Tag: Clinical-Nursing

Health Insurance Portability and Accountability Act (HIPAA) Essay

Health Insurance Portability and Accountability Act  (HIPAA)

The Health Insurance and Accountability Act (HIPAA), started operating in the year 1996, where it ensured the health of patient was provided with health facilities that would help them recover from their diagnosis without them knowing. According to HHS.gov (n,d), it was invented by the federal law, to ensure that there is creation of the national  standards for the protection of the sensitive patients, most especially those who are not in a position to support themselves, or sometimes no relatives who could help them overcome their diagnosis.
Th
e Health and Human Services (HHS), which the Department of the United States invented, issued out the HIPAA privacy rule so that HIPAA could be able to generate its requirements and be independent Health Insurance Portability and Accountability Act (HIPAA) Essay.

Different scholarly studies have dissect that the HIPAA provision of safe harbor is linked with the HIPAA Privacy Rule. The HIPAA Privacy Rule has its own limitations, one of the most essential limitation is that it discloses Protected Health Information (PHI) Compliancy Group (2020). The HIPAA safe harbor rule is the rule that identifies protected health information that have already been identified. The HIPAA Privacy Rule is a rule that protects diagnosis of an individual that can be identified. The rule involves performing some diagnosis, then letter on provides relevant information which are transmitted through an entity that is covered, or its business associates, in various different forms such as; oral, paper, electronic or media. This information that is transmitted, is referred as the Protected Health Information (PHI).

The Individually Identifiable Health Information is an information that provides the demographic data that is linked to: the past, present and future mental or physical health of a patient, providing health care to the diagnosed patient, or the past present or future payment for the provision of health care to the patient. HIPAA Safe Harbor De – identification is the process that involves the removal of specific patient identifier, the relatives of the patient, employers and or the members of the household. The HIPAA Safe Harbor De – identification requirements process was to become satisfying if the specific identifiers had been removed. The moment the information of the protected health has been De – identified, the result is no longer known as the PHI Health Insurance Portability and Accountability Act (HIPAA) Essay.

According to Sweeney, Loo and Brody (2017), there are some of the specific information that has to be De – identified with regards to HIPAA Safe Harbor Provision. This specific information include; specified data elements which can consequently be used to  identify a patient uniquely. The pieces of data that can be used to identify an individual uniquely include; geographic locators, names, the date elements that are related to the patient except the year, cellphone, telephone and fax numbers, email, IP addresses – this may be useful when identifying physical addresses, social security numbers, numbers of the medical record, among others.

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Finally, it is important to state that the HIPAA Safe Harbor De – identification is usually carried out for the purpose of De – identifying certain PHI. Once these elements of data have been De – identified, they are no longer known as the PHI. This means that they can now be used to perform other different diagnosis such as studies that are competitive or certain types of research which could be relevant in providing medical information Health Insurance Portability and Accountability Act (HIPAA) Essay.

References.

HHS.gov (n,d). Summery of Health Insurance Portability and Accountability Act (HIPAA) Security Rule. Retrieved from
https://www.hhs.gov/hipaa/for-professionals/security/laws-regulations/index.html

Compliancy Group (2020). What is the HIPAA Safe Harbor Provision? Retrieved from

What is the HIPAA Safe Harbor Provision?

Sweeney, L., Too, J. & Brody, G. (2017). Re – identification Risks in HIPAA Safe Harbor Data: A Study of Data from one Environmental Health Study. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6344041/

Health Insurance Portability and Accountability Act (HIPAA) Essay

Gout Essay- NURS 6501 Case Study Analysis

Pathophysiology

Gout is a form of arthritis characterized by severe pain and tenderness in the joints (Singh & Cleveland, 2018). Unlike other diseases, gout results from a combination of factors such as demographic factors of an individual to underlined health conditions, medications, and diet. It is therefore a condition that needs to be prevented by observing both social and lifestyle practices that promotes health and wellbeing.

The symptoms presented by the patient result from gout. Gout comes about as a result of the accumulation of urate crystals in an individual’s joint resulting in inflammation and severe pain in the joins. Urate crystals develop when an individual has excess uric acid in the blood, which then builds up in the joints hence causing pain (Burke, Kottgen, & McAdams-DeMarco, 2019). From the case study, the patient has excess uric acid meaning that he is likely suffering from gout Gout Essay- NURS 6501 Case Study Analysis. Moreover, urate crystals can come about when a human kidney fails to excrete enough urate. If any of the two processes take place, then an individual is likely to develop gout. As presented in the case, gout majorly targets the big toe but can develop in any other joint such as the ankles, elbows, fingers, and knees. The pain develops fast and would be severe within 12 hours after the time it begins.

Gout affects an individual’s physical function, productivity, and even health-related quality of life (McCance, Huether, Brashers, & Rote, 2019). For instance, the severe pain in the joints affects mobility and can also interfere with other body functions such as resulting in headaches.  It also results in increased healthcare costs, where an individual, especially the old has to constantly seek medical attention due to severe pain in the joints. When not controlled on time, gout can increase the severity of other health conditions Gout Essay- NURS 6501 Case Study Analysis.

The gout problem is different among diverse demographics. The problem is more prevalent among men than women at an early age. However, in older ages the gender variations and risk of gout reduces. In terms of race and ethnicity, blacks have a high chance of suffering from gout than whites (McCance, Huether, Brashers, & Rote, 2019). Additionally, research reveals that blacks and other ethnic minorities are not well exposed to quality healthcare than the white majority hence resulting in disproportionate morbidity.

There are various processes or risk factors that result in gout. The major risk factor is medical conditions. Here, individuals with certain health conditions like diabetes, kidney problems, Type II diabetes, Hypertension, Obesity, heart problems, and high blood pressure can easily develop gout (Choi, Karlson, & Curhan, 2020). These conditions affect the way the kidney excretes uric acid or how uric acid is absorbed in the blood hence resulting in excess of the acid in the blood which is later transported into the joints Gout Essay- NURS 6501 Case Study Analysis. The specific type of medical prescription might also increase the chance of being diagnosed with gout. For instance, some medications like thiazide diuretics for treating hypertension trigger the increase of uric acid in the human blood. When such medications are used without proper control, they might result in gout development. The age and sexual orientation of an individual have an impact on gout conditions. In most cases, gout is prevalent among men than women since women naturally have lower uric acid in their bodies. However, this changes after menopause, where the women uric acid levels are almost equal to that of men resulting from decreased levels of estrogen, and hence they have an almost equal risk of developing gout. Generally, gout affects older individuals of more than 50 years of age due to lower rates of excretion of urate in the kidney. Diet also affects the risk of being diagnosed with gout. Food rich in meat, fruit sugar, and seafood have a lot of uric acids which in turn increase their levels in the body (Choi, Karlson, & Curhan, 2020). Moreover, an individual whose family history presents persistent cases of gout has a higher possibility of developing the disease Gout Essay- NURS 6501 Case Study Analysis.

In conclusion, gout conditions can result from different factors such as age, gender, medical conditions and interventions, and dietary patterns. The combination of these factors increases the risk of getting the disease, meaning that individuals should be careful about their lifestyle practices as a sure way of controlling gout.

 

References

Burke, B., Kottgen, A., & McAdams-DeMarco, M. (2019). Gout in Older Adults:The Atherosclerosis Risk in Communities Study.
The Journals of Gerontology Serries A:Biological Sciences and Medical Sciences
, 223-227.

Choi, H., Karlson, A., & Curhan, G. (2020). Obesity,weight change,hypertension,diuretic use,and risk of gout in men:the health professionals follow-up study.
Arch Intern Med
, 742-748.

McCance, K., Huether, S., Brashers, V., & Rote, N. (2019).
Pathophysiology: The Biologic Basis for Disease in Adults and Children.
New York: Elsevier.

Singh, J., & Cleveland, J. (2018). Gout and dementia in the elderly:a cohort study of medicare claims.
BMC Geriatrics
, 12-16 Gout Essay- NURS 6501 Case Study Analysis.

Module 2 Assignment: Case Study Analysis

An understanding of the cardiovascular and respiratory systems is a critically important component of disease diagnosis and treatment. This importance is magnified by the fact that these two systems work so closely together. A variety of factors and circumstances that impact the emergence and severity of issues in one system can have a role in the performance of the other.

Effective disease analysis often requires an understanding that goes beyond these systems and their capacity to work together. The impact of patient characteristics, as well as racial and ethnic variables, can also have an important impact.

