Question 231 pts
A pharmacologic treatment for patients with Hydradenitis Suppurativa (HI) may include
Group of answer choices
Clindamycin
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Minocycline
Metformin
All of the
above
Tag: Clinical-Nursing
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NURS 6050 week 1 discussion
Presidential Agendas – NURS 6050 week 1 discussion
Rather than focus on the treatment of chronic disease, policies that influence population health tend to emphasize prevention and wellness; the reduction or elimination of waste and the eradication of health disparities based on race, ethnicity, language, income, gender, sexual orientation, disability and other factors. The reasoning is that good health belongs to the whole, not just an individual. (New York State Dept. of Health, n.d.)
Regardless of political affiliation, every citizen has a stake in healthcare policy decisions. Hence, it is little wonder why healthcare items become such high-profile components of presidential agendas. It is also little wonder why they become such hotly debated agenda items.
Consider a topic (mental health, HIV, opioid epidemic, pandemics, obesity, prescription drug prices, or many others) that rises to the presidential level. How did the current and previous presidents handle the problem? What would you do differently?
Reference:
New York State Department of Health. (n.d.).
Making New York the healthiest state: Achieving the triple aim
. Retrieved June 21, 2021 from https://www.health.ny.gov/events/population_health_summit/docs/what_is_population_health.pdfResources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
To Prepare:
Review the Resources and reflect on the importance of agenda setting.
Consider how federal agendas promote healthcare issues and how these healthcare issues become agenda priorities.
By Day 3 of Week 1
Post
your response to the discussion question: Consider a population health topic that rises to the presidential agenda level. Which social determinant most affects this health issue? How did two recent presidents handle the problem? What would you do differently?By Day 6 of Week 1
Respond
to at least
two
of your colleagues
* on two different days
by expanding on their response and providing an example that supports their explanation or respectfully challenging their explanation and providing an example.*Note:
Throughout this program, your fellow students are referred to as colleagues.Reply from XX
Opioid Epidemic
Policies are available to ensure that healthcare services are rendered appropriately (Lamb et al., 2015). Policies depend on available healthcare challenges and issues that may require urgent consideration (DeMarco & Tufts, 2014). A health issue that has risen to the presidential level in the United States of America is the opioid epidemic. Opioid use and addiction have been long-term issues in the country. This health issue endangers many people’s health and negatively impacts the economic output and national security. The health topic is considered a crucial issue. Whenever the president declares opioid addiction a national emergency, the healthcare sector is sure to have treatment and recovery resources for the affected population.
Social Determinants of Health
Two social determinants of health related to health topics. Level of education plays a crucial role in determining the type of decisions an individual shall make regarding opioid usage or seeking healthcare interventions. There are higher chances of individuals with a low level of education being at a higher risk of misusing opioids. The individual may not understand the effects and may not have the opportunity of making the necessary decision to seek immediate healthcare interventions. The second social determinant of health is income (Islam, 2019). Low-earning individuals may have limited chances of fully utilizing the available treatment and resources that lead to positive outcomes. Low-income earners may not have enough to purchase private health insurance to facilitate accessing the required healthcare services.
How did Presidents Trump and Biden Handle the Issue?
The recent presidents enacted much effort in ensuring the opioid emergence issue has been resolved. For instance, during President Trump’s reign, numerous statements, reforms, and declarations were made to ensure that the affected population could receive necessary healthcare help. In October 2017, the president declared the opioid epidemic a national public health emergency. The declaration was followed by the formation of the Commission for Combating Drug Addiction and the Opioid Crisis; the commission’s role was to inform the country on how best to address the issue. In November 2019, he signed an executive order allowing the federal government and agencies to have strategies to prevent opioid overdose-related deaths. The declaration made it possible to have an increased supply of overdose reversal medications such as naloxone, making treating opioid overdose an easy journey.
In the current era, President Biden has also contributed to addressing the health issue by proposing $4 billion to be channeled to address the opioid epidemic in the country. It is evident that the effects of the opioid epidemic are devastating to the communities, and the funds shall be crucial for addressing the issue. President Biden has also encouraged an increment in the accessibility of the overdose reversal drug that is naloxone. The president has expanded the available resources and accessibility to resources. Naloxone is a safe and effective medication for reversing the effects of opioids and can be used or provided by anybody regardless of the medical foundation.
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What would I have done differently?
Like President Trump, I would have declared the opioid epidemic a public health emergency. By doing so, it could be easy to access additional resources. Other willing agencies will contribute to ensuring that the issue is resolved. I would also consider ensuring that the affected population gets the necessary support. I would focus on expanding the treatment and resources that shall ensure that there is unlimited access to available resources and ensure the achievement of quality health outcomes. Treatment and recovery across the country are essential for individuals struggling with addiction. I shall also focus on ensuring that the research institutions conduct studies on how the issue can be managed effectively.
References
DeMarco, R., & Tufts, K. A. (2014). The mechanics of writing a policy brief.
Nursing Outlook
,
62
(3), 219-224. https://www.nursingoutlook.org/article/S0029-6554(14)00057-8/fulltextIslam M. M. (2019). Social Determinants of Health and Related Inequalities: Confusion and Implications.
Frontiers in Public Health
,
7
, 11. https://doi.org/10.3389/fpubh.2019.00011Lamb, G., Newhouse, R., Beverly, C., Toney, D. A., Cropley, S., Weaver, C. A., … & Peterson, C. (2015). Policy agenda for nurse-led care coordination.
Nursing Outlook
,
63
(4), 521-530.
https://www.nursingoutlook.org/article/S0029-6554(15)00183-9/fulltext
Links to an external site.Reply from
More Americans now die every year from drug overdoses than they do in motor vehicle crashes. New data from the Centers for Disease Control and Prevention (CDC) show that opioids—a class of drugs that include prescription pain medications and heroin—were involved in 28,648 deaths in 2014 (Office of the Press Secretary, 2016). More Americans now die every year from drug overdoses than they do in motor vehicle crashes. New data from the Centers for Disease Control and Prevention (CDC) show that opioids—a class of drugs that include prescription pain medications and heroin—were involved in 28,648 deaths in 2014(Office of the Press secretary, 2016). The opioid epidemic has been an ongoing crisis for years. People from all ages and walks of life have been affected by opioid misuse. There are several social determinants that affect the opioid epidemic such as the neighborhood where the person resides, access to healthcare, access to food, safe housing, quality education, and economic well-being (MN Dept. of Health, n.d.).
President Trump and Barack Obama have both made proposals to help the opioid epidemic, In 2016, Obama made a proposal of $1 billion in new funding to address prescription opioid and heroin abuse (Press Release, 2016). This funding will boost efforts to help individuals with opioid use disorder seek treatment, successfully complete treatment, and sustain recovery (Office of the Press Secretary, 2016). The program was created during the Obama administration and subsidizes state Medicaid programs that provide insurance coverage for roughly 40% of Americans receiving opioid addiction treatment (Mann, 2020).
In 2017, President Trump declared the opioid epidemic a public health emergency. He declared 3 parts under his opioid crisis plan. Part 1 consisted of reducing overprescription and educating patients on the dangers of misusing opioids. Part 2 focused on the supply chains through international and domestic drug supply. Part 3 provided Americans with treatment and recovery support services for those struggling with addiction. As of October 2018, the Trump Administration had secured $6 billion in new funding over a two-year window to fight opioid abuse (Mann, 2020).
What I would do differently would be to mandate treatment services in jails, prisons, and hospitals. For instance, if you were in the hospital for an opioid overdose, I would mandate all persons to attend outpatient or inpatient treatment. I would have more recovery centers and mental health services to help. Many persons with opioid addiction struggle with mental health so they turn to drugs. Providing more mental health services can help prevent opioid overdoses, addiction, misuse, and deaths. For persons who have drug charges in detentions, I would mandate treatment and recovery centers upon release. I would organize outreach resources that will go out to shelters and to the streets recruiting persons for treatment recovery. Both presidents secured a substantial amount of funds to help the opioid epidemic. I would use the same funds but within mandates.
References
Social Determinants of Substance Use and amp; Overdose Prevention – MN Dept. of Health
. (n.d.).
https://www.health.state.mn.us/communities/opioids/prevention/socialdeterminants.html
Links to an external site.Cummings Praises President Obama’s Proposal to Address Prescription Opioid and Heroin Abuse. (2022, September 7).
House Committee on Oversight and Reform
. https://oversight.house.gov/news/press-releases/cummings-praises-president-obama-s-proposal-to-address-prescription-opioid-andFACT SHEET: President Obama Proposes $1.1 Billion in New Funding to. (2016c, February 4).
Whitehouse.Gov
. https://obamawhitehouse.archives.gov/the-press-office/2016/02/02/president-obama-proposes-11-billion-new-funding-address-prescriptionMann, B. (2020, October 29). Opioid Crisis: Critics Say Trump Fumbled Response To Another Deadly Epidemic.
NPR.Org
.
https://www.npr.org/2020/10/29/927859091/opioid-crisis-critics-say-trump-fumbled-response-to-another-deadly-epidemic
Links to an external site.Ending America’s Opioid Crisis –. (n.d.).
The White House
. https://trumpwhitehouse.archives.gov/opioids/Expand discussion thread from Dewona K Wilson
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Henry Ros Gonzalez
Nov 29, 2022 8:14pm
|
Last reply Dec 1, 2022 10:31pmReply from Henry Ros Gonzalez
Pain has always been one of the most critical
healthcare issues
that providers address regularly. In doing so, many have been introduced to and left to struggle with opioids. In the nineties, many pharmaceutical companies insisted to physicians that patients would not become addicted to opioid pain relievers (Assistant Secretary of Public Affairs (ASPA), 2021). The opioid crisis has, therefore, been recently addressed as a crisis and made a core topic in political debates that have reached the presidential level. With prevention being the main target when fighting substance abuse, previous administrations have attempted to carry out plans that have the same goal via different strategies. These strategies have similar approaches, although certain implementations were unique to every administration. According to (House, 2022), the administration of our president, Joe Biden, has focused efforts on investing billions of dollars in expanding resources allocated to support strategic organizations and entities. The predecessor administration of former president Donald Trump developed plans to reduce over-prescription, targeting supply chains and extending education campaigns and evidence-based treatment (
Ending America’s Opioid Crisis –
, n.d.).The efforts that the scientific community, healthcare professionals, and legislators have carried out for decades to fight the opioid crisis tell about their dedication to the issue. We must always ask ourselves and our colleagues how to improve and work together to solve the problems plaguing our communities. We must also target the difficulties from which opioid abuse stems. It would be ideal to see researchers encountering new methods to address pain without relying on substances and that we can receive the full support of the government and other entities to develop them. That is what I would consider doing differently if I had the opportunity of bringing my voice to a presidential administration. That is why it is so important to learn how to bring up research to our legislators and effectively communicate their importance so they can help move the engines of our nation to get us on the right path.
References
Assistant Secretary of Public Affairs (ASPA). (2021, October
27
).
About the Epidemic
. HHS.gov.
https://www.hhs.gov/opioids/about-the-epidemic/index.html
Links to an external site.House, T. W. (2022, September 23).
FACT SHEET: Biden-Harris Administration Announces New Actions and Funding to Address the Overdose Epidemic and Support Recovery
. The White House.
https://www.whitehouse.gov/briefing-room/statements-releases/2022/09/23/fact-sheet-biden-harris-administration-announces-new-actions-and-funding-to-address-the-overdose-epidemic-and-support-recovery/
Links to an external site.Ending America’s Opioid Crisis –
. (n.d.). The White House. https://trumpwhitehouse.archives.gov/opioids/Expand discussion thread from Henry Ros Gonzalez
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Madeline Reighard
Nov 29, 2022 6:45pm
|
Last reply Dec 2, 2022 10:21pmReply from Madeline Reighard
According to the National Institute on Drug Abuse (NIDA, n.d.) opioids are defined as “a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription” (para. 1). The opioid epidemic has been an ongoing issue in America that countless policymakers have attempted to spearhead with no real victory. The economic cost alone of $120 billion dollars in loss of productivity related to drug abuse treatment, overdose, and imprisonment portrays the sheer effect opioid abuse has on our economy as a whole (Office of National Drug Control Policy, para. 2). Opioid abuse and misuse are straining our resources in terms of healthcare, employment, and our communities.
Social determinants of health (SDOH), are factors that impact where individuals live, learn, and grow (World Health Organization, n.d.). Given this opioid epidemic is affected by numerous social determinants of health, I feel education quality is a prevailing social determinant that most affects this health issue. Education is at the route of several other factors that affect the opioid epidemic problem such as healthcare access, one’s built environment, and economic stability. If one’s quality of education is poor their health literacy can in turn be diminished which can ultimately affect the lifestyle decisions one makes and their level of growth both physically and mentally.
In 2015, President Obama announced that prescriber training would be implemented to over 540,000 health care providers in order to educate prescribers in proper opioid prescribing (Office of the Press Secretary, 2015). The Obama administration also improved access to treatment by means of investing in drug overdose prevention strategies, greater access to treatment programs, as well as additional access to naloxone which is an opioid overdose reversal medication. Similarly, President Trump released his initiative to halt opioid abuse in 2018 and focused on decreasing over-prescription through providing education to Americans about opioid misuse and abuse, cutting down on drug supply chains, and providing aid to those struggling with recovery support (The White House, n.d.). If I were to make a change in regard to the opioid epidemic I would start downstream in lower and higher education. Students should be educated about opioid misuse and abuse and recognize the signs of addiction and the dangers associated with opioid addiction. Children will grow up to be adults and some children may even face opioid addiction in their own home, it is essential that they can recognize the issue, repercussions, and recovery and/or treatment options. If we provide our society with this knowledge early on in our lives even teaching it within health classes, we may have hope in decreasing opioid addiction in our future population.
References
National Institute on Drug Abuse. (n.d.). Opioids. Retrieved November 27, 2022, from https://nida.nih.gov/research-topics/opioids
Office of National Drug Control Policy. (n.d.). How Illicit Drug Use Affects Business and the Economy. Retrieved November 27, 2022, from https://obamawhitehouse.archives.gov/ondcp/ondcp-fact-sheets/how-illicit-drug-use-affects-business-and-the-economy
Office of the Press Secretary. (2015). Fact Sheet: Obama Administration Announces Public and Private Sector Efforts to Address Prescription Drug Abuse and Heroin Use. Retrieved November 29, 2022, from https://obamawhitehouse.archives.gov/the-press-office/2015/10/21/fact-sheet-obama-administration-announces-public-and-private-sector
The White House. (n.d.). Ending America’s Opioid Crisis. Retrieved November 29,
2022, from https://trumpwhitehouse.archives.gov/opioids/Expand discussion thread from Madeline Reighard
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Sara Catherine Tuck
Nov 29, 2022 12:13pm
|
Last reply Dec 3, 2022 12:10pmReply from Sara Catherine Tuck
So why is agenda setting important to the health care professionals such as ourselves? For quality health care and to advocate on behalf of the nursing profession and patients. This opens the doors to power brokers and decision-makers.(The Online Journal of Issues in Nursing, 2017)For this discussion, obesity is the topic chosen mainly because it is the root of so many chronic conditions. While Obama was president they put together a “let’s move campaign” and the goal was to create practical tools tailored to children and their families facing a wide range of challenges and life circumstances. (American Public health association & Goodman, 2009)One of the main pillars was putting healthier foods in schools, I remember this- do you?
On the other hand, President Trump in 2017 announced that schools would no longer have to meet some of the requirements. previously mandated which could have possibly hindered the prevention of childhood obesity in the United States. (Duramy, 2018). Of course these are only examples and the problem is way bigger than just food in schools. What would I have done differently?? I really believe the restructuring of “health class” would be a great start. Showing kids what can happen to them if they make bad choices and not choosing a healthy lifestyle. I think kids need to be a little afraid of this. Obviously, it begins at home and the parents need to promote healthy behaviors.
References
American Public health association & Goodman, A. (2009). President Obama’s health plan and community based prevention. American Journal of Public Health, 99(10), 1736–1738.
https://doi.org/www.ncbi.nlm.nih.gov
Links to an external site.Duramy, B. F. (2018). Child Obesity, School Food Environments and the Best Interests of the Child. Retrieved November 29, 2022, from
https://doi.org/digitalcommons.law.ggu.edu
Links to an external site.The Online Journal of Issues in Nursing. (2017). Influencing health care in the legislative arena. OJIN. Retrieved November 28, 2022, from
https://doi.org/10.3912/OJIN.Vol12No01Man02 -
NRNP 6552 Midterm Exam Walden University – The only antimicrobial medications that are effective against Trichomoniasis vaginalis are:
Question 22 1 pts
The only antimicrobial medications that are effective against Trichomoniasis vaginalis are:
Group of answer choices
tinidazole or metronidazole
Amoxicillin or Augmentin
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doxycycline or minocycline
cephalexin or ceftriaxone
NRNP 6552 Midterm Exam Walden University
-
Presidential Agendas and Health Policies – NURS 6050 Walden University
Presidential Agendas
Rather than focus on the treatment of chronic disease, policies that influence population health tend to emphasize prevention and wellness; the reduction or elimination of waste and the eradication of health disparities based on race, ethnicity, language, income, gender, sexual orientation, disability and other factors. The reasoning is that good health belongs to the whole, not just an individual. (New York State Dept. of Health, n.d.)
Regardless of political affiliation, every citizen has a stake in healthcare policy decisions. Hence, it is little wonder why healthcare items become such high-profile components of presidential agendas. It is also little wonder why they become such hotly debated agenda items.
Consider a topic (mental health, HIV, opioid epidemic, pandemics, obesity, prescription drug prices, or many others) that rises to the presidential level. How did the current and previous presidents handle the problem? What would you do differently?
Reference:
New York State Department of Health. (n.d.).
Making New York the healthiest state: Achieving the triple aim
. Retrieved June 21, 2021 from https://www.health.ny.gov/events/population_health_summit/docs/what_is_population_health.pdfResources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
To Prepare:
Review the Resources and reflect on the importance of agenda setting.
Consider how federal agendas promote healthcare issues and how these healthcare issues become agenda priorities.
By Day 3 of Week 1
Post
your response to the discussion question: Consider a population health topic that rises to the presidential agenda level. Which social determinant most affects this health issue? How did two recent presidents handle the problem? What would you do differently?By Day 6 of Week 1
Respond
to at least
two
of your colleagues
* on two different days
by expanding on their response and providing an example that supports their explanation or respectfully challenging their explanation and providing an example.*Note:
Throughout this program, your fellow students are referred to as colleagues.To my colleagues,
I struggled to write this post, as it is not of popular opinion that a medical professional stand up against these initiatives and regulations. My feelings about chronic pain sufferers do not in any way diminish the importance of a person who is plagued with Substance Use Disorder.
In 2015, President Obama announced that prescriber training would be implemented for over 540,000 healthcare providers in order to educate prescribers in proper opioid prescribing (Office of the Press Secretary, 2015). President Trump released his initiative to halt opioid abuse in 2018 and focused on decreasing over-prescription by providing education to Americans about opioid misuse and abuse, cutting down on drug supply chains, and providing aid to those struggling with recovery support (The White House, n.d.).
While education can provide the knowledge needed for adults to know the risks of using and abusing illicit substances, it cannot prevent it. The world is a wide and vast place with so many different places and circumstances, that education being the be-all-end-all in reducing Substance Use Disorder, although ideal, is misguided.
President Obama and President Trump’s initiatives to halt opiate abuse by creating a narrative that opioid abuse is most common due to overprescribing by medical providers is at best incorrect and negligent. These initiatives have left patients that live with chronic medical conditions, resulting in pain, to be pushed away by the medical community for fear of sanctions and revocation of their licensure and criminal prosecution and imprisonment. The government’s own data, collected from the Centers for Disease Control and Prevention and the National Survey on Drug Use and Health, show no association between the volume of opioid prescriptions and the nonmedical use or addiction in persons over age 12. This tragic finding is the result of policymakers refusing to reassess their assumption that the overdose crisis was caused by doctors overprescribing opioids to their patients in pain. And this is aside from the fact that there is no concise definition of overprescribing. Yet, policymakers keep doubling down on a misguided mission to reduce or eliminate opioid prescribing, putting patients back in miserable pain, and mental anguish and sometimes driving them to the black market. All the while, overdoses soar among the population of nonmedical users who long ago moved on to heroin and fentanyl, provided cheaply and efficiently by the black market generated by drug prohibition.
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As a member of the medical community, I have worked with patients suffering from chronic pain, and from Substance Use Disorder. These patients present very differently. Patients who suffer from medically diagnosed illnesses that cause chronic pain have documentation to provide a base for their claims. These patients are apprehensive to ask for anything for fear of being labeled a “drug seeker” and will often suffer in silence, ending up sitting across from me or my colleagues because they attempted suicide to end the pain. They are literally sick and tired of being sick and tired. Conversely, patients with Substance Use Disorder have no to minimal fear of asking for anything to alleviate their suffering related to withdrawals from their substance of choice. These patients are provided MAT (Medication Assisted Treatment) medications and given referrals to outpatient mental health providers, counselors, and meetings. Chronic pain patients are left to deal with their pain with injections that do not work, physical therapies that increase their pain, and over-the-counter medications that do not work.
How can we as medical professionals and patient advocates escalate the proper treatment of chronic pain patients to lawmakers? I would perform extensive research on the conversion of legally prescribed opiate medication to overdose deaths in my state. From there, I would draft a proposal document to obtain signatures to get the information in front of lawmakers and voted on. While this would be daunting, it would be a step in the right direction for patients who have a diminished quality of life because their pain is being left un or undertreated.
2020 National Survey of Drug Use and Health (NSDUH) Releases. (2022). Retrieved November 30, 2022, from https://www.samhsa.gov/data/release/2020-national-survey-drug-use-and-health-nsduh-releases
Office of the Press Secretary. (2015). Fact Sheet: Obama Administration Announces Public and Private Sector Efforts to Address Prescription Drug Abuse and Heroin Use. Retrieved November 30, 2022, from
https://obamawhitehouse.archives.gov/the-press-office/2015/10/21/fact-sheet-obama-administration-announces-public-and-private-sector
Links to an external site.White House. (n.d.). Ending America’s Opioid Crisis. Retrieved November 30,
2022, from https://trumpwhitehouse.archives.gov/opioids/Expand discussion thread from Amber Marie Boulrice
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Shelly Bailey
Dec 1, 2022 1:09am
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Last reply Dec 2, 2022 10:25pmReply from Shelly Bailey
Mental health
is a severe health topic that requires the attention of the president of the United States of America. Mental health needs to be at the top of the presidential agenda so that policies and resources can be made to help serve those Americans who have mental illness and mental health issues.Social determinants affecting mental health are access to care, poverty, transportation, geographical location, educational level, and ethical and cultural backgrounds. According to Whealin et al. (2017), telehealth treatment for veterans facing mental health issues can alleviate the social determinants of rural area locations and veterans with diverse backgrounds or cultures. Rural areas are associated with higher suicide rates (Tarlow et al., 2019). Rural areas are underserved, and most live below the poverty line. Rural areas have low socioeconomic status, which gives way to underserved medical care, primarily mental health care (Tarlow et al., 2019).
The past two administrations have made great strides to improve mental health and work toward awareness, prevention, treatment, and wellness.
The Trump administration can be credited for the majority of these improvements. The Biden Administration has continued with these improvements and made more funding available.
As noted by Satel & Torrey (2021), President Trump appointed the first psychiatrist for the positions of the assistant secretary for mental health and substance use and the director of the Substance Abuse and Mental Health Services Administration (SAMHSA). SAMHSA is a federal agency that facilitates federal mental health policy. Dr. Elinore McCance-Katz is known for many improvements to SAMHSA by focusing on the agency’s priorities and treating mental illness (Satel & Torrey, 2021). On October 3, 2020, President Trump signed Executive Order 13954, “Saving Lives Through Increased Support for Mental and Behavioral Needs.” Light of the Coronavirus pandemic caused many to face stress, loss of jobs, and social isolation (The White House, October 5, 2020). These factors increased the number of Americans’ facing mental and behavioral health issues due to the negative impact of shutdowns. Trump also signed into law a designated 9-8-8 hotline for suicide prevention and mental health crisis (States News Services, October 19, 2020).
The Biden Administration, on March 12, 2021, announced that SAMHSA would be providing $2.5 billion to help the states with addressing continuing mental health and addiction crises through grant programs (State News Service, March 12, 2021). Biden Administration also has sourced millions in funding through grants for community behavioral health centers. The grant funding will come from the Bipartisan Safer Communities Act (Gonzalez & Harris, 2022). The Biden Administration has provided $4 billion for the American Rescue Plan (ARP) and made the connection to care more accessible along with a continuum of care and support for Americans’ facing mental health or substance abuse factors (The White House, May 31, 2022).
One thing I would do differently is to focus on access to telehealth care for rural areas. I would make funding available to provide the equipment and services to provide telehealth care via the person’s home setting.
References:
Gonzalez, A., & Harris, E., (October 18, 2022). Biden administration announces millions in
Funding for community behavioral health center.
https://www.nyl.com/nyc/all-boroughs/politics/2022/10/18/biden-administration
Links to an external site.Satel, S. & Torrey, E. F. (February 01, 2021). Don’t undo Trump Administration’s mental-
health reforms. American Enterprise Institute,
https://www.aei.org/articles/don’t-undo-the-trump-administartions-mental-health-reform/
Links to an external site.States News Services, (March 12, 2021). Trone Hails Biden Administration’s $2.5
Billion investment in mental health and addiction services. Gale,
https://go.gale.com/ps/i.do?=EAIM&u=minn4020&v=2.1&it=r&i/A654735553
Links to an external site.State News Service, (October 19, 2020). Trump signs Reed’s Bipartisan plan to adopt national
9-8-8 suicide and mental health crisis hotline into law. Gale,
https://go.gale.com/ps/i.do?p=Eaim&u=minn4020&id=GaleA6338890961
Links to an external site.Tarlow, K. R., Johnson, T. A., McCord, C. E. (2019). Rural status, suicide ideation, and
Telemental health: Risk assessment in clinical sample.
The Journal of Rural Health
, 35,247-252.
https://doi.org/10.111/jrh.12310
Links to an external site.The Whitehouse. (May 31, 2022). Fact Sheet: Biden-Harris Administration highlights strategy to address the national mental health crisis. The White House,
https:www.whitehouse.gov/briefing-room/statement-release/2022/
The Whitehouse. (October 5, 2020). President Donald J. Trump is safeguarding Americans’
https://doi.org/10.1177/0091217417703291
Links to an external site.Whealin, J. M., King, L., & Spira, JL., (January 2017). Diverse veterans’ pre- and post-
intervention perceptions of home telemental health for posttraumatic stress disorder
delivered via tablet.
The International Journal of Psychiatry in Medicine,
52, 3-20,
https://doi.org/10.1177/0091217417703291
Links to an external site.Expand discussion thread from Shelly Bailey
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Jestanon Ratunil
Dec 1, 2022 12:25am
|
Last reply Dec 3, 2022 5:06pmReply from Jestanon Ratunil
My topic of interest is childhood obesity. Childhood obesity is a national problem that carries the risks of potential co-morbidities and increased risk of chronic diseases. In the United States alone, the prevalence has tripled in the last thirty years and at present, more than 30% of American children are overweight or obese. (Vash, P.D. 2015).
The cause of the increased rates of childhood obesity is complex and multifactorial and must be addressed on different levels. (Sommer, A., Twig, G. 2018). One of the most obvious problems is to change the messages our children received about food (Casazza, K.R.& Hanks, L.J., 2015).
One of my observations as I traveled to Paris, France last year, where obesity is one of the lowest in the world for both children and adults was, I barely see any soda bottles lining the store shelves including the hallways of the airport. According to the Journal of American Dietetic Association, 70% of Americans consumed more than 1 glass of sweetened beverage per day which is linked to obesity (ncbi.nlm.nih.gov).
Given that big corporations are unlikely to readily change their advertising practices about food, the government needs to get involved. (Vash, P.D. 2015). One example was the project of then-former first lady Michelle Obama in 2010 who introduced the “Let’s Move” movement which emphasized solving childhood obesity problems on a different level, from educating parents to schools to communities.
As practicing nurses with always have a goal to help and have a responsibility to be an advocate for our patients and their families, it is very difficult to witness when the patient is unable to access what they need. With a problematic healthcare system, we nurses are dealing with serious healthcare disparity in the communities we serve. (Abood, S. 2007). Through this learning and discussions, I hope to learn and be able to be proactively influenced my patient and their families and colleagues to bring about change in the community I served.
References:
Vash, P. D. (Ed.). (2015).
The childhood obesity epidemic : Why are our children obese-and what can we do about it?
. Apple Academic Press, Incorporated.Casazza, K. R., & Hanks, L. J. (Eds.). (2014).
Clinical insights : Obesity and childhood
. Future Medicine Ltd.Abood, S. (January 31, 2007). “Influencing Health Care in the Legislative Arena”. OJIN: The Online Journal of Issues in Nursing. Vol. 12 No. 1, Manuscript 2. from
https://doi.org/10.3912/OJIN.Vol12No01Man02Links to an external site.
Links to an external site.Sommer, A., & Twig, G. (2018). The Impact of Childhood and Adolescent Obesity on Cardiovascular Risk in Adulthood: a Systematic Review.
Current Diabetes Reports, 18
(10), 1-6. https://doi.org/10.1007/s11892-018-1062-9Expand discussion thread from Jestanon Ratunil
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Cheryl Athurine Spence
Nov 30, 2022 11:51pm
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Last reply Dec 4, 2022 2:36pmReply from Cheryl Athurine Spence
Income as a Social Determinant of Mental Health
Numerous studies have established a high incidence of mental disorders in poor and disadvantaged communities all over the world. The social determinants of health act reflexively upon one another such that an effect such as poor mental health can hardly be attributed to only one factor. Poverty results from low incomes, and low incomes result from a wide array of other factors, for instance, racial discrimination, poor education, and unemployment. Notably, this part of the discussion looks only into low income as the most impactful social determinant of mental health.
Income level is crucial to individual and group health outcomes. Low incomes have been associated with premature mortality, life expectancy, and mortality rates in physical health. Low incomes impact mental health by contributing to poor mental health, increased incidence and risk for mental disorders and substance abuse, and worsening outcomes for those already affected by substance use disorders and mental illnesses. Katz-Wise et al (2017) found that low income is related to the higher incidence of suicide attempts, self-harm, and depression in transgender adults. Low income has also been linked to increased anxiety and depression among pregnant women, a condition that elevates the risk for neonates. Compton & Shim (2015) suggest that low incomes are associated with more mentally unhealthy days, a higher risk of death from a drug overdose, and poor child well-being scores.
Trump and Biden Administration response to mental illness
Interventions to healthcare issues can be clinical-level or policy-level interventions. While clinical interventions are applicable for individuals, lasting population-wide effects can only be achieved through policy action at the state and federal levels. President Trump held stewardship of the country at a time of healthcare crisis, where COVID-19 was running rife, and people had to adapt to a new way of life. The losses and uncertainties of this period resulted in aggravated mental health with 40% of adults showing symptoms of mental health disorders. President Trump signed Executive Order 13594 on October 5, 2020, creating a Coronavirus Mental Health Working Group to evaluate existing federal mental health programs and mitigate the negative effects of COVID-19 on mental health (Knopf, 2020). Another action by the Trump administration was to increase funding for suicide prevention by $50 through the CARES Act.
One of President Biden’s actions to tackle mental illness is approving funding for the launch of the 988 mental health crisis hotlines for emergency care. The $180 million from the Biden administration goes to staffing crisis call centers and local response teams. In addition, the Biden administration has invested approximately $4 billion in expanding access to mental health and substance use services through the American Rescue Plan; issued an advisory on healthcare worker burnout; and expanded provider training via Nurse Corps, AmeriCorps, and community behavioral facilities (Smith & Sisti, 2022).
Criticism and Concluding Thoughts
Even though the Trump administration increased funding for suicide prevention programs, this was directed to veterans and not to the mass of Americans undergoing mental health crises. Also, Executive Order 13594 was largely an academic exercise where concrete action was required. More effective action would be directing additional funding to training counselors and increasing access to mental healthcare providers for millions of Americans in poor mental health. Even though veterans are a vulnerable group, other similarly vulnerable groups did not receive suicide prevention assistance. The Biden administration is commendable in its response to mental health disorders as demonstrated by increased funding for mental health, improved access to care, the crisis hotline pilot test, and the expansion of provider networks. My Change would create more community centers for underserved populations and open more counseling centers.
References
Compton, M. T., & Shim, R. S. (2015). The social determinants of mental health.
Focus
,
13
(4),419-425.
Katz-Wise, S. L., Reisner, S. L., White Hughto, J. M., & Budge, S. L. (2017). Self-reported
changes in attractions and social determinants of mental health in transgender adults.
Archives of Sexual Behavior
,
46
(5), 1425-1439.Knopf, A. (2020). The transition of the federal government: The path forward for SAMHSA.
Alcoholism& Drug Abuse Weekly
,
32
(44), 1-5.Smith, W. R., & Sisti, D. A. (2022). Rapprochement and reform: overcoming factionalism in
policymaking for serious mental illness.
Psychiatric Services
,
73
(5), 539-546.Expand discussion thread from Cheryl Athurine Spence
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Mark as UnreadBonita Leone
(She/Her)Nov 30, 2022 10:02pm
Reply from Bonita Leone
Main Question Post
During his campaign, President Donald Trump had a platform to fight drug addiction. He planned to build a wall on the US-Mexican border to stop illegal drugs from coming into the country. Ultimately, by the end of his four years in office, 80 miles of the wall had been built. Short of covering the nearly 1,200-mile Texas and Mexico border, according to Garcia and Cai (2016). Trump’s Vice President, Mike Pence, acknowledged that drugs were mainly coming into the US through ports of entry (Gomez, 2019) and not the border.
Converse to Trump, Biden’s platform was not building a wall but holding big pharmaceuticals responsible and directing services to support people with substance use disorders. Biden also identified the need to stop smuggling from Mexico and China, according to Joe Biden for President: Official Campaign Website (2020). In comparing funding to support their drug policies, Trump’s first budget requested 27.8 billion Souza (2017). In 2022, Biden’s budget asked 41 billion Cunningham (2022).
What would I do differently? Good question. Recognizing the checks and balances in place with the different branches of government, not all a president-elect or president says can be done independently. In a world where budgets go through the multistep process of checks and balances, I would have focused some funding on identifying illegal drugs coming into the country through the US Postal Service. I would also support legislation to normalize drug testing to be an annual health screening to help identify people who may need treatment starting in adolescents. I would look for expert opinions to predict future trends and recommendations. Last, I would utilize a committee to study these issues in other countries, see how countries with the most successful outcomes handle drug addiction and provide funding to set up pilot programs.
References
The Biden plan to end the opioid crisis. Joe Biden for President: Official Campaign Website. (2020, August 3). Retrieved November 28, 2022, from
https://joebiden.com/opioidcrisis/#
Links to an external site.Cunningham, D. (2022, March 2). Biden’s budget would spend $41 billion on drug policy efforts. UPI. Retrieved November 29, 2022, from
https://www.upi.com/Top_News/US/2022/03/02/Biden-drug-policy-budget/9461646237606/
Links to an external site.Gomez, A. (2019, January 16). Fact-checking Trump officials: Most drugs enter us through legal ports, not vast, open borders. USA Today. Retrieved November 29, 2022, from
https://www.usatoday.com/story/news/politics/2019/01/16/fact-check-mike-pence-donald-trump-drugs-crossing-southern-border-wall/2591279002/
Links to an external site.Souza, S. (2017, May 23). President Trump’s first budget commits significant resources to fight the opioid epidemic – AAAP. American Academy of Addiction Psychiatry. Retrieved November 29, 2022, from
https://www.aaap.org/president-trumps-first-budget-commits-significant-resources-fight-opioid-epidemic/
Links to an external site.Use of Postal Service Network to – oversight.gov. (n.d.). Retrieved November 30, 2022, from
https://www.oversight.gov/sites/default/files/oig-reports/SAT-AR-18-002.pdf
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Kayla Holt
Nov 30, 2022 9:40pm
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Last reply Dec 1, 2022 7:46pmReply from Kayla Holt
A population health topic that rises to the presidential agenda level is obesity. Effective obesity prevention requires intervening at all levels of society, including the governmental level (Kobes et al., 2022). According to the American Heart Association (AHA), obesity puts you at an increased risk for many serious health problems, including heart disease, stroke, high blood pressure, high cholesterol, and diabetes.
It is important to educate children on the benefits of an active lifestyle along with a healthy diet (American Heart Association, 2017). If we can change nutritional related behaviors and beliefs among children, we can prevent the cycle of obesity throughout the lifespan (Cook et al., 2017). The education effort must be collaborative among adults, including teachers and parents (Cook et al., 2017). Adult lifestyle behaviors have a direct influence on children’s nutrition patterns (Cook et al., 2017). Several policies and programs have been put into place nationwide to provide nutrition based education and make healthy food options more accessible to all people (Cook et al., 2017). Many school-aged children rely on government programs for their basic nutritional needs (Cook et al., 2017).
Presidents Trump and Biden have both made efforts to encourage lifestyle changes. President Trump’s healthcare vision put American patients, families, and seniors first by providing more choice, better care, and lower costs (The White House, 2015). The Trump Administration took historic actions to lower prescription drug prices, expand access to affordable coverage, deliver hospital and insurer price transparency, and allow Americans to access trusted doctors (The White House, 2015). President Trump guaranteed to always protect people with pre-existing conditions, and he signed legislation to end surprise medical billing after repeatedly calling on Congress to take action (The White House, 2015). Biden pushed for national soda tax. Reducing sugar-sweetened beverage consumption through taxation is a promising public health response to the obesity epidemic in the U.S. (Long et al., 2015). Public health intervention will be required at the policy level to promote healthy behavioral changes in consumers (Frank et al., 2013).
I would implement free educational programs that are available to the community on ways to improve health. For instance, I would do one lecture on how losing a few pounds if you are overweight can improve your health (American Heart Association, 2017). I believe that it is important to provide communities with knowledge, to provide a safe place to ask questions, and to provide resources.
References
American Heart Association. (2017). Keeping a healthy body weight. Retrieved from
https://www.heart.org/en/healthy-living/healthy-eating/losing-weight/keeping-a-healthy-body-weight
Links to an external site.Cook, S., Gerber, S., Heines, K., Martin, C., Reeder, B., Schmidt, S., Sidebottom, E., & Wimsatt, S. (2017) Combating Obesity: Teaching Children to Eat Right.
Kentucky Nurse, 65
(2), 10-11.Franck, C., Grandi, S. M., & Eisenberg, M. J. (2013). Agricultural Subsidies and the American Obesity Epidemic.
American Journal of Preventive Medicine, 45
(3), 327-333. https://doi.org/10.1016/j.amepre.2013.04.010Kobes, A., Kretschmer, T., & Timmerman, M. (2022). The association between obesity-related legislation in the United States and adolescents’ weight.
Health Policy Open, 3
(100056-).
https://doi.org/10.1016/j.hpopen.2021.100056
Links to an external site.
.Long, M. W., Gortmaker, S. L., Ward, Z., Resch, S. C., Moodie, M. L., Sacks, G., Swinburn, B. A., Carter, R. C., & Claire Wang, Y. (2015). Cost Effectiveness of a Sugar-Sweetened Beverage Excise Tax in the U.S.
American Journal of Preventive Medicine, 49
(1), 112-123.
https://doi.org/10.1016/j.amepre.2015.03.004
Links to an external site.The White House. (2015). Retrived from
https://trumpwhitehouse.archives.gov/issues/healthcare/
Links to an external site.Wk 1 Discussion 6050.docx
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Essie Tani Richardson
Nov 30, 2022 9:23pm
Reply from Essie Tani Richardson
The COVID-19 conflict is the first major international crisis since the end of the Cold War in which the US has not taken the initiative to respond. For better or worse, virtually every international crisis has seen the US serve as a model for the rest of the world by providing leadership, direction, coordination, and assistance to nations. But this did not take place during the coronavirus crisis. Everyone who is interested in learning about the US reaction to the new coronavirus, or SARS-CoV-2, is aware by this point that there were significant errors in judgment and inaction in January, February, and even March of this year. While errors are unavoidable in the face of such a sizable and swiftly evolving local and global threat, our federal government’s response fell short of many other countries, many of which were already affected by the virus before us. It will take years to fully analyze the faults that led to our poor response, even though we will likely find ways to fix them in the near future.
The president during the Pandemic was Donald Trump who was preoccupied with impeachment at the beginning of that crucial lost month, when his government could have recovered, and he disregarded the harm to the economy and public health. At the month’s conclusion, Trump declared, “It’s going to leave,” indicating that the virus was about to disappear in the US. It will almost suddenly disappear one day. Less than a week before taking office, Biden released a major $1.9 trillion plan that included short-, medium-, and long-term solutions to reduce the current infection and mortality rates and position the US for a long-term recovery from COVID-19 and the economic havoc it has caused.
What I would have done differently was tackle the crisis with all seriousness in the very early stages by getting the vaccines made, which may necessitate invoking the Defense Production Act (DPA), which requires industry to accept and prioritize government contracts in order to ramp up production quickly. I would set an Administration to rely on states to broaden and standardize the categories of people who are eligible for vaccinations, such as all people 65 years and older and front-line workers who are not necessarily medical workers, such as transit, pharmacy, and grocery store employees.
References
https://www.americanprogress.org/issues/security/news/2020/03/26/482274/us-leading-global-response-coronavirus-crisis/
Links to an external site.https://www.brookings.edu/research/the-federal-governments-coronavirus-actions-and-failures-timeline-and-themes/%3famp
Links to an external site.https://www.nytimes.com/2020/03/28/us/testing-coronavirus-pandemic.html
Links to an external site.http://zimmer.csufresno.edu/~johnca/spch100/7-4-agenda.html
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Mark as UnreadLima Vadakkedam
Nov 30, 2022 8:29pm
Reply from Lima Vadakkedam
In the United States, there are many different socioeconomic
factors
that
impact
healthcare policy. Healthcare is one of the top burdens in the day to day lives of Americans who do and do not have ins
urance. Medical bills take years to pay off for some,
especially
for
those who
fall into the low-income gap. Those individuals who
fall into the low-income
category
find that healthcare bills can become a huge stressor and financial burden
especially
if they do not have any coverage or insurance.
Knowledge as
well plays a
crucial
role
. Most individuals do not have the essential education
when it comes to
the healthcare world which in turn can affect them for potential health hazards. Finally, where the individual lives as well can play a
crucial
role. Some people who live
in different regions of the world may lack the medical treatment that other
individuals
from other geographic areas have.
.
The two former presidents, President Barack Obama and President Donald Trump took on two different views when it came to healthcare. President Obama
created the Affordable Care Act. USA.gov states that the act entails making health insurance available to more people. The law provides consumers with subsidies (“premium tax credits”) that lower costs for households with incomes between 100% and 400% of the
federal overtly level. (USA.gov 2018). This act created by the Obama administration allowed for those with
lower
economic
classes to be able to afford health insurance.
On the
contrary, Donald Trump wanted to reform the Affordable Care Act.
President Obama’s desire to want to expand Medicaid to
assist
those
individuals
in obtaining private insurance. President Trump on the other hand wants to reduce the f
unding
for Medicaid.
Working in healthcare, if I were to become president there are a few things that I would have handled differently that
President
Obama
and
Trump
failed to
do. I would first push for a universal
healthcare
plan that allowed for healthcare to be free like it
is for Canadians.
The
Commonwealth fund
states
that “all citizens and permanent residents receive medically necessary
hospital
and
physician
services free at the point of
use. This
allows for everyone to have access to quality healthcare regardless of their ability to pay. Regardless of e
conomic status everyone should have
access
to quality healthcare. Another big issue is what some known as Big Pharma. Big Pharma will not let its profit margin suffer; therefore, the cost will forever be escalating. (Meller & Ahmed, 2019).
As we know, in hospital setting a simple bag of IV fluids can cost up to seven hundred dollars,
whereas
the production cost
is
not
nearly as
expensive. I would try to work with the various pharmaceutical corporations to reduce the cost of medications.Overall minimizing the cost of healthcare would be
beneficial
for all Americans.
References:
USA.gov. (n.d.).
A-Z index of U.S. government departments and agencies
Links to an external site.
. Retrieved September 20, 2018, from
https://www.usa.gov/federal-agencies/a
Links to an external site.Meller, A., & Ahmed, H. (2019, August 30).
How Big Pharma Reaps Profits While Hurting Everyday Americans
. Center for American Progress.
https://www.americanprogress.org/article/big-pharma-reaps-profits-hurting-everyday-americans/Mark as Unread
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Marie V Licin-Valerius
Nov 30, 2022 8pm
Reply from Marie V Licin-Valerius
NURS:6050 Week 1 Discussion
Mental health consists of psychological, emotional, and social well-being. Mental health determines how people feel, think, and act and determines a person’s ability to relate with other people, handle stress, and make healthy choices. Mental health is needed during childhood, adolescence, and adulthood. However, mental health is different from mental illness. Mental health is as important as physical health because an individual with mental health issues is likely to suffer other physical health complications such as heart disease, stroke, and diabetes. Mental illnesses are prevalent in the United States. For example, over 50% of Americans are diagnosed with mental illness at some point. Similarly, 1 in every 5 American experiences mental illness in a specific area, while one in five children are currently affected by mental illness. One in every 25 Americans lives with severe mental illness like bipolar disorder, schizophrenia, or depression (Centers for Disease Control and Prevention, 2021). Mental illnesses do not have definite causes, but numerous factors contribute. They include early adverse life experiences, experiences linked to chronic conditions like diabetes, use of drugs or alcohol, chemical imbalances or biological factors, and isolation (Centers for Disease Control and Prevention, 2021). Mental illness is an issue that has reached the presidential level and has been handled by two recent presidents.
Management of Mental Health Issues by President Donald Trump and President Joe Biden
The administration of President Trump has been supporting mental health in various ways. One of the remarkable ways is to sign the Law Enforcement Mental Health and Wellness Act into law. President Trump signed the Act into law on January 10th, 2018, after it was passed by the House of Representatives and the Senate. The law is significant to mental health because it has grants that help to fund mental health. The grants also help fund mentorship pilot programs and research focused on determining the impact of Annual mental health checks and crisis hotlines (U.S. Government Publishing Office, 2020). Similarly, Triumph’s administration supported mental health through executive order 13954. Section 1 of this order explains that Trump’sTrump’s administration is committed to preventing suicide tragedies and ending the opioid crisis by improving behavioral and mental health. Section 2 elaborates on the policy to prevent drug-related deaths, suicide, and poor behavioral health outcomes (U.S. Government Publishing Office, 2020). This is crucial because mental health issues increased with the prolonged effect of covid 19.
Similarly, President Joe Biden supports mental health wellness and views it as a bipartisan issue that his administration is committed to serving. President Biden is committed to increasing mental health professionals across the United States and working towards developing an emergency response system with an emergency hotline for mental illnesses. Bi
Biden’s administration also supports mental health and has recently announced two new actions addressing the youth mental health crisis. The initiative helps to understand mental health issues, integrated treatment, and access to healthcare services. Biden announced the awarding of 300 million dollars secured through FY2022 to a bipartisan agreement to expand mental health services across U.S. schools (The White House, 2022). The action was to encourage governors to invest more resources in school-based mental health services.
What I Would do Differently
The two presidents have supported mental health in recommendable ways. Each of them has dedicated a good amount of funds toward mental illness. What I would do differently is to ensure more facilities are built in every state. This ensures that those affected by mental health issues can be admitted into facilities within their locality. It helps to increase social support because family and friends can easily visit the patient because they are within. Similarly, I would increase mental health awareness programs to ensure the community is sensitized about mental health.
References
Centers for Disease Control and Prevention. (2021, November 23). About mental health.
https://www.cdc.gov/mentalhealth/learn/index.htmU.S. Government Publishing Office. (2020). Executive Order 13954—Saving Lives Through Increased Support for Mental- and Behavioral-Health Needs.
https://www.govinfo.gov/content/pkg/DCPD-202000758/pdf/DCPD-202000758.pdfThe White House. (2022, July 29). FACT SHEET: Biden-Harris administration announces two new actions to address youth mental health crisis.
https://www.whitehouse.gov/briefing-room/statements-releases/2022/07/29/fact-sheet-biden-harris-administration-announces-two-new-actions-to-address-youth-mental-health-crisis/Mark as Unread
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Sarah E. Tasker
Nov 30, 2022 7:45pm
Reply from Sarah E. Tasker
Presidential Agendas and Health Policies
When thinking about health policies that have risen to the presidential level is the Patient Protection and Affordable Care Act (ACA). As previous President, Barack Obama, established this history-making law in 2010 to address insurance accessibility, rising healthcare costs, and preventative medicine (Affordable Care Act, n.d.). The ACA improved many aspects of the nation’s healthcare and took the uninsured rate from 16.0% in 2010 to 8.9% in 2016 (National Archives and Records Administration, n.d.). The American Hospital Association claims that studies show that people with insurance coverage have better access to care, more positive health outcomes, and are more likely to use appropriate healthcare resources (American Hospital Association, 2022). In 2016 when President Donald Trump came into office, he proposed the American Health Care Act (AHCA) that would shape the Affordable Care Act so that people may choose to obtain health insurance coverage (Obamacare Enrollment, 2021). This law also would have let insurance companies charge more if a person had preexisting or chronic health conditions (Obamacare Enrollment, 2021). The senate did not approve Trump’s proposal (Davalon, 2022). Contradictory of Donald Trump’s original proposition, current President Joe Biden has later restored the ACA to its original form (Luhby, 2021). Knowing how much of an impact preventative medicine and accessibility of health care make, I believe in and would act upon strengthening the ACA to lessen each person’s burdens of their social determinants of health.
References
Affordable Care Act
. (n.d.). Health Affairs. https://www.healthaffairs.org/topic/4#:~:text=The%20purpose%20of%20the%20ACA,curb%20rising%20health%20care%20costs
American Hospital Association. (2022).
Report: The importance of health coverage
.
https://www.aha.org/guidesreports/report-importance-health-coverage
Links to an external site.
.Davalon. (2022).
Trumpcare (AHCA) vs. Obamacare (ACA)
. eHealth.
https://www.ehealthinsurance.com/resources/affordable-care-act/trumpcare-vs-obamacare
Links to an external site.
.Luhby, T. (2021).
Biden signs executive order to reopen Affordable Care Act enrollment
. CNN.
https://www.cnn.com/2021/01/28/politics/biden-executive-orders-health-care-aca-medicaid
Links to an external site.
.National Archives and Records Administration. (n.d.).
Improving health for all Americans
. whitehouse.gov. https://obamawhitehouse.archives.gov/the-record/health-care.Obamacare Enrollment. (2021).
Trumpcare vs. Obamacare
. Obamacare Enrollment 2022. https://obamacareenrollment.org/trumpcare-vs-obamacare/.Mark as Unread
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Rafael Carlos Martinez
Nov 30, 2022 7:43pm
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Last reply Dec 4, 2022 8:06pmReply from Rafael Carlos Martinez
According to Healthy People 2030, approximately 1 in 10 people within the United States do not have health insurance, which significantly limits their access to healthcare services. Access to quality healthcare, is in of itself a social determinant of health (U. S. Department of Health and Human Services, 2022). President Obama addressed this issue directly when he passed the Affordable Care Act in 2010, which provided financial assistance to improve access to healthcare for millions of Americans who previously could not afford health insurance through state and federally funded marketplaces (Patient Protection and Affordable Care Act, 2010). The Affordable Care Act also improved access to healthcare by ensuring that health insurance companies could not deny coverage for individuals who have pre-existing health conditions (Patient Protection and Affordable Care Act, 2010). President Biden also improved access to healthcare for our nation’s veteran population through the Health Care for Burn Pit Veterans Act which became law this year. This legislation improved access to healthcare for veterans who were exposed to toxic burn pit fumes while deployed overseas during the Global War on Terrorism. Prior to this legislation, veterans like myself who were exposed to toxic burn pit fumes had to go through a lengthy process to prove that our health problems were caused by these toxic burn pits. This legislation expanded the list of presumptive positive conditions associated with burn put exposure to include a myriad of health care problems, including a number of different kinds of cancer, and extended VA eligibility periods for these individuals who had previously been denied care under the previous guidelines.
In terms of what I would have done differently, I don’t think I would amend anything regarding the Affordable Care Act. It did have the unintended consequence of increasing health care premiums across the country for many individuals, but I am not sure how this could have been prevented through the legislation. I would, however, have worked to pass legislation improving access for veterans exposed to toxic burn pits a decade ago. Toxic burn pit exposure was a known problem that the VA and the Department of Defense refused to take responsibility for, and as a result many veterans died before they were able to receive any healthcare related to their burn pit exposure. I personally had friends and comrades who died from burn pit associated cancer that the VA denied was service related for years. In my opinion, this was an incredible disservice to our veterans who have sacrificed so much for our country.
References:
H.R.3590 – 111th Congress (2009-2010): Patient Protection and Affordable Care Act. (2010, March 23).
https://www.congress.gov/bill/111th-congress/house-bill/3590
Links to an external site.S.3541 – 117th Congress (2021-2022): Health Care for Burn Pit Veterans Act. (2022, February 18). https://www.congress.gov/bill/117th-congress/senate-bill/3541
The Affordable Care Act’s Impacts on Access to Insurance and Health Care for Low-Income Populations. (2017).
Annual Review of Public Health
,
38
, 489.
https://doi.org/10.1146/annurev-publhealth-031816-044555
Links to an external site.S. Department of Health and Human Services. 2022.
Healthy People 2030
:
Health Care Access and Quality.
Retrieved November 30, 2022 from https://health.gov/healthypeople/objectives-and-data/browse-objectives/health-care-access-and-qualityExpand discussion thread from Rafael Carlos Martinez
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Rachel Butcher
Nov 30, 2022 5:36pm
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Last reply Dec 2, 2022 5:10pmReply from Rachel Butcher
There are so many different issues in America that are addressed at the presidential level. Some of the issues that America tries to help prevent or reduce are HIV, mental health problems, the opioid epidemic, pandemics, obesity, and prescription drug prices. All these issues are addressed on the presidential level by people trying to correct them. The issue that I want to talk about on a presidential level is opioid drug abuse and how the American president has tried to fix it.
President Biden sent his Administration’s inaugural National Drug Control Strategy to Congress. This was when drug overdose had reached its record high. The goal was to access evidence-based prevention, treatment, recovery, and harm reduction. The plan is to help reduce the drug supply of fentanyl. Biden wanted to treat drug addiction like any other disease. Biden’s plan is to help prevent drug trafficking and stop delivery routes, supply chains, and actions happening on the internet. President Biden wants to beat the overdose epidemic. (
President Biden Releases National Drug Control Strategy to Save Lives, Expand Treatment, and Disrupt Trafficking
, 2022). In 2018, almost 68,000 Americans died from drug overdoses; of those 68,000 Americans, 47,000 were involved with opioids. Bidens wants to ensure Americans access good quality healthcare, including substance use disorder treatment plans and mental health services in their healthcare. Biden’s plan is to hold the pharmaceutical companies because of their role in the opioid crisis and wants to make recovery services and effective prevention services available. Biden has invested $125 billion in federal investments toward opioid treatment and helped prevent overprescribing medication while ensuring the needed pain management was available. (
The Biden Plan to End the Opioid Crisis
, 2022).President Trump, on March 29, 2017, signed an Executive Order for Combating Drug Addiction and Opioid Crisis. Five meetings were held in 2107 going over the Addiction Policy Forum, young people in recovery, the National Council on Alcoholism, Drug Dependence, Community Anti-Drug Coalitions of America, and Partnership for Drug-Free Kids. (
President’s Commission on Opioids
, n.d.). President Trump has stated that there are $1.8 billion dollars in grants to prevent people’s lives from being taken by overdose and to help stop the opioid crisis. There is also another $900 million going toward the research in overdoses for treatment and improving overdose data through the Center for Disease Control and Prevention. During President Trump’s running the country, there had been almost 5,000 pounds of fentanyl stopped along the border in one year. President Trump had 3,000 high areas of drug trafficking stopped, along with money laundering organizations. When President Trump was in office, he provided Americans with education about how dangerous opioid misuse was. He had organizations called The Office of National Drug Control Policy along with the Truth Initiative partner to educate the youth about the misuse of opioids. By January 2017, there was a 31 percent decrease in the number of opioids that were prescribed. During the first two years President Trump was in office, and there was a 28 percent decrease in the number of veterans on opioids by the Department of Veterans Affairs. There were more efforts in providing supplies of naloxone to help prevent Americans from losing their lives to overdose. Kentucky, New Hampshire, West Virginia, Pennsylvania, and Ohio were most affected by people overdosing. There was a 5% decrease Nationwide in drug overdoses between 2017 and 2018. The drug overdose levels had decreased by 8 percent in West Virginia, 10 percent in New Hampshire, 24 percent in Pennsylvania, 16 percent in Kentucky, and 24 percent in Ohio. There was a decrease in American drug misuse by 11.4 million in 2017 to 10.3 in 2018. (
President Donald J. Trump Has Dedicated His Administration to Fighting Back against the Opioid Crisis
, 2019).I agree with what both presidents were trying to achieve by reducing drug overdose to help save American lives. When it comes to educating Americans on drug addiction, there also needs to be more facts about how people will eventually turn to IV drugs to get their fix. Once that happens, the sharing of needles will happen. That is how HIV gets spread and hepatitis. There needs to be more education for Americans on what the effects of misuse of drugs can cause if left untreated. There is more drug abuse in the low-income part of towns because of not having access to proper health care. People need education so they can learn prevention. Their local health departments can help them to get the proper health care. Having more nurse practitioners help with this also. People need to be educated on the resources available in their area to help avoid drug abuse. Both presidents focused more on drug treatment and how they stopped drug trafficking than on prevention. I think more attention should be put on prevention. My local health department provides a nurse practitioner for low-income people. They provide addiction prevention and information on how to get medical insurance. I believe this would help reduce or prevent opioid misuse.
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Marie V Licin-Valerius
Nov 30, 2022 5:07pm
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Last reply Dec 4, 2022 4:19pmReply from Marie V Licin-Valerius
NURS: 6050
Week 1 Discussion
It is almost apparent that every American President faces a crisis at work regarding various issues such as unlawful intimidation, catastrophic events, financial disasters, and political outrage. Some of the issues that have reached the presidential agenda level include controlling and managing infectious diseases. During the tenure of President George W Bush, the issue of HIV/AIDS was rampant. President Bush put much effort into the fight against HIV/AIDS across the world, especially in Africa (Green, 2021). Their efforts are commendable and recognized by both Democrats and Republicans. His efforts stood out among his father’s mixed cultures.
For example, during the reign of senior Bush, he signed two legislations to protect people with HIV-AIDS. One of the policies is the Individuals with Disability Act which ensures that disabled people suffering from HIV AIDS are not secluded. The other Act is Ryan White Comprehensive Aids Assets Emergency Act which helps to offer sick people funds for their treatment. Although the initiative was good and President Bush put much effort, he was still criticized because he declined to sign a policy that would have prevented individuals suffering from HIV AIDS from getting into the nation (Green, 2021).
In addition, he created the President’sPresident’s Emergency Plan for HIV/AIDS Alienation (PEPFAR) for efficiently handling the pestilence. The program was the most popular worldwide and was a satisfactory component of the Bush Administration. Since it started, PEPFAR has used over 80 billion dollars in preventing, treating, and researching HIV/AIDS (Jacobson, 2020). Therefore, it is the most significant global health initiative focusing on a single disease across history. The initiative is popular because it has saved many lives, especially in sub-Saharan Africa.
Shortly after PEPFAR was established in 2003, there was an outbreak of severe acute respiratory syndrome (SARS). The President requested that SARS be added to the infectious disease category that can cause segregation of people. Over 8,000 people were affected by SARS, and around 775 died in 2003 (Roussel et al., 2020).
Similarly, President Barack Obama had to deal with health issues concerning infectious diseases. However, during his tenure, the prevalent infectious diseases were not SARS and HIV but Ebola and Zika. During his reign, an Ebola outbreak killed more than 11,000 people in West Africa (Ostergard Jr, 2020). In July 2014, President of Barack Obama established an emergency operations center to offer specialized help, such as deploying people to West Africa to respond to the situation. The initiative facilitated training more than 25,000 Clinical services personnel in West Africa to help manage and prevent Ebola (Ostergard Jr, 2020).
Like President Bush, President Obama was criticized for not signing the law preventing all infected people from coming to the U.S. President Obama also received a backlash from Republicans for not imposing travel restrictions from nations with Ebola outbreaks. However, only 11 people all over the United States have been treated for Ebola (Ostergard Jr, 2020). His failure to impose travel restrictions did not expose the Americans to significant risks.
Shortly after the struggles with Ebola, Obama also battled with the zika insect that spread the infectious virus. The zika outbreak in 2015 originated in Brazil, and by the end of 2016, around 40,000 cases had been reported across the United States (Grillet et al., 2019). To fight zika, President Obama’s administration allocated 1.9 billion Dollars as an emergency fund. Around $1.1 billion of the budget was ratified by Congress. Another critical initiative during President Obama’s tenure is establishing a health safety and biodefense Unit. The organization’s main aim was to take responsibility for pandemic preparedness (Grillet et al., 2019).
References
Green, A. (2021). A history of US engagement in the HIV/AIDS response.
The Lancet
,
398
(10315), 1956-1957. https://doi.org/10.1016/S0140-6736(21)02540-XGrillet, M. E., Hernández-Villena, J. V., Llewellyn, M. S., Paniz-Mondolfi, A. E., Tami, A., Vincenti-Gonzalez, M. F., & Alarcón-de Noya, B. (2019). Venezuela’s humanitarian crisis, resurgence of vector-borne diseases, and implications for spillover in the region.
The Lancet Infectious Diseases
,
19
(5), e149-e161.Jacobson, L. E. (2020). President’s Emergency Plan for AIDS Relief (PEPFAR) Policy Process and the Conversation around HIV/AIDS in the United States.
Journal of Development Policy and Practice
,
5
(2), 149-166.https://doi.org/10.1177/2455133320952210Ostergard Jr, R. L. (2020). The West Africa Ebola outbreak (2014-2016): a health intelligence failure?.
Intelligence and National Security
,
35
(4), 477-492. https://doi.org/10.1080/02684527.2020.1750136Roussel, Y., Giraud-Gatineau, A., Jimeno, M. T., Rolain, J. M., Zandotti, C., Colson, P., & Raoult, D. (2020). SARS-CoV-2: fear versus data.
International journal of antimicrobial agents
,
55
(5), 105947. https://doi.org/10.1016/j.ijantimicag.2020.105947Expand discussion thread from Marie V Licin-Valerius
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Nchetaka Okeke
Nov 30, 2022 5:03pm
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Last reply Dec 2, 2022 9:30pmReply from Nchetaka Okeke
Presidential Agendas
Mental Health Issues
A quarter of adult Americans report experiencing emotional distress or having a mental health disorder like depression or anxiety. People with mental health issues are much more likely to experience various health issues and difficulties, such as substance abuse and chronic diseases like diabetes and heart disease (Milstead & Short, 2019). Spending on healthcare for adults with chronic illnesses and mental health conditions is nearly three times higher than for adults with chronic illnesses only. Generally, Americans have some of the worst outcomes related to mental health, including the highest rate of suicide and the second-highest rate of drug-related deaths among high-income nations.
Social Factors That Impact Mental Health
Age, educational accomplishment, gender, income, place of residence, sexual orientation, and a few more variables have all been linked to mental health. Other social factors, such as family and community dynamics, social support, housing quality, employment opportunities, and working conditions, can have a good or negative impact on mental health outcomes and risk (Milstead & Short, 2019). For example, safe public spaces for social gatherings, such as churches and recreational areas, might be beneficial for mental health. Maintaining and enhancing the mental health of all Americans requires a thorough understanding of these social elements, their effects, and how they interact.
The management of mental health issues by two recent presidents
The year 2018 saw the launch of President Donald Trump’s Law Enforcement Mental Health and Wellness initiative, which provided funding for initiatives for the mentally ill. He also signed a bill creating a national suicide hotline (Conley & Baum, 2022). Additionally, President Trump provided more than $700 million in funding for mental health services and initiatives in 2019. He advocated for treating people with mental health disorders in public and community hospitals (Conley & Baum, 2022). President Trump also prioritized decreasing suicides among veterans, and he issued an executive order urging campaigns to boost public awareness of mental health issues and financing research into suicide prevention.
President Biden, on the other hand, presented the nation’s mental health problems as a problem with broad bipartisan support and unveiled a determined plan to solve them. The plan’s main objectives are to increase system capacity and link those who require assistance to a continuum of care (The White House. 2022). It includes initiatives to increase the number of mental health professionals, work to build an emergency response system to support the launch of the 988-emergency hotline, a focus on children’s mental health, and proposals to pressure insurance companies to improve their behavioral health care coverage. Every health plan will be required by the Biden administration to include comprehensive behavioral healthcare services.
What I would change in the future
The absence of sufficient resources for treating mental health illnesses remains a major concern, notwithstanding the presidents’ various mental health programs. Naturally, this delays patient care. Frequently, people with mental health issues wind up being admitted to facilities outside of their home states without the support of friends or family. Furthermore, many persons who struggle with substance misuse wind up in psychiatric hospitals rather than facilities or programs that cater to their needs (Everett et al., 2019). Therefore, I would make changes by implementing more outreach and mental health treatment programs to increase the accessibility to these services. Additionally, I would guarantee that everyone has access to mental health care and advise states to increase the number of facilities for both substance misuse and mental health treatment.
References
Conley, D. L., & Baum, M. J. (2022). Predictors of structural stigma in state mental health legislation during the Trump administration.
Social Work in Mental Health, 36
(12), 1-27.
https://doi.org/10.1080/15332985.2022.2062272
Links to an external site.Everett, A., Lee-Tauler, S. Y., & Bommersbach, T. (2019). Community and public mental services in the United States. Public Mental Health, 28(09), 417-438.
https://doi.org/10.1093/oso/9780190916602.003.0016
Links to an external site.Milstead, J. A., & Short, N. M. (2019).
Health policy and politics: A nurse’s guide
(6
th
ed.). Jones & Bartlett LearningThe White House. (2022, March 1).
FACT SHEET: President Biden to announce strategy to address our national mental health crisis, as part of unity agenda in his First State of the union.
Retrieved August 28, 2022, from
https://www.whitehouse.gov/briefing-room/ststements-releases/2022/03/01/fact-sheet-president-biden-to-announce-strategy-to-address-our-national-mental-health-crisis-as-part-of-unity-agenda-in-his-first-state-of -the-union/
Links to an external site.Expand discussion thread from Nchetaka Okeke
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Nchetaka Okeke
Nov 30, 2022 4:51pm
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Last reply Dec 1, 2022 6:46pmReply from Nchetaka Okeke
Presidential Agendas
Mental Health Issues
A quarter of adult Americans report experiencing emotional distress or having a mental health disorder like depression or anxiety. People with mental health issues are much more likely to experience various health issues and difficulties, such as substance abuse and chronic diseases like diabetes and heart disease (Milstead & Short, 2019). Spending on healthcare for adults with chronic illnesses and mental health conditions is nearly three times higher than for adults with chronic illnesses only. Generally, Americans have some of the worst outcomes related to mental health, including the highest rate of suicide and the second-highest rate of drug-related deaths among high-income nations.
Social Factors That Impact Mental Health
Age, educational accomplishment, gender, income, place of residence, sexual orientation, and a few more variables have all been linked to mental health. Other social factors, such as family and community dynamics, social support, housing quality, employment opportunities, and working conditions, can have a good or negative impact on mental health outcomes and risk (Milstead & Short, 2019). For example, safe public spaces for social gatherings, such as churches and recreational areas, might be beneficial for mental health. Maintaining and enhancing the mental health of all Americans requires a thorough understanding of these social elements, their effects, and how they interact.
The management of mental health issues by two recent presidents
The year 2018 saw the launch of President Donald Trump’s Law Enforcement Mental Health and Wellness initiative, which provided funding for initiatives for the mentally ill. He also signed a bill creating a national suicide hotline (Conley & Baum, 2022). Additionally, President Trump provided more than $700 million in funding for mental health services and initiatives in 2019. He advocated for treating people with mental health disorders in public and community hospitals (Conley & Baum, 2022). President Trump also prioritized decreasing suicides among veterans, and he issued an executive order urging campaigns to boost public awareness of mental health issues and financing research into suicide prevention.
President Biden, on the other hand, presented the nation’s mental health problems as a problem with broad bipartisan support and unveiled a determined plan to solve them. The plan’s main objectives are to increase system capacity and link those who require assistance to a continuum of care (The White House. 2022). It includes initiatives to increase the number of mental health professionals, work to build an emergency response system to support the launch of the 988-emergency hotline, a focus on children’s mental health, and proposals to pressure insurance companies to improve their behavioral health care coverage. Every health plan will be required by the Biden administration to include comprehensive behavioral healthcare services.
What I would change in the future
The absence of sufficient resources for treating mental health illnesses remains a major concern, notwithstanding the presidents’ various mental health programs. Naturally, this delays patient care. Frequently, people with mental health issues wind up being admitted to facilities outside of their home states without the support of friends or family. Furthermore, many persons who struggle with substance misuse wind up in psychiatric hospitals rather than facilities or programs that cater to their needs (Everett et al., 2019). Therefore, I would make changes by implementing more outreach and mental health treatment programs to increase the accessibility to these services. Additionally, I would guarantee that everyone has access to mental health care and advise states to increase the number of facilities for both substance misuse and mental health treatment.
References
Conley, D. L., & Baum, M. J. (2022). Predictors of structural stigma in state mental health legislation during the Trump administration.
Social Work in Mental Health, 36
(12), 1-27.
https://doi.org/10.1080/15332985.2022.2062272
Links to an external site.Everett, A., Lee-Tauler, S. Y., & Bommersbach, T. (2019). Community and public mental services in the United States. Public Mental Health, 28(09), 417-438.
https://doi.org/10.1093/oso/9780190916602.003.0016
Links to an external site.The White House. (2022, March 1).
FACT SHEET: President Biden to announce strategy to address our national mental health crisis, as part of unity agenda in his First State of the union.
Retrieved August 28, 2022, from
https://www.whitehouse.gov/briefing-room/ststements-releases/2022/03/01/fact-sheet-president-biden-to-announce-strategy-to-address-our-national-mental-health-crisis-as-part-of-unity-agenda-in-his-first-state-of -the-union/
Links to an external site.Milstead, J. A., & Short, N. M. (2019).
Health policy and politics: A nurse’s guide
(6
th
ed.). Jones & Bartlett Learning.Expand discussion thread from Nchetaka Okeke
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Holly Anne Mayes
Nov 30, 2022 1:48pm
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Last reply Nov 30, 2022 3:30pmReply from Holly Anne Mayes
Consider a population health topic that rises to the presidential agenda level. Which social determinant most affects this health issue? How did two recent presidents handle the problem? What would you do differently?
I live in New Mexico, and while there are many population health topics I could discuss, the opioid epidemic is truly rampant here. With the cartels sending it over the border in droves, our local news has reported that we have seen a 900% increase in Fentanyl alone our state over the last few years. According to (Murray, 2019), “Millions of Americans are impacted by the opioid crises.” People are dying at alarming rates due to opioid overdoses. Drug abuse has crippled our neighborhoods and communities for decades and continues to be on the rise.” The opioid epidemic has so many crucial impacts that it is a significant population health issue that will continue to rise to the presidential agenda level with each new president. With growth rates of 900% in some areas of the United States and no signs of slowing down, it is easy to see why. Education, poverty, and mental health are all social determinants of health that have factored into the opioid epidemic.
President Obama signed the very first Bipartisan bill that addressed the opioid epidemic. On July 22, President Barrack Obama signed the Comprehensive Addiction and Recovery Act, the first of its kind to offer a multifaceted federal response to the prescription opioid and heroin epidemic ravaging communities across the United States (Reilly, 2016). The purpose of this bill was to combat the misuse of opioids and ensure that people have access to effective treatment.
According to (Ending America’s Opioid Crises, The White House) “President Trump’s Initiative to Stop Opioid Abuse, unveiled in 2018, confronting the driving forces behind the opioid crises”. President Trump saw education as a critical piece of addressing the opioid problem and allocated funds to support education efforts. Next, he wanted to address how the drugs were coming into the U.S. he believed that building the wall between the U.S. and Mexico would help decrease drugs crossing the border. Finally, President Trump pushed for more treatment centers to address the growing number of Americans who had become addicted and were seeking help.
As opioid addiction has continued to grow and become a more pronounced issue that many Americans face, I am thankful for the support our Presidents have shown in trying to address it. I believe there is more we can do, starting with mental health. We continue to see a link between drug use and mental health. I genuinely believe it is time to dedicate suitable funds and resources to help address the opioid problem from a mental health standpoint: more treatment options and facilities and more coverage for patients seeking treatment.
References
Murray, K. (2019).Racial Disparities in Opioid Addiction Treatment in Black and White Populations. Retrieved June 1, 2020, from https.//www.addictioncenter.com/news/2019/10/racial-disparities-opioid-addiction-treatment/
Ending America’s Opioid Crises|The White House,(2020). The White House. Retrieved June 1, 2020, from https://www.whitehouse.gov/opioids/
Reilly, K., (2016). President Obama Signs Bipartisan Bill to Combat Opioid Epidemic. Retrieved on June 1, 2020, from https://www.pewtrusts.org/en/research-and-analysis/articles/2016/07/22/president-obama-signs-bipartisan-bill-to-combat-opioid-epedimic
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Mark as UnreadAnna Fortenberry Williams
Nov 30, 2022 12:58pm
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Last reply Dec 3, 2022 7:12pmReply from Anna Fortenberry Williams
Prescription drug costs are astronomical and rob Americans of the ability to maintain health. The cost of prescriptions continues to skyrocket, and people’s health continues to decline. Overuse of the emergency room due to inability to afford medications. The cost of healthcare as a whole continues to increase and one way to correct this is to get patients preventative and maintenance care before an acute exacerbation of chronic illness.
Trump and Biden have made attempts to address this issue, although the proposal will likely not help. Healthcare is just simply not affordable. (Meller & Ahmed, 2019) Biden believes an affordable help care act could reduce the cost of healthcare. This act will allow Americans to obtain affordable health care. While health care may be more affordable the quality will be worse. (Office, 2022) The cost of drugs is driven by the gain from drug companies. Big Pharma will not let its profit margin suffer; therefore, the cost will forever be escalating. (Meller & Ahmed, 2019) Biden has an agenda to continue to address this issue, but nothing as of now has been effective and we are still at a standstill. (House, 2022)
I am not certain there is a solution or a way I would handle it better. The structure of health care is not benefiting the providers or patients. We hand out a lot of free healthcare and we practice liability medicine due to providers’ fear of being sued. The problem in health care is we do too much. If I were to fix the problem, I would shave off over half the health care we provide. Million-dollar work ups in the ER over and over again drives the costs up. I would reduce the use of medical resources and only order what is necessary for patients.
Resources
Office, A. P. (2022, September 29).
Biden-Harris Administration Announces Lower Premiums for Medicare Advantage and Prescription Drug Plans in 2023
. HHS.gov.
https://www.hhs.gov/about/news/2022/09/29/biden-harris-administration-announces-lower-premiums-for-medicare-advantage-and-prescription-drug-plans-in-2023.html
Links to an external site.Meller, A., & Ahmed, H. (2019, August 30).
How Big Pharma Reaps Profits While Hurting Everyday Americans
. Center for American Progress.
https://www.americanprogress.org/article/big-pharma-reaps-profits-hurting-everyday-americans/
Links to an external site.House, T. W. (2022, October 14).
Executive Order on Lowering Prescription Drug Costs for Americans
. The White House. https://www.whitehouse.gov/briefing-room/presidential-actions/2022/10/14/executive-order-on-lowering-prescription-drug-costs-for-americans/Expand discussion thread from Anna Fortenberry Williams
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Stephen Blickley
Nov 30, 2022 12:42pm
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Last reply Dec 2, 2022 3:51pmReply from Stephen Blickley
One thing I have noticed throughout my career as a nurse is how difficult our healthcare system is to navigate. Even for nurses working within their own healthcare system, maximizing what they can get for their patients is difficult. Without assigning responsibility for this, it is easy to see why your average joe has issues doing everything that is asked of them by healthcare professionals. As a nurse that works in home health, I am provided with a unique perspective of just how poorly healthcare facilities do with discharging and educating patients to succeed in the home environment. This isn’t the facilities’ faults, but the fact is if we were able to improve that portion of the process, I think we would see huge improvement in patient outcomes. One huge issue facing providers trying to do right by their patients is the price of prescription drugs and how they vary depending on the patient’s coverage. This issue results in different people paying outrageous prices for medications while others pay nothing. As a home health nurse, there have been numerous times I have been forced to help a patient budget what medications they can take instead of taking them as ordered.
One thing President Trump did to address this concern was met with some controversy but was aimed at reducing drug costs across the board. He signed an executive order on September 13, 2020 with the aim at aligning our drug prices with the best offered across the globe (Mulaney, 2020). While this sounds good on paper, it wasn’t successful and not held up in courts. I believe part of the reason for it’s lack of success was related to the added costs our country incurs related to all the testing we conduct. A drug might cost cheaper elsewhere, but it also might not test to the point that it is as safe as drugs we manufacture and distribute.
Current President Biden’s approach was more direct and has me feeling more optimistic. In October, Biden announced the plan to allow Medicare to negotiate directly with pharmaceutical companies for the first time and cap the out-of-pocket expenses for those on medicare at $2,000 a year (Whitehouse.gov, 2022). This has me excited because a lot of people are paying over that in co pays yearly, often for one medication. An example of this that I personally experienced when I was prescribed Xarelto, my insurance wanted me to pay $500. Luckily, I was able to apply for a program through the manufacturer to get that largely discounted, but last time I checked that program wasn’t available for those on Medicaid and medicare. I often have patients who thought they had great coverage end up paying close to what I did for their Xarelto, and they can’t get it discounted due to their status. If I were President I would make sure that everyone has the same prices for medications universally. I also would make sure that people didn’t lose insurance coverage if they were unemployed. Hopefully that would help our most vulnerable populations.
President Trump Signs Executive Order on prescription drug pricing
. AAMC. (2020, September 18). Retrieved November 30, 2022, from https://www.aamc.org/advocacy-policy/washington-highlights/president-trump-signs-executive-order-prescription-drug-pricingThe United States Government. (2022, October 14).
Fact sheet: President Biden takes action to lower health care and prescription drug costs for Americans
. The White House. Retrieved November 30, 2022, from https://www.whitehouse.gov/briefing-room/statements-releases/2022/10/14/fact-sheet-president-biden-takes-action-to-lower-health-care-and-prescription-drug-costs-for-americans/ -
The most common STI in the United States is HPV
Question 21 1 pts
The most common STI in the United States is:
Group of answer choices
HPV
Gonorrhea
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Chlamydia
HIV
NRNP 6552
Midterm Exam
Walden University -
Name two drugs that are highly affected by the first pass effect. As a prescriber, what actions would you take in prescribing these drugs to counter the first pass effect?
Name two drugs that are highly affected by the first pass effect. As a prescriber, what actions would you take in prescribing these drugs to counter the first pass effect?
I will describe the common adverse effects of Atenolol, including cold extremities, weariness, and dizziness. Also, I will emphasize that these side effects might decrease as the body becomes used to the drug (Whelton et al., 2018).
Additionally, I will reinforce teaching on the importance of taking medication regularly to manage hypertension effectively. Also, I will discuss the
Name
two drugs
that are highly affected by the first pass effect. As a prescriber, what actions would you take in prescribing these drugs to counter the first pass effect? -
A 44-year-old women is currently taking Glipizide and Phenytoin. She has a new prescription for Ceftriaxone. All three medications are known to be highly protein bound. What effect does protein binding have on drug availability? How would you manage this patient’s medication?
A 44-year-old women is currently taking Glipizide and Phenytoin. She has a new prescription for Ceftriaxone. All three medications are known to be highly protein bound. What effect does protein binding have on drug availability? How would you manage this patient’s medication?
Since Ceftriaxone can displace Glipizide and Phenytoin from their protein-binding sites, all three medicines in this scenario are substantially protein-bound. This displacement may result in higher free concentrations of Phenytoin and Glipizide, potentially increasing the risk of toxicity for these drugs.
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In addressing the problem, I will keep a close eye out for any indications of Glipizide and Phenytoin toxicity, such as assessing for signs and symptoms of hypoglycemia and any neurological problems in the patient. Also, to lessen the possibility of an increase in free concentrations, consider modifying the dosages of phenytoin and glipizide (Ter Heine et al., 2019). Additionally, I will also consider utilizing a different antibiotic that does not significantly affect protein binding to lower the potential of medication interactions (Fructuoso-González et al., 2023). Further. Collaborates with the neurologist team to seek advice on further managing this patient…
A 44-year-old women is currently
taking Glipizide and Phenytoin
. She has a new prescription for Ceftriaxone. All three medications are known to be highly protein bound. What effect does protein binding have on drug availability? How would you manage this patient’s medication? -
A 52-year-old man was recently discharged from the hospital following treatment for atrial fibrillation. He was discharged on Warfarin 5 mg po q day and Amiodarone 200 mg tid. His INR is 8.8. What interaction has occurred with these 2 medications? What changes in his medications would you make?
A 52-year-old man was recently discharged from the hospital following treatment for atrial fibrillation. He was discharged on Warfarin 5 mg po q day and Amiodarone 200 mg tid. His INR is 8.8. What interaction has occurred with these 2 medications? What changes in his medications would you make?
Due to Amiodarone’s ability to enhance Warfarin’s anticoagulant effect, the combination of the two medications may increase the risk of bleeding. Higher doses of anticoagulation are indicated by an INR of 8.8, which carries a high risk of bleeding problems (Kluwer, 2023).
To avoid future increases in anticoagulation, withholding the doses and consulting the patient cardiologist regarding taking Amiodarone and Warfarin therapy would be my nursing assessment. Also, I would assess the patient and conduct a history of dietary regime and instructions on items to avoid contributing to the patient’s heart and INR levels.
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A close monitoring of the patient for any signs of bleeding. Moreover, it assesses any significant changes requiring a Vitamin K prescription to counteract Warfarin’s effects (Grubb & Mentz, 2020). If bleeding is substantial, I will consider prothrombin complex concentrate (PCC) for quick reversal.
Additionally, depending on the patient’s condition and INR levels, I will consider lowering the doses of Warfarin and Amiodarone. Further follow-up with the patient cardiologist and the anticoagulation team for advice on best managing anticoagulant therapy (Teixeira et al., 2023). Also, I will work together with a chemist to evaluate the medication interaction and suggest any necessary intervention.
For week 1 there are two assignments.
1. Read and acknowledge that you understand the practicum manual.
2. Assignment:
Directions:
For each of the scenarios below, answer the questions below using clinical practice guideline where applicable. Explain the problem and explain how you would address the problem. If prescribing a new drug, write out a complete medication order just as you would if you were completing a prescription. Use at least 3 sources for each scenario and cite sources using APA format.A 52-year-old man was recently discharged from the hospital following treatment for atrial fibrillation. He was discharged on Warfarin 5 mg po q day and Amiodarone 200 mg tid. His INR is 8.8. What interaction has occurred with these 2 medications? What changes in his medications would you make?
A 44-year-old women is currently taking Glipizide and Phenytoin. She has a new prescription for Ceftriaxone. All three medications are known to be highly protein bound. What effect does protein binding have on drug availability? How would you manage this patient’s medication?
Name two drugs that are highly affected by the first pass effect. As a prescriber, what actions would you take in prescribing these drugs to counter the first pass effect?
4. James is a 49-year-old male that was prescribed atenolol for his high blood pressure. James states that he only occasionally takes the medication because he does not like the side effects. What information would you provide to the patient at his visit? How would you manage his medication?
A
52-year-old man was recently discharged from the hospital following treatment for atrial fibrillation
. He was discharged on Warfarin 5 mg po q day and Amiodarone 200 mg tid. His INR is 8.8. What interaction has occurred with these 2 medications? What changes in his medications would you make? -
NURS-6521 Week 1 assignment 1
NURS-6521 Week 1 assignment 1 Advance Pharmacology
First Scenario: A 52-year-old man with an INR of 8.8 was released from treatment while taking Warfarin and Amiodarone.
Due to Amiodarone’s ability to enhance Warfarin’s anticoagulant effect, the combination of the two medications may increase the risk of bleeding. Higher doses of anticoagulation are indicated by an INR of 8.8, which carries a high risk of bleeding problems (Kluwer, 2023).
To avoid future increases in anticoagulation, withholding the doses and consulting the patient cardiologist regarding taking Amiodarone and Warfarin therapy would be my nursing assessment. Also, I would assess the patient and conduct a history of dietary regime and instructions on items to avoid contributing to the patient’s heart and INR levels.
ORDER A HUMAN-WRITTEN PAPER HERE
A close monitoring of the patient for any signs of bleeding. Moreover, it assesses any significant changes requiring a Vitamin K prescription to counteract Warfarin’s effects (Grubb & Mentz, 2020). If bleeding is substantial, I will consider prothrombin complex concentrate (PCC) for quick reversal.
Additionally, depending on the patient’s condition and INR levels, I will consider lowering the doses of Warfarin and Amiodarone. Further follow-up with the patient cardiologist and the anticoagulation team for advice on best managing anticoagulant therapy (Teixeira et al., 2023). Also, I will work together with a chemist to evaluate the medication interaction and suggest any necessary intervention.
Second Scenario: A 44-year-old female patient was prescribed Ceftriaxone together with Glipizide and Phenytoin.
Since Ceftriaxone can displace Glipizide and Phenytoin from their protein-binding sites, all three medicines in this scenario are substantially protein-bound. This displacement may result in higher free concentrations of Phenytoin and Glipizide, potentially increasing the risk of toxicity for these drugs.
In addressing the problem, I will keep a close eye out for any indications of Glipizide and Phenytoin toxicity, such as assessing for signs and symptoms of hypoglycemia and any neurological problems in the patient. Also, to lessen the possibility of an increase in free concentrations, consider modifying the dosages of phenytoin and glipizide (Ter Heine et al., 2019). Additionally, I will also consider utilizing a different antibiotic that does not significantly affect protein binding to lower the potential of medication interactions (Fructuoso-González et al., 2023). Further. Collaborates with the neurologist team to seek advice on further managing this patient.
Drugs Highly Affected by the First Pass Effect
Propranolol – the liver’s extensive first-pass metabolism significantly decreases Propranolol’s bioavailability.
The counteractions include:
Prescribing a higher initial dose to compensate for the loss that first-pass metabolism is expected to cause.
Bypassing the first pass and administering intravenously guarantees a more consistent bioavailability (Srinivasan, 2019).
Keeping an eye on medication levels by checking propranolol levels frequently and changing dosages as necessary (Beringer, 2023).
Lidocaine – During the first pass, lidocaine undergoes substantial hepatic metabolism, which lowers its systemic bioavailability.
The counteractions include:
Giving a more significant starting dose to overcome first-pass metabolism and produce the intended therapeutic effect.
Using alternate routes to circumvent the initial pass and guarantee a more consistent reaction, intravenous administration may be considered (Wagner, 2018).
Check medication levels frequently to adjust dosages and, avoid toxicity, and check lidocaine levels.
Third Scenario: James, prescribed Atenolol, dislikes side effects
I will describe the common adverse effects of Atenolol, including cold extremities, weariness, and dizziness. Also, I will emphasize that these side effects might decrease as the body becomes used to the drug (Whelton et al., 2018).
Additionally, I will reinforce teaching on the importance of taking medication regularly to manage hypertension effectively. Also, I will discuss the possibility of any adverse effects of inconsistent drug adherence, like elevated risk of cardiovascular events and uncontrolled blood pressure (Mattingly et al., 2021).
Lastly, I will examine and provide substitutes for antihypertensive drugs that may have fewer adverse effects—in addition, evaluating the patient’s potential by looking at a new beta-blocker or other antihypertensive drug classes like calcium channel blockers or ACE inhibitors (Rodgers et al., 2024).
James should be encouraged to express his worries and side effects honestly. He discussed and educated patients on lifestyle changes, including meal choices, exercise regimes, and supplemental or drug therapy. Also, I will work together with James to develop a treatment strategy that complements his interests and way of life.
References
Beringer, P. (2023). Winter’s basic clinical pharmacokinetics. Lippincott Williams & Wilkins.
Fructuoso-González, L., Najera-Perez, M. D., Manresa-Ramón, N., Torrano-Belmonte, P., Caracena-López, S., & Pacheco-López, P. (2023). Isavuconazole–tacrolimus drug–drug interactions in HSCT patients. Journal of Antimicrobial Chemotherapy, 78(10), 2559-2562.
Grubb, A., & Mentz, R. J. (2020). Pharmacological management of atrial fibrillation in patients with heart failure with reduced ejection fraction: review of current knowledge and future directions. Expert review of cardiovascular therapy, 18(2), 85-101.
Kluwer, W. (2023). Lexicomp: evidence-based drug referential content.
Mattingly, A. N., Gianturco, S. L., Pavlech, L. L., Storm, K. D., & Yuen, M. V. (2021). Atenolol: Summary Report.
Rodgers, A., Salam, A., Cushman, W., de Silva, A., Di Tanna, G. L., Gnanenthiran, S. R., … & Whelton, P. (2024). Rationale for a New Low-Dose Triple Single Pill Combination for the Treatment of Hypertension. Global Heart, 19(1).
Srinivasan, A. V. (2019). Propranolol: A 50-year historical perspective. Annals of Indian academy of neurology, 22(1), 21.
Teixeira, R. A., Fagundes, A. A., Baggio Junior, J. M., Oliveira, J. C. D., Medeiros, P. D. T. J., Valdigem, B. P., … & Leal, J. C. F. (2023). Brazilian Guidelines for Cardiac Implantable Electronic Devices–2023. Arquivos Brasileiros de Cardiologia, 120.
Ter Heine, R., Kane, S. P., Huitema, A. D., Krasowski, M. D., & van Maarseveen, E. M. (2019). Nonlinear protein binding of phenytoin in clinical practice: Development and validation of a mechanistic prediction model. British journal of clinical pharmacology, 85(10), 2360-2368.
Wagner, J. G. (2018). Pharmacokinetics for the pharmaceutical scientist. CRC Press.
Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Dennison Himmelfarb, C., … & Wright, J. T. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology, 71(19), e127-e248.
Assignment 1: Case Studies
Case studies are a useful way for you to apply your knowledge of pharmacokinetics and pharmacodynamic aspects of pharmacology to specific patient cases and health histories.
For this Assignment, you evaluate drug treatment plans for patients with various disorders and justify drug therapy plans based on patient history and diagnosis.
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
To Prepare:
Review the case study posted in “Announcements” by your Instructor for this Assignment
Review the information provided and answer questions posed in the case study
When recommending a medication, write out a complete prescription for the medication
Whenever possible, use clinical practice guidelines in developing your answers when possible
Include at least three references to support your answer and cite them in APA format.
By Day 7 of Week 1
Submit the Assignment.
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NURS_6521_Week1_Assignment1_Rubric
NURS_6521_Week1_Assignment1_Rubric
Criteria
Ratings
Pts
This criterion is linked to a Learning Outcome
Scenario 1: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.15
to >
11.0
pts
Excellent
Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.11
to >
7.0
pts
Good
Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.7
to >
3.0
pts
Fair
Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.3
to >
0
pts
Poor
Medication selected is inappropriate or would not be provided based on patient unique characteristics.15
ptsThis criterion is linked to a Learning Outcome
Scenario 1: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.3
pts
Complete
Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.0
pts
Poor
The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.3
ptsThis criterion is linked to a Learning Outcome
Scenario 1: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.4
pts
Excellent
References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.3
pts
Good
References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.2
pts
Fair
References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.0
pts
Poor
No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.4
ptsThis criterion is linked to a Learning Outcome
Scenario 1: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation3
pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors.2
pts
Good
Contains a few (1 or 2) grammar, spelling, and punctuation errors.1
pts
Fair
Contains several (3 or 4) grammar, spelling, and punctuation errors.0
pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.3
ptsThis criterion is linked to a Learning Outcome
Scenario 2: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.15
to >
11.0
pts
Excellent
Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.11
to >
7.0
pts
Good
Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.7
to >
3.0
pts
Fair
Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.3
to >
0
pts
Poor
Medication selected is inappropriate or would not be provided based on patient unique characteristics.15
ptsThis criterion is linked to a Learning Outcome
Scenario 2: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.3
pts
Complete
Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.0
pts
Poor
The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.3
ptsThis criterion is linked to a Learning Outcome
Scenario 2: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.4
pts
Excellent
References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.3
pts
Good
References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.2
pts
Fair
References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.0
pts
Poor
No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.4
ptsThis criterion is linked to a Learning Outcome
Scenario 2: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation3
pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors.2
pts
Good
Contains a few (1 or 2) grammar, spelling, and punctuation errors.1
pts
Fair
Contains several (3 or 4) grammar, spelling, and punctuation errors.0
pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.3
ptsThis criterion is linked to a Learning Outcome
Scenario 3: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.15
to >
11.0
pts
Excellent
Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.11
to >
7.0
pts
Good
Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.7
to >
3.0
pts
Fair
Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.3
to >
0
pts
Poor
Medication selected is inappropriate or would not be provided based on patient unique characteristics.15
ptsThis criterion is linked to a Learning Outcome
Scenario 3: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.3
pts
Complete
Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.0
pts
Poor
The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.3
ptsThis criterion is linked to a Learning Outcome
Scenario 3: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.4
pts
Excellent
References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.3
pts
Good
References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.2
pts
Fair
References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.0
pts
Poor
No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.4
ptsThis criterion is linked to a Learning Outcome
Scenario 3: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation3
pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors.2
pts
Good
Contains a few (1 or 2) grammar, spelling, and punctuation errors.1
pts
Fair
Contains several (3 or 4) grammar, spelling, and punctuation errors.0
pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.3
ptsThis criterion is linked to a Learning Outcome
Scenario 4: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.15
to >
11.0
pts
Excellent
Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.11
to >
7.0
pts
Good
Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.7
to >
3.0
pts
Fair
Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.3
to >
0
pts
Poor
Medication selected is inappropriate or would not be provided based on patient unique characteristics.15
ptsThis criterion is linked to a Learning Outcome
Scenario 4: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.3
pts
Complete
Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.0
pts
Poor
The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.3
ptsThis criterion is linked to a Learning Outcome
Scenario 4: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.4
pts
Excellent
References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.3
pts
Good
References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.2
pts
Fair
References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.0
pts
Poor
No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.4
ptsThis criterion is linked to a Learning Outcome
Scenario 4: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation3
pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors.2
pts
Good
Contains a few (1 or 2) grammar, spelling, and punctuation errors.1
pts
Fair
Contains several (3 or 4) grammar, spelling, and punctuation errors.0
pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.3
ptsTotal Points:
100 -
Alterations in Cellular Processes Examples
The role genetics plays in the disease.
The gene that is essential for the emergence of opiate addiction is the receptor MOP-r gene (OPM1), which is the main target of opioids (Genereaux, 2019). Opioid addiction is more common in those with an OPM1 variant. Opiate drugs have stronger effects because of their higher substrate affinity. Nonetheless, the genetics of opiate addiction is influenced by both heredity and nurture. While certain natural mutations increase a person’s susceptibility to opiates, the environment can also encourage genes that especially contribute to the overuse of opiates (Genereaux, 2019).
Why the patient is presenting with the specific symptoms described.
This patient is exhibiting signs of soft tissue necrosis and hyperkalemia; it is probable that he is suffering from rhabdomyolysis as a result of a drug overdose with an unidentified downtime. Rhabdomyolysis is the result of muscles breaking down quickly and releasing intracellular materials (Kumar et al., 1999). In this instance, the patient’s full weight being directly compressed into a hard surface and the resulting decreased blood circulation led to the breakdown of skeletal muscle fibers and tissue necrosis over the left greater trochanter and forearm (Bigham, 2017).
The physiologic response to the stimulus presented in the scenario and why you think this response occurred.
In rhabdomyolysis, the breakdown of the muscle cell’s plasma membrane, or sarcolemma, results in a change in the sodium-potassium gradients that permits an excess of potassium to enter the bloodstream. Due to the hyperexcitability of the heart muscle, hyperkalemia alters the EKG; sustained depolarization inactivates sodium channels, lengthening the PR interval. Furthermore, hyperkalemia causes peaked T waves because it raises action potential and reduces repolarization because of the ventricular sensitivity to potassium (McCance & Huether, 2019). This patient’s gangrenous necrosis is another symptom of rhabdomyolysis. Cell death, or necrosis, can happen when damage to a cell becomes irreversible (Bigham, 2017). Gangrenous necrosis is a severe hypoxic damage that usually results from a blood flow obstruction, like the patient’s weight resting against his forearm and hip.
The cells that are involved in this process.
Although distinct genetic materials can influence the characteristics and functions of cells, there does not appear to be a genetic component to this patient’s particular physiological reaction to rhabdomyolysis. Gene deficiencies resulting in the lack of certain enzymes, such as myophosphorylase, carnitine, lactate dehydrogenase, or myoadenylate deaminase, can cause rabdomyolysis (McCance & Huether, 2019).
How another characteristic (e.g., gender, genetics) would change your response.
If the patient had been a woman instead of a man, the evaluation of the case would still not have changed. Although men are more likely than women to experience rhabdomyolysis (Cabral et al., 2020), a female’s gender would not influence the cellular changes that occur in pathophysiology.
References
Bigham, B. (2017). Are you considering crush injury in narcotic overdoses? Emergency and Mobile Medicine Learning Network. Retrieved from https://www.hmpgloballearningnetwork.com/site/emsworld/article/12317524/are-you- considering-crush-injury-in-narcotic-overdoses.
Cabral, B. M., Edding, S., Portocarrero, J., & Lerma, E. (2020). Rhabdsomyolysis. Disease-a- Month, 66(8). https://doi.org/10.1016/j.disamonth.2020.101015
Genereaux, N. M. (2019). The Opioid Crisis: Biological, Psychological and Sociological Factors in the Etiology and Future Mitigation of Opioid Addiction.
Kumar, R., West, D. M., Jingree, M., & Laurence, A. S. (1999). Unusual consequences of heroin overdose: rhabdomyolysis, acute renal failure, paraplegia and hypercalcaemia. The British Journal of Anaesthesia, 83(3), 496–498.
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.
Expand discussion thread from Essie Tani Richardson
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Guadalupe Angie Ruelas
Nov 28, 2023 7:58pm
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Last reply Dec 2, 2023 10:51amReply from Guadalupe Angie Ruelas
Week 1 discussion :
Case studyA 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. The 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.
Response
To my understanding the patient is most likely experiencing rhabdomyolysis which can be defined as muscle tissue breakdown which leads to the release of muscle cells into the bloodstream. Matsusue et al (2011) states that “there is a possibility that rhabdomyolysis can be triggered by fragility of muscular cells or a reduction in the metabolism of a causative agent, such as methamphetamine”. Since the patient reacted to naloxone, we can say he was under some sort of substance. then cells being affected. with this disease are the muscle cells.
McCance & Huether (2019) states that rhabdomyolysis may cause a number of serious side effects, such as hyperkalemia (from the release of intracellular potassium into the blood), metabolic acidosis (from the release of intracellular phosphorus and sulfate), acute renal failure (myoglobin precipitates in the tubules, obstructing flow through the nephron and causing injury), and even disseminated intravascular coagulation (DIC) (brought on by activation of the clotting cascade by sarcolemma damage and release of intracellular components from the injured muscles). The patient is experiencing the prolonged PR interval and peaked T waves from the hyperkalemia. The burning pain over his left hip and forearm and necrotic tissue is due to muscle cell contents being released into the bloodstream, irritating surrounding tissues and causing severe muscle damage. The patients present with the following symp0toms due to several factors including possible trauma since he was found on the floor and substance abuse.
If the patient would have had a genetic family history of muscle related diseases in his family, we could possibly attribute the muscle damage to the genetics itself. Matsusue et al (2011) mention that “ion channel mutations may cause further muscle phenotypes, including progressive myopathies, altering muscle structure, thereby highlighting a significant role of ion channels in muscle cell division, proliferation, differentiation, and survival”.
References
Matsusue, A., Hara, K., Kashiwagi, M., Kageura, M., Sugimura, T., & Kubo, S. (2011). Genetic analysis of the rhabdomyolysis-associated genes in forensic autopsy cases of methamphetamine abusers.
Legal Medicine
,
13
(1), 7–11. https://doi.org/10.1016/j.legalmed.2010.08.007McCance, K. L. & Huether, S. E. (2019).
Pathophysiology: The biologic basis for disease in adults and children
(8th ed.). St. Louis, MO: Mosby/Elsevier.Expand discussion thread from Guadalupe Angie Ruelas
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Joseph Costa
Nov 28, 2023 7:21pm
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Last reply Dec 1, 2023 6:29pmReply from Joseph Costa
CASE STUDY:
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. The 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.
All conditions affect the body on a cellular level. High potassium interferes with the cell’s ability to move sodium and potassium across the membrane causing depolarization. The cell membrane cannot function when outside of the optimal range causing the cell to become less effective, if effective at all. Ischemia causes lack of nutrients, oxygen, and ability to remove waste from cells. The substances being used by this individual can be causing an inflammatory response causing the body to attack healthy cells through the immune response. It all comes down to the cells ability to produce ATP, synthesize proteins, and regenerate. Disruptions to this process cause abnormalities resulting in cellular death.
Genetics plays a broad role in most disease processes. Genetics refers to the susceptibility or resistance of any given environmental factor. Whether a disease progresses or not, can be determined by individual genetic makeup. Differences in response to medications can be influenced by genetics. It’s possible for individuals to carry and pass on genetic traits without showing symptoms themselves. Genetic testing can be done to predict the likelihood of developing certain diseases.
Genetics can influence the body’s response to substances and its ability to process and eliminate them. Certain genetic predispositions may affect the metabolism of drugs, leading to toxic build up and complications like hyperkalemia. In this case, if there’s a genetic disposition affecting the kidney’s ability to regulate potassium, it could exacerbate the condition.
The symptoms could be a result of substance abuse leading to prolonged immobility, causing pressure sores and tissue damage. It could also be the substance being used, it could be having a necrotic effect on the tissue itself. The cardiac symptoms are indicative of hyperkalemia , affecting cardiac muscle contractility.
The high potassium level affects the electrical activity of the heart, leading to abnormal EKG findings. The prolonged PR interval and peaked T waves are classic findings in hyperkalemia, reflecting the high potassium on cardiac cells.
Muscle cells are directly affected by high potassium levels, altering their electrical and functional properties. Skin and subcutaneous tissue cells are involved in necrosis due to prolonged pressure and possible ischemia.
Gender and genetics can influence the presentation and severity of these symptoms. For example, genetic differences in potassium channels or drug metabolism enzymes could alter the severity of hyperkalemia and cardiac effects. Additionally gender differences in body composition and cardiovascular responses could influence the presentation and progression of symptoms.
These conditions affect the body on a cellular level. High potassium interferes with the cell’s ability to move sodium and potassium across the membrane causing depolarization. The cell membrane cannot function when outside of the optimal range causing the cell to become less effective, if effective at all. Ischemia causes lack of nutrients, oxygen, and ability to remove waste from cells. The substances being used by this individual can be causing an inflammatory response causing the body to attack healthy cells through the immune response. It all comes down to the cells ability to produce ATP, synthesize proteins, and regenerate. Disruptions to this process cause abnormalities resulting in cellular death.
References:
Lin SH, Yang SS, Chau T. A practical approach to genetic hypokalemia. Electrolyte Blood Press. 2010 Jun;8(1):38-50. doi: 10.5049/EBP.2010.8.1.38. Epub 2010 Jun 30. PMID: 21468196; PMCID: PMC3041498
NIDA. 2023, March 22. New NIH study reveals shared genetic markers underlying substance use disorders. Retrieved from https://nida.nih.gov/news-events/news-releases/2023/03/new-nih-study-reveals-shared-genetic-markers-underlying-substance-use-disorders on 2023, November 27
McCance, K. L. & Huether, S. E. (2019).
Pathophysiology: The biologic basis for disease in adults and children
(8th ed.). St. Louis, MO: Mosby/Elsevier.Chapter 2: Altered Cellular and Tissue Biology: Environmental Agents (pp. 46-61; begin again with Manifestations of Cellular Injury pp. 83-97); Summary Review
Potential complications of IV drug use
. Potential Complications Of IV Drug Use | Semel Institute for Neuroscience and Human Behavior. (n.d.). https://www.semel.ucla.edu/dual-diagnosis-program/News_and_Resources/Potential_Complications_Of_IV_Drug_UseExpand discussion thread from Joseph Costa
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Mark as UnreadBrooke Hurst
Nov 28, 2023 5:15pm
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Last reply Dec 2, 2023 6:22pmReply from Brooke Hurst
Main Posting Response:
The Role Genetics Play
Scientists have discovered through data taken from over 1,000,00 people that genes are commonly inherited across addiction disorders, regardless of the substance being used. Substance use disorders are inheritable by complex genes and multiple environmental factors. (NIDA 2023) Through a lot of research, it has been found that genomic patterns can predict whether a person will have a genetic predisposition to substance use disorders. However, I do not believe that genetics lead to the necrosis that the patient had suffered or hyperkalemia.
Symptom Presentation, Physiologic Response, and Cells
Narcan is an opioid antagonist, meaning that it attaches to the opioid receptors in the brain and blocks the effects of the opioids being used. (NIDA 2022) This could explain why the patient began to complain of the pain that was associated with the necrosis on the left hip and forearm. When it comes to the necrosis in the hip, we can assume that the tissue had became infected and died via autolysis. After research into causes of these symptoms, we can also assume that the patient is in a state of rhabdomyolysis. Rhabdomyolosis can be drug induced and can lead to the interference of ATP production, leading to the death of the tissue. (Cabral et, al. 2020) One of the symptoms of rhabdomyolysis includes hyperkalemia. With the destruction, ATP depletion causes intracellular calcium to increase. The plasma membrane of the cells is supposed to exchange calcium for potassium. The increased number of calcium, leads to the inability to exchange the appropriate amount of potassium, leading to hyperkalemia. (Cabral et, al. 2020) According to many studies, hyperkalemia can lead to noticeable EKG changings. With the change in the potassium level, there is change in the electrical gradient across the membranes of the cell. This can lead to increased usage of the cardiac muscles and rapid repolarization of the ventricles, leading to peaked T-Waves on the EKG. (Parham et. all, 2006)
Other Characteristics
It would be interesting to know how long the patient has been unconscious prior to EMS arriving and administering the narcan. Something else that may change the outcome of my thought process would be to know how long the necrotic tissue had been there prior to the patient overdosing. Could it had been caused by a used needle, which lead to infection? How long had the patient been in active use prior to this event? I am unsure that the sex of the individual would change my response to the scenario.
Cabral, B. M., Edding, S. N., Portocarrero, J. P., & Lerma, E. V. (2020). Rhabdomyolysis.
Disease-a-Month
,
66
(8), 1–21. https://doi.org/10.1016/j.disamonth.2020.101015NIDA (2022).
Naloxone Drug Facts
. https://nida.nih.gov/publications/drugfacts/naloxoneNIDA (2023).
New NIH Study Reveals Shared Genetic Markers Underlying Substance Use Disorders
. https://nida.nih.gov/news-events/news-releases/2023/03/new-nih-study-reveals-shared-genetic-markers-underlying-substance-use-disordersParham, W. A., Mehdirad, A. A., Biermann, K. M., & Fredman, C. S. (2006). Hyperkalemia revisited.
Texas Heart Institute journal
,
33
(1), 40–47.vExpand discussion thread from Brooke Hurst
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Andrea M Ward
Nov 28, 2023 2:59pm
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Last reply Dec 2, 2023 6:07pmReply from Andrea M Ward
Initial Post: Andrea Ward
Scenerio :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. The 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.
The role genetics plays in disease.
Substance abuse has a complex etiology which is influenced by many things. Genetic factors can play a large role in an individual’s susceptibility to substance abuse in several ways. Certain genetic variations may increase the risk of developing substance use disorders. These genetic factors can influence the brain’s reward pathways, making some individuals more susceptible to the reinforcing effects of drugs. For example, “Genes that code for cytochrome enzymes in the liver (CYP variants) can influence how quickly an individual metabolizes a drug, which influences how they respond to medications and other substances” (Mosel,2023). Variations in drug metabolism enzymes can influence the intensity and duration of the drug’s effects. Therefore, a person with a genetic predisposition for slower metabolism of a particular substance may experience more prolonged and intense effects, potentially increasing the risk of substance abuse.
Why the patient is presenting with the specific symptoms described.
The patient was found to be unresponsive with an unknown amount of downtime lying on the floor. The patient is unresponsive due to the toxic levels of the drugs in the body which surpasses the body’s ability to metabolize and eliminate it. The substance which was taken by the patient caused respiratory depression and lack of oxygen to the brain as well as other organs. After the Naloxone was given the patient complained of burning over his left hip and forearm. The ED evaluation revealed that the patient had a large among of necrotic tissue over his hip and The burning pain and necrotic tissue are a result of vasoconstriction and tissue hypoxia caused by increased intracellular calcium. The EKG shows prolonged PR interval and peaked T- waves. The peaked T- waves are an indicator of high potassium. Which is correlated with the serum potassium of 6.9 meq/ml.
The physiologic response to the stimulus presented in the scenario and why you think this response occurred.
Opioids suppress the respiratory system. Leading to slow and shallow breathing, or respiratory arrest. The patient may become hypoxic due to his inability to ventilate himself properly. Which leads to his decreased level of consciousness. Due to his inability to ventilate and oxygenate himself properly the body naturally delivers the oxygen first to the main organs. When muscle and tissues do not get enough oxygen the membrane structure deteriorates and causes cell death. His body is going through rhabdomyolysis. According to the Cleveland Clinic (n.d), during rhabdomyolysis the muscles breakdown and deteriorate into your blood. This includes large amounts of Potassium, Phosphate, Myoglobin, Creatinine Kinase, and urate. Since the Kidneys are responsible for removal of these components from your blood, thru urine. The inability of the kidneys to function properly causes kidney damage, electrolyte abnormalities, and metabolic acidosis. Necrosis happens when there is a “rapid loss of plasma membrane structure, organelle swelling mitochondrial dysfunction and lack of typical features of apoptosis” (McCance, K. L. & Huether, S. E. (2019). So, the lack of oxygenation to the cells caused the cells to breakdown and auto digest. Due to the membrane integrity being lost, the necrotic cell contents leaked out into the tissue.
The inability to excrete Potassium led to the 6.9 meq/ml of potassium in the blood and the peaked T-waves. T waves represent repolarization of the ventricles. During repolarization there is movement of the potassium ions into the cell. Therefore, the peaked T-waves are due to delayed repolarization from excess amount entering the cell.
The cells that are involved in this process.
In an opioid overdose, the primary cells involved in the physiological response are neurons in the brain and spinal cord. Opioids bind to specific opioid receptors which inhibit the release of certain neurotransmitters. According to Rameriez et. al, Opioid receptors are plentiful in the brainstem, specifically in the medulla oblongata. The medulla oblongata is critical for controlling autonomic functions such as respiration and cardiovascular activity. By administering the naloxone, it reversed the effects of the opioid by binding to those receptors. Waking the patient up.
Skeletal muscle cells are the main cells involved in rhabdomyolysis. These cells make up the skeletal muscles, which are under voluntary control and are responsible for body movement. When these cells become damaged or injured, the contents of the muscle cells, including myoglobin’s, get released into the bloodstream. Myoglobin, which is found in muscle cells, is responsible for storing and transporting oxygen. When the muscle cells are damaged, myoglobin is released into the bloodstream. High levels can lead to kidney damage, as the kidneys can struggle to filter and excrete a large amount of this protein.
How another characteristic (e.g., gender, genetics) would change your response.
If the patient were female, the scenario might differ. This is because men generally exhibit a greater muscle mass. Consequently, rhabdomyolysis could potentially result in more severe cases in men compared to women, given their elevated muscle mass. “The incidence of rhabdomyolysis is higher in males than in females, especially in the subgroups of patients with trauma and inherited enzyme deficiencies” (Morales De Guzman, 2021). Understanding the individual’s medical history, including any gender-specific risk factors, can guide the diagnostic and management approach of rhabdomyolysis.
References
Cleveland Clinic. (n.d.).
How do I know if I have rhabdomyolysis?
. Rhabdomyolysis. https://my.clevelandclinic.org/health/diseases/21184-rhabdomyolysisMcCance, K. L. & Huether, S. E. (2019).
Pathophysiology: The biologic basis for disease in adults and children
(8th ed.). St. Louis, MO: Mosby/Elsevier.Morales De Guzman, M. (2021, October 16).
Rhabdomyolysis
. Practice Essentials, Background, Pathophysiology. https://emedicine.medscape.com/article/1007814-overview?form=fpf#a5Mosel, S. (2023, August 29).
Is drug addiction genetic?
. American Addiction Centers.
https://americanaddictioncenters.org/rehab-guide/addiction-genetic
Links to an external site.Ramirez, J. M., Burgraff, N. J., Wei, A. D., Baertsch, N. A., Varga, A. G., Baghdoyan, H. A., Lydic, R., Morris, K. F., Bolser, D. C., & Levitt, E. S. (2021). Neuronal mechanisms underlying opioid-induced respiratory depression: our current understanding.
Journal of neurophysiology
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125
(5), 1899–1919. https://doi.org/10.1152/jn.00017.2021Expand discussion thread from Andrea M Ward
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Oluwatosin Adeyemo
Nov 28, 2023 1:46pm
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Last reply Dec 3, 2023 7:03pmReply from Oluwatosin Adeyemo
The role genetics plays in the disease.
The role that genetics can play in the case study is that, given the patient’s family history, there could be an element of substance abuse linked to the patient’s family lineage. Due to the predisposition to substance abuse, the individual in the case study was more likely to have chronic drug use.
Why the patient is presenting with the specific symptoms described.
The rationale behind some of the symptoms that the patient is undergoing can be attributed to various reasons. One of the issues is the patient’s potassium levels in the blood. Potassium is an essential electrolyte in cardiac contraction and performance(McCance & Huether, 2019). However, the excess buildup in the blood can cause electrical dysrhythmias in the heart. This would explain why the patient has prolonged PR intervals and PTS due to the distribution of appropriate electrical Conduction of the SA, AV, and bundle of his and Purkinje fibers(McCance & Huether, 2019). In addition, the patient could have developed elevated potassium due to the possible extended downtime. We are unsure how long they were on the floor until they received medical attention. Rhabdomyolysis can occur when an individual is on the ground for a prolonged period, which causes musculoskeletal breakdown (Meng et al., 2023). When this occurs, muscle proteins from the breakdown travel through the blood, and once they reach the kidneys, acute kidney damage can occur, causing ineffective filtration and elimination and buildup of electrolytes such as potassium (Meng et al., 2023).
The physiologic response to the stimulus presented in the scenario and why you think this response occurred.
The physiological response that occurs in this scenario happened to this individual for several reasons. Because they used the naloxone on the individual, there is a possibility that what they may have overdosed on is an opiate. In addition to that, the burning necrotic tissue found in the left forearm and left hip area, coupled with the fact that the individual is a substance user, leads me to believe that these necrotic sites are from IV drug insertion. Necrotic and infected tissue can be linked to substance use, especially if the insertion equipment is not clean, reused, and administered in an unsterile manner(Peyrière et al., 2013).
The cells that are involved in this process.
The cells involved in this scenario are the cardiac muscles as well as the electrical pathways of the heart. Due to the necrosis, skin cells are also damaged depending on how deep the closest is. It could affect the dermis epidermis hypodermis, if not more profound, such as musculoskeletal tissue.
Lastly, the cells in the kidneys are also affected if the individual is undergoing Rhabdomyelitis (McCance & Huether, 2019).
References
McCance, K. L. & Huether, S. E. (2019).
Pathophysiology: The biologic basis for disease in adults and children
(8th ed.). St. Louis, MO: Mosby/Elsevier.Meng Y, Zhou M-X, Wu C-B, Wang D-H, Zhao J-R, Shi D-Y. Continuous venovenous hemodiafiltration versus standard medical therapy for the prevention of rhabdomyolysis-induced acute kidney injury: a retrospective cohort study.
BMC
nephrology
. 2023;24
(1):215. doi:10.1186/s12882-023-03242-xPeyrière H, Léglise Y, Rousseau A, Cartier C, Gibaja V, Galland P. Necrosis of the Intranasal Structures and Soft Palate as a Result of Heroin Snorting: A Case Series.
Substance Abuse
. 2013;34
(4):409-414. doi:10.1080/08897077.2013.781565Expand discussion thread from Oluwatosin Adeyemo
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Catrina Michelle Grant
Nov 27, 2023 6:13pm
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Last reply Dec 2, 2023 7:42pmReply from Catrina Michelle Grant
Pathophysiology explains the cause for all diseases, conditions, ailments, etc. It is a means of getting to the root cause of a health problem which also shows us how to correct the deficiency. In this case study, I noticed many systems impacted by the patient’s actions. As opioid abuse continues to be a rising epidemic, the correlating rise in these fatalities are very concerning. Drug overdoses seem obvious on the surface, but the pathophysiology of how this unfortunate adverse effect occurs is quite complex. In this discussion post, I will show the correlation between genetics and addiction, explain the reasoning behind the symptoms mentioned in this case study, the body’s physiologic response, the cells and systems involved and variables that could present a different outcome for the patient.
Role genetics plays in the disease
Nature vs nurture shows that sometimes role our genetics plays gravely supersedes our environment, but not always. Genetic and environmental influences both contribute to addiction, in this case genetics carries the responsibility. For instance, the 5-HTTLR gene, MAOA gene, and the CRHR1 genes are all inherited (Jiang et al., 2023). These are genes responsible, in some way, for the serotonin transfer that is contributes to addiction being passed from one generation to the next. It is estimated that nearly thirty-six million people suffer from substance abuse disorders, currently. 11.7% of those age twelve or older admit to some type of illicit drug use at some point in their lives (CDC, 2022). Heritability accounts for up to 75% of substance abuse and dependency (CDC. , 2022). Stressful life events play a significant role in altering an individuals normal mental health status. When the mental health status is negatively affected, the likelihood of substance abuse exponentially increases.
Why is the patient presenting with the specific symptoms.
With the Narcan treatment being effective in the field in helping the patient to regain consciousness and given the other symptoms he experienced, it is safe to assume his emergency was an opioid drug overdose. Overdoses are a type of chemical injury, an injury in which a cell is exposed to a toxin. In this case, the patient’s affected cells were not able to adapt to the injury which resulted in cellular necrosis of his hip and arm (). IV drug users often experience this due to missing the vein or deterioration of the vascular system in the affected extremities due to repetitive needlesticks. It causes an interruption in the plasma membrane which ultimately prevents protein synthesis and ATP generation resulting in cellular death. In this case, the cellular death manifested itself as necrosis. The effects of the opioid receptor agonism on his cardiovascular system are multifactorial (2023). Usage of illicit drugs in an amount large enough to cause an overdose will affect the polarization of the heart’s atrium and ventricles. This increases the depolarization and repolarization of the SA node, also known as the pacemaker of the heart, thus causing the tachycardia present on his initial assessment (Schiller et al., 2023). With the increased pulse the patient is at increased risk for cardiac tamponade, which is only heightened by his elevated potassium level. Opioid receptor activation enhances the smooth muscle contractility of the potassium channel while inhibiting the calcium channel which, in turn, presents as an elevated potassium level (Schiller et al., 2023).
The physiologic response to the stimulus presented in the scenario and why this response occurred.
I determined that the patient was experiencing an overdose of an opioid of some classification. An overdose occurs when a person has excessive unopposed stimulation of the opiate pathway which decreases the respiratory effort and can cause death (Haynes & Mihailoff, 2018). This is because the opioid acts as a potent antagonist against the mu receptor. The result is a euphoric feeling as it releases dopamine in the brain and blocks pain signals. The mu receptor controls multiple bodily functions such as analgesia, euphoria, respiratory depression, and physical dependence. In the process of an overdose, they are responsible for a decreased medullary response from the medulla oblongata (Iodanova & Reddivari, 2018). This impaired response of this vital part of the brain controls many involuntary functions in the body such as breathing. In essence, opioids block the firing of synapses to and from the medulla which results in a decreased stimulus to breathe and causes apnea. This is why the patient was found unresponsive due to a slowing of involuntary bodily functions when the level of CO2 in his blood became too high (Leader, 2023). He likely went into hypercarbic respiratory failure as a result.
The cells that are involved in this process.
Opiates bind to receptors on nerve cells in the body (Schiller et al., 2023). In normal dosing, they block the pain receptors, but slow your breathing, digestion and heartbeat. In the case of an overdose, they can have an opposite effect on the cardiovascular system. The nerve receptors most affected are a group of proteins, G protein-coupled receptors. These cells are activated inside the nerve cells at the surface. They induce nanobody signaling of the golgi apparatus and the golgi outposts (2018).
How another characteristic (e.g., gender, genetics) would change your response.
If the patient has fewer risk factors, either modifiable or nonmodifiable, my answers would vary slightly. Given there was no genetic predisposition to chemical dependency, the statistics are remarkably diminished . If the user were to not be alone, the risk for an overdose related event would likely decrease as well, given the co-user remains lucid enough to alert EMS. If the user were female, the risk for overdose is tripled as compared to the male counterpart (APA, 2023). All other answers would not change as opioid overdose have a consistent manner of absorption and its relating affects despite genetics, gender, etc. Age related changes makes it more likely that the opiate will cross the blood-brain barrier which can intensify the effects more rapidly and cause a poorer prognosis (CDC, 2019).
In summation, opioid drug overdoses affect a diverse population. Regardless of if it is prescribed or illicit, opioid substance abuse can have grave consequences, including death. Prescriptions should only be taken as prescribed and illicit drugs should be avoided by everyone. Help should be sought for anyone experiencing an addiction to or dependency on opiates before it’s too late. The patient in this case study was fortunate in that emergency medical services were alerted prior to complete suppression of his respiratory drive.
Jiang, Z., Chen, Z., & Chen, X. (2023). Candidate gene-environment interactions in substance abuse: A
systematic review. PLoS ONE, 18(10), 1–31.
https://doi.org/10.1371/journal.pone.0287446
Links to an external site.Overdose. Addiction Center. (2023, October 26).
https://www.addictioncenter.com/drugs/overdose/
Links to an external site.Schiller EY, Goyal A, Mechanic OJ. Opioid Overdose. [Updated 2023 Jul 21].
In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023
Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK470415/
Links to an external site.Haines DE, Mihailoff GA. The Medulla Oblongata. Fundamental Neuroscience for Basic and Clinical
Applications 5e, 2018. Chapter 11, 160-171.
Iordanova R, Reddivari AKR. Neuroanatomy, Medulla Oblongata
(https://www.ncbi.nlm.nih.gov/books/NBK551589/). [Updated 2021 Jul 31]. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2021 Jan-.
Leader, D. (2023, June 12). Health problems can cause excess carbon dioxide blood levels.
Verywell Health. https://www.verywellhealth.com/hypercapnia-symptoms-treatment-
914862
U.S. Department of Health and Human Services. (2018, June 5). How opioid drugs activate
receptors. National Institutes of Health. https://www.nih.gov/news-events/nih-research-
matters/how-opioid-drugs-activate-receptors
American Psychological Association. (2023, July 20). Know the risk factors for an opioid
overdose. https://www.apa.org/topics/substance-use-abuse-addiction/opioids-overdose-
risks
Centers for Disease Control and Prevention. (2019). Overdose deaths involving prescription opioids
among Medicaid enrollees–Washington, 2014–2017. Morbidity and Mortality Weekly Report, 58(42),
1171–1175.
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Rosy Ofili
Nov 27, 2023 4:36pm
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Last reply Dec 2, 2023 11:24pmReply from Rosy Ofili
The scenario presented involves a 27-year-old patient with a history of substance abuse who was found unresponsive and subsequently treated with naloxone. The patient complains of burning pain over the left hip and forearm, and upon evaluation, necrotic tissue is identified over the greater trochanter and forearm. Additionally, the patient exhibits an EKG with a prolonged PR interval and peaked T waves, along with a serum potassium level of 6.9 mEq/L.
The role genetics plays in the disease
.In the context of this scenario, there may be a
genetic predisposition to the patient’s susceptibility to substance abuse
. Genetic factors can influence an individual’s vulnerability to addiction through various mechanisms, including the regulation of neurotransmitter pathways and the response to external stimuli such as drugs. Genetic variability can affect drug metabolism, receptor sensitivity, and the overall neurobiological response to substances of abuse, contributing to the development of substance use disorders (McCance & Huether, 2019).Why the patient is presenting with the specific symptoms described.
The patient’s presentation with burning pain and necrotic tissue over the left hip and forearm suggests a potential complication known as rhabdomyolysis (Cabral et al., 2020). Substance abuse, particularly opioids, can lead to prolonged immobility and pressure on specific body parts, resulting in ischemia and subsequent tissue necrosis. Rhabdomyolysis involves the breakdown of skeletal muscle tissue, releasing myoglobin and other intracellular contents into the bloodstream, leading to tissue damage and potential renal impairment (Cabral et al., 2020). The burning pain is likely a manifestation of the ischemic insult to the affected areas.
The physiologic response to the stimulus presented in the scenario and why you think this response occurred.
The prolonged PR interval and peaked T waves on the EKG, along with the elevated serum potassium level (6.9 mEq/L), are indicative of hyperkalemia (Palmer et al., 2021). Opioid toxicity, as seen in this case, can lead to the inhibition of the sympathetic nervous system, causing a release of acetylcholine. This excess acetylcholine can lead to hyperkalemia by promoting the shift of potassium out of cells. The resultant elevation in serum potassium levels can lead to cardiac conduction abnormalities, manifesting as the observed EKG changes.
The cells that are involved in this process.
Rhabdomyolysis involves the breakdown of skeletal muscle cells (Cabral et al., 2020). The release of intracellular contents, such as myoglobin, can overwhelm the kidneys, potentially leading to acute kidney injury. Additionally, the cardiac conduction abnormalities observed in the EKG involve cells of the cardiac conduction system, specifically affecting the atrioventricular (AV) node and the myocardium.
How another characteristic (e.g., gender, genetics) would change your response.
Another characteristic that could influence the response is the specific substance or substances abused. Different substances have varying effects on the body, and the pharmacogenetics of drug metabolism may vary among individuals. Gender may also play a role, as there can be differences in drug metabolism and susceptibility to certain complications. Furthermore, the presence of any underlying genetic cardiac conditions could exacerbate the observed EKG abnormalities (Palmer et al., 2021).
In conclusion, the presented scenario involves a complex interplay of substance abuse, rhabdomyolysis, and opioid toxicity, with genetic factors potentially contributing to the patient’s susceptibility to substance abuse. The resulting pathophysiology includes tissue necrosis, hyperkalemia, and cardiac conduction abnormalities, highlighting the intricate connections between genetic predisposition, substance abuse, and organ system dysfunction (McCance & Huether, 2019).
References:
Cabral, B. M. I., Edding, S. N., Portocarrero, J. P., & Lerma, E. V. (2020). Rhabdomyolysis.
Disease-a-Month
,
66
(8), 101015.McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier
Muzyk, A., Smothers, Z. P., Collins, K., MacEachern, M., & Wu, L. T. (2019). Pharmacists’ attitudes toward dispensing naloxone and medications for opioid use disorder: a scoping review of the literature. Substance abuse, 40(4), 476-483.
Palmer, B. F., Carrero, J. J., Clegg, D. J., Colbert, G. