov 30, 2. (2020, November 30). COVID-related nursing shortages hit hospitals nationwide. Retrieved December 02, 2020, from https://www.cidrap.umn.edu/news-perspective/2020/11/covid-related-nursing-shortages-hit-hospitals-nationwide COVID-19 pandemic and Nursing Burnout discussion essay

response

Excellent information in your post.  I think a lot of us have experienced the struggles of trying to maintain some sense of normalcy at work during the COVID pandemic.  As you mentioned, trying to go about our daily work routine while constantly worrying about the lack of hospital supplies only fuels the already elevated stress levels many of us have.  A recent survey from healthcare improvement company Premier Inc. found the item most in demand among hospitals surveyed are exam gloves (King, 2020).  My hospital is unfortunately, no exception to this issue.  We have had to resort to using dietary grade gloves in place of medical gloves for a lengthy amount of time this year.

Another area of increased demand that many hospital lack the supplies to accommodate are PPE supplies.  In behavioral health, we do not use PPE very often but this year has been the exception.  As we have had our fair share of positive patient cases, the need to keep these supplies stocked has been a point of emphasis.  Sadly, we have had to resort to reusing unsoiled supplies in order to get by.  In protests covered by the news media, healthcare workers compared themselves to firefighters putting out fires without water and soldiers going into combat with cardboard body armor (Cohen, Rodgers, 2020).

 

Cohen, J., Rodgers, Y. (2020). Contributing factors to personal protective equipment shortages during the COVID-19 pandemic. 
Preventive Medicine
, 141:106263. doi:10.1016/j.ypmed.2020.106263

King, R. (2020). Fierce Healthcare. Gloves in demand for hospitals facing shortages due to COVID-19: Premier. Retrieved from 
https://www.fiercehealthcare.com/hospitals/gloves-demand-for-hospitals-facing-shortages-due-to-covid-19-premier

Discussion: Review of Current Healthcare Issues

If you were to ask 10 people what they believe to be the most significant issue facing healthcare today, you might get 10 different answers. Escalating costs? Regulation? Technology disruption?

These and many other topics are worthy of discussion. Not surprisingly, much has been said in the research, within the profession, and in the news about these topics. Whether they are issues of finance, quality, workload, or outcomes, there is no shortage of changes to be addressed.

In this Discussion, you examine a national healthcare issue and consider how that issue may impact your work setting. You also analyze how your organization has responded to this issue.

To Prepare:

Review the Resources and select one current national healthcare issue/stressor to focus on.

Reflect on the current national healthcare issue/stressor you selected and think about how this issue/stressor may be addressed in your work setting.

By Day 3 of Week 1

Post
 a description of the national healthcare issue/stressor you selected for analysis, and explain how the healthcare issue/stressor may impact your work setting. Then, describe how your health system work setting has responded to the healthcare issue/stressor, including a description of what changes may have been implemented. Be specific and provide examples.

Healthcare facilities face many challenges and issues; one of the biggest issues seen today is a nationwide nursing shortage. Nurses are the forefront of healthcare and a critical to patient care. They make up the biggest portion of the health profession. Some statistics found from StatPearls (Haddad, 2020): There are approximately 3.9 million nurses in the United States (US) and in 2020 it was estimated that 1 million additional nurses would be needed. In the US, More RN jobs will be available in 2022 than any other profession. To avoid a further shortage, 11 million additional nurses are needed COVID-19 pandemic and Nursing Burnout discussion essay.

Nursing shortage has been a topic for many years, but it appears to be an increasingly progressive issue. There are many potential reasons why the shortage is worsening such as, aging population, aging work force, nursing burnout, negative work environment, and poor staff ratios (Haddad, 2020). One of the biggest, current reasons today is COVID-19 causing stress and fatigue on nurses in and outside the healthcare setting. With the increased demand in many hospitals due to COVID-19, staffing ratios are increasing and nurses are burning out wanting to look elsewhere for work. Many nurses are feeling there was a lack of pandemic preparedness, which ultimately resulted in anxiety and fear among the workplace (Nyashanu et al., 2020).I work at a small, community hospital on the med/surg/telemetry floor where we have 99 inpatient beds. Our hospital has not been immune to the nursing shortage. We struggle most days to safely staff our floors. Often, nurses are working overtime each week to help fill the void. We have faced the issue of nurses feeling burnt out and have left the facility working in a non-hospital setting. Our hospital has implemented some changes over the last year to help with the staff shortage. These changes are listed:

• Have become affiliated with local colleges to improve student nursing clinical experience. The American Association of Colleges of Nursing (AACN, 2020) recommends that nursing schools form partnerships and seek support from healthcare facilities to expand their student capacity in order to properly train new RN’s COVID-19 pandemic and Nursing Burnout discussion essay.

• Nurses are precepting nursing students along with clinical leader.

• Bonuses offered to employees who recruit nurses who stay employed for a certain amount of time.
 

• Housing and a relocation stipend is offered to those who relocate to the area and remain employed.

• Longer new graduate orientation period for new nurses with improved educational materials and resources through the nurse educator.
 

 

Healthcare facilities need to be creative in finding ways to meet the needs of nurses, especially their current employees, not just potential new ones. Becoming a leader in your workplace you can encourage coworkers and give ideas to administration on how to retain employees.

References

AACN. (2020, September).
 
News & Information
. American Association of Colleges of Nursing: The Voice of Academic Nursing. https://www.aacnnursing.org/News-Information/Fact-Sheets/Nursing-Shortage.
 

Haddad, L. (2020, November 16).
 
Nursing Shortage
. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK493175/.
 

Nyashanu, M., Pfende, F., & Ekpenyong, M. (2020, July 17).
 
Exploring the challenges faced by frontline workers in health and social care amid the COVID-19 pandemic: experiences of frontline workers in the English Midlands region, UK
. Taylor & Francis . https://www.tandfonline.com/doi/full/10.1080/13561820.2020.1792425.
 

 

By Day 6 of Week 1

Respond
 to at least 
two
 of your colleagues 
on two different days
 who chose a different national healthcare issue/stressor than you selected. Explain how their chosen national healthcare issue/stressor may also impact your work setting and what (if anything) is being done to address the national healthcare issue/stressor.

I enjoyed reading your post. The nursing shortage is a pertinent problem affecting our healthcare system today. Over the years, the nursing shortage continues to progress. Notably, the nursing shortage almost doubled from 40,000 in 2010 to approximately 80,000 in 2020 due to nurses leaving the profession (AACN, 2020). Nurses’ continual downward turn affects the quality of patient care and increases nurse burnout, which further impacts the shortage. I feel the nursing shortage and burnout go hand and hand. Another significant issue affecting the deficit is work overload and high staff turnover COVID-19 pandemic and Nursing Burnout discussion essay.

Staff burnout has serious negative consequences on healthcare costs for organizations and their employees due to the physical and psychological tolls, which increases employees’ absenteeism (Mudallal et al., 2017). The nursing shortage/burnout will steadily increase, especially during the COVID-19 pandemic. Real solutions to the nursing shortage’s ever-growing concerns must take priority because the health of this nation depends on it.

References

AACN. (2020). 
Nursing shortage
. American Association of Colleges of Nursing. 
https://www.aacnnursing.org/news-information/fact-sheets/nursing-shortage

Mudallal, R., Othman, W. M., & Al Hassen, N. F. (2017). 
Nurses’ burnout: The influence of leader empowering behaviors, work conditions, and demographic traits
. National Center for Biotechnology, U.S. National Library of Medicine. 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5798741/

NURS_6053_Module01_Week01_Discussion_Rubric

Grid View

List View

Excellent

Good

Fair

Poor

Main Posting

45 
(45%)
 – 50 
(50%)

Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.

Supported by at least three current, credible sources.

Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

40 
(40%)
 – 44 
(44%)

Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.

At least 75% of post has exceptional depth and breadth.

Supported by at least three credible sources.

Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

35 
(35%)
 – 39 
(39%)

Responds to some of the discussion question(s).

One or two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Post is cited with two credible sources.

Written somewhat concisely; may contain more than two spelling or grammatical errors.

Contains some APA formatting errors.

0 
(0%)
 – 34 
(34%)

Does not respond to the discussion question(s) adequately.

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only one or no credible sources.

Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.

Main Post: Timeliness

10 
(10%)
 – 10 
(10%)

Posts main post by day 3.

0 
(0%)
 – 0 
(0%)

0 
(0%)
 – 0 
(0%)

0 
(0%)
 – 0 
(0%)

Does not post by day 3.

First Response

17 
(17%)
 – 18 
(18%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Responds fully to questions posed by faculty.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.

15 
(15%)
 – 16 
(16%)

Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

13 
(13%)
 – 14 
(14%)

Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

0 
(0%)
 – 12 
(12%)

Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.

Second Response

16 
(16%)
 – 17 
(17%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Responds fully to questions posed by faculty.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.

14 
(14%)
 – 15 
(15%)

Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

12 
(12%)
 – 13 
(13%)

Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

0 
(0%)
 – 11 
(11%)

Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.

Participation

5 
(5%)
 – 5 
(5%)

Meets requirements for participation by posting on three different days.

0 
(0%)
 – 0 
(0%)

0 
(0%)
 – 0 
(0%)

0 
(0%)
 – 0 
(0%)

Does not meet requirements for participation by posting on 3 different days.

Total Points: 100

Name: NURS_6053_Module01_Week01_Discussion_Rubric

sample essay 3

The COVID-19 pandemic has earned the badge of being the top stressor in the healthcare field. The uncertainty on how much longer the virus is a threat to the well-being of the people, heightens our anxiety and fear. Nursing shortages, minimal personal protective equipment, burnout, and mental strain are a few issues that accompany this virus COVID-19 pandemic and Nursing Burnout discussion essay.

Shortage of nursing has been an issue, even before the pandemic. People are sicker at a rate faster than they can be cared for. Nurses are looking to be recruited across the United States. I have seen a lot of nurses take contracts through different agencies to work with COVID-19 patients. They mostly do this due to the higher rate of pay. The full-time employment nurses are not receiving enough pay to compensate for what they are risking when working on a unit or floor with patients affected with the virus.

The facility I work for has tried their best to keep up with the ever-changing rules and standards that come with handling coronavirus. The biggest thing was implementing tele-health for the psychiatrists to see the psychiatric inpatients we care for. We were also practicing safe distancing inside the nurses’ station and break rooms. Our patients must wear a mask, while employees wear masks and face shields. This is regardless of having a positive or negative COVID-19 swab. Healthcare agencies and facilities are learning as they go. It has become a mental strain to keep employees and patients safe.

 

 

Jacobs, Barbara, MSN, NEA-BC, RN-BC, CCRN-K, McGovern, Julie, MA, SPHR, Heinmiller, Jamie, et al. (2018). Engaging Employees in Well-Being: Moving from the Triple Aim to the Quadruple Aim. Nursing Administration Quarterly, 42, 231-245. 
https://doi.org/10.1097/NAQ.0000000000000303

Ricketts, T. C., & Fraher, E. P. (2013). Reconfiguring health workforce policy so that education, training, and actual delivery of care are closely connected.
 Health Affairs, 32
(11), 1874-80. Retrieved from https://ezp.waldenulibrary.org/login?qurl=https%3A%2F%2Fwww.proquest.com%2Fdocview%2F1458313016%3Faccountid%3D14872 COVID-19 pandemic and Nursing Burnout discussion essay

response

Healthcare strain is real, and it affects nurses and care providers worldwide (Worringer, et. al., 2020).  Covid-19 has brought this strain to the forefront of problems, especially here in the United States.  I know in the ICU where I previously worked, people were already pushed to their limit prior to Covid-19, with our annual flu season keeping our hospitals well over 100% capacity for months on end.  When the Covid-19 patients began rolling in, the burnout pushed many of my former coworkers to the brink and they began to find new jobs.  The stress of ICU work paired with long hours and what many termed not enough pay, were too much to handle.

I understand where people are coming from, especially with young families and wanting to be safe and have energy for them.  In my view, this has been an evolving topic for several years.  I got into nursing to help people, and then into critical care because I wanted the challenge and autonomy that it offered.  I knew going in that the hours would be long, and it would be difficult treating people who were truly on their last breath.  For me, my family was more important, and having time with them paired with going back to school to open more doors in my career was something that appealed to me. I don’t know that I have a solution for a nursing burnout, and I don’t believe that more pay will mitigate this factor.  There is no amount of money that will bring more energy and time to someone searching for higher quality of life (Sköldunger, Sandman, & Backman, 2020) COVID-19 pandemic and Nursing Burnout discussion essay.

References

Anders Sköldunger, Per-Olof Sandman, & Annica Backman. (2020). Exploring person-centred care in relation to resource utilization, resident quality of life and staff job strain – findings from the SWENIS study. 
BMC Geriatrics
, 
20
(1), 1–9. https://doi-org.ezp.waldenulibrary.org/10.1186/s12877-020-01855-7

Worringer, B., Genrich, M., Müller, A., Junne, F., Contributors Of The Seegen Consortium, & Angerer, P. (2020). How Do Hospital Medical and Nursing Managers Perceive Work-Related Strain on Their Employees? 
International Journal of Environmental Research and Public Health
, 
17
(13). https://doi-org.ezp.waldenulibrary.org/10.3390/ijerph17134660

sample post 4

Main Discussion Post Wk1:

National Healthcare Issue/Stressor

A national healthcare issue/stressor affecting healthcare systems across America for many years is the nursing shortage issue. The current nursing shortage has three parts; the aging population, and the limited supply of new nurses, and the aging workforce. Baby boomers play a critical role in the aging population. Right now, baby boomers are becoming close to retirement age; this means one out of every five people will be over the age of 65 (Haddad & Toney-Butler, 2020).

How healthcare issue/stressor may impact your work setting

With the shortage of nursing and the longer life expectancy of the aging population is growing at a faster rate than new nursing begin their career (Leung et al., 2020). As people age, their healthcare needs increase, creating more inpatient stays for the floor nurse to manage. With more patients needing medical attention, it will cause the crowded local emergency rooms, causing more nurses to work out of nurse to patient ratio at all levels of care. This, in turn, creates stressful work environments and staff burnout—ultimately, fewer nurses due to the staff turnover rate COVID-19 pandemic and Nursing Burnout discussion essay.

Describe how your health system work setting has responded to the healthcare issue/stressor

Currently, many local hospitals are now offering nurses a sign-on bonus to work at their facility. The bonuses are given over a year. My workplace has been using traveling nurses to help with the nursing shortage. My workplace needs to offer more incentives to all nurses. Nurses also need a better strategy to address staff and patient issues to management. Many times nurses voice concern and never hear back from management. I recently read an article where nurses left their job after being there for five years due to the managers’ lack of pay more attention to their nursing staff’s job satisfaction and the safety of their nurses (Marzieh Adel-Mehraban, & Azam Moladoost, 2020). With the COVID pandemic, the nursing shortage has become an even greater issue.

References

Haddad LM & Toney-Butler TJ. (2020, November 16). Nursing Shortage. StatPearls. Retrieved December 2, 2020, from 
https://www.ncbi.nlm.nih.gov/books/NBK493175/

Leung, P. P. L., Wu, C. H., Kwong, C. K., & Ching, W. K. (2020). Nursing shortage in the public healthcare system: an exploratory study of Hong Kong. 
Enterprise

Marzieh Adel-Mehraban, & Azam Moladoost. (2020). Nursing Staff Shortage: How About Retention Rate? 
Preventive Care in Nursing and Midwifery Journal
, 
9
(1), 40–48 COVID-19 pandemic and Nursing Burnout discussion essay.

response

It sounds like you were experiencing hospital shortages before Covid-19 hit, and then it was truly exacerbated with the additional need for beds?  The shortage experienced in the United States is seen globally, and the biggest threat is beginning to take effect in specialty areas where extensive training is needed for patient care (Glasper, 2017).  The specialty areas are labor intensive and expensive for hospitals to get nurses up to speed.  You mentioned adding incentives for nurses to come work, do the incentives come with contracts for nurses so they must stay for a period of time?  I feel that the hospitals need to have some assurance that the staff will stick around to make sure they get their money work.