Photo Credit: yodiyim / Adobe Stock

An understanding of the symptoms of alterations in cardiovascular and respiratory systems is a critical step in diagnosis and treatment of many diseases. For APRNs this understanding can also help educate patients and guide them through their treatment plans.

In this Assignment, you examine a case study and analyze the symptoms presented. You identify the elements that may be factors in the diagnosis, and you explain the implications to patient health.

To prepare:

By Day 1 of this week, you will be assigned to a specific case study scenario for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor Gout Essay- NURS 6501 Case Study Analysis.

Assignment (1- to 2-page case study analysis)

In your Case Study Analysis related to the scenario provided, explain the following

The cardiovascular and cardiopulmonary pathophysiologic processes that result in the patient presenting these symptoms.

Any racial/ethnic variables that may impact physiological functioning.

How these processes interact to affect the patient.

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By Day 7 of Week 4

Submit 
your Case Study Analysis Assignment
 by Day 7 of Week 4

Reminder: 
The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The sample paper provided at the Walden Writing Center provides an example of those required elements (available at 
https://academicguides.waldenu.edu/writingcenter/templates
). All papers submitted must use this formatting Gout Essay- NURS 6501 Case Study Analysis.

 

NURS_6501_Module2_Case Study_Assignment_Rubric

Grid View

List View

Excellent

Good

Fair

Poor

Develop a 1- to 2-page case study analysis, examing the patient symptoms presented in the case study. Be sure to address the following:

Explain both the cardiovascular and cardiopulmonary pathophysiologic processes of why the patient presents these symptoms.

28 
(28%)
 – 30 
(30%)

The response accurately and thoroughly describes the patient symptoms.

The response includes accurate, clear, and detailed reasons, with explanation for both the cardiovascular and cardiopulmonary pathophysiologic processes supported by evidence and/or research, as appropriate, to support the explanation.

25 
(25%)
 – 27 
(27%)

The response describes the patient symptoms.

The response includes accurate reasons, with explanation for both the cardiovascular and cardiopulmonary pathophysiologic processes supported by evidence and/or research, as appropriate, to support the explanation.

23 
(23%)
 – 24 
(24%)

The response describes the patient symptoms in a manner that is vague or inaccurate.

The response includes reasons for the cardiovascular and/or cardiopulmonary pathophysiologic processes, with explanations that are vague or based on inappropriate evidence/research.

0 
(0%)
 – 22 
(22%)

The response describes the patient symptoms in a manner that is vague and inaccurate, or the description is missing.

The response does not include reasons for either the cardiovascular or cardiopulmonary pathophysiologic processes, or the explanations are vague or based on inappropriate or no evidence/research.

Explain how the cardiovascular and cardiopulmonary pathophysiologic processes interact to affect the patient.

28 
(28%)
 – 30 
(30%)

The response includes an accurate, complete, detailed, and specific explanation of how the cardiovascular and cardiopulmonary pathophysiologic processes interact to affect the patient.

25 
(25%)
 – 27 
(27%)

The response includes an accurate explanation of how the cardiovascular and cardiopulmonary pathophysiologic processes interact to affect the patient.

23 
(23%)
 – 24 
(24%)

The response includes a vague or inaccurate explanation of how the cardiovascular and cardiopulmonary pathophysiologic processes interact to affect the patient.

0 
(0%)
 – 22 
(22%)

The response includes a vague or inaccurate explanation of how the cardiovascular and cardiopulmonary pathophysiologic processes interact to affect the patient.

Explain any racial/ethnic variables that may impact physiological functioning.

23 
(23%)
 – 25 
(25%)

The response includes an accurate, complete, detailed, and specific explanation of racial/ethnic variables that may impact physiological functioning supported by evidence and/or research, as appropriate, to support the explanation.

20 
(20%)
 – 22 
(22%)

The response includes an accurate explanation of racial/ethnic variables that may impact physiological functioning supported by evidence and/or research, as appropriate, to support the explanation.

18 
(18%)
 – 19 
(19%)

The response includes a vague or inaccurate explanation of racial/ethnic variables that may impact physiological functioning, and/or explanations based on inappropriate evidence/research.

0 
(0%)
 – 17 
(17%)

The response includes a vague or inaccurate explanation of racial/ethnic variables that may impact physiological functioning, or the explanations are based on inappropriate or no evidence/research.

Written Expression and Formatting – Paragraph Development and Organization:

Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.

5 
(5%)
 – 5 
(5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity Gout Essay- NURS 6501 Case Study Analysis.

A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

4 
(4%)
 – 4 
(4%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.

3 
(3%)
 – 3 
(3%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

Purpose, introduction, and conclusion of the assignment are vague or off topic.

0 
(0%)
 – 2 
(2%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided. Written Expression and Formatting – English Writing Standards: Correct grammar, mechanics, and proper punctuation 5  (5%)  – 5  (5%) Uses correct grammar, spelling, and punctuation with no errors. 4  (4%)  – 4  (4%) Contains a few (1 or 2) grammar, spelling, and punctuation errors. 3  (3%)  – 3  (3%) Contains several (3 or 4) grammar, spelling, and punctuation errors. 0  (0%)  – 2  (2%) Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list. 5  (5%)  – 5  (5%) Uses correct APA format with no errors. 4  (4%)  – 4  (4%) Contains a few (1 or 2) APA format errors. 3  (3%)  – 3  (3%) Contains several (3 or 4) APA format errors. 0  (0%)  – 2  (2%) Contains many (≥ 5) APA format errors. Total Points: 100 Name: NURS_6501_Module2_Case Study_Assignment_Rubric Gout Essay- NURS 6501 Case Study Analysis

NURS 6501: Advanced Pathophysiology Module 1 Assignment: Case Study Analysis

Introduction

This essay describes the disease that is highlighted in the scenario of the 11-year old boy. In the scenario, the boy complains of wheezing and difficulty “getting enough air.” These symptoms especially increase when the boy is exercising, and there is an improvement when the activity stops. The mother suggests that the boy is allergic to cat dander, and since the next-door neighbor started sheltering cats, the symptoms have worsened even when the boy is at rest. Auscultation showed wheezes on forced expiration throughout all lung fields. This study will analyze the cardiovascular and cardiopulmonary pathophysiologic processes of the diseases that are presented in the case study NURS 6501: Advanced Pathophysiology Module 1 Assignment: Case Study Analysis.

The disease is likely a result of the blocking of the airways in the lungs. The blockage may be a result of narrowing, swelling, or production of extra mucus in the lungs. When this happens, the space for passing air is constricted, making a person force the passage of air, struggle to breathe, and this ends up producing the wheezing sound. The problem may be aggravated by the cat dander, a situation the mother says that the boy is allergic to. In this case, the inner walls of the lungs’ airways contain mucosal cells that produce mucus to act as a protective system against the foreign matters in the lungs. In the case there is dander from the cats in the air, these are tiny pieces of dead skin, the boy may inhale them and invoke a reaction that makes antigen-presenting cells in the airways to make extra mucus (McCance & Huether, 2019). As a result, the mucus further blocks the airways leading the boy to struggle to breathe and thus wheezing sound.

In genetics, children who have been born in families with cases of allergic asthma have had a high likelihood of developing the same conditions. According to research, certain gene variations that change the encoding of epithelial cell-derived cytokines like interleukin-33 and thymic stromal lymphopoietin are involved in the pathogenesis of allergies (Min, 2010). These gene variations are inherited from parent to child, and thus the family history of the condition increases the risk of developing this condition. Other gene variations in the ORMDL3 and GSDML genes that are also hereditary are associated with early-onset of the condition NURS 6501: Advanced Pathophysiology Module 1 Assignment: Case Study Analysis.

The other factor that may affect the propensity to develop the condition is race and ethnicity. According to studies, some races are less exposed to allergies and asthma more than others. The chance of developing such conditions varies dramatically based on the ethnicity and race of an individual. For example, Caucasians are found to have the highest rate of allergies that are about three times more than the Asians from presented with the lowest rate (Ortiz & Barnes , 2015).

In this case, the stimulus could include exercise activities and exposure to cat dander. In exercise activities, the body requires more oxygen than when the person is stationary. Therefore, the heightened oxygen requirement is faced with narrowed or swollen airways making the boy breathe hard to supply more oxygen. In the case of cat dander, they stimulate a reaction that produces more mucus that ends up blocking the airways NURS 6501: Advanced Pathophysiology Module 1 Assignment: Case Study Analysis.

Conclusion

From the analysis, the boy is suffering from asthma that is worsened by the allergy to cat dander. The physiology of the problem involved narrowed or swollen airways in the lungs. The extra mucus may also block the airways causing heavy breathing and wheezing sound. Genetic factors could have played a role in predisposing the child to a hereditary condition NURS 6501: Advanced Pathophysiology Module 1 Assignment: Case Study Analysis.

References

McCance, K. L., & Huether, S. E. (2019).
Pathophysiology: The Biologic Basis for Disease in Adults and Children.
New York: Elsevier.

Min, Y.-G. (2010). The Pathophysiology, Diagnosis and Treatment of Allergic Rhinitis.
Allergy Asthma Immunol Res.
, 65-76.

Ortiz, R. A., & Barnes , K. C. (2015). Genetics of Allergic Diseases.
Immunol Allergy Clin North Am
, 19-44.

Module 1 Assignment: Case Study Analysis

An understanding of cells and cell behavior is a critically important component of disease diagnosis and treatment. But some diseases can be complex in nature, with a variety of factors and circumstances impacting their emergence and severity.

Effective disease analysis often requires an understanding that goes beyond isolated cell behavior. Genes, the environments in which cell processes operate, the impact of patient characteristics, and racial and ethnic variables all can have an important impact.

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Photo Credit: Getty Images/Hero Images

An understanding of the signals and symptoms of alterations in cellular processes is a critical step in the diagnosis and treatment of many diseases. For APRNs, this understanding can also help educate patients and guide them through their treatment plans NURS 6501: Advanced Pathophysiology Module 1 Assignment: Case Study Analysis.

In this Assignment, you examine a case study and analyze the symptoms presented. You identify cell, gene, and/or process elements that may be factors in the diagnosis, and you explain the implications to patient health.

To prepare:

By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.

The Assignment (1- to 2-page case study analysis)

Develop a 1- to 2-page case study analysis in which you:

Explain why you think the patient presented the symptoms described.

Identify the genes that may be associated with the development of the disease.

Explain the process of immunosuppression and the effect it has on body systems.

By Day 7 of Week 2

Submit
 your Case Study Analysis Assignment 
by Day 7 of Week 2
.

Reminder: 
The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The sample paper provided at the Walden Writing Center provides an example of those required elements (available at 
https://academicguides.waldenu.edu/writingcenter/templates
). All papers submitted must use this formatting.

 

NURS_6501_Module1_Case Study_Assignment_Rubric

Grid View

List View

Excellent

Good

Fair

Poor

Develop a 1- to 2-page case study analysis, examining the patient symptoms presented in the case study. Be sure to address the following:

Explain why you think the patient presented the symptoms described.

28 
(28%)
 – 30 
(30%)

The response accurately and thoroughly describes the patient symptoms.

The response includes accurate, clear, and detailed reasons, with explanation for the symptoms supported by evidence and/or research, as appropriate, to support the explanation.

25 
(25%)
 – 27 
(27%)

The response describes the patient symptoms.

The response includes accurate reasons, with explanation for the symptoms supported by evidence and/or research, as appropriate, to support the explanation.

23 
(23%)
 – 24 
(24%)

The response describes the patient symptoms in a manner that is vague or inaccurate.

The response includes reasons for the symptoms, with explanations that are vague or based on inappropriate evidence/research.

0 
(0%)
 – 22 
(22%)

The response describes the patient symptoms in a manner that is vague and inaccurate, or the description is missing.

The response does not include reasons for the symptoms, or the explanations are vague or based on inappropriate or no evidence/research.

Identify the genes that may be associated with the development of the disease.

23 
(23%)
 – 25 
(25%)

The response includes an accurate, complete, detailed, and specific analysis of the genes that may be associated with the development of the disease NURS 6501: Advanced Pathophysiology Module 1 Assignment: Case Study Analysis.

20 
(20%)
 – 22 
(22%)

The response includes an accurate analysis of the genes that may be associated with the development of the disease.

18 
(18%)
 – 19 
(19%)

The response includes a vague or inaccurate analysis of the genes that may be associated with the development of the disease.

0 
(0%)
 – 17 
(17%)

The response includes a vague or inaccurate analysis of the genes that may be associated with the development of the disease is missing.

Explain the process of immunosuppression and the effect it has on body systems.

28 
(28%)
 – 30 
(30%)

The response includes an accurate, complete, detailed, and specific explanation of the process of immunosuppression and the effect it has on body systems.

25 
(25%)
 – 27 
(27%)

The response includes an accurate explanation of the process of immunosuppression and the effect it has on body systems.

23 
(23%)
 – 24 
(24%)

The response includes a vague or inaccurate explanation of the process of immunosuppression and the effect it has on body systems.

0 
(0%)
 – 17 
(17%)

The response includes a vague or inaccurate explanation of the process of immunosuppression and the effect it has on body systems.

Written Expression and Formatting – Paragraph Development and Organization:

Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.

5 
(5%)
 – 5 
(5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

4 
(4%)
 – 4 
(4%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.

3 
(3%)
 – 3 
(3%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

Purpose, introduction, and conclusion of the assignment are vague or off topic.

0 
(0%)
 – 2 
(2%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided. Written Expression and Formatting – English Writing Standards: Correct grammar, mechanics, and proper punctuation 5  (5%)  – 5  (5%) Uses correct grammar, spelling, and punctuation with no errors. 4  (4%)  – 4  (4%) Contains a few (1 or 2) grammar, spelling, and punctuation errors. 3  (3%)  – 3  (3%) Contains several (3 or 4) grammar, spelling, and punctuation errors. 0  (0%)  – 2  (2%) Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list. 5  (5%)  – 5  (5%) Uses correct APA format with no errors. 4  (4%)  – 4  (4%) Contains a few (1 or 2) APA format errors. 3  (3%)  – 3  (3%) Contains several (3 or 4) APA format errors. 0  (0%)  – 2  (2%) Contains many (≥ 5) APA format errors. Total Points: 100 Name: NURS_6501_Module1_Case Study_Assignment_Rubric NURS 6501: Advanced Pathophysiology Module 1 Assignment: Case Study Analysis

Discussion: Alterations in Cellular Processes

Pathophysiology case study discussion

Pathology is the study of disease diagnosis through the investigation of indicators for a given disease in samples of surgically removed tissues, organs, body fluids, and even the whole body. Proper understanding of disease symptoms and underlying pathophysiology is imperative in the mastery of pathology. Furthermore, competency in pathology is essential in advanced Practice Nursing since it ensures effective patient management through the employment of rational treatment plans. This discussion highlights the role of genetics, underlying reasons for symptom manifestation, and physiologic response to the stimulus presented in a case scenario Discussion: Alterations in Cellular Processes.

The case scenario involves a 16-year –old boy that presents with a sore throat that had persisted for three days with a negative past medical history of ear infections, nor treatment of colds and influenza. His posterior pharynx is reddened and produces a white exudate from the 3+ enlarged tonsils. The patient has no known food and drug allergies but later presents with anaphylaxis upon taking the first dose of amoxicillin.

Role of genetics.

Sore throat infections are commonly due to infection by streptococcus group A bacterium. Recurrent infection by the bacteria is linked to an underlying genetic predisposition that makes the body’s immune system unable to fight off the infection (Crotty, 2020). The large scale genome-wide association studies suggest shared genetics between autoimmunity, related phenotypes, and allergy. This finding is based on the identification of GWAS of monogenic diseases. Furthermore, these findings support the concept of an allergic response to particular triggers being affected by genetic factors (Klaus Bønnelykke, 2015).

Presentation of symptoms.

            
Signs and symptoms are indicative features of an underlying disease. Therefore, investigating and understanding the presenting signs and symptoms is imperative in establishing a rational diagnosis in pathology. For example, infection by the streptococcus bacteria caused an inflammatory response of the throat which presents as pain, reddening and swelling of the tonsils. Production of exudate is also a result of immune response to the bacterial invasion, which results in the production of pus. Anaphylactic response is a condition characterized by excessive release of chemical mediators upon exposure to specific allergens. This production of chemical triggers results in symptoms such as dyspnea, swelling of the tongue and lips, and wheezing. The patient having presented the anaphylactic response upon taking amoxicillin may be allergic to penicillin, which is commonly associated with such reactions Discussion: Alterations in Cellular Processes.

Physiologic response to the stimulus and involved cells.

Infection by streptococcus group A bacterium, as confirmed by a rapid strep test, presents as enlarged tonsils that produce an exudate and positive cervical adenopathy. This presentation is due to an underlying immune response in an attempt to fight off the infection through the release of mediators such as chemokines, PGE2, leukotriene B4, eicosanoids, proinflammatory cytokines, and antimicrobial peptides.

Anaphylactic presentation is due to the release of chemical mediators due to exposure to triggers. Chemical mediators that play a significant role include histamine that leads to increased vasodilation and permeability and changes in cardiac contractility and heart rate. Prostaglandin D is also a chemical mediator that functions as pulmonary and cardiac vasoconstrictor that also causes peripheral vasodilation and vital organs hypoperfusion. Leukotrienes also play a significant role in bronchoconstriction and airway remodeling, which causes difficulty in breathing. Other significant chemical mediators include platelet activation factor and TNF alpha (McLendon & Sternard., 2021).

Consideration of the patient’s age is essential in the management of group A streptococci infection. This consideration is especially significant in elderly populations, whereby it is considered a life-threatening condition, especially in individuals who reside in long term care facilities. Management of the disease in such population thereby requires a different response approach that involves large scale efforts which includes infectious disease practitioners, the staff, and public health officials in an attempt of preventing and managing GAS outbreak (Kevin P. High, 2007)

                                                                                              References

Crotty, S. (2020). 
Strep Throat
. Retrieved from La Jolla Institute For Immunology: https://www.lji.org/diseases/strep-throat/

Kevin P. High, H. T. (2007). Group A Streptococcal Disease in Long-Term Care Facilities: Descriptive Epidemiology and Potential Control Measures. 
Oxford ACADEMIC
.

Klaus Bønnelykke, R. S. (2015). Genetics of allergy and allergic sensitization: common variants, rare mutations. 
National Center for Biotechnology Information
.

McLendon, K., & Standard., B. T. (2021). Anaphylaxis. 
National Center for Biotechnology Information Discussion: Alterations in Cellular Processes
.

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Discussion: Alterations in Cellular Processes

At its core, pathology is the study of disease. Diseases occur for many reasons. But some, such as cystic fibrosis and Parkinson’s Disease, occur because of alterations that prevent cells from functioning normally.

Understanding of signals and symptoms of alterations in cellular processes is a critical step in diagnosis and treatment of many diseases. For the Advanced Practice Registered Nurse (APRN), this understanding can also help educate patients and guide them through their treatment plans.

For this Discussion, you examine a case study and explain the disease that is suggested. You examine the symptoms reported and explain the cells that are involved and potential alterations and impacts.

To prepare:

By Day 1 of this week, you will be assigned to a specific scenario for this Discussion. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.

By Day 3 of Week 1

Post an explanation of the disease highlighted in the scenario you were provided. Include the following in your explanation:

The role genetics plays in the disease.

Why the patient is presenting with the specific symptoms described.

The physiologic response to the stimulus presented in the scenario and why you think this response occurred.

The cells that are involved in this process.

How another characteristic (e.g., gender, genetics) would change your response.

Read
 a selection of your colleagues’ responses.

Genetic factors play two roles in this case first, as you have mentioned, genetics play a role in the recurrent  infection, especially in cases where genetics contributes to reduced immunity or allergies (Loh et al., 2017). It is also important to appreciate the role of genetics when it comes to triggering the hypersensitivity to amoxicillin.  It is likely that a mutation  in the patient’s HLA-B*55:01 has contributed to the development of mild forms of penicillin allergies in the patient (Krebs et al., 2020). This calls for extricate investigation in order to find an antibiotic that will not trigger anaphylaxis in the patient and thus guarantees positive outcomes in the patient Discussion: Alterations in Cellular Processes.

References

Krebs, K., Bovijn, J., Zheng, N., Lepamets, M., Censin, J. C., Jürgenson, T., … & Fadista, J. (2020). Genome-wide study identifies association between HLA-B∗ 55: 01 and self-reported penicillin allergy. The American Journal of Human Genetics, 107(4), 612-621.

Loh, J. M., Lorenz, N., Tsai, C. J. Y., Khemlani, A. H. J., & Proft, T. (2017). Mucosal vaccination with pili from Group A Streptococcus expressed on Lactococcus lactis generates protective immune responses. Scientific reports, 7(1), 1-9 Discussion: Alterations in Cellular Processes.

NURS 6501 necrotic tissue Essay – Alterations in Cellular Processes Discussion

Advanced Pathophysiology Week 1 Initial Post

Scenario 4

A 27-year-old patient with a history of substance abuse is found unresponsive by emergency medical services (EMS) after being called by the patient’s roommate. The roommate states that he does not know how long the patient had been lying there. Patient received naloxone in the field and has become responsive. He complains of burning pain over his left hip and forearm. Evaluation in the ED revealed a large amount of necrotic tissue over the greater trochanter as well as the forearm. EKG demonstrated prolonged PR interval and peaked T waves. Serum potassium level 6.9 mEq/L  NURS 6501 necrotic tissue Essay – Alterations in Cellular Processes Discussion.

Why is the patient presenting with these symptoms?

The patient was unresponsive due to an overdose. Narcan, an opioid antagonist used to reverse the actions of opioid overdose, was given in the field. Opioids are known for depressing the respiratory system thus leading to respiratory failure or distress. The patient mos t likely experienced respiratory failure and passed out (McCane & Huether, 2019). The necrotic tissue is most likely the result of a fall after passing out and could represent cellular damage and perhaps even a broken bone. Necrosis might also represent damage from lying or an undetermined amount of time in one position, in this case, the left hip and forearm (McCance & Huether, 2019). Necrosis is tissue death caused by lack of blood and oxygen and can be caused through or because of Rhabdomyolysis (Cabral, Edding, Portacarrero, & Lerma, 2020). This could have also caused the high level of potassium (Chatzizisis, Misirli, Hatzitolios, & Giannoglou, 2020). This release of potassium could also be what is causing the prolonged PR interval and peaked T-waves (Weiss, Qu, & Shivkumar, 2017).

How would gender or genetics change your answer?

In this case, gender would not play a significant role. The clinical presentation of drug overdose in male versus female are not greatly different as shown in the study by (Syse, et al., 2019). Age would play a difference only in that it usually takes less of a drug taken by mouth to cause an overdose in polder adults due to decreased metabolism and excretion (Vu, Beselman, Monolakis, Wag, & Rastegar, 2018). The mentioned study also points out that people with heart conditions or COPD are also at greater risk of opioid overdose. NURS 6501 necrotic tissue Essay – Alterations in Cellular Processes Discussion

References

Cabral, B., Edding, S., Portacarrero, J., & Lerma, E. (2020). Rhabdomyolysis. 
Disease a Month
, 66.

Chatzizisis, Y., Misirli, G., Hatzitolios, A., & Giannoglou, G. (2020). The syndrome of rhabdomyolysis: Complications and treatment. 
European Jourmal of Inernal Medicine
, 568-574.

McCance, K., & Huether, S. (2019). 
Pathophysiology the biologic basis for disease in adults and children.
 St Louis, MO: Elsevier.

Syse, V., Brekke, M., Grimsrud, M., Persett, P., Heyerdahl, .., Hovda, K., & Vallersnes, O. (2019). Gender differences in acute recreational drug toxicity: a case series from Oslo, Norway. 
BMC Emergency Medicine
, 29.

Vu, Q., Beselman, A., Monolakis, J., Wag, A., & Rastegar, D. (2018). Risk factors for opioid overdose among hospitalized patients. 
Journal of Clinical Pharmacy & Therapeutics
, 784-789.

Weiss, J., Qu, H., & Shivkumar, K. (2017). Electrophysiology of Hypokalemia and Hyperkalemia. 
Circulation: Arrhythmia & Electrophysiology
, 1-10 NURS 6501 necrotic tissue Essay – Alterations in Cellular Processes Discussion.

response 1

Hi Margaret. The scenario assigned to you gave me an interest. I had a patient last month with necrotic tissue on her right arm due to substance abuse. I was fascinated with your post, and I did some readings that I would like to share.

According to Ciccarone, Unick, Cohen, Mars, Rosenblum, abscesses, cellulitis, and injection-related wounds are highly prevalent among persons who inject drugs, likely due to repeated injection into the same anatomical site, resulting in venous and other tissue trauma (Ciccarone, et al. ,2016). Moreover, injections in a nonsterile environment and practices such as reusing needles or sharing used equipment facilitate local soft-tissue bacterial inoculation, with subsequent risk of serious complications such as sepsis, gangrene, amputation, and death. (Smith, Robinowitz, Chaulk, Johnson, 2015).

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In addition, frequency of injection has a direct relationship with infection risk as well. Type of drug injected also affects the risk of skin soft tissue infections, with heroin and speedball (combined heroin and cocaine) posing a greater risk of infection and methamphetamines decreasing this risk. (Brown & Ebright, 2002). Also, Black tar heroin has specifically been associated with higher rates of skin infections (Phillips & Stein, 2010) NURS 6501 necrotic tissue Essay – Alterations in Cellular Processes Discussion.

With these learnings, I am cautious with my patients who are being discharged to take out their IV access before endorsing transport services. This instance can prevent our in-hospitalized patient to use the IV access for illicit drug use just in case.

 

References:

Brown PD, Ebright JR. (2002). Skin And Soft Tissue Infections in Injection Drug Users. Retrieved from https://www.liebertpub.com/doi/full/10.1089/wound.2020.1243#B19.

Ciccarone D, Unick GJ, Cohen JK, Mars SG, Rosenblum D. (2016). Nationwide Increase in Hospitalizations for Heroin-related Soft Tissue Infections: Associations with Structural Market Conditions. Retrieved from https://www.liebertpub.com/doi/full/10.1089/wound.2020.1243#B19.

Phillips KT, Stein MD. (2010). Risk Practices Associated with Bacterial Infections Among Injection Drug Users in Denver, Colorado. Retrieved from 
https://www.liebertpub.com/doi/full/10.1089/wound.2020.1243#B19
.

Smith ME, Robinowitz N, Chaulk P, Johnson KE. (2015). High Rates of Abscesses and Chronic Wounds in Community-Recruited Injection Drug Users and Associated Risk Factors. Retrieved from https://www.liebertpub.com/doi/full/10.1089/wound.2020.1243#B19 NURS 6501 necrotic tissue Essay – Alterations in Cellular Processes Discussion.

Sample response 2

Great post. Overdoses are becoming more common and Narcan is one of those drugs we always keep handy especially in the hospital setting. Naloxone reverses opiate-related cases in and out the hospital without the addictive effects (Wojcicki, 2019). In most opiate OD cases it most time not intentional. Depending on the drug of choice the symptoms vary, but eventually respiratory distress begins, and the users is not far from becoming unresponsive, like the patient was in the scenario. An opioid overdose is caused by the overly excessive stimulation of the opiate pathways leading to respiratory issues and maybe even death (Schiller, 2021). I agree that your patient may have lost consciousness and fell to the ground on that necrotic side and may have possible broken something causing another systemic response. Gender wouldn’t affect the results. Whether male or female, an overdose with pretty much affect everyone the same way but in different rates.

Schiller, E. Y. (2021, July 18). 
Opioid overdose
. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK470415.

Wojcicki, J. M. (2019). Dying alone: the sad irrelevance of naloxone in the context of solitary opiate use. 
Addiction (Abingdon, England)
, 
114
(3), 574–575. https://doi-org.ezp.waldenulibrary.org/10.1111/add.14508 NURS 6501 necrotic tissue Essay – Alterations in Cellular Processes Discussion

Discussion: Alterations in Cellular Processes

Photo Credit: Getty Images

At its core, pathology is the study of disease. Diseases occur for many reasons. But some, such as cystic fibrosis and Parkinson’s Disease, occur because of alterations that prevent cells from functioning normally.

Understanding of signals and symptoms of alterations in cellular processes is a critical step in diagnosis and treatment of many diseases. For the Advanced Practice Registered Nurse (APRN), this understanding can also help educate patients and guide them through their treatment plans.

For this Discussion, you examine a case study and explain the disease that is suggested. You examine the symptoms reported and explain the cells that are involved and potential alterations and impacts.

To prepare:

By Day 1 of this week, you will be assigned to a specific scenario for this Discussion. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor NURS 6501 necrotic tissue Essay – Alterations in Cellular Processes Discussion.

By Day 3 of Week 1

Post an explanation of the disease highlighted in the scenario you were provided. Include the following in your explanation:

The role genetics plays in the disease.

Why the patient is presenting with the specific symptoms described.

The physiologic response to the stimulus presented in the scenario and why you think this response occurred.

The cells that are involved in this process.

How another characteristic (e.g., gender, genetics) would change your response.

Read
 a selection of your colleagues’ responses.

By Day 6 of Week 1

Respond
 to 
at least two
 of your colleagues on 
2 different days 
and respectfully agree or disagree with your colleague’s assessment and explain your reasoning. In your explanation, include why their explanations make physiological sense or why they do not

Note:
 For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on 
Submit! NURS 6501 necrotic tissue Essay – Alterations in Cellular Processes Discussion

Adolescent Hispanic/Latino boy living in a middle-class suburb

Main post

Adolescent Hispanic/Latino boy living in a middle-class suburb 

An accurate health history is vital when creating a care plan that is inclusive of the patient’s needs. According to Ball et al. (2018), it is a key component when diagnosing and treating any patient. Gaining trust and allowing for autonomy is crucial with this particular age group. According to Erickson’s stages of development, “finding themselves” is a key area of growth for adolescents (Orenstein, 2020). By creating a relationship in which the adolescent can participate in providing a health history, they will be more inclined to also participate in activities that improve their health Adolescent Hispanic/Latino boy living in a middle-class suburb.

Communication/Interview Techniques and Targeted Questions

Communication and interview techniques must be tailored based on with whom the provider is working. For example, when interviewing a 75 year old, male Hispanic, I would utilize formal greetings, shake hands and make eye contact. I would use proper terms for anatomical parts, but not necessarily formal medical terminology. For an adolescent, I would utilize techniques that generate involvement from both the patient as well as their parent. For example, I would ask leading questions like “when was the last time you played on your Xbox and when was the last time you played outside. These types of questions acknowledge that mental play and physical play time are equally important. It is important they both feel like they play a role in the health and wellness of the adolescent.

Social Determinants of Health

Asking targeted questions that are appropriate for the social determinants is important in gaining a trusting relationship. For example, it would not make sense for an adolescent of this socioeconomic standing to be asked if they know where or when their next meal might be. However, asking how many fruits or vegetables they eat per day, would be a more appropriate question. Likewise, obesity is not uncommon in this culture so framing questions that are non-judgmental is important as well. An example might be, “do you know why your body needs healthy foods?” This not only engages them in understanding their own body but allows for education where gaps might be highlighted Adolescent Hispanic/Latino boy living in a middle-class suburb.

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Risk Assessment Tools

According to Ball (2019), understanding the growth and development of adolescents is important when taking a health history. For example, ensuring the individual met all of their development milestones, regardless of their current reason for visiting will help in understanding where the issues might originate. Next, depression and anxiety are becoming more prevalent in this age group, so utilizing a screening tool that is age appropriate would be important. An example of an age appropriate tool would be the Center for Epidemiologic Studies Depression Scale for Children (CES-DE), which is utilized to assess as well as monitor ongoing treatment plans in children and young adults aged 6-23 (Zsamboky et al., 2021). The benefit of this tool is the length of time in which it is appropriate to use. As a result, this is the risk assessment tool I would utilize, primarily because having years of growth and development to review can make creating individualized treatment plans that much easier Adolescent Hispanic/Latino boy living in a middle-class suburb.

Other Health Related Risks

Obesity and mental health are noted as chronic health related problems afflicting this population (Isasi et al., 2016). It has been well-documented that chronic obesity has psychological consequences. Rankin et al. (2016), finds that obese children are significantly more likely to struggle with psychiatric and psychological disorders than children who are not obese. Additionally, Tamayo et al., (2020) argues that ¼ of Hispanic youths in the U.S. are obese. This is clearly an important health related issue that must be addressed for this population.

Five (+) Targeted Questions

How many fruits and vegetables do you eat every day?

How often do you eat breakfast?

How many cups of water do you drink at school? How big are those cups?

Do you have a best friend at school?

How many days in a week do you feel sad or lonely?

Who do you talk to about feeling sad or lonely?

 

References

Ball, J., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). 
Seidel’s guide to physical examination: An Interprofessional approach
. Mosby.

Isasi, C. R., Rastogi, D., & Molina, K. (2016). Health issues IN Hispanic/latino youth. 
Journal of Latina/o Psychology
, 
4
(2), 67–82. https://doi.org/10.1037/lat0000054

Orenstein, G. A. (2020, November 22). 
Eriksons stages of psychosocial development
. StatPearls [Internet]. 
https://www.ncbi.nlm.nih.gov/books/NBK556096/
.

Rankin, J., Matthews, L., Cobley, S., Han, A., Sanders, R., Wiltshire, H. D., & Baker, J. S. (2016). Psychological consequences of childhood obesity: Psychiatric comorbidity and prevention. 
Adolescent Health, Medicine and Therapeutics
, 
Volume 7
, 125–146. https://doi.org/10.2147/ahmt.s101631

Tamayo, M. C., Dobbs, P. D., & Pincu, Y. (2020). Family-centered interventions for treatment and prevention of childhood obesity in hispanic families: A systematic review. 
Journal of Community Health
, 
46
(3), 635–643. 
https://doi.org/10.1007/s10900-020-00897-7

Zsamboky, M., Haskell, B., Vick, R., & Schroer, M. (2021). Treating child and adolescent depression and anxiety in primary care. 
The Journal for Nurse Practitioners
, 
17
(1), 54–59. https://doi.org/10.1016/j.nurpra.2020.08.019 Adolescent Hispanic/Latino boy living in a middle-class suburb

response

Thanks for your post.  In addition to increased risk for obesity and mental health issues, a middle-class adolescent is at higher risk for teen substance abuse.  In a study conducted by Patrick et al. (2012), it was noted that there is a higher incidence of substance use among youth from families with higher socioeconomic status.  Substances more likely to be abused are alcohol and marijuana (Patrick et al., 2012).  In a study by Martin (2019), it was noted that adolescents living in suburban neighborhoods were more likely to abuse drugs or alcohol.  This may be due in part to the fact that people in higher socioeconomic groups are more likely to engage in deviant behaviors (Martin, 2019).  I would employ the PACES risk assessment tool when interviewing this patient.  PACES stands for parents/peers, accidents/alcohol or drugs, cigarettes, emotional issues, and school/sexuality (Ball et al., 2019) Adolescent Hispanic/Latino boy living in a middle-class suburb.

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). 
Seidel’s guide to physical examination: An interprofessional approach
 (9th ed.). Mosby.

Patrick, M. E., Wightman, P., Schoeni, R. F., & Schulenberg, J. E. (2012). Socioeconomic status and substance use among young adults: A comparison across constructs and drugs. 
Journal of Studies on Alcohol and Drugs
, 
73
(5), 772–782. 
https://doi.org/10.15288/jsad.2012.73.772

 

Sample response 2

I enjoyed reading your reply, it was interesting and contained many valid points. It is crucial to understand how to conduct a proper assessment geared towards gathering as much patient history as possible. I agree gaining trust and allowing for autonomy is crucial with this particular age group. It’s important to remember that this age group and ethical background are at risk for having an unhealthy diet. When assessing what the patients diet is its important to ask questions with a non judge mental attitude. “Erikson’s Stages of Psychosocial Development can be utilized by mental health providers when treating patients who are facing periods of adjustment or turning points in life”(Orenstein, G. A. 2020). These stages are also important for nurses to use when conducting an assessment and gaining back ground information. Evaluation for drug use should also be conducted. These turning points in life often cause adolescents to explore and experiment.
 

References
 

Orenstein, G. A. (2020, November 22). Eriksons stages of psychosocial development. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK556096/Adolescent Hispanic/Latino boy living in a middle-class suburb.

16-year-old white pregnant teenager living in an inner-city neighborhood

Initial Post

My specific patient is a 16-year-old white pregnant female living in an inner-city neighborhood. This specific patient is a pregnant female. I would focus my assessment on women’s health and examining the fetus. First, before I begin collecting information, I would introduce myself. The introduction is essential; it establishes your professional role. I would also ask the patient for permission to be involved in her care. Often patients do not want the opposite sex providing care. Respect for the patient’s beliefs, attitudes, and rights enhances patient rapport. It is crucial to communicate empathy because this encourages patients to express their concerns. I would focus my questions on an open-ended format; this way, I can understand what kind of care the patient has received previously. Open-ended questions also allow for the patient to speak freely 16-year-old white pregnant teenager living in an inner-city neighborhood.

Several important points need to be addressed to assess health risks for a pregnant woman properly. I would focus on what kind of prenatal care has been completed. What are the plans this patient has as far as breastfeeding? I would also inquire about any cigarette smoking and alcohol use. “Entry into prenatal care represents the beginning of her new life. The adolescent should be praised for beginning prenatal care, particularly if it is in the 1st trimester” (Montgomery, K. S. 2003). Another critical factor that needs to be addressed is the mothers feeling and attitude towards her pregnancy. A potential health-related risk that should be taken into consideration is possible postpartum depression. This is a 16-year-old girl who hasn’t experienced much in life. Poverty and a high-risk pregnancy due to her age are important factors that need to be monitored. I would complete a functional assessment for this patient. “Quite simply, functional assessment is an attempt to understand a patient’s ability to achieve the basic activities of daily living” (Ball, J 2019). It is important to understand how this young woman plans to raise her child.

Questions-

Have you been pregnant before?

What do your peers say about your pregnancy?

Have you set up the baby room?

Is your partner excited?

What hospital have you chosen?

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.) 16-year-old white pregnant teenager living in an inner-city neighborhood

Montgomery, K. S. (2003). Nursing care for pregnant adolescents. Journal of Obstetric, Gynecologic & Neonatal Nursing, 32(2), 249–257. https://doi.org/10.1177/0884217503252191

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Response

We get a lot of women under the age of
 
18
 
and pregnant, admitted to our floor.
 
  The main issue we deal with most of the time is these women are addicted to
 
opioids. Opioid dependence in pregnancy carries clear identifiable maternal and fetal risk (Shainkar et al., 2012). Most are admitted for issues ranging from cellulites to endocarditis. Many of them don’t know they are pregnant or they do,
 
and they don’t care.  It can be very challenging as a nurse to separate your emotions from these particular cases.
 
A significant barrier to treatment for pregnant women is
 
caregiver
 
attitudes. Pregnant women who abuse substances are the mostly likely group to be stigmatized and
 
treated punitively for their addiction-related behavior (Crawford et
 
al., 2015).  Some of the questions we need to ask them are “if they have a desire to have the baby” and if so, “are they willing to get help to stop doing drugs”.  Unfortunately, a large majority of them have no plans to stop their drug use.  The questions would appear as if they could be answered very cut and dry, although many if not all of the patient population we receive have very complicated pasts that range from histories of sexual abuse, homelessness, mental health issues, and little to no family support.  In these particular circumstances it can be very frustrating to know all the right questions to ask, but subsequently end up feeling defeated and helpless when a patient refuses help and elopes during treatment 16-year-old white pregnant teenager living in an inner-city neighborhood.

References

Crawford, C., Sias, S., & Goodwin, L. (2015).
 
Treating Pregnant Women With Substance Abuse Issues in an OBGYN Clinic: Barriers to Treatment
. https://www.counseling.org/docs/default-source/vistas/treating-pregnant-women-with-substance-abuse-issues-in-an-obgyn-clinic-barriers-to-treatment.pdf?sfvrsn=6

Shainker, S. A., Saia, K., & Lee-Parritz, A. (2012). Opioid Addiction in Pregnancy.
 
Obstetrical & Gynecological Survey
,
 
67
(12), 816–824. https://doi.org/10.1097/ogx.0b013e3182788e8c

Response 2

Women ages from 15-19 who are pregnant are at a risk for maternal death related to maternal complications (Amjad, et. al., 2019). With this risk of complication for this patient it is important that she continues with prenatal care for herself and the baby. This will assist in any early detection of complications from the pregnancy. Another risk area that needs to be considered and reviewed postpartum is depression. Within this age range these individuals are finishing high school and have many other stressors in their life. Now they will be having an addition of a baby. Depression occurs two times the rate for adolescents who are raising children as opposed to those who are not raising children (Russotti, et. al., 2020) 16-year-old white pregnant teenager living in an inner-city neighborhood.

Continued effective communication for this individual is needed so that they will sustain prenatal and postpartum care. They will need assistance with knowledge regarding community resources. One question that should be asked is what support do you have at home to assist with the baby?  Another would be what resources are you aware of within the community for assistance?

References

Amjad, S., Macdonald, I., Chambers, T., Osornio-Vargas, A., Chandra, S., Voaklander, D., & Ospina, M. B. (2019). Social determinants of health and adverse maternal and birth outcomes in adolescent pregnancies. A systematic review and meta-analysis. 
Paediatric and Perinatal Epidemiology, 33
(1), 88-99. 
https://doi-ord.ezp.waldenulibrary.org/10.1111/ppe.12529

Russotti, J., Handley, E. D., Rogosch, F. A., Toth, S. L., & Cicchetti, D. (2020). The interactive effects of child maltreatment and adolescent pregnancy on late-adolescent depressive symptoms. 
Journal of Abnormal Child Psychology, 48(
9), 1223-1237. https://doi-org.ezp.waldenulibrary.org/10.1007/s10802-020-00669-w 16-year-old white pregnant teenager living in an inner-city neighborhood

55-year-old Asian female living in a high-density public housing complex

Summary of interview

Patient Scenario:

55-year-old Asian female living in a high-density public housing complex

 

As noted in Seidels Physical Examination book, to prevent misinterpretations and misrepresentations, practitioners must make every effort to see the world of the individual patient as the patient sees it (Ball et al., 2019). Each patient is unique, with unique circumstances and our first meeting with a patient helps to set the tone for the relationship (Ball et al., 2019). Both physical and emotional comfort is needed for effective communication, as well as carefully crafting your patient questions to ensure your patient responds effectively to you (Ball et al., 2019). Our communication with each patient differs based on their present needs, and comfort. As illustrated by Ball, establishing a positive patient relationship depends on communication built on courtesy, comfort, connection, and confirmation (Ball et al., 2019) 55-year-old Asian female living in a high-density public housing complex.

My patient is a 55-year-old Asian woman living in a high-density population complex. Using the courtesy, comfort, connection, and confirmation framework for our interview, I addressed my patient formally, learned her name and respected her need for modesty including if she wanted others, such as another family member, friend, or woman in the room as well (Ball et al., 2019). Additionally, since my patient would be identified as an older adult with possible change in cognitive abilities, memory, and personality I wanted her to feel as comfortable as possible and ensure the settings in the room would not magnify any possible issues (Ball et al., 2019). I used this technique to ensure she felt comfortable with me. I allowed the patient to speak freely, giving her time to absorb the situation and decide how much she wanted to divulge. Since I was not clear on how comfortable she would feel with a lot of eye contact, I asked her what would make her feel more comfortable and allowed her to guide us down this discussion.

As noted above, my patient is an older woman living in high density public housing complex and because of that my first questions were focused on her home or living conditions, which included number of people she was living with, types of furnishing, and any pets (Ball et al., 2019). Additionally, I asked her about family, her occupation to determine if there were any additional risks identified, travel, and access to care including transportation and health insurance coverage (Ball et al., 2019). Through this interview, I was able to get a glimpse into her day-to-day life and emotional health.

 

The Risk Assessment Tool

Each patient is assessed based on information gathered during the interview process by using open ended question. My patient lives in a high-density complex and could be at risk of falling and not getting the proper care that she needs, in a reasonable time (Adly et al., 2019). As a practitioner, one would evaluate how she is getting around and access to health care. An understanding of this would lead to developing a plan of care that can help meet the need of the patient 55-year-old Asian female living in a high-density public housing complex.

 

Targeted Questions

It is important to ask the right questions and utilize open ended question to further insight to patient for various risk factors such as fall, abuse, and malnutrition. To develop a tailored care plan for my patient based on her age, socioeconomic status, I would ask the following questions:

1. What is your current employment status?

2. What is your day to day like?

3. What time do you wake up and what type of meals do you normally like to eat?

4. Do you live with family? If not, how often do you visit family or does family visit you?

5. How do you feel?

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6. Are you currently taking any medication?

7. Do you have access to transportation?

8. Do you like to participate in any physical activities?

10. What’s your insurance status?

11. When was the last time you had a doctor visit? 55-year-old Asian female living in a high-density public housing complex

Reference

Adly, N. N., Abd-El-Gawad, W. M., &Abou-Hashem, R. M. (2019). Relationship between malnutrition and different fall risk assessment tools in a geriatric in-patient unit. Aging Clinical and experimental Research, 32 (7), 1279- 1287.

https://doi.org/10.1007/s40520-019-01309-0

Ball, J.W., Dains, J.E., Flynn, J. A, Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9
th
 ed.). St. Louis, MO: Elsevier Mosby

response

Thank you for your discussion, it was very informative and descriptive. I agree, it is important to be non-judgmental and use open ended questions to communicate with a teenager.  Communication, giving and receiving information, in general can be challenging. Some techniques to improve communication are increasing cultural awareness and understanding of various life experiences and cultures, developing empathy and compassion for people, being aware of one’s own body language and paying attention to the patient’s/other’s body language (Raypole, 2020) 55-year-old Asian female living in a high-density public housing complex.

The female in your case study is a 16-year-old female, which makes her at a higher risks of contracting a sexually transmitted infection. According to the CDC, youth between the ages of 15 and 24 make up half of the 26 million new sexually transmitted infections that occurred in United States. Furthermore, in the United States, 12.7% of sexually active adolescents and young adults who are on their parent’s health insurance won’t seek sexual and reproductive healthcare for fear that their parents would find out (Centers for Disease Control and Prevention, 2021).

References

Centers for Disease Control and Prevention. (2021, April 8). 
Adolescents and young adults
. Centers for Disease Control and Prevention. https://www.cdc.gov/std/life-stages-populations/adolescents-youngadults.htm.

Raypole, C. (2020, January 16). 
19 communication techniques to add to your arsenal
. Healthline. https://www.healthline.com/health/communication-techniques#body-language 55-year-old Asian female living in a high-density public housing complex.

response 2

Thank you for your discussion, I found it very informative. I agree using the courtesy, comfort, connection, and confirmation approach would be beneficial in commutating and building a rapport with your patient. Communication, giving and receiving information, in general can be challenging. Some techniques to improve communication are increasing cultural awareness and understanding of various life experiences and cultures, developing empathy and compassion for people, being aware of one’s own body language and paying attention to the patient’s/other’s body language (Raypole, 2020).

There are health risks associated with high density housing such as infectious diseases like STDs, tuberculosis, pneumonia, and diarrhea and noncommunicable diseases like heart disease, stroke, asthma and other respiratory illnesses, cancers, diabetes and depression (World Health Organization, 2021). Also, studies reveal that high density housing environments has an impact on respiratory health, because of poor air quality, and physical activity (Chen et al., 2019).

References

Chen, R., Li, X., Sun, W., Wang, L., & Yang, X. (2019, December 30). 
Impact of high-density urban built environment on chronic obstructive pulmonary disease: A case study of Jing’an district, shanghai
. International journal of environmental research and public health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6982330/ 55-year-old Asian female living in a high-density public housing complex.

Raypole, C. (2020, January 16). 
19 communication techniques to add to your arsenal
. Healthline. https://www.healthline.com/health/communication-techniques#body-language.

World Health Organization. (2021). 
Urban health
. World Health Organization. https://www.who.int/health-topics/urban-health 55-year-old Asian female living in a high-density public housing complex.

Week 1 Knowledge Check – NRNP 6568 Synthesis in Advanced Nursing Practice of Patients in Family Care Settings

NRNP-6568-6-Syn Adv Nurs Pr Patient Family

Quiz – Week 1 Knowledge Check

 

QUESTION 1

Health insurers can use genetic information to make enrollment or coverage decisions

True

False

1 points   

QUESTION 2

DNP stands for Doctor of Nursing Profession

True

False

1 points   

QUESTION 3

What are the main benefits to the NP of NP practice ownership?

Decides on the length of patient visits and how the practice is the run

Chooses employees and controls qualities

May titrate workload to income

A and B only

All of the above

1 points   

QUESTION 4

At what level of government is the role of the nurse practitioner defined?

By the county in which the NP practices

By the state in which the NP practices

By the federal government
Week 1 Knowledge Check – NRNP 6568 Synthesis in Advanced Nursing Practice of Patients in Family Care Settings

1 points   

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QUESTION 5

When using a device other than a landline telephone to participate in telemedicine, the device must comply with ________________ and ____________ requirements.

HIPAA; HITECH

HIPAA; OSHA

HIPAA; DEA

HITECH; DEA

1 points   

QUESTION 6

When speaking to a patient who is not a native English speaker, which of the following is the preferred interpreter to be used?

Family members

Friends of the patient

Professional interpreters experienced in healthcare interpretation

All of the above

1 points   

QUESTION 7

It is vital for an NP to obtain a family history because

Teaches you to have biases about your care

Indicate need for Genetic testing

Guide the decision for Diagnostic testing

B and C correct 

All of the above
Week 1 Knowledge Check – NRNP 6568 Synthesis in Advanced Nursing Practice of Patients in Family Care Settings

1 points   

QUESTION 8

There are several titles for NPs, and some are based on the state requirement. What does ARNP stand for?

Adult Registered Nurse Practitioner

Advanced Registered Nurse Practitioner

Acute Registered Nurse Practitioner

Advanced Registered Nurse Provider

1 points   

QUESTION 9

When giving patients written information, what is the suggested reading level for that health information?

10
th
 grade

7
th
 grade

1
st
 grade

5
th
 grade

1 points   

QUESTION 10

Which of the following are obstacles to improved patient health and safety?

Missed appointments

Failure to follow up with a referral or a diagnostic test

Failure to comply with dietary, medication, or exercise recommendations
Week 1 Knowledge Check – NRNP 6568 Synthesis in Advanced Nursing Practice of Patients in Family Care Settings

All of the above

None of the above

Bottom of Form
Week 1 Knowledge Check – NRNP 6568 Synthesis in Advanced Nursing Practice of Patients in Family Care Settings

B76-year-old black male with disabilities living in an urban setting

y Day 3 of Week 1

Post 
a summary of the interview and a description of the communication techniques you would use with your assigned patient. Explain why you would use these techniques. Identify the risk assessment instrument you selected, and justify why it would be applicable to the selected patient. Provide at least five targeted questions you would ask the patient.

76-year-old black male with disabilities living in an urban setting

Post a summary of the interview and a description of the communication techniques you would use with your assigned patient. Explain why you would use these techniques. Identify the risk assessment instrument you selected, and justify why it would be applicable to the selected patient. Provide at least five targeted questions you would ask the patient 76-year-old black male with disabilities living in an urban setting.

 A strong patient-provider relationship facilitates cooperation and provides greater opportunities to learn about a patient’s unique health needs. This enables providers to better connect patients with the treatments and resources to improve overall health.

How would your communication and interview techniques for building a health history differ with each patient? Before entering the room I would knock and wait for a response The first thing I would do upon entering the room would be a smile and introduction myself.  I would address the patient by his name and ask permission to sit in front of the patient, so I will have eye contact.  I would identify those problems that matters to the patient.  Questions should be tailored base on patient’s age, culture, and cognition (Ball el. al, 2019). Seeking clarity when needed to understand what the patient  is saying 76-year-old black male with disabilities living in an urban setting.

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How might you target your questions for building a health history based on the patient’s social determinants of health? Social determinants of health are the conditions in which people are born, grow, live, work and age that shape health. It’s important to understand that  reviewing the patient social determinants The spiritual, psychosocial, and cultural contexts of the patient’s life are essential to an understanding.  Asking the patients if he has any habits: like nutritional and diet; regularity and patterns of eating and sleeping; quantity of coffee, tea, tobacco, alcohol; Home conditions: housing, economic condition, types of furnishings, pets and their health.eligious and cultural preferences: any religious proscriptions concerning food, medical care; spiritual needs. Access to care: transportation and other resources available to patient, type of health insurance coverage (if any), worries in this regard, primary care provider, customary pattern of seeking care. Social needs: insurance/medication coverage, food insecurity, housing instability, employment assistance need. It is important to have the conversation. Addressing social determinants of health is important for improving health and reducing longstanding disparities in health and health care (Ball el. al, 2019).

What risk assessment instruments would be appropriate to use with each patient, or what questions would you ask each patient to assess his or her health risks?  The Functional. The risk assessment tool that  I would  use  the Home Safety Self-Assessment Tool (HSSAT), this tool was developed to evaluate the living conditions of older adults and whether the home was a safe environment to prevent falls and also provide a space that older adults can stay in their home longer. (Horowitz, Nochajski, & Schweitzer, 2013, p.218). I would also do a functional assessment to prevent further loss of function and to maintain the self-care status of many elders. Performing an office-based functional assessment measures the elder’s ability to perform self-care 76-year-old black male with disabilities living in an urban setting.

Identify any potential health-related risks based upon the patient’s age, gender, ethnicity, or environmental setting that should be taken into consideration. Health risk assessment is an important in identifying risks with  chronic diseases, preventing  complications, and as well as to allowing  providers managed interventions that helps preventive care such as screening for potential health risks (Wu and Orlando, 2015). Obtaining the health history iis the baseline  for assessing the present concern. Major adult illnesses or chronic diseases: tuberculosis, hepatitis, diabetes, hypertension, myocardial infarction, heart disease, stroke, respiratory disease, tropical or parasitic diseases, other infections; any nonsurgical hospital admissions (Lushniak, 2015). Getting the health history is important to help improve health care .

Understanding an older patient’s usual level of functioning and knowing about any recent significant changes are fundamental to providing appropriate health care. The Functional Assessment tool would assist and leeting to provide know what the patient can do for example can the patient completed his ADL. Knowing the limitation of the disability will assist the provider and family to better care for the patient. A functional assessment is a multidimensional and often interdisciplinary diagnostic process, which assesses and quantifies an older adult’s medical, the patient, and family to develop a comprehensive plan for therapy and future care decisions and can also help in the process of long-term care decision-making (Ball el. al, 2019) 76-year-old black male with disabilities living in an urban setting.

Targeted questions you would ask your selected patient to assess his or her health risks and begin building a health history.  I would try to gather data before meeting with the patient. Request previous medical records or, if there is time, mail forms that the patient or a family member can complete at home (Ball el. al, 2019).

 1. What are areas do you think you need help in?

2. Do you live alone?

3. Do you feel safe in your home?

4. Have you fallen recently?

5. What medications are you currently taking and what method do you use to organize your medications?

6. Do you have family that visit?

References

Horowitz, B., Almonte, T., Kaur, S., & Vasil, A. (2016). Use of the home safety self assessment tool (hssat) within community health education to improve home safety. 
American Journal of Occupational Therapy
, 
70
(4_Supplement_1), 7011510221p1. Retrieved September 1, 2021, from 
https://doi.org/10.5014/ajot.2016.70s1-po5081

Lushniak, B. D. (2015). Family health history: Using the past to improve future health. 
Public Health Reports
, 
130
(1), 3–5. Retrieved September 12, 2021, from 
https://doi.org/10.1177/003335491513000102

Wu,, R. A., & Orlando,, L. A. (2015). 
Implementation of health risk assessments with family health history: Barriers and benefits | postgraduate medical journal
 [91 (1079), p 508-513.]. Retrieved September 1, 2021, from 
https://pmj.bmj.com/content/91/1079/508

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). 
Seidel’s guide to       physical examination: An interprofessional approach 
(9th ed.). Elsevier Mosby.

By Day 6 of Week 1

Respond 
to 
at least two
 of your colleagues 
on 2 different days
 who selected a different patient than you, using one or more of the following approaches:

response

It is crucial for Nurse Practitioners to develop and build a relationship with their patients as you indicated. Making patients feel comfortable physically and emotionally without being judgmental especially when interviewing an elderly patient is highly significant (Ball et al., 2019). Considering factors such as age, gender, functional abilities, culture, and environment that may have a significant impact on a patient’s wellbeing is crucial as well (Ball et al., 2019) 76-year-old black male with disabilities living in an urban setting.

Fall is a leading cause of death among the elderly and performing a comprehensive assessment will guide the practitioner in individualizing a plan of care for the patient. An assessment tool that can be utilized is the Berge Balance Scale; the screening tool used to measure patients’ mobility, balance, transfer, and gait (Landers et al., 2016). As people advance in age, various factors that can impact their health includes; a decline in cognition, life stress, illness, and physical limitations (Ball et al., 2019). It is therefore significant that clinicians have a sound knowledge of health assessment and be able to use different screening tools that would guide diagnosis, treatment, and plan of care (Wu & Orlando, 2015).

 

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., Stewart, R. W. (2019).
 Seidel’s guide to physical examination: An interprofessional approach (9th ed).
 St. Louis, MO: Elsevier Mosby

Landers, M. R., Oscar, S., Sasaoka, J., Vaughn, K. (2016, April). Balance confidence and fear of falling. Avoidance behavior is most predictive of falling in older adults: Prospective Analysis. 
Academic Journal,
 433-442.

Wu, R., & Orlando, L. A. (2015). Implementation of health risk assessments with family health history: barriers and benefits. 
Postgraduate Medical Journal, 91
(1079), 508-513. http://pmj.bmj.com/content/91/1079/508 76-year-old black male with disabilities living in an urban setting