Despite the shortage of nurses and hospital beds here in the United States, many other countries have seen significant decline in resources since the pandemic began (McMahon, Peters, Ivers, & Freeman, 2020).  We are extremely fortunate to live here where our problems truly are first world problems.  The issues we as a country and healthcare community have would never exist in other countries because often people go completely without treatment for critical diseases.  I don’t anticipate the nursing shortage improving in the near future, but hopefully there will be improvements toward work environment and possibly pay to help improve the nurse’s attitude and decrease burnout

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.

References

Glasper, E. A. (2017). Does a Shortage of Specially Trained Nurses Pose a Threat to the Provision of Optimum Care for Sick Children in Hospital? 
Comprehensive Child & Adolescent Nursing
, 
40
(1), 1–5. 
https://doi-org.ezp.waldenulibrary.org/10.1080/24694193.2017.1289740

McMahon, D. E., Peters, G. A., Ivers, L. C., & Freeman, E. E. (2020). Global resource shortages during COVID-19: Bad news for low-income countries. 
PLoS Neglected Tropical Diseases
, 
14
(7), 1–3. https://doi-org.ezp.waldenulibrary.org/10.1371/journal.pntd.0008412 COVID-19 pandemic and Nursing Burnout discussion essay

Family structures discussion NRS-429VN Topic 2 DQ 1

What is a definition of family that encompasses the different family structures prevalent today? Discuss the importance of acknowledging nontraditional family structures. Explain how family systems theory can be used to better understand the interactions of a modern family (traditional or nontraditional).

Re: Topic 2 DQ 1

What is a definition of family that encompasses the different family structures prevalent today?The definition of a family that encompasses the different family structures in modern times is the family of choice. According to Green (2018), this type of family is unique in that the individual chooses the individual to care, love and trust for them rather than their family or origin.Discuss the importance of acknowledging nontraditional family structures Family structures discussion NRS-429VN Topic 2 DQ 1.It’s important for the nurse to acknowledge the non- traditional family structure so that health promotion can be implemented according to their family structure. The concerns of a nontraditional family might be different than a traditional family unit. As mentioned in the chapter on health promotion, for the nurse to understand what “family,” is, it’s important to assess so that proper interventions can be placed (Green, 2018). Proper assessment of the family structure of the individual will aid the nurse to promote health and behavioral changes. It’s also important to note that an individual’s illness affects the family’s health as well. The family unit can have a negative or positive impact on each other.

Explain how family systems theory can be used to better understand the interactions of a modern family (traditional or nontraditional)

The family systems theory can be used when interacting with any type of family whether traditional or non-traditional as the approach is the same. In family systems theory, the family is a whole and each member of the unit affect each other. The family member is independent, has personal goals, roles, functions, and individual characteristic, but is interdependent of the family unit. Understanding the importance of each person in the patient’s family unit is crucial to engage the family in promoting changes to improve health outcomes Family structures discussion NRS-429VN Topic 2 DQ 1. The family systems theory helps to aid the Nurse in health promotion to understanding the patient’s behaviors. Among family systems theories the main theme is that they all empower the individual to make decisions that will make them feel valued, loved, and accepted. Individual want others attention, approval, and support as well as feel connected to their family unit. The family unit is an emotional unit that is very emotionally connected (Devlin, 2021).

References

Devlin, K. (2021). Family Systems Theory Definition & What is it? Retrieved October 11, 2021from 
https://www.regain.us

Green, S.Z. (2018). 
Health Promotion: Health and Wellness Across the Continuum. 
Retrieved from

URL:
https://www.gcumedia.com/digital-resources/grand-canyon-university/2018/health-promotion_health-and-wellness-across-the-continuum_1e.php
sample 2

Family systems is defined as “The theory that has every individual or subsystem of relatives or system influences other parts of the system; therefore, a person can’t be studied apart from the family.” (Edelman et al., 2014). So, a standard family might be, a family that has parents male and female and offspring inhabitation with the identical ancestry as a social or grouping, which is traditional. Now nontraditional can consist of a pair and their children is now, families are more complex, multicultural, and dynamic unit consisting of legal, biological, or emotionally linked parents and kids. it’s important to include nontraditional families because family is a component of the care process, as their involvement and opinions often help and encourage the patient to succeed in treatment. The family dynamic plays a will be a template an give the nurse insight about the patient and members of the family and using knowledge about values, beliefs, and cultural background to boost the delivery of care and corresponding plans. Families are invited to figure alongside healthcare leaders to partake in everything from the advancement and implementation of programs to the delivery of care. Especially during time when home health is being turn over to families more delivering care Family structures discussion NRS-429VN Topic 2 DQ 1.

Edelman, C. L., Kudzma, E. C., & Mandle, C. L. (2014). 
Health 
p
romotion 
t
hroughout the 
l
ife 
s
pan
 (8th ed.). St. Louis, MO: Elsevier Mosby.

Wright, Lorraine M, and Maureen Leahey. 
Nurses and Families A Guide to Family Assessment and Intervention : A Guide to Family Assessment and Intervention
, F. A. Davis Company, 2012.
 ProQuest Ebook Central
, http://ebookcentral.proquest.com/lib/gcu/detail.action?docID=1069220.

Created from gcu on 2021-10-12

Green, S. Grand Canyon University (Ed). (2018). 
Health promotion: Health & wellness across the continuum.
Retrieved from https://lc.gcumedia.com/nrs429vn/health-promotion-health-and-wellness-across-the-continuum/v1.1/

sample 3

Re: Topic 2 DQ 1

Family is a collection of folks that are associated through blood or via marriage. Family now no longer best includes best own circle of relatives however additionally buddies who’re near us and that they too come to be our own circle of relatives. In modern there are numerous kinds of devices found in our society.

The U.S. Census Bureau (2015) considers own circle of relatives to be the ones dwelling in a housing unit associated with the aid of using birth, marriage, or adoption; however, those definitions of own circle of relatives with the aid of using bloodline or family can’t embody the additives of contemporary-day families, main to a number of terminology in use Family structures discussion NRS-429VN Topic 2 DQ 1.

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The family structures approach to people and their houses provides a way to better understand the interactions of a society own circle of relatives unit (Huffman, Mathews, & Irving, 2017). Family members have an impact on each other as well as their own circle of relatives as a whole. The own circle of relatives is categorized as a whole machine of interacting and interdependent own circle of relatives participants, as well as man or woman participants (Huffman et al., 2017). Family structures speak within to the person or girl subsystems and out of doors the appliance with even massive structures or suprasystem that embody the community or community. One instance is Bowen’s own circle of relatives structures plan or model, whole} totally on trendy structures idea, could be a ancient technique to analyzing own circle of relatives techniques and issues (Bitter & Carlson, 2017; Yoder, Ruch, & Hodge, 2016).

According to Dr. Bowen’s Family Theory and Study, even for disconnected family members, Bowen’s Family Systems Theory suggests that the family unit or family center in general always has a profound impact on their emotions. and their actions. Although the degree of interdependence may vary between different families depending on the functioning of their family emotional system or unique family center or human relationship systems, all families have some level of interdependence among family members. their family. Understanding family conditions and theory help the nurses to talk and communicate to the families. Cause families are important to patient Family structures discussion NRS-429VN Topic 2 DQ 1

References:

Green, S. (2018). 
CCC Web Books by AWS & CDD
. Gcumedia.com. https://lc.gcumedia.com/nrs429vn/health-promotion-health-and-wellness-across-the-continuum/v1.1/#/chapter/4 Family structures discussion NRS-429VN Topic 2 DQ 1

cluster headache essays

Module 11: Discussion

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Bob, a 38 year old male, has been experiencing severe intermittent headaches for about 10 years. When they occur, he experiences intense burning pain on one side of his head, tearing in his eye, congestion and a runny nose. These headaches generally occur several times a day and last approximately one hour. The headaches are episodic; Bob can be headache free for several months but then experience an attack.

Based on the case scenario, provide a diagnosis for Bob. Provide the pathophysiology for this type of headache and discuss current treatment options.

Post your initial response by Wednesday at midnight. Respond to one student by Sunday at midnight. Both responses must be a minimum of 150 words, scholarly written, APA formatted, and referenced. A minimum of 2 references are required (other than your text). Refer to grading rubric for online discussioncluster headache essays.

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Candice Russell posted Mar 30, 2021 5:09 PM

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            “Headache is a common neurologic disorder and is usually a benign symptom” (Boss & Huether, 2020, p. 400). There are times when headaches are associated with serious illness or disease. “Headaches can be so severe that patients and doctors often fear life-threatening underlying cerebral pathologies” (Michl & Michl, 2017, para. 1). There are many different types of headaches, chronic headaches can occur constantly, for many days out of the month. “The constant nature of chronic daily headaches makes them one of the most disabling headache conditions” (Mayo Clinic, 2019). Trigeminal autonomic cephalalgia (TAC) is a primary headache disorder “characterized by pain in the distribution of the first division of the trigeminal nerve in parallel with cranial autonomic features on the same side of the head” (Ljubisavljevic & Jasana, 2019, p. 1059). Cluster headaches (CH) are said to be the most common TAC, “headaches involving the autonomic division of the trigeminal nerve” (Boss & Huether, 2020, p. 401). Cluster headaches are one of the most studied forms of TAC, however, “the pathophysiology of cluster headache is complex and the underlying mechanisms are not fully elucidated” (Wei et al., 2018, para. 11). Neurovascular and chronobiological headache disorder, TAC can be broken down into three major features: trigeminal pain, rhythmicity (particularly in cluster headache), and autonomic signs. Various structures within the peripheral nervous system and central nervous system (CNS) are associated with the causation of CH.Figure 1(Wei et al., 2018) documents a detailed description of the pathophysiology in CH:Due to the severe pain caused by CH, it has earned the nickname “suicide headache”, “and a suicidal risk exists in this condition” (Rozen & Fishman, 2012, as cited by Rossi et al., 2018, p. 57). CH can have a rapid onset without warning, some individuals experience aura and nausea. Some common symptoms include rapid intense pain, usually one-sided head pain, restlessness, tearing, eye redness on the affected side, nasal congestion and runny nose on the affected side, sweating of the face or forehead on the affected side, eye swelling of the affected side. Pallor and dropping of the eye on the affected side may be present, pain is usually continuous. Men between the ages of 20 and 50 are more commonly affected. Episodic headaches may alternate sides, severe stabbing and throbbing pain may be present (Boss & Huether, 2020, p. 401) cluster headache essays. Individuals typically experience 1-3 headaches a day, however, as many as 8 attacks are possible. Another nickname earned by CH is “alarm clock headaches”, as they are linked to circadian rhythm. Attacks can happen around the same time each day, nighttime attacks can be more severe than daytime attacks. CH attacks can last from minutes to hours, for several days, followed by remission.  Huether, S. E., McCance, K. L., & Brashers, V. L. (2020). 
Understanding pathophysiology / Sue E. Huether, Kathryn L. McCance ; section editor, Valentina L. Brashers
 (7th ed.). Elsevier.Ljubisavljevic, S., & Jasna, Z. T. (2019). Cluster headache: pathophysiology, diagnosis and treatment.
 Journal of Neurology, 266
(5), 1059-1066. http://dx.doi.org.wilkes.idm.oclc.org/10.1007/s00415-018-9007-4Michl, M., & Michl, G. M. (2017). headaches.
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View profile card for Amandeep Kaur

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April 4 at 11:29 PM
 by Amandeep Kaur

Wei, D. Y., Yuan Ong, J. J., & Goadsby, P. J. (2018). Cluster Headache: Epidemiology, Pathophysiology, Clinical Features, and Diagnosis. 
Annals of Indian Academy of Neurology
, 
21
(Suppl 1), S3–S8. https://doi.org/10.4103/aian.AIAN_349_17

Rossi, P., PhD., Little, P., De La Torre, Elena Ruiz, & Palmaro, A., PhD. (2018). If you want to understand what it really means to live with cluster headache, imagine… fostering empathy through European patients’ own stories of their experiences.
 Functional Neurology, 33
(1), 57-59. https://wilkes.idm.oclc.org/login?url=https://www-proquest-com.wilkes.idm.oclc.org/scholarly-journals/if-you-want-understand-what-really-means-live/docview/2045245091/se-2?accountid=62703

Mayo Foundation for Medical Education and Research. (2019, April 9). 
Chronic daily headaches
. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/chronic-daily-headaches/symptoms-causes/syc-20370891 cluster headache essays.

Hoffmann, J., & May, A. (2018). Diagnosis, pathophysiology, and management of cluster headache.
 The Lancet Neurology, 17
(1), 75-83. http://dx.doi.org.wilkes.idm.oclc.org/10.1016/S1474-4422(17)30405-2 cluster headache essays

Reference:

            Based on symptoms and hx described by our patient, a diagnosis of Cluster Headaches seems appropriate. There is no existing cure for cluster headaches. The goal of treatment is to reduce pain, decrease the time of each headache and prevent CH attacks (Mayo Clinic, 2019). Acute treatment includes oxygen therapy, administration of triptans, octreotide, the use of local anesthetics, and administration of dihydroergotamine. Each of the treatment options has varying effects on CH. For individuals with new-onset cluster headaches, preventive measures are available.  Preventive measures, which should be implemented at the onset of CH episodes. The goal of preventive therapy is to suppress attacks (Mayo Clinic, 2019). Some prevention treatment includes the use of CCB, corticosteroids, Lithium carbonate, and administration of nerve blocking agents. Surgery is rarely used, however, may be recommended for those suffering from chronic cluster headaches who experience no relief from other forms of treatment. Lifestyle modifications may be effective in avoiding attacks.

Pain afferents from the trigeminovascular system traverse the ophthalmic division of the trigeminal nerve, taking signals from the cranial vessels and dura mater (shown by purple fibers). These inputs synapse in the TCC and project to higher brain structures such as the thalamus (T) and cortex resulting in pain perception (shown in blue fibers). Activation of the trigeminovascular system by stimulation of dural structures also causes neuronal activation in the SSN within the pons, which is the origin of cells for the cranial parasympathetic autonomic vasodilator pathway cluster headache essays. There is subsequent activation of this parasympathetic reflex through the outflow from the SSN and is relayed through the SPG (shown by pink fibers), but also through the facial (VII
th
 cranial) nerve (not shown). Activation of both trigeminal and autonomic nerves defines the trigeminal autonomic reflex arc, which is integral to the pathophysiology of cluster headache and the other TACs. The HT is functionally connected to the ipsilateral trigeminal system and other brain areas of the pain matrix. Red dashed lines indicate the pathways by which the HT controls or triggers pain. A third-order sympathetic nerve lesion thought to be caused by vascular changes to the ICA in the cavernous sinus with subsequent irritation of the local plexus of nerve fibers, can give rise to sympathetic symptoms (incomplete Horner syndrome). (Wei et al., 2018, para. 11)

For a sequence of attacks to take place, three key structures need to interact: the trigeminovascular system, the parasympathetic nerve fibers (trigeminal autonomic reflex), and the hypothalamus. Only if all three systems are involved can cluster headache attacks be initiated, and subsequently cortical areas of the CNS—known to be involved in the processing and perception of pain—will be activated. (Hoffmann & May, 2018, p. 77)

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Hilary Szpara posted Mar 30, 2021 8:12 PM

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Based on the case scenario, I would diagnose Bob with cluster headaches. Cluster headaches are characterized by being unilateral, last on average 45 minutes to 90 minutes, happen multiple times during the day, and often include eye discomfort and nasal symptoms such as congestion and/or runny nose (Wei et al., 2018). There are many other symptoms of cluster headaches including aural fullness, throat swelling. Flushing, agitation and restlessness, and ptosis (Wei et al., 2018). The pathophysiology of cluster headaches is complex and not fully understood. They are neurovascular headaches, rather than vascular headaches. Vascular cerebral changes that occur are driven by the effects of trigeminal-autonomic reflex activation (Wei et al., 2018). The cranial autonomic symptoms that arise during cluster headaches, come from the reflex activation of the trigeminal-autonomic reflex pathway through parasympathetic outflow which results in vasodilation and parasympathetic activation (Wei et al., 2018). Due to the clinical presentation of cluster headaches, some believe that the hypothalamus may be involved and that cluster headaches occur more often when the clocks change during daylight savings, which suggests and inability to synchronize internal circannual pacemaker with external environmental light cues (Wei et al., 2018). Since cluster headaches come on quickly and don’t last long, they require fast-acting treatment. The acute treatment drugs of choice are currently subcutaneous sumatriptan and/or high flow oxygen (Brandt et al., 2020). Sumatriptan is thought to be the most effective abortive treatment, with pain relief occurring in 75% of patients within 15 minutes (Brandt et al., 2020). There are also prophylactic treatments available, including verapamil, lithium, and topiramate (Brandt et al., 2020). These pharmacologic treatments require more research but have so far found to be effective in preventing cluster headache attacks.Brandt, R. B., Doesborg, P., Haan, J., Ferrari, M. D., & Fronczek, R. (2020). Pharmacotherapy for Cluster Headache. 
CNS drugs
, 
34
(2), 171–184. https://doi.org/10.1007/s40263-019-00696-2Wei, D. Y., Yuan Ong, J. J., & Goadsby, P. J. (2018). Cluster Headache: Epidemiology, Pathophysiology, Clinical Features, and Diagnosis. 
Annals of Indian Academy of Neurology
, 
21
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View profile card for Steven Bartos

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 by Steven Bartos

Cluster Headaches
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Aina Oluwo posted Mar 31, 2021 11:20 AM

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Headaches are generally known to be benign but when it becomes more persistent it is associated with chronic conditions. Based on the few symptoms being experienced by this patient, a diagnosis to consider will be cluster headache (CH). According to Huether et al., (2017), cluster headaches occurs primarily in men between ages 20 and 50 years of age. It occurs in breaks throughout the day and lasts minutes to hours. It is also associated congestion of the mucosa, tearing of the eye and unilateral intense pain. All these symptoms are currently being experienced by Bob. CH is characterized by an alternation of excruciatingly painful attacks and pain‐free periods (Pohl et al., 2020). The recommended treatments are based on an update to the 2010 American Academy of Neurology (AAN) review. Robbins et al., (2016) illustrated the treatment plan for acute CH and maintenance. Acute treatment involves subcutaneous sumatriptan, zolmitriptan nasal spray, high flow oxygen and newly introduced sphenopalatine ganglion stimulation which is not currently practiced in the US. Lithium and verapamil are considered the best for maintenance and prophylactic management of CH.Barloese, M., Jürgens, T., May, A., Lainez, J., Schoenen, J., Gaul, C., Goodman, A., Caparso,stimulation: Experiences in chronic cluster headache patients through 24 months.
 Journal
Pohl, H., Gantenbein, A., Sandor, P., Schoenen, J., & Andrée, C. (2020). Interictal burden ofbased, cross-sectional study of people with cluster headache. 
Headache
, 60(2), 360-369.Robbins, M., Starling, A., Pringsheim, T., Becker, W., & Schwedt, T. (2016). Treatment ofguidelines.
 Headache, 56
(7), 1093-1106. 
https://doi.org/10.1111/head.12866
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View profile card for Hilary Szpara

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 by Hilary Szpara

cluster headache: The american headache society Evidence‐Based

https://doi.org/10.1111/head.13711

cluster headache: Results of the EUROLIGHT cluster headache project, an internet-

of Headache and Pain, 17
(1), 1-8. 
https://doi.org/10.1186/s10194-016-0658-1

A., & Jensen, R. (2016). Cluster headache attack remission with sphenopalatine ganglion

References

The pathophysiology can be attributed to activation of a trigemino-autonomic reflex that is mediated through the sphenopalatine ganglion (SPG). The SPG connects directly and indirectly with the hypothalamus, superior salivatory nucleus (SSN), trigeminovascular system, meninges, and somatic and autonomic nerves innervating cranial structures (Barloese et al., 2016).

Module 11
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Joanne Hogan posted Mar 30, 2021 4:37 PM

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Module 11Cluster headache is considered one of the more rare headache disorders, only affecting roughly 0.1% of the population and typically affects males more than females (Ljubisavljevic & Trajkovic, 2018). People who suffer from cluster headache typically have an increased level of calcitonin gene related peptide (CGRP) (Ljubisavljevic & Trajkovic, 2018). Not enough is known regarding the mechanism of CGRP to know the specifics regarding why this causes cluster headache, but this is generally what therapy is targeted to in treatment (Buture et al., 2019). Most research suggests that the parasympathetic nervous system goes into a type of overdrive and causes disturbances in the hypothalamus which leads to vasodilation (Ljubisavljevic & Trajkovic, 2018).   Ljubisavljevic, S., & Trajkovic, J. Z. (2018). Cluster headache: Pathophysiology, diagnosis and treatment. 
Journal of Neurology
, 
266
(5), 1059–1066. 
https://doi.org/10.1007/s00415-018-9007-4
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Buture, A., Boland, J. W., Dikomitis, L., & Ahmed, F. (2019). Update on the pathophysiology of cluster headache: Imaging and neuropeptide studies. 
Journal of Pain Research
, 
Volume 12
, 269–281. 
https://doi.org/10.2147/jpr.s175312

References

High flow oxygen is typically used for patients who are in the midst of an attack and often times reduces the need for rescue medications as traditional rescue medications can be ineffective in providing comfort (Ljubisavlejevic & Trakjovic, 2018). Triptans can be useful in the midst of an attack if parentally administered but does not always work effectively so the main goal in treatment of cluster headaches lies with preventative treatment (Ljubisavelejevic & Trakjovik, 2018). Preventative treatment includes corticosteroids which has been proven effective in reducing the reoccurrence of the frequency of attacks and lithium or verapamil can be effective in reducing the frequency of attacks in patients who suffer from chronic cluster headaches (Ljubisavelejevic & Trakjovik, 2018).

Based on the information given in the case study this week, Bob appears to be suffering from cluster headaches. According to Ljubisavljevic & Trajkovic (2018), cluster headache is noted to be severe pain that occurs unilaterally to either the orbital, supraorbital, or temporal area. The duration of pain can last anywhere from 15 minutes to up to 3 hours and can occur up to 8 times a day in some cases (Buture et al., 2019). Cluster headache effects trigeminal nerve and is the most common type of trigeminal autonomic cephalgia headache disorders (Ljubisavljevic & Trajkovic, 2018). Like Bob, people who suffer from cluster headache can have rhinorrhea, nasal congestion, and ptosis alongside the severe unilateral pain (Buture et al., 2019). Additional symptoms include eyelid edema, agitation, and facial sweating (Buture et al., 2019) cluster headache essays.

Bob
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Tallona Boddy posted Mar 30, 2021 6:43 PM

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Bob most likely is experiencing a cluster headache. A cluster headache can occur unilaterally, it can last for 15 minutes to 3 hours.  Runny nose, excessive tearing and restlessness are all signs and symptoms of a cluster headache. Episodes of recurrent headaches throughout the day can happen for days, weeks or months at time. Cluster headaches can have periods of no signs or symptoms, this can last for up to 12 months at a time. The cause of cluster headaches is not yet known, a current theory is a disruption in the body’s hypothalamus as a contributing factor (Mayo Clinic, 2019). 
References
University of Michigan Medicine. (4 August, 2020). 
Medicines for cluster headaches
. 
https://www.uofmhealth.org/health-library/abk7653
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View profile card for Dennies Jones

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 by Dennies Jones

Mayo Clinic. (04 June, 2019).
 Cluster headaches
. 
https://www.mayoclinic.org/diseases-conditions/cluster-headache/symptoms-causes/syc-20352080

High-flow oxygen has been shown to stop a cluster headache for seven out of 10 people, within 15 minutes. Triptans can be used via injection, oral, or nasal spray, for relief of the pain and pressure from a cluster headache. Lithium has been shown to help prevent cluster headaches. Ergotamine can be used at night to prevent cluster headaches. Opioids are not recommended for use to alleviate a cluster headache (University of Michigan Medicine, 2020).  Understanding the person’s severity and pattern of their cluster headaches will help the provider determine the best medication regimen.

Week 11 Discussion Post – Cluster Headaches
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Gisselle Mustiga posted Mar 30, 2021 8:05 PM

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The symptoms experienced by the patient are an indication of cluster headaches. The disease is associated with symptoms that include strictly unilateral headaches, excruciating pain precisely on one side of the head, commonly referred to as proximal hemicrania (Huether et al. 2020). The headaches are short-lasting, typically lasting from minutes up to one hour. There is also a recurrence of headaches during the day. A patient also may have redness of the face and nasal congestion. Other symptoms are autonomic, which entails lacrimation. Tearing and ptosis of the eye on the affected side is also another indication. The disease is prevalent in males. The descriptions in the case study match cluster headaches symptoms. As such, the client should be given urgent medical attention to counter its effects.
References
Huether, S. E., McCance, K. L. & Brashers, V. L. (2020). 
Understanding  
May, A., Schwedt, T. J., Magis, D., Pozo-Rosich, P., Evers, S., & Wang, S. J. (2018). Cluster headache. 
Nature Reviews Disease Primers
, 
4
(1), 1-17.less1 UnreadUnread5 ViewsViews

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View profile card for Candice Russell

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April 4 at 6:18 PM
 by Candice Russell

     Pathophysiology 7
th
 ed. 
 Elsevier Mosby.

Hoffmann, J., & May, A. (2018). Diagnosis, pathophysiology, and management of cluster headache. 
The Lancet Neurology
, 
17
(1), 75-83.

Cluster headaches are associated with regions of the brain, specifically the hypothalamus. Abnormal activity of this region causes both pain and autonomic symptoms. The pain is also a result of the release of vasoactive substances and neurogenic inflammation formation (May et al., 2018). The other key player is the trigeminovascular system which induces episodic headaches. For the treatment, abortive drugs like triptans and sumatriptan are used since they are the most effective in countering the consequences of the symptoms (Hoffmann & May 2018). To prevent a recurrence, verapamil and lithium carbonate should be administered. However, the clinician should be worried about the side effects. In a case where the side effects are adverse, topiramate is considered the preventative drug. For transitional treatment, the acute attacks are managed with oxygen inhalation, and occipital nerve stimulation. Patients have an important role to play by adopting a regular sleep schedule and avoiding alcohol intake.

Bob’s cluster headaches
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Jennifer Bryant posted Mar 31, 2021 12:45 AM

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Bob’s symptoms meet the International Classification of Headache Disorders classification for cluster headaches. Diagnostic criteria include more than 5 attacks, severe unilateral pain, lacrimation, congestion and frequency occurring between one every other day and 8 per day (IHS, 2018). The duration of 10 years of episodic episodes would put Bob at 28 for age of onset. Typical age of onset is 20-40 and men are afflicted three times often than women (IHS, 2018).ReferencesInternational Classification of Headache Disorders, 3rd edition. 
Cephalalgia
 
38
, 1–211.headache, 
The Lancet Neurology, 
17(1) 75-83.May, A., Schwedt, T., Magis, D., Pozo-Rosich, P., Evers, S., Wang, S.J. (2018). Clusterless1 UnreadUnread3 ViewsViews

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View profile card for Eleany Yasein

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headache. 
Nat Rev Dis Primers
 
4
. https://doi.org/10.1038/nrdp.2018.6

https://doi.org/10.1016/S1474-4422(17)30405-2.

Hoffmann, J & May, A., (2018) Diagnosis, pathophysiology, and management of cluster

Headache Classification Committee of the International Headache Society (2018). The

The pathophysiology of cluster headache is not fully understood but includes alterations in both the central and peripheral nervous systems, including activation of the trigeminovascular system (May et al, 2018). Treatment options include management of acute attacks, prophylaxis and trigger avoidance. Triptans, oxygen and lidocaine are effective in aborting acute attacks (Hoffman & May, 2018). Prevention has been effective with verapamil and lithium (Hoffman & May, 2018). Future treatments include clinical trials for monoclonal antibodies and botulinum toxin and other medications suggest effectiveness in uncontrolled trials (Hoffman & May, 2018) cluster headache essays.

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Melissa Morgan posted Mar 27, 2021 9:46 PM

The patient in this case study, Bob, is experiencing cluster headaches. According to Huether, et al., this type of headache occurs primarily in men who are 20-50 years old, has a rapid onset, can last for minutes to hours and up to 8 attacks per day, and patients can experience lacrimation and rhinorrhea (2020). The patient who has cluster headaches can experience spontaneous remission, which Bob is noted in the case study to have also. 
Treatment. 
Cluster headaches affect only about 1% of the population, but it represents one of the most painful conditions (Kingston & Didick, 2018).
 
Treatment for this disorder includes prophylactic drugs; avoidance of triggers; and managing acute attacks with oxygen inhalation, sumatriptan, or inhaled ergotamine administration, and nerve stimulation (Huether, et al., 2020). Delivering oxygen via a nonrebreather face mask has been shown to be an effective treatment (Kingston & Didick, 2018). A drawback to using oxygen is that it can be cumbersome for people to carry oxygen around all day. However, unlike triptans, there is no set limit of how many times a person can use oxygen, especially for those who experience multiple attacks per day. Preventative drugs used to treat cluster headaches are verapamil and lithium. They are the most widely used in first-line preventive treatment, and if they are not effective or contraindicated then topiramate can be used (Brandt, et al., 2020).  Brandt, R. B., Doesborg, P., Haan, J., Ferrari, M. D., & Fronczek, R. (2020). Pharmacotherapy for Cluster Headache. 
CNS drugs
, 
34
(2), 171–184. https://doi.org/10.1007/s40263-019-00696-2Kingston, W. S., & Dodick, D. W. (2018). Treatment of Cluster Headache. 
Annals of Indian Academy of Neurology
, 
21
(Suppl 1), S9–S15. https://doi.org/10.4103/aian.AIAN_17_18less0 UnreadUnread

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 by Gisselle Mustiga

Huether, S., McCance, K., and Brashers, V. (2020).  
Understanding Pathophysiology
 (7
th
 ed.).  Elsevier

References

Pathophysiology. 
Cluster headaches involve the autonomic division of the trigeminal nerve and are one of a group of disorders called trigeminal autonomic cephalalgias (Huether, et al., 2020). The mechanism for trigeminal activation is unknown, but “The pathogenic mechanism for pain is related to the release of vasoactive substances and the formation of neurogenic inflammation” (Huether, et al., 2020, p. 401). This disorder is characterized by sympathetic underactivity and parasympathetic activation with unilateral trigeminal distribution and ipsilateral autonomic manifestations (Huether, et al., 2020).

Module 11, Eleany Yasein
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Eleany Yasein posted Mar 31, 2021 12:17 PM

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          Based on the symptoms that are described, Bob is experiencing cluster headaches. Cluster headaches are rare, but are considered one of the most severe types of headache (Kandel & Mandiga, 2020). Cluster headaches are described as a unilateral headache that can happen anywhere from every other day, to eight times a day. Although they occur mainly during night time, they also occur around the same time during the day as well. There is not a clear understanding of cluster headaches, but there are different research studies suggesting the root of this headache. Trigeminovascular system and the parasympathetic nerve fibers are involved. There is a defect in the central pathway that controls pain and dysregulation in the autonomic nervous system. The supraspinal control of pain does not function normally and cognitive processing is affected. Studies also state that there is a dysfunction of intracellular signaling pathways of neurotransmitters, ion channels, and inflammation related molecules (Kandel & Mandiga, 2020).ReferenceWei, Y. D., Yuan Ong, J. J., & Goadsby, J. P. (2018, April). Cluster Headache: Epidemiology, Pathophysiology, Clinical Features, and Diagnosis. 
Annals of Indian Academy of Neurology
, 
21
(1), S3–S8. 
https://doi.org/10.4103/aian.AIAN_349_17
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 by Jazmin Jerez-Rivera

Kandel, A. S., & Mandiga, P. (2020, June 30). Cluster Headache. 
StatPearls. 
https://www.ncbi.nlm.nih.gov/books/NBK544241/

Moreover, there is activation of the posterior hypothalamus during cluster headache attacks (Wei et al., 2018). The involvement of the hypothalamus provides support for clinical presentation and treatments (Wei et al., 2018). Acute treatment for cluster headaches includes 100% oxygen therapy, triptans, intranasal lidocaine, octreotide and ergotamine (Kandel & Mandiga, 2020). Preventative treatments include verapamil, lithium, valproic acid and oral steroids (Kandel & Mandiga, 2020).  Electrical stimulation including deep brain stimulation of the hypothalamus has also been effective (Wei et al., 2018).

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Amandeep Kaur posted Mar 29, 2021 12:19 PM

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Based on the case scenario one can infer that Bob’s symptoms are consistent with cluster headaches. Cluster headaches have a clinical manifestation of severe unilateral pain, with agitation and restlessness (Wei et al., 2018) cluster headache essays. These attacks can last anywhere from 15 minutes to a couple of hours, up to eight times a day. These headaches can also cause eye redness, tearing and discomfort, nasal congestion, aural fullness, throat swelling, and flushing. These types of headaches occur predominantly in males, age of onset being 20-49 years old. The pathophysiology of these headaches is not fully understood. The symptoms and imaging lead to the theorization that the hypothalamus may be involved (Blanda, 2021). This is due to the nature of the attacks being intermittent and the hypothalamus controls circadian rhythm (biologic clock). There is also involved with central disinhibition of the nociceptive and autonomic pathways, specifically the trigeminal nociceptive pathways. Vascular dilation is also cited as possible causation for these headaches; however, studies show inconsistent results. The extracranial blood flow is increased but only after the initiation of pain. These cluster headaches also seem to initiate after the release of histamines, antihistamines have no effect in stopping these headaches. There are two forms of treatment for these headaches, symptomatic and prophylactic. Symptomatic treatments can include administration of oxygen, anesthetics, etc. NSAIDs have proven to give some pain relief in these headaches. Galcanezumab is one drug that has gotten FDA approval for prophylactic usage. It is cited to decrease the frequency of these headaches. Depending on the individual there are procedures that can be performed on the trigeminal nerve or the autonomic pathways. These include alcohol injections or even avulsion of nerves for chronic refractory cases.Wei, D. Y., Yuan Ong, J. J., & Goadsby, P. J. (2018). Cluster Headache: Epidemiology, Pathophysiology, Clinical Features, and Diagnosis. 
Annals of Indian Academy of Neurology
, 
21
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 by Joanne Hogan

Blanda, M. (2021, March 01). Cluster headache. Retrieved March 29, 2021, from https://emedicine.medscape.com/article/1142459-overview

References

Cluster Headaches
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Caroline Otto posted Apr 1, 2021 7:44 AM

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Pathophysiology of the Cluster Headache.They occur in one side of the head, and men between the ages of 20 and 50 years old are mostly affected. The source may alternate sides with each headache episode, and they are commonly described as stabbing and throbbing (Huether, S. E., McCance, K.L. & Brashers, V.L. 2020).The triggers are like those that cause migraine headaches, and these involve triggers that decrease the threshold for a migraine. They may be genetic, or associated with fatigue, oversleeping, missed meals, overexertion, weather change, stress or relaxation from stress, hormonal changes, or over stimulation from either bright lights, strong smells, and chemicals such as alcohol or nitrates.Current Treatment options for Patients who present with Cluster headaches.The medical treatment relies on prophylactic drugs.According to the American Headache Society evidenced based guidelines; Sumatriptan subcutaneous, zolmitriptan nasal spray, and high flow oxygen remain the treatments with a level A recommendation. For prophylactic therapy suboccipital steroid injections have emerged as the only treatment to received Level A recommendation. Notably what did receive a Level C recommendation – meaning a positive study was warfarin, I would personally not want to take warfarin ever, unless I absolutely had to.There has been some success noted with Zolmitriptan 5mg and 10mg, however it has been identified that these patients remain undertreated if treated at all. The main goal and focus should adhere to evidence based practice guidelines, as in all other areas of Medicine.References:7
th
 ed. Elsevier MosbyRobbins, M. S., Starling, A. J., Pringsheim, T. M., Becker, W. J., & Schwedt, T. J. (2016). Treatment of Cluster Headache: The American Headache Society Evidence-Based Guidelines. 
Headache
, 
56
(7), 1093–1106. https://doi.org/10.1111/head.12866less1 UnreadUnread5 ViewsViews

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View profile card for Sheryl Dixon

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 by Sheryl Dixon

Kingston, W. S., & Dodick, D. W. (2018). Treatment of Cluster Headache. 
Annals of Indian Academy of Neurology
, 
21
(Suppl 1), S9–S15. https://doi.org/10.4103/aian.AIAN_17_18

Huether, S. E., McCance, K.L. & Brashers, V.L. (2020). Understanding Pathophysiology.

According to another source, Oxygen at 6-15 L/min by a nonrebreather face mask has been shown to improve headaches in these clients. This continues to be the mainstay of treatment with much debate surrounding other options.

Acute Cluster headache attacks are treated with oxygen inhalation, sumatriptan or inhaled ergotamine administration and nerve stimulation.

Overall, the patient’s main goal should be to identify and become aware of what triggers these attacks and avoiding those triggers, such as caffeine, tyramine, fluorescent lighting, and alcohol.

When a Cluster headache develops there is trigeminal activation, but the mechanism of action is unclear. The pathogenic mechanism for pain is related to the release of vasoactive substances and the formation of neurogenic inflammation. Autonomic dysfunction is characterized by sympathetic underactivity and parasympathetic activation. There is unilateral trigeminal distribution of severe with ipsilateral autonomic manifestations, including tearing and ptosis of the eye on the affected side, and congestion of the nasal passages.

These headaches occur in clusters, thereby getting its name, and individuals may have up to 8 attacks per day, and they often last for minutes to hours for a period of days, followed by a long period of spontaneous cessation. These headaches are episodic and chronic varying between extreme pain intensity and short duration. If these headaches present without spontaneous cessation, they are referred to as; chronic cluster headaches which involve 10% to 20% of cases.

Cluster headaches are commonly referred to as trigeminal autonomic cephalalgias, meaning headaches that involve the autonomic division of the trigeminal nerve.

Cluster headache
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Jazmin Jerez-Rivera posted Mar 30, 2021 9:55 PM

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After analyzing the patient’s symptoms further, it looks like Bob is suffering from Cluster Headaches. The pathophysiology can be complex and underlying causes are not fully clarified. The headache is neurovascular in nature and it stems from the trigeminal-autonomic reflex activation. This pathway “consists of a brainstem connection between the trigeminal nerve and facial cranial nerve parasympathetic outflow” (Wei et. al., 2018, p. 4). It is triggered by the stimulation of the trigeminovascular pathways. Pain afferents cross the ophthalmic division and receive signals from cranial vessels and dura mater. These synapse in the Trigeminocervical complex (TCC) and projects to brain structures that trigger pain, including the thalamus, cortex and hypothalamus (Wei et. al., 2018). The hypothalamus is connected to the ipsilateral trigeminal system which causes associated symptoms of tearing, ptosis of the eye, and nasal congestion (Huether et. al. 2020). Treatments for cluster headaches include oxygen therapy, and sumatriptan (Imitrex) injectable and nasal spray, which is frequently used for migraines. Another fast-acting nasal spray used is zolmitriptan (Zomig). Other injectables prescribed are ocreotide and dihydroergotamine (MFMER, 2019).ReferencesMayo Foundation for Medical Education and Research. (2019). Cluster headache. Retrieved from https://www.mayoclinic.org/diseases-conditions/cluster-headache/symptoms-causes/syc-20352080less1 UnreadUnread1 ViewsViews

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View profile card for Jennifer Bryant

Last post 
April 2 at 1:34 AM
 by Jennifer Bryant

Wei, D. Y., Yuan Ong, J. J., & Goadsby, P. J. (2018). Cluster Headache: Epidemiology, Pathophysiology, Clinical Features, and Diagnosis. 
Annals of Indian Academy of Neurology
, 
21
(Suppl 1), S3–S8. https://doi.org/10.4103/aian.AIAN_349_17

Huether, S. E., McCance, K. L., Brashers, V. L. (2020). Understanding Pathophysiology (7 Ed.).  Elsevier.

Module 11
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Sheryl Dixon posted Mar 31, 2021 6:13 PM

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A cluster headache is an uncommon type of headache “Cluster” is a descriptive term that refers to the way the attacks occur in groups, bursts or clusters, which can last from days to months and then go into remission, often for years at a time. The clusters occur with some seasonal regularity, most often in the spring or fall. During a cluster period, a patient may have one or several headaches in a day. The attacks frequently occur at night, waking the patient from a sound sleep. The pain is of short duration, lasting from a few minutes to several hours, though most often for 30 to 45 minutes. The pain is rarely present longer than four hours (Phelps, 2008).Cluster headaches may be triggered by alcohol and cigarette smoking, high altitudes (trekking and air travel), bright light (including sunlight), exertion (physical activity), heat (hot weather or hot baths), foods high in nitrites (bacon and preserved meats), certain medicines and cocaine (Medlineplus, 2020).Medications to improve quality of life. Prescription medications can shorten a headache cycle. They can also make the headaches less severe. Calcium channel blockers, verapamil, lithium carbonate, divalproex sodium, melatonin or topiramate may help. There is a new preventive therapy that is a calcitonin gene-related peptide (CGRP) monoclonal antibody.                                                                                                           ReferencesMedlineplus, (2020).
Cluster headache
. Retrieved from https://medlineplus.gov/ency/article/000786.htmless1 UnreadUnread6 ViewsViews

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View profile card for Cassie Fritzinger

Last post 
April 1 at 11:04 AM
 by Cassie Fritzinger

Phelps. P. (2008), 
Case Studies in Headache: Cluster Headache
. Retrieved from https://headaches.org/2008/05/06/case-studies-in-headache-cluster-headache/

Clevelandclinic, (2018).
Cluster Headaches
. Retrieved from https://my.clevelandclinic.org/health/diseases/5003-cluster-headaches

Other options when needed Surgeons have tried operations for cluster headaches. But they haven’t had much success preventing them. Researchers are now testing newer therapies to see if they can work. One option uses mild electrical stimulation on the neck. Another creates electrical stimulation by placing a medical device through the upper gums (Clevelandclinic, 2018).

Unfortunately, there is no cure for cluster headaches. But you do have treatment options that can make them a little less painful. Treatment options include Abortive treatment to stop attacks: Often, a headache will stop before you have a chance to see a healthcare provider. But if you get there in time, there are several effective ways to stop a cluster headache. A healthcare provider may give you injected medications or a nasal spray. These include sumatriptan, dihydroergotamine and zolmitriptan. The provider may also give you oxygen through a mask.

Doctors do not know exactly what causes cluster headaches. They seem to be related to the body’s sudden release of histamine (chemical in the body released during an allergic response) or serotonin (chemical made by nerve cells) in the area of a nerve in the face called the trigeminal nerve. A problem in a small area at the base of the brain called the hypothalamus may be involved. More men than women are affected. The headaches can occur at any age, but are most common in the 20s through middle age cluster headache essays. They tend to run in families.

Dennies Jones
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Dennies Jones posted Mar 31, 2021 6:38 PM

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Bob is suffering from clustered headaches. According to Huether et al. (2020), “cluster headaches are part of a group of disorders known as trigeminal autonomic cephalalgias, headaches involving the autonomic division of the trigeminal nerve. CH headache is usually felt on one side of the head and is seen primarily in males between the age of 20 and 50” (p. 970. The headaches occur in clusters and can last from minutes to hours for several days, followed by months of nonrecurrence (Huether et al., 2020). Signs and symptoms are lacrimation, nasal congestion, rhinorrhea, forehead and facial sweating miosis, ptosis, eyelid edema, and restlessness or agitation.       less1 UnreadUnread6 ViewsViews

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View profile card for Cassie Fritzinger

Last post 
April 1 at 10:44 AM
 by Cassie Fritzinger

Ljubisavljevic, S., & Zidverc Trajkovic, J. (2019). Cluster headache: pathophysiology, diagnosis, and treatment. Journal of neurology, 266(5), 1059–1066. https://doi.org/10.1007/s00415-018-9007-4

Huether, S., McCance, K., & Brashers, V. (2020). 
Understanding Pathophysiology
 
(7th ed.). Elsevier.

Guo, X. N., Lu, J. J., Ni, J. Q., Lu, H. F., Zhao, H. R., & Chen, G. (2019). The role of oxygen in cluster headache. Medical gas research, 9(4), 229–231. https://doi.org/10.4103/2045-9912.273961

References

            According to (Huether et al., 2020), “prophylactic drugs are used to treat CH. Avoiding things that trigger headaches is essential; acute attacks are treated with oxygen inhalation, sumatriptan, or inhaled ergotamine administration and nerve stimulation” (p. 971). High flow oxygen has been recommended for alleviating acute attacks of CH and is one of the first-line acute treatments. Oxygen is better when compared to other acute medications, such as sumatriptan and zolmitriptan; oxygen causes very few side effects or long-term harm (Guo et al., 2019).

Module 11
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Steven Bartos posted Mar 31, 2021 11:02 PM

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Based on this week’s scenario, I would provide a diagnosis of Cluster Headaches. Bob met the following diagnostic criteria for cluster headaches, which includes having severe unilateral orbital, supraorbital, and/or temporal pain lasting 15 – 180 min, up to eight times a day, if left untreated. Furthermore, Bob had at least one of the following: conjunctival injection and/or lacrimation, nasal congestion and/or rhinorrhea, eyelid edema, forehead and facial sweating, and miosis and/or ptosis (Ljubisavljevic & Trajkovic, 2019).            Acute cluster headaches are typically treated with inhaled oxygen, recommended at 12 – 15 L/min for 15 – 20 min through a non-rebreathing facemask. Parenteral treiptans have also been shown to be effective, however, oral triptans have not. Sumatriptan subcutaneously is the most effective triptan. Sumatriptan and Zolmitriptan nasal spray have both been proven to be effective. If these interventions are ineffective or contraindicated, Lidocaine has been effective in approximately one third of patients (Hoffmann & May, 2018). Preventative options include verapamil 360 mg and lithium 900 mg doses have been shown effective in research. Research into neurostimulation of the hypothalamus and occipital nerve also shows promise for treating cluster headaches (Ljubisavljevic & Trajkovic, 2019).Hoffmann, J., & May, A. (2018) cluster headache essays. Diagnosis, pathophysiology, and management of cluster headache. 
Lancet Neurology, 17
(1), 75 – 83. 
https://dx.doi.org/10.1016/S1474-4422(17)30405-2
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View profile card for Caroline Otto

Last post 
April 1 at 8:15 AM
 by Caroline Otto

Ljubisavljevic, S., & Trajkovic, J.Z. (2019). Cluster headache: Pathophysiology, diagnosis and treatment. 
Journal of Neurology, 266
(5), 1059 – 1066. 
https://dx.doi.org/10.1007/s00415-018-9007-4

References

Cluster headaches involve the autonomic division of the trigeminal nerve. The exact mechanism in the pathophysiology of cluster headaches remains unclear, but it is believed to involve several structures of the peripheral nervous system and central nervous system. When the trigeminovascular system is activated, and the pain associated with cluster headaches is related to the release of CGRP, a vasodilator that regulates the nociceptive trigeminal neurons. Furthermore, the parasympathetic system is connected to the trigeminal nerve through the superior salivatory nucleus, via the facial nerve; this regulates conjunctival injection, lacrimation and rhinorrhea, and cranial and extracranial vasodilation. Recently, research with MRI’s and animal studies has also shown that the hypothalamus may be involved as well, possibly related to melatonin, the GABAergic, and the glutamatergic receptor systems (Hoffmann & May, 2018).

Fritzinger, Discussion wk 11
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Cassie Fritzinger posted Mar 28, 2021 11:41 PM

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Based on Bob’s presentation I would diagnosis him with Cluster Headaches. According to Heuther, McCance & Brasher (2020), cluster headaches are also known as trigeminal autonomic cephalalgias. The usual presentation of these types of headaches includes pain on one side of the head such as stabbing and throbbing (which can alternate sides with each episode), unilateral tearing of the eye, ptosis, as well as nasal congestion. Cluster headaches typically present in males between the ages of 20 and 50 (Heuther, McCance, Brasher, 2020). Bob is exhibiting typical signs/symptoms of cluster headaches and does have periods of remission when he is headache free for several months thus he does not have chronic cluster headaches which occurs in a small percentage of cases (Heuther, McCance, & Brasher, 2020).Cluster headaches have also been seen to be related to abnormal melatonin levels. These patients have a low nocturnal melatonin level, thus have had some success with supplementation. However, Wei & Jensen (2018) report that those with chronic cluster headaches did not have relief with the melatonin treatments, and those with episodic cluster headaches had minimal relief. Although with the low potential adverse effects one may suggest adding melatonin to other treatments as an adjunctive therapy (Wei & Jensen, 2018). ReferencesChrisholm-Burns, M. A., Schwinghammer, T.L., Malone, P.M., Kolesar, J.M., Lee, K.C., Bookstaver, P.B. (2019). Pharmacotherapy: Principles and practices (5th ed.) McGraw-Hill Education.Wei, D. & Jensen, R. (2018) Therapeutic Approaches for the Management of Trigeminal Autonomic Cephalalgias. Neurotherapeutics. 15(2): 346-360. 
10.1007/s13311-018-0618-3

Heuther, S. E., McCance, K. L., & Brashers, V. L. (2020). Understanding Pathophysiology (7th ed.). Elsevier.

Barloese, M.C.J. (2018) cluster headache essays. The pathophysiology of the trigeminal autonomic cephalalgias, with clinical implications. 
Clin Autonomic Research
 28, 315–324. 
https://doi.org/10.1007/s10286-017-0468-9

While there are different views on the treatments of headaches, it would be important for the patient to evaluate their headaches and start a headache journal to document any triggers. Knowing triggers will assist the patient in attempting to avoid these triggers potentially lessening the frequency of their headaches. Chrisholm-Burns, Schwinghammer, Malone, Kolesar, Lee & Bookstaver (2019), recommend the treatment for cluster headaches begin with the administration of 100% oxygen via a high glow nonrebreather mask at 12-15L/min for a time of 15 minutes. This is suggested secondary to the reported increased amount of cluster headaches with high-altitude exposure suggesting hypoxemia as a cause of cluster headaches (Chrisholm-Burns, Schwinghammer, Malone, Kolesar, Lee & Bookstaver, 2019). Should the administration of oxygen be ineffective to the treatment of these cluster headaches, another suggestion would be to begin adjunctive therapy using triptan class medications. For the acute cluster headache, it is suggested to use intranasal or subcutaneous sumatriptan for a more rapid onset of relief of symptoms. The oral use of triptans may play a better role in the limiting of recurrence cluster attacks secondary to their delayed onset. A caution with triptans is the vasoconstrictive property which should be avoided in patients with underlying ischemic vascular disease. For these patients, octreotide a somatostatin analogue administered subcutaneously, can be used. Octreotide does not have the vasoconstrictive properties (Chrisholm-Burns, Schwinghammer, Malone, Kolesar, Lee & Bookstaver, 2019).

Cluster headaches or trigeminal autonomic cephalalgias are poorly understood in means of pathology. The presentation of these headaches is only a portion of the complex symptoms associated with the pathophysiology of this type cephalalgia. There is an activation of the trigeminal-autonomic reflex, this reflex which is controlled by higher centers in an important part of the wide range of symptoms likely indicating a homeostatic disturbance. It has been suggested that the hypothalamus plays a key role in these headaches (Barloese, 2018). Unique symptomology of cluster headaches is the “circannual and circadian tendency, as well the neurohormonal changes in testosterone, cortisol, and melatonin”, supporting the hypothalamus as being a part of these symptoms (Wei & Jensen, 2018) cluster headache essays. Wei & Jensen (2018), also report that Nitric oxide also plays a part in cluster headaches, and it was found that patients with cluster headaches have a higher level of nitric oxide in their plasma. Because of this the use of nitroglycerin has been found to trigger cluster headaches. While indomethacin is classified as a nonsteroidal anti-inflammatory drug (NSAIDs) it is not equal to all other NSAIDs and has been found to affect the Nitric Oxide mechanism associated with cluster headaches. This treatment is part of a Nitric Oxide-cyclic guanosine monophosphate (NO-cGMP) cascade which is a therapeutic target for treatment cluster headache essays.

Family Health Assessment Part I GCU NRS-429VN

Family Health Assessment Part-1

Performing a family health assessment is a way that nurses can interact with the family.  Obtaining knowledge about one’s family structure, how they function, and the way they process situations, and perform task will inform the nurse on how they can optimize a nursing care educational plan to in cooperate in their family structure and can provide individualized nursing care plans that will be unique to their family system. According to (Kaakinen, 2018).

I have chosen a family that is very dear to me, but that has endured great tragedy recently and other medical and mental health problems. I thought this would be a great family to conduct this interview. In this family there are four members that consist of three teenagers that include a 15-year-old boy, girl A who is 19, Girl B who is 17, a mother and a recently deceased father Family Health Assessment Part I GCU NRS-429VN.

They all work well in supporting each other, especially with the recent loss of their father. The current health of the family is not the best due to their circumstances, they all know this though and are willing and taking appropriate steps to achieve a healthy outcome. Some of the areas they could improve would be the nutritional, exercise, and following medication orders provided by the doctor.

The Family states that their health is important to them especially since the untimely death of the kids’ father was due to a massive heart attack at age 34 who was extremely overweight. The eldest daughter has recently gained a substantial amount of weight and is not making the best decisions on what she eats states the mother. The son is extremely active and plays basketball and football, he states that he works out regularly during the week at school Family Health Assessment Part I GCU NRS-429VN.

Nutrition

The mother said that during the week it is hard for them to eat at home all together due to everyone’s busy schedules, school activities, and work. She said that when they are all home on the weekends though that they do eat at home and a well-balanced meal. However, the eldest daughter has been eating a lot of sweets and carbs said she is worried that the loss of her father is making her depressed, and she has been eating a lot due to that.

Sleep/rest

All the family members stated that they do not get enough sleep and do not feel very rested in the mornings, the son stated that he comes home every day from school and lays down till around 7 or 8pm. The middle daughter takes melatonin to assist in falling asleep, and mother states she is only getting about four hours of sleep at night, she lies awake every night and worries about her kids in this difficult time and stresses out over her financial situation. (Radek, 2021) states that the recommended amount of sleep is 7-8 hours of sleep.

 

Elimination

All family members stated they do not have any problems with their bowels or bladder except mother, she stated she has a large kidney stone, but she cannot have surgery due to Covid right now and that the hospital will only do emergency surgeries at this time. According to (Ferraro, 2020) it is recommended to increase fluid intake, and maintain a healthy well-balanced diet with reducing intake of sodium and animal proteins, and to also increase fiber intake Family Health Assessment Part I GCU NRS-429VN.

Activity and exercise

Except for the son, the family states that they do not have a regular exercise routine and the eldest daughter cannot exercise due to a foot injury she had a few years ago that she is still suffering from. However, they do stay active and are always on the go.

Cognitive

The mother reports all the children are doing well in school and the son is in all honors classes and making all A’s, the eldest daughter just started college and the middle daughter is doing well also, they also all hold down a job with no issues.

Sensory/ perception

All members of the family report they do not wear glasses or contacts, they are up to date on their eye exams and deny any hearing problems.

Self-perception

When asked about this all members stated they are very depressed, and life is not very enjoyable at this moment however they do know that it will get better they are just dealing with a hard time in life right now. I deny any feelings of self-harm and are all currently in counseling to help grieve their loss.

Role relationship

The mother is the head of household but states the oldest daughter helps a lot as well, she assists in taking the other kids to and from school and anywhere else they need to go while the mother is working and helps a lot with housework Family Health Assessment Part I GCU NRS-429VN.

Sexuality

The kids are not in relationships and deny having any sexual partners. The mother States that she has zero sex drive since her hysterectomy two years ago. She states that she tried the hormones, but she could not stand the way that they made her feel, so she stopped taking them and now suffers from vaginal dryness and painful sex. She states that she knows that she needs to see the doctor and inquire about trying a different kind of medication.

Coping

This family has had a recent tragedy and all state that they are doing the best they can to just get by. The kids are in counseling, and mother states she thinks it is slowly helping. The mother states that she just deals by not thinking about it, which then immediately stated she knew that was not the healthy thing to do.

 

Family focused questions and answers

Values/ Health perception

How do you view your overall health as a family? Mother states “I think we have our

moments where a kid will get sick here or there but overall, I feel like we’re a pretty normal and healthy family”

Have you had any major surgeries, or does anyone have any chronic illness?

“I had several surgeries on my foot after I stepped on a big piece of glass in the lake three years ago, I went to the hospital and they did not clean it, and just stitched it up. They didn’t even give me any antibiotics. I ended up being care flighted to a children’s hospital where I had to have several more surgeries to save my foot.” Says daughter 1

Do any of you smoke or drink on a regular basis?

“They better not” laughs mom, then adds “I vape”

Nutrition

Would you all say of your eating habits are healthy? “I don’t know about healthy, but I also wouldn’t say it was the best” says Mom

Do you all drink enough water throughout the day? Son states “That is all I drink, I don’t drink anything else, well except tea occasionally.” All others state they drink plenty of water.

Do you eat more home cooked meals or eat out for the most part? “Honestly, we eat out a lot, like a lot. We are all so busy with school, sports, and work during the week that we mostly just grab something on our own.” Says mom

Sleep/ Rest

How many hours on average do you think you all get a night? “Anywhere from 3-8 hours depending on the day.

Do any of you take any medications to assist with falling asleep? Girl 2 started taking melatonin recently after the death of her father.

Do you feel rested in the mornings? They all agree they do Family Health Assessment Part I GCU NRS-429VN.

Elimination

Do you all have regular bowel movements? All 3 girls respond together while laughing saying that the son “has no problem at all going.” Then say they are regular as well.

Do you have any problems urinating? “I have a large kidney stone that makes it difficult sometimes” states mom.

Any complaints of constipation? They all deny

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Activity/ Exercise

Family Health Assessment Part I

 

Understanding family structure and style is essential to patient and family care. Conducting a family interview and needs assessment gathers information to identify strengths, as well as potential barriers to health. This information ultimately helps develop family-centered strategies for support and guidance.

This family health assessment is a two-part assignment. The information you gather in this initial assignment will be utilized for the second assignment in Topic 3.

Develop an interview questionnaire to be used in a family-focused functional assessment. The questionnaire must include three open-ended, family-focused questions to assess functional health patterns for each of the following:

Values/Health Perception

Nutrition

Sleep/Rest

Elimination

Activity/Exercise

Cognitive

Sensory-Perception

Self-Perception

Role Relationship

Sexuality

Coping

Select a family, other than your own, and seek permission from the family to conduct an interview. Utilize the interview questions complied in your interview questionnaire to conduct a family-focused functional assessment. Document the responses as you conduct the interview.

Upon completion of the interview, write a 750-1,000-word paper. Analyze your assessment findings. Submit your questionnaire as an appendix with your assignment.

Include the following in your paper:

Describe the family structure. Include individuals and any relevant attributes defining the family composition, race/ethnicity, social class, spirituality, and environment.

Summarize the overall health behaviors of the family. Describe the current health of the family.

Based on your findings, describe at least two of the functional health pattern strengths noted in the findings. Discuss three areas in which health problems or barriers to health were identified.

Describe how family systems theory can be applied to solicit changes in family members that, in turn, initiate positive changes to the overall family functions over time.

Cite at least three peer-reviewed or scholarly sources to complete this assignment. Sources should be published within the last 5 years and appropriate for the assignment criteria.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. 

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Course Materials if you need assistance.

Do you exercise regular? “No”, says mom, well son 1 “does because he is in athletics, and they have to go to weight room every day.” She added

Are there any barriers that would prevent any of you to exercise? “My foot shoots pain if I lift heavy things.” States daughter 1, mom says “No, just time and motivation.”

Would you say you are all active throughout the day? “Yes.” reply all Family Health Assessment Part I GCU NRS-429VN

Cognitive

How are your grades in school, do you feel like you are able to understand and comprehend when the teacher is teaching? “Yes” state the kids.

While at work do any of you have any problems completing task? They all deny any issues

Do any of you have any problems focusing or remembering things? Mom says “I am so forgetful, but I think it’s just because I have so much going on, and things I have to remember. Kids deny any problems

Sensory perception

Do any of you wear glass or contacts? No

Do any of you wear hearing aids? No

Have you all had your vision and hearing test done recently? “We just had ours all done actually” says mom

Self- perception

Do any of you struggle with feeling depressed? Yes, they all answer and all 4 tear up, these sweet kids lost their dad very unexpectedly recently and they are all struggling with coping with it. Daughter one states “everyday” while the others nod yes.

Do you ever have any thoughts of self- harm? “No” they all say

Are any of you on any anti-depressants? “I am” says daughter 2. She was a daddy’s girl, and as a close friend of the family I know how bad she is struggling with this sudden loss.

Role relationship

Mom is the head of the house, but the oldest daughter helps with taking the other kids to school, and to and from work.

Sexuality

I asked this question to mom in private and she told me that she has “zero desire” she explained that she had to have a hysterectomy at age 35 so 2 years ago and she has not taken her hormone pills. Kids deny being intimate with anyone.

Coping

“All 3 kids just started counseling” says mom,” they are all dealing with this loss in their own way and that she cannot stand that she cannot take their pain away. She also adds that daughter 2 with just start whaling and crying uncontrollably and mom states “it is the hardest thing we have ever had to handle and so I knew I had to get them in to see someone.”Family Health Assessment Part I GCU NRS-429VN

 

References

Ferraro, P. M. (2020, March 15). 
Risk of kidney stones: Influence of dietary factors, dietary patterns, and vegetarian–vegan diets
. MDPI. 
https://www.mdpi.com/2072-6643/12/3/779

Kaakinen, J. (2018). 
Family health care nursing
. Google Books. 
https://books.google.com/books?hl=en&lr=&id=wNFJDwAAQBAJ&oi=fnd&pg=PR1&dq=family+health+assessment+nursing&ots=29hQpo5to6&sig=48onmdHtUQpNQCDCjyIA912xGrQ#v=onepage&q=family%20health%20assessment%20nursing&f=false

Radek, K. (2021, June 3). 
An overview of worldwide sleep disturbance | Highlights on medicine and medical science Vol. 3
. Book Publisher International. 
https://stm.bookpi.org/HMMS-V3/article/view/1609

 

Course Code

Class Code

Assignment Title

Total Points

NRS-429VN

NRS-429VN-O502

Family Health Assessment Part I

150.0

Criteria

Percentage

Unsatisfactory (0.00%)

Less than Satisfactory (75.00%)

Satisfactory (79.00%)

Good (89.00%)

Excellent (100.00%)

Comments

Points Earned

Content

80.0%

Interview Questionnaire Assessing Functional Health Patterns

15.0%

Interview questionnaire is omitted. The interview questionnaire presented does not include family-focused functional health patterns. More than three of the functional heath patterns have been omitted. Four or more of the functional health patterns have fewer than three open-ended questions.

The interview questionnaire presented is incomplete. One or two of the functional heath patterns have been omitted. Two or three of the functional health patterns have fewer than three open-ended questions. Overall, the interview questionnaire is inconsistent with the assignment criteria.

The interview questionnaire presented. One of the functional heath patterns has been omitted. One of the functional health patterns has fewer than three open-ended questions. Overall, the interview questionnaire is consistent with the assignment criteria. Some of the open-ended questions are not family-focused or not relevant to the scope of the assignment.

The interview questionnaire presented. All functional heath patterns are included, and each has three open-ended questions that are family focused and relevant to functional health patterns. The interview questionnaire is consistent with the assignment criteria. Overall, the open-ended questions are family-focused and relevant to the scope of the assignment.

The interview questionnaire presented and demonstrates strong insight into family-focused assessment strategies.  All functional heath patterns include three highly relevant open-ended questions.

Family Structure (individuals, relevant attributes of family composition, race/ethnicity, social class, spirituality, environment)

15.0%

Description of family structure omitted.

A partial description of family structure is presented. Not all individuals are included. Relevant attributes are listed but incomplete. Some attributes are missing. There are inaccuracies.

A summary of family structure is presented. All individuals are included. Most relevant attributes listed are summarized. Some aspects are vague. There are minor inaccuracies.

The family structure is described. All individuals and relevant attributes are presented. Overall, the discussion provides insight into the family structure.

The family structure is clearly described. All individuals and relevant attributes are discussed in detail. The discussion demonstrates an in-depth perspective into family structure.

Family Health and Health Behaviors

15.0%

Health behaviors and current health of the family are not presented.

Health behaviors and current health of the family are partially presented. Overall, the health and health behaviors of the family are unclear.

Health behaviors and current health of the family are summarized. Overall, the health and health behaviors of the family are generally presented.

Health behaviors are identified and presented. The current health behaviors of the family are described.

Health behaviors are identified and presented in detail.  The current health of the family is described. A clear understanding of family health and health behavior is demonstrated.

Findings (functional health patterns strengths, health problems or barriers to health)

15.0%

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Two functional health pattern strengths, and three health problems or barriers to health are partially presented. Some aspects presented are not relevant, or are not consistent with findings.

Two functional health pattern strengths, three health problems, and barriers to health are summarized. Aspects presented are relevant and generally consistent with findings.

Two functional health pattern strengths, three health problems, and barriers to health are discussed. Aspects presented are relevant and consistent with findings.

Two functional health pattern strengths, three health problems, and barriers to health are discussed. Discussion identifies and assesses key aspects from findings. Discussion demonstrates insight into assessment of findings to identify functional health pattern strengths and health problems or barriers.

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Application of family systems theory is presented. A general discussion on how the theory will be applied to initiate positive changes in family functions over time is presented. There are minor inaccuracies in the application or representation of the theory.

Application of family systems theory to initiate positive changes in family functions over time is discussed. The manner in which the theory is applied is relevant and generally supports steps toward the desired outcomes.

Application of family systems theory to initiate positive changes in family functions over time is thoroughly discussed. The manner in which the theory is applied is highly relevant and strongly supports steps to achieving the desired outcomes.

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Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.

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Argument shows logical progressions. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.

Clear and convincing argument that presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

Mechanics of Writing  (includes spelling, punctuation, grammar, language use)

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Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.

Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present.

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Template is fully used; There are virtually no errors in formatting style.

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Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.

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Family Health Assessment Part I GCU NRS-429VN

Module 10: Discussion

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A 28-year-old male presents to the primary care office for evaluation of left calf pain, swelling, and redness. He reports that this started one day ago and worsened today. He ran a 27-mile marathon 2 days ago and traveled for 3 hours in a car today. He reports slight pain on walking and a swollen red calf. He took Ibuprofen 600 mg twice today without relief. Patient reports being an experienced runner, running 3-5 miles daily. He trained for the marathon for 4 months. Patient also reports a history of exercise induced asthma and uses albuterol sulfate HFA as needed.

On physical exam patient appears in good health T 99 P 68 R 18 BP 118/78 wt. 175 lb, height 72 in. BMI 23.1. Heart rate is regular without murmurs, rubs, or gallops. Lungs clear bilaterally. HEENT WNL. Strength lower extremities +5 and DTRs + 2. Left calf erythematous, edematous, warm and tender on palpation. Pulses 3+ acute renal failure in rhabdomyolysis Essay.

Two possible diagnoses were considered: deep vein thrombosis (DVT) and rhabdomyolysis.

Stat ultrasound of left leg to rule out DVT was ordered and read as normal

CBC WNL

Creatine Kinase (CK) 23,000 U/L (normal 24-170 U/L)

BUN and Creatinine WNL

A diagnosis of rhabdomyolysis was made.

Discuss the pathophysiology of acute renal failure in rhabdomyolysis.

Post your initial response by Wednesday at midnight. Respond to one student by Sunday at midnight. Both responses must be a minimum of 150 words, scholarly written, APA formatted, and referenced. A minimum of 2 references are required (other than your text). Refer to grading rubric for online discussion.

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a kaur
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Amandeep Kaur posted Mar 24, 2021 10:58 PM

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Rhabdomyolysis occurs when muscle tissue begins to break down and die, specifically skeletal muscle (Cabral et al., 2021). This releases the intracellular contents of the cell into the blood. This occurs as the sarcolemmal membrane is broken down. Rhabdomyolysis diagnosis will be made if and when the serum creatine kinase level is 5 times the upper limit normal level. This can present in many different ways clinically; asymptomatic increase in serum enzymes, damaged muscles, volume depletion, metabolic abnormities, and acute kidney injury. Significant increases in myoglobin can also be indicative of rhabdomyolysis. These toxins are processed through the kidney, in which they release hydroxyl radical (OH) (Petejova & Martinek, 2014). The release of this reactive species is nephrotoxic, causing acute kidney injury.  In the case of this gentleman, his rhabdomyolysis was exercise-induced (Kim et al., 2015). Excessive use of muscles due to marathon training led to muscle injury by the increased intercellular calcium levels. Rhabdomyolysis can be easily overlooked in athletes is just muscle pain or soreness.Cabral, Brian Michael I., Sherida N. Edding, Juan P. Portocarrero, and Edgar V. Lerma. “Rhabdomyolysis.” 10 June 2020. Web. 25 Mar. 2021.Kim, Jooyoung, Joohyung Lee, Sojung Kim, Ho Young Ryu, Kwang Suk Cha, and Dong Jun Sung. “Exercise-induced Rhabdomyolysis Mechanisms and Prevention: A Literature Review.” 
Journal of Sport and Health Science
. Elsevier, 03 June 2015. Web. 25 Mar. 2021.less2 UnreadUnread7 ViewsViews

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March 28 at 11:47 PM
 by Aina Oluwo

Petejova, N., & Martinek, A. (2014). Acute kidney injury due to rhabdomyolysis and renal replacement therapy: a critical review. 
Critical care (London, England)
, 
18
(3), 224.

References

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Candice Russell posted Mar 22, 2021 12:14 AM

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            “Rhabdomyolysis is a syndrome that involves skeletal muscle necrosis and lysis followed by the release of intracellular content to peripheral blood, which may cause electrolyte imbalance, cardiac arrhythmias and multifactorial acute renal failure” (Khan, 2009, as cited by De Gracia-Nieto et al., 2016, 329). Rhabdomyolysis can result from traumatic and non-traumatic injury to the skeletal muscle acute renal failure in rhabdomyolysis Essay. “Since skeletal muscle comprises about 40% of body mass, such an insult can result in the accumulation of cellular contents that could eventually overwhelm the underlying elimination mechanism” (Cervellin et al., 2017, as cited by Cabral et al., 2020, p. 2).As the myocyte degenerates, large quantities of intracellular substances particularly potassium, myoglobin and CK leak into the circulation. If more than 100 grams of skeletal muscle is damaged, the circulating myoglobin levels will exceed the protein-binding capacity of the plasma and can precipitate in the glomerular filtrate. Excess myoglobin may thus cause renal tubular obstruction, direct nephrotoxicity, and acute renal failure. (Vanholder et al., 2000; Knochel, 1993; Bosch, 2009; as cited by Cabral et al., 2020, p. 6)Reference:De Gracia-Nieto, A. E., Angerri, O., Bover, J., Salas, D., Villamizar, J. M., & Villavicencio, H. (2016). Acute Renal Failure Secondary to Rhabdomyolysis as a Complication of Major Urological Surgery: The Experience of a High-Volume Urological Center. 
Medical principles and practice : international journal of the Kuwait University, Health Science Centre
, 
25
(4), 329–335. https://doi.org/10.1159/000445115Michelsen, J., Cordtz, J., Liboriussen, L., Behzadi, M. T., Ibsen, M., Damholt, M. B., Møller, M. H., & Wiis, J. (2019). Prevention of rhabdomyolysis‐induced acute kidney injury – A DASAIM/DSIT clinical practice guideline.
 Acta Anaesthesiologica Scandinavica, 63
(5), 576-586. 
https://doi.org/10.1111/aas.13308
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View profile card for Amandeep Kaur

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March 28 at 10:35 PM
by Amandeep Kaur acute renal failure in rhabdomyolysis Essay

Díaz-Tejeiro, R., Regidor, D., Morales, J., Padrón, M., Cueto, L., Muñoz, M. A., Torres, M., Ahijado, F. J., & García Díaz, J. E. (2018). Acute renal failure due to rhabdomyolysis. renal replacement therapy with intermediate cut-off membranes (EMIC2).
 Nefrología, 38
(6), 664-665. 
https://doi.org/10.1016/j.nefroe.2018.04.009

Cabral, B. M. I., Edding, S. N., Portocarrero, J. P., & Lerma, E. V. (2020). rhabdomyolysis.
 Disease-a-Month, 66
(8), 101015-101015. 
https://doi.org/10.1016/j.disamonth.2020.101015

Prevention of AKI by early fluid resuscitation and intravascular volume is suggested. Proposal of multiple supportive therapies such as diuretics, alkalinisation, antioxidants, and renal replacement therapy may assist in AKI prevention (Bosch et al., 2009; as cited by Michelsen et al., 2019, p. 577).

Cabral et al. (2020) documented Acute Kidney Injury (AKI) as one of the most dreaded complications of rhabdomyolysis. Strenuous muscular exercise or activity is an exertional non-traumatic cause of rhabdomyolysis. “The more strenuous or prolonged the activity, the more damage there is” (Cabral et al., 2020, p. 4). A change in body temperature has also be associated with Rhabdomyolysis. Michelesen et al. (2019) described the first account of rhabdomyolysis was observed by Bywaters and Beall, severe renal failure in crush injured victims in 1941 London. During an autopsy, an examination of the kidneys displayed “eosinophilic casts in the loops of Henle and collecting tubules, which were later identified as myoglobin” (Michelesen et al., 2019, p. 576). Diaz-Tejeiro et al. (2018) stated the release of myoglobin is responsible for acute kidney failure (AKF). He described “three myoglobin-mediated nephrotoxic mechanisms have been described. Renal vasoconstriction, the formation of intratubular casts, and direct damage to tubular cells” (Ronco et al., 2009; Zager et al., 2012; as cited by Diaz-Tejeiro et al., 2018, p. 664).

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Melissa Morgan posted Mar 23, 2021 5:05 PM

Acute renal failure is the most serious complication of rhabdomyolysis, which happens as a result of myoglobin precipitates in the tubules through which the flow of ultrafiltrate through the nephron is obstructed and produces injury. (Huether, et al., 2020). The patient has a creatine kinase of 23,000 units/L, which is more than 5-10 times the upper limit of normal CK. A diagnosis of acute renal failure is likely once the CK level is past 15,000 units/L (Huether, et al., 2020). According to Esposito, et al., the mechanism of acute renal failure in rhabdomyolysis is the massive release of myoglobin into the circulation (2018). Myoglobinuria may be the only symptom of rhabdomyolysis, but it is not a definite diagnosis of the condition since the renal threshold for myoglobin is low (Huether, et al., 2020). The release of myoglobin in the urine “causes cast formation and accumulation of iron in proximal tubules, with intratubular obstruction and proximal tubular cell injury” (Esposito, et al., 2018, p. 2). Sequestration, or third spacing, of fluids into injured muscles causes volume depletion, which results in acute tubular injury and AKI (Esposito, et al., 2018). The exact incidence of AKI in rhabdomyolysis is unknown, and ranges possibly from 10% 10 55% and does not have a good prognosis especially in the presence of multiple organ failure (Chavez, et al., 2016). The goal of treatment is to maintain adequate kidney perfusion with rapid intravenous hydration (Huether, et al., 2020).Chavez, L. O., Leon, M., Einav, S., & Varon, J. (2016). Beyond muscle destruction: a systematic review of rhabdomyolysis for clinical practice. 
Critical care (London, England)
, 
20
(1), 135. https://doi.org/10.1186/s13054-016-1314-5Huether, S., McCance, K., and Brashers, V. (2020).  
Understanding Pathophysiology
 (7
th
 ed.).  Elsevierless0 UnreadUnread

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 by Gisselle Mustiga

Esposito, P., Estienne, L., Serpieri, N., Ronchi, D., Comi, G. P., Moggio, M., Peverelli, L., Bianzina, S., & Rampino, T. (2018). Rhabdomyolysis-Associated Acute Kidney Injury. 
American journal of kidney diseases : the official journal of the National Kidney Foundation
, 
71
(6), A12–A14. https://doi.org/10.1053/j.ajkd.2018.03.009

References

Rhabdomyolysis
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Aina Oluwo posted Mar 24, 2021 10:27 PM

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Rhabdomyolysis (RBD) is defined as the breakdown of muscle that causes the release of intracellular contents into the extracellular space and bloodstream (Huether et al., 2020).  It can be caused by traumatic and non-traumatic causes. Traumatic like physical trauma to the muscle and non-traumatic which can be hereditary or metabolic. It is important to note that the symptoms of rhabdomyolysis are muscle pain, weakness and dark urine but only 10% of patients exhibit the three symptoms at a presentation (Zhou & Bagga, 2020). This condition is life threatening and interventions should be applied immediately.The pathophysiology of acute renal injury is explained by Navarro-Blackaller et al., (2019) as the Tubular obstruction and oxidative injury due to the precipitation of the Tamm-Horsfall protein with myoglobin. Under physiological conditions, myoglobin is reabsorbed by the renal tubule cells, but when the presence of this pigment exceeds the re-absorptive capacity, it precipitates in the tubules as pigmentary cylinders, forming hyaline cylinders and causing endothelial dysfunction and tissue damage acute renal failure in rhabdomyolysis Essay. This in turn activates the sympathetic nervous system, the renin-angiotensin-aldosterone system and vasopressin release, which together reduce urine output. Huether, S., McCance, K., and Brashers, V.  (2020).  
Understanding
Navarro-Blackaller, G., Chávez-Iñiguez, J. S., Maggiani-Aguilera, P., Gómez-Hernández, G. L.,Rhabdomyolysis and acute kidney injury associated with clostridium difficile infection,Zhou, S., & Bagga, A. (2020). Rhabdomyolysis and acute kidney injury associated with
Disease
,
 7
https://doi.org/10.1177/2054358120951371
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March 28 at 7:52 PM
 by Hilary Szpara

terbinafine use: A case report.
 Canadian Journal of Kidney Health and

case report.
 Nefrología, 39
(2), 208-209. 
https://doi.org/10.1016/j.nefroe.2018.07.009

Carreón-Bautista, E. E., Moreno-Alvarado, R. A., & Garcia-Garcia, G. (2019).

Pathophysiology
 (7
th
 ed.).  Elsevier.

References

The goal is preventing further complications such as disseminated intravascular coagulation (DIC). Treatments for this patient will be rapid intravenous hydration to maintain kidney function and urinary flow (Huether et al., 2020).

            With regards to the case study, it was right to consider DVT and RBD as patient also presented with symptoms of DVT. The diagnostic marker for RBD is the creatine kinase (CK) which if 5 to 10 times more than the normal level or >5000 U/L is concerning for rhabdomyolysis (Zhou & Bagga, 2020). The patient had 23, 000 U/L which is 10 times more than the normal indicated. It is known that once the CK levels exceed 15000 u/L, there is a high possibility of acute renal failure.

Dennies Jones
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Dennies Jones posted Mar 24, 2021 8:39 PM

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      A 28-year-old male presents to the primary care office for evaluation of left calf pain, swelling, and redness. He reports that this started one day ago and worsened today. The male patient was diagnosed with rhabdomyolysis. According to Harding et al. (2020), “rhabdomyolysis is a syndrome caused by the breakdown of damaged skeletal muscle cells. This breakdown causes the release of myoglobin into the bloodstream. Myoglobin precipitates and obstructs renal tubules” (p. 78469). The patient’s signs and symptoms were all associated with muscle injury and breakdown. The severity of the muscle injury led to myoglobinuria, which resulted in acute kidney injury (AKI). Díaz-Tejeiro et al. (2018) explained that “the mechanism responsible for AKF lies in the release of myoglobin. Three myoglobin-mediated nephrotoxic mechanisms have been described. Renal vasoconstriction, the formation of intratubular casts, and direct damage to tubular cells” (p. 664). Myoglobin is reabsorbed into the glomerular filtrate, is catabolized within proximal tubule cells, and easily filtered through the glomerular basement membrane. Rhabdomyolysis includes direct tubular toxicity mediated by myoglobin-associated oxidative injury and tubular obstruction due to myoglobin casts’ formation (Choy et al., 2020). With AKI patient could start experiencing decrease urinary output, swelling due to fluid retention, nausea, fatigue , and shortness of breath.    Choy, K. H., McVeigh, M., Holgate, S., Delmenico, L., & Friedman, N. D. (2020). Rhabdomyolysis cases and acute kidney injury: a 10-year experience at a regional tertiary center. Renal Society of Australasia Journal, 16(3), 98–105. https://doi-org.wilkes.idm.oclc.org/10.33235/rsaj.16.3.98-105Harding, Mariann M., Kwong, Jeffrey, Roberts, Dottie, Hagler, Debra, Reinisch, Courtney. Lewis’s Medical-Surgical Nursing E-Book (Kindle Locations 78469-78470). Elsevier Health Sciences. Kindle Edition.less2 UnreadUnread11 ViewsViews

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View profile card for Steven Bartos

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March 28 at 7:18 PM
 by Steven Bartos

Díaz-Tejeiro, R., Regidor, D., Morales, J., Padron, M., Cueto, L., Munoz, M., . . . Garcia Diaz, J. (2018). Acute renal failure due to rhabdomyolysis. Renal replacement therapy with intermediate cut-off membranes (EMIC2). Acute Renal Failure Due to Rhabdomyolysis. Renal Replacement Therapy with Intermediate Cut-off Membranes (EMIC2). doi:https://doi.org/10.1016/j.nefro.2017.11.001

References

Rhabdomyolysis & AKI
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Jazmin Jerez-Rivera posted Mar 23, 2021 8:44 PM

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In our case study this week the DVT diagnosis was ruled out and rhabdomyolysis was determined. Creatine kinase (CK) is the marker for muscle damage and when it is higher than 1000 units/l rhabdomyolysis is considered, and in this example it is 23,000 u/l and normal value is (24-170u/l). If CK levels surpass 15,000 u/l acute renal failure may be evident (Huether et. al., 2020). Rhabdomyolysis is characterized as “muscle injury leading to the disintegration of muscle constituents into the extracellular fluid and systemic circulation” (Choy et. al., 2020, p. 98). Research by Nielson et. al. suggests that high CK levels are associated with a higher risk of acute kidney injury (2020). Renal injury is caused by the fast breakdown of the muscle, which releases protein, myoglobin and cellular contents into the bloodstream. The cellular content and myoglobin casts infiltrate the nephron and tubules in the kidneys causing obstruction which leads to oxidative injury, and tubular toxicity (Choy et. al., 2020). Clinical manifestations include dark urine, weakness, and muscle pain.Choy, K. H., McVeigh, M., Holgate, S., Delmenico, L., & Friedman, N. D. (2020). Rhabdomyolysis cases and acute kidney injury: a 10-year experience at a regional tertiary centre. 
Renal Society of Australasia Journal
, 
16
(3), 98–105. 
https://doi-org.wilkes.idm.oclc.org/10.33235/rsaj.16.3.98-105
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 by Jennifer Bryant

Nielsen, F. E., Cordtz, J. J., Rasmussen, T. B., & Christiansen, C. F. (2020). The Association Between Rhabdomyolysis, Acute Kidney Injury, Renal Replacement Therapy, and Mortality. 
Clinical epidemiology
, 
12
, 989–995. https://doi.org/10.2147/CLEP.S254516

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Steven Bartos posted Mar 24, 2021 8:21 PM

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Rhabdomyolysis is the breakdown and necrosis of muscle that subsequently leads to the release of intracellular content into the bloodstream. The pathophysiology of rhabdomyolysis begins with the breakdown of the sarcolemmal cell membrane and ATP depletion, which causes an increase of intracellular calcium, leading to the activation of cell apoptosis pathways, mitochondrial dysfunction, and ultimately cell death (Chavez et al., 2016).ReferencesChavez, L.O., Leon, M., Einav, S., & Varon, J. (2016). Beyond muscle destruction: A systematic review of rhabdomyolysis for clinical practice. 
Critical Care, 20
(135). 
https://dx.doi.org/10.1186%2Fs13054-016-1314-5
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View profile card for Eleany Yasein

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 by Eleany Yasein

Cabral, B.M., Edding, S.N., Portocarrero, J.P., & Lerma, E.V. (2020). Rhabdomyolysis. 
Disease-a-Month, 66
(8), 1 – 21. 
https://doi-org.wilkes.idm.oclc.org/10.1016/j.disamonth.2020.101015

One pathophysiological cause of acute kidney failure is renal vasoconstriction. When these muscles are destroyed, intracellular fluid is sequestered to the extracellular spaces, which decreases intravascular volume and initiates the renin-angiotensin-aldosterone system, antidiuretic hormone, and the sympathetic nervous system. This contributes to vasoconstriction, renal water and salt retention. Myoglobin circulating in the kidneys also increases the release of vasoconstrictors and decreases vasodilators (Cabral et al., 2020). Another cause of kidney failure is from Myoglobin being released into the blood stream. This causes a cytotoxic effect on the nephrons of the kidneys, forming casts which subsequently lead to tubular obstruction. Necrotic muscle also releases uric acid, which further contributes to tubular obstruction (Chavez et al., 2016).

Discuss the pathophysiology of acute renal failure in rhabdomyolysis.
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Caroline Otto posted Mar 25, 2021 6:56 AM

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Rhabdomyolysis is the rapid breakdown of muscle that causes the release of intracellular contents, including the protein pigment myoglobin, into the extracellular space and bloodstream. It is my understanding that these protein molecules are too large to pass through the intramedullary cellular system inside the kidneys while being excreted and cause obstruction thereby causing Acute renal failure.A classical triad of muscle pain, weakness and dark urine is considered typical of rhabdomyolysis. The renal threshold for myoglobin is low (approximately 0.5 mg/dl or urine); therefore, only 200g of muscle needs to be damaged to cause visible changes in the urine. Along with the release of myoglobin, creatine kinase (CK) and other serum enzymes are released in massive quantities, the efflux of intracellular proteins and enzymes includes loss of potassium, phosphate, nucleotides, creatinine, and creatine. The risk of renal failure increases proportionately to the increase in the levels of serum CK, potassium and phosphorus.Raised levels of Serum Creatinine levels has been reported immediately after endurance events, and even a small increase or rise in serum creatinine can put the sportsman at risk (Hodgson, et.al 2017).
References:
Huether, S. E., McCance, K.L. & Brashers, V.L. (2020). Understanding Pathophysiology. 7
th
 ed. Elsevier Mosbyless2 UnreadUnread8 ViewsViews

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View profile card for Tallona Boddy

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 by Tallona Boddy

Rojas-Valverde, D., Sánchez-Ureña, B., Crowe, J., Timón, R., & Olcina, G. J. (2021). Exertional rhabdomyolysis and acute kidney injury in endurance sports: A systematic review. 
European journal of sport science
, 
21
(2), 261–274.

Hodgson, L. E., Walter, E., Venn, R. M., Galloway, R., Pitsiladis, Y., Sardat, F., & Forni, L. G. (2017). Acute kidney injury associated with endurance events-is it a cause for concern? A systematic review. 
BMJ open sport & exercise medicine
, 
3
(1), e000093. 
https://doi.org/10.1136/bmjsem-2015-000093

Just another reason, why Id rather stick to sports that are not so high in endurance because the overall toll overtime, I believe outweighs the risks compared to the health gains.

According to study that was published in the European journal of sport science by Rojas-Valverde and team; there has been quite a few studies that have been done with regards to endurance events in sports such as open water swimming, cycling, running and triathlons and there has been a rise in concerns related to the potential implications of renal function and kidney health. This study found that most cases of patients monitored who developed Rhabdomyolysis, and then developed acute kidney injury associated to the activity, was indeed found in long distance runners acute renal failure in rhabdomyolysis Essay.

Acute renal failure is one of the most clinically significant complication associated to Rhabdomyolysis. Myoglobin precipitates in the tubules, obstructing the flow of ultrafiltrate through the nephrons thereby producing injury.

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Hilary Szpara posted Mar 24, 2021 11:37 PM

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Rhabdomyolysis is a condition that is characterized by the breaking down and necrosis of damaged skeletal muscles and the release of the contents of the muscle. The substances released include myoglobin and sarcoplasmic protein into the extracellular fluid and circulation (Makris & Spanou, 2016). The myoglobin then moves to the glomeruli of the kidneys and can lead to acute kidney injury (AKI) in different ways (Gaut & Liapis, 2020). Examples of ways in which the release and buildup of myoglobin can lead to AKI include intratubular obstruction secondary to protein precipitation, renal vasoconstriction, and inflammation and tubular damage associated with reactive oxygen production (Makris & Spanou, 2016). Unfortunately diagnosing rhabdomyolysis can be difficult due to patients often not displaying what are thought to be classic symptoms, such as muscle pain, weakness, and dark urine (Gaut & Liapis, 2020). The laboratory value which can help to identify rhabdomyolysis is creatinine phosphokinase (CPK). CPK tends to increase within 12 hours of the onset of the muscle injury and declines about three to five days after cessation of the injury. Unfortunately, at the time of the biopsy, the CPK may have already dissipated (Gaut & Liapis, 2020). It is also believed that myoglobin alone will rarely lead to kidney injury, but that it requires other risk factors such as ischemia, volume depletion, and hypotension to lead to AKI (Gaut & Liapis, 2020).Gaut, J. P. & Liapis, H. (2020). Acute kidney injury pathology and pathophysiology: A retrospective review. 
Clinical Kidney Journal
 
14,
(2), 526-536.Makris, K. & Spanou, L. (2016). Acute kidney injury: Definition, pathophysiology, and clinical phenotypes. 
The Clinical Biochemist Reviews 37
(2), 85-98.less1 UnreadUnread5 ViewsViews

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AKI
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Tallona Boddy posted Mar 23, 2021 4:02 PM

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There is not one specific mechanism that causes rhabdomyolysis.  Rhabdomyolysis can result from a variety of causes, such as trauma, ischemic injury, drugs, infection and extreme physical exercise. The case presented in this week’s discussion, suggests that the most likely cause of the patient’s rhabdomyolysis is extreme exercise (running a 27 mile marathon). Rhabdomyolysis is essentially the breakdown of injured skeletal muscle. As the skeletal muscle breaks down intracellular muscle components are released into the bloodstream.  One of the muscle components released is, myoglobin (Torres et al., 2015). Acute renal failure proceeding rhabdomyolysis is theorized to be caused by the myoglobin, a toxin to the kidney. 10%-40% of patients that experience rhabdomyolysis will experience acute renal injury (Esposito et al., 2018). Myoglobin is believed to cause renal vasoconstriction, formation of intratubular casts and direct toxicity of myoglobin to the kidney (Petejova & Martinek, 2014).   Another factor that contributes to acute renal failure is volume depletion due to third spacing at the sight of the muscle injury.  As the skeletal muscle continues to break down metabolic acidosis, hyperkalemia, hyperphosphatemia, and/or a high anion gap could become present which can exacerbate acute renal failure. (Esposito et al., 2018). 
Esposito
, P., 
Estienne
, L., 
Serpieri
, N., 
Ronchi
, D., 
Comi
, G.P., 
Moggio
, M., 
Peverelli
, L., 
Bianzina
, S. & 
Rampino
, T. (2018, June 01). Rhabdomyolysis-associated acute kidney injury. 
American Journal of Kidney Disease. 71
(6), PA12-acute renal failure in rhabdomyolysis EssayA14. 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056317/
Torres, P. A., Helmstetter, J. A., Kaye, A. M., & Kaye, A. D. (2015). Rhabdomyolysis: pathogenesis, diagnosis, and treatment. 
The Ochsner journal, 15
(1), 58–69. 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4365849/
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Petejova, N., & Martinek, A. (2014). Acute kidney injury due to rhabdomyolysis and renal replacement therapy: a critical review. 
Critical Care (London, England), 18
(3), 224. 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056317/

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Eleany Yasein posted Mar 24, 2021 1:02 PM

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         Rhabdomyolysis is a result of muscle injury that has systemic effect (Stanley & Adigun, 2021). The muscle injury is caused by destruction of myocyte cell membrane. Destructive enzymes such as phospholipase and protease are activated, which cause myolysis and cell death. There is a leakage of muscle intracellular components (ex. potassium, myoglobin, creatine kinase, and phosphate) into the blood. This leads to hyperkalemia, hyperphosphatemia and hyperuricemia. It can eventually lead to acute kidney injury, electrolyte imbalance and intravascular coagulation (Stanley & Adigun, 2021). About 10% to 40% of patients who suffer from rhabdomyolysis develop acute kidney injury (Esposito et al., 2018). The release of myoglobin into the blood causes nephrotoxicity. It can cause buildup of iron in the proximal tubules and cause intratubular obstruction and tubular cell injury. Third spacing is also seen due to fluids moving into the injured muscles. Moreover, the release of intracellular constituents can lead to metabolic acidosis which can further damage the tubular (Esposito et al., 2018).  Acute renal failure is a major factor in mortality from rhabdomyolysis (Stanley & Adigun, 2021).  Patients with acute renal failure in rhabdomyolysis will present with increased serum creatine, increased phosphate levels, decreased bicarbonate, decreased calcium levels. Furthermore, increased BUN and hypoalbuminemia can be seen (Stanley & Adigun, 2021).  Esposito, P., Estienne, L., Serpieri, N., Ronchi, D., Comi, P. G., Moggio, M., Peverelli, L., Bianzina, S., & Rampino, T. (2018, June 01). Rhabdomyolysis-Associated Acute Kidney Injury. 
American Journal of Kidney Diseases
, 71(6), xii-xiv. 
https://www.ajkd.org/action/showPdf?pii=S0272-6386%2818%2930549-3
Stanley, M., & Adigun, R. (2021, February 15). Rhabdomyolysis. 
StatPearls. 
https://www.ncbi.nlm.nih.gov/books/NBK448168/
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Sheryl Dixon posted Mar 24, 2021 1:26 AM

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The clinical syndrome of rhabdomyolysis is caused by injury of skeletal muscles, leading to the release of various intracellular muscle constituents. Rhabdomyolysis occurs frequently but is usually asymptomatic (i.e., lab abnormalities only). However, in more serious cases, severe electrolyte disorders and acute renal failure may occur, leading to life-threatening situations. Rhabdomyolysis can develop in any circumstances where energy demands in muscles exceed the available energy supplies; it accounts for between 2 and 5% of all cases of acute renal failure in the ICU. Frequent causes of severe rhabdomyolysis include crush injuries, prolonged immobilization, seizures, severe infections and drug toxicity. Factors contributing to the development of more severe clinical symptoms include hypovolemia, hyperthermia, electrolyte disorders and the presence of pre-existing (congenital) muscle disorders(Polderman,2004).The pathophysiology of RM-induced AKI is believed to be triggered by myoglobin as the toxin causing renal dysfunction. This claim is given substance from studies in animal models of glycerol-induced AKI. Intramuscular injection of glycerol in the rabbit induces a model of AKI at a dose of 10 mg/kg that resembles the AKI caused by massive release of myoglobin in crush syndrome in humans. Glycerol-induced AKI is characterized by myoglobinuria, tubular necrosis and renal vasoconstriction. The most important role in glycerol-induced nephrotoxicity has been attributed to reactive oxygen metabolites (reactive oxygen species), in particular the hydroxyl radical (OH.), the same cause as for myoglobin-induced AKI (Petejova & Martinek,2016).                                                                                          ReferencesPolderman K. H. (2004). 
Acute renal failure and rhabdomyolysis
. The International journal of artificial organs, 27(12), 1030–1033. https://doi.org/10.1177/039139880402701204less0 UnreadUnread

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Petejova, N., & Martinek, A. (2014). 
Acute kidney injury due to rhabdomyolysis and renal replacement therapy: a critical review. 
Critical care (London, England), 18(3), 224. https://doi.org/10.1186/cc13897 acute renal failure in rhabdomyolysis Essay

The diagnosis is established by elevation of serum muscle enzymes and muscle constituents such as creatinine phosphokinase and myoglobin. Preventive measures include maintenance of normal or high intravascular volume and administration of diuretics (loop diuretics rather than mannitol) once hypervolemia/euvolemia have been achieved. Some evidence suggests that early initiation of renal replacement therapy can help improve outcome. Administration of bicarbonate to induce urinary alkalosis can be considered, but it has not been proven to be effective (Polderman,2004).

Week 10 Discussion Post – Rhabdomyolysis

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Gisselle Mustiga posted Mar 24, 2021 12:30 AM

Rhabdomyolysis is a potentially life-threatening syndrome resulting from the breakdown of skeletal muscle fibers with leakage of muscle contents into the bloodstream (Huether et al. 2020). These components are the sarcoplasmic proteins myoglobin (MB), creatine kinase (CK), and alanine transaminase (ALT). The condition’s causative agents include crush injury, overexertion, alcohol abuse, toxic substances, and medications, such as antihistamines and antibiotics. Additionally, as in the case of the male patient in the case study, the condition can be caused by muscle breakdown associated with strenuous exercise or normal exercise under extreme circumstances and is termed Exertional Rhabdomyolysis (ER) (Das et al. 2020).  A person suffering from this illness may present with clinical features that comprise of muscle pain, muscle weakness, oliguria, and myoglobinuria – a pigmented and dark brown urine. In ER, the level of serum concentration of CK rises 5-10 folds the average amount. The rise in CK concentration is directly associated with acute renal failure. Hyperthermia and repetitive eccentric muscle loads are the key contributors to the presence of both ER and acute kidney failure.
References
Das, S., Hanuman, S. B., & Mylapalli, J. L. (2020). Rhabdomyolysis associated acute renal failure–Report of two fatal cases and a brief review of literature. 
Journal of forensic and legal medicine
, 
71
, 101941. less0 UnreadUnread

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Huether, S. E., McCance, K. L. & Brashers, V. L. (2020). 
Understanding  
Pathophysiology 7
th
 ed. 
 Elsevier Mosby.

Abbas, M., Brown, V., Rietveld, A. P., & Hoek, A. E. (2019). A marathon runner with rhabdomyolysis. 
Nederlands tijdschrift voor geneeskunde
, 
163
.

If undiagnosed, both conditions can have adverse effects on the patient, notably, Acute Kidney Failure. The diagnostic biomarkers are Myoglobinuria and CK and early detection is critical. Standard treatment is the administration of IV fluids, mannitol, which decreases osmotic swelling and edema in the injured muscle cells and helps restore the skeletal muscle function, as well as bicarbonate, which neutralizes the urine. In case of Exercise –induced Rhabdo, patients can take preventive measures, such staying hydrated, becoming acclimatized to one’s physical activity and environmental conditions, since hot and humid climates are contributing factors.  (Abbas, et al. 2019).

Rhabdomyolysis
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Jennifer Bryant posted Mar 23, 2021 2:54 PM

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     Rhabdomyolysis is the breakdown of skeletal muscle that causes the release of its cellular contents, including protein pigment myoglobin into the systemic circulation (Manis et al., 2019). The causes are varied but may include excessive exercise like the runner in our case study. CPK is an enzyme found in the mitochondria and cytoplasm of various tissues throughout the body including, skeletal and cardiac muscle, and brain tissue. The release of CPK resulting in a level approximately 5 times the upper limits of the reference range, approximately 1000 U/L, is considered confirmatory for the diagnosis of rhabdomyolysis (Manis et al, 2019). In this case, the patients level is 23,000 for a positive diagnosis.References Rhabdomyolysis, 
Disease-a-Month
, 66(8).Manis, T., George-Varghese, B., & Kashani, J. (2019). Rhabdomyolysis – go big or godoi:http://dx.doi.org.wilkes.idm.oclc.org/10.1016/j.ajem.2019.03.024rhabdomyolysis.
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doi:http://dx.doi.org.wilkes.idm.oclc.org/10.1007/s40279-017-0689-z

Rawson, E. S., Clarkson, P. M., & Tarnopolsky, M. A. (2017). Perspectives on exertional

home.
 The American Journal of Emergency Medicine, 37
(12), 2194-2196.

https://doi.org/10.1016/j.disamonth.2020.101015.

Cabral, B.M., Edding, S. N., Portocarrero, J. P., Lerma, E. V. (2020).

            What we do not know in this case is the urine myoglobin. Myoglobin is cleared by the kidneys. Myoglobin, and likely other proteins, can precipitate in the kidney or be directly nephrotoxic (oxidative stress), resulting in acute renal failure that-if left untreated-could be life threatening (Rawson et al, 2017). Acute kidney injury can occur in 7-10% of all patients who have rhabdomyolysis. The exact mechanism by which rhabdomyolysis impairs glomerular filtration rate is unclear, but there is growing evidence that suggests: renal vasoconstriction; direct and ischemic tubule injury and tubular obstruction (Cabral et al, 2020). Exertional muscle damage produced by eccentric exercise in healthy individuals can cause profound CK and myoglobin elevations without renal impairment, and elevated CK is likely a population-specific bio-marker (Rawson et al, 2017). Maintaining adequate urinary flow and prevention of kidney failure is the goal of treatment with rapid IV hydration.

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Joanne Hogan posted Mar 23, 2021 1:18 PM

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Module 10While complications from rhabdomyolysis vary, acute kidney injury occurs in up to 40% of patients and those with acute kidney injury have an increased mortality rate of up to 80% (Cabral et al., 2020). In a patient with acute kidney injury caused by rhabdomyolysis, the urine will be dark and tea colored (Rawson et al., 2017). According to Rawson et al. (2017), urine dip stick analysis will show acidic urine with myoglobin casts and epithelial cells. Proteinuria can commonly occur in these patients due to the increased excretion of globin (Cabral et al., 2020).  Elevated CK levels, potassium, creatine, and creatinine all increase risk for acute kidney injury as well (Huether et al., 2020). According to Huether et al. (2020), once CK levels reach levels of 15,000, renal failure becomes more likely. Due to increased fluid depletion, the RAAS system is activated and ADH is activated, increasing fluid and salt retention (Rawson et al., 2017). Cabral, B. I., Edding, S. N., Portocarrero, J. P., & Lerma, E. V. (2020). Rhabdomyolysis. 
Disease-a-Month
, 
66
(8), 101015. 
https://doi.org/10.1016/j.disamonth.2020.101015
Rawson, E. S., Clarkson, P. M., & Tarnopolsky, M. A. (2017). Perspectives on exertional rhabdomyolysis. 
Sports Medicine
, 
47
(S1), 33–49. 
https://doi.org/10.1007/s40279-017-0689-z
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Huether, S. E., McCance, K. L., & Brashers, V. L. (2020). 
Understanding pathophysiology
 (7th ed.). Elsevier.

References

To prevent renal failure, it is important to treat patients suffering from rhabdomyolysis with IV fluids to prevent excess fluid loss and to prevent the formation of casts and to ensure adequate renal perfusion (Cabral et al. 2020). In cases where the cause of the rhabdomyolysis can be isolated, such as in cases where the illness is caused by medications or drugs, it is imperative to alter lifestyles to prevent further illness (Rawson et al., 2017). IV sodium bicarbonate should also be administered to prevent acidosis, and mannitol may also be given IV to ensure adequate urine output (Rawson et al., 2017).

Rhabdomyolysis is a potentially life-threatening disease where muscle tissue is broken down and intracellular contents are released into the blood stream (Rawson et al., 2017).  It is caused by an injury to the muscle and due to the large quantity of muscle in the body, the spilling of intracellular contents into the systemic circulation can be overwhelming for the body (Rawson et al., 2017). ATP is depleted and calcium level in the cells increase causing cell lysis (Rawson et al., 2017).

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Cassie Fritzinger posted Mar 22, 2021 10:21 PM

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Rhabdomyolysis is a condition following the breakdown of skeletal muscle, releasing intracellular contents into the extracellular space and bloodstream. Common causes being trauma, overexertion, toxic substances including alcohol abuse. Complications secondary to this condition due to muscle cell necrosis include hyperkalemia, hypocalcemia, acute kidney injury (AKI) and hypovolemic shock. AKI occurs in approximately 19%-58% of those patients who have rhabdomyolysis (Candela, et al., 2020).            Symptoms of AKI may include muscle pain, weakness, and dark urine. While dark urine is often seen, this alone is not a reliable indicator of rhabdomyolysis acute renal failure in rhabdomyolysis Essay. Labs studies noted in the evaluation of rhabdomyolysis may include CK, potassium, phosphorus, blood urea nitrogen (BUN) to creatinine ratio, and calcium. The CK level of 5-10 times normal is seen in rhabdomyolysis. A CK level of greater than 15,000 units/L indicates a likelihood of acute renal failure (Chrisholm-Burns, Schwinghammer, Malone, Kolesar, Lee & Bookstaver, 2019).            The patient of discussion has a CK level of 23,000 which is over 135 times greater than the normal level. His presentation of pain, swelling and redness of his left calf are also consistent with the diagnosis of rhabdomyolysis. His risk factors of significant strenuous activity of running the marathons and training significantly for the past few months is another additional risk factor of rhabdomyolysis. While his BUN and Creatinine are currently within normal limits it would be important to start fluid rehydration and monitor any electrolyte imbalances. The BUN/Creatinine indicate he has not yet progressed into AKI. However, as stated previously a CK greater than 15,000units/L would be highly suggestive of impending AKI and prevention of this progression if possible or limiting this progression is of great importance. Candela, N., Silva, S., Georges, B., … Faguer, S. (2020). Short- and Long-Term Rental Outcomes Following Severe Rhabdomyolysis: A French Multicenter Retrospective Study of 387 Patients. Annals of Intensive Care. 10:27. 
https://doi.org/10.1186/s13613-020-0645-1
Diaz-Tejeiro, R., Regidor, D., Morales, J., Padron, M., Cueto, L. Munoz, MA, et al. (2018). Acute Renal Failure due to Rhabdomyolysis. Renal Replacement Therapy with Intermediate Cut-Off Membranes (EMIC2). Nefrologia. 38(6) 660-680. 
https://doi.org/10.1016/j.nefroe.2018.06.013

Chrisholm-Burns, M. A., Schwinghammer, T.L., Malone, P.M., Kolesar, J.M., Lee, K.C., & Bookstaver, P.B. (2019). Pharmacotherapy: Principles and practices (5th ed.) McGraw-Hill Education.

References

            The treatment for rhabdomyolysis is to improve urinary output with adequate hydration ultimately working to prevent secondary AKI. Diaz-Tejeiro, et al. (2018), found that not all patients will have resolution of kidney function with simple hydration and may require renal replacement therapy such as dialysis. The early initiation of replacement therapy with improved myoglobin clearance and decreased serum levels equated to improved and earlier recovery from AKI (Diaz-Tejeiro, et al, 2018).

            AKI secondary to rhabdomyolysis results from the release of myoglobin, lactate dehydrogenase, creatine kinase (CK) and other electrolytes into the circulation and interstitial space. The circulation of myoglobin reaching the renal tubules leads to an obstruction creating injury of the kidney filtration function. AKI is characterized by a sudden decrease in kidney function with decreased glomerular filtration (GFR) and decreased urine output. Renal vasoconstriction, intratubular casts, and the direct tubular cell damage are three nephrotoxic mechanisms which cause the AKI (Chrisholm-Burns, Schwinghammer, Malone, Kolesar, Lee, & Bookstaver, 2019)acute renal failure in rhabdomyolysis Essay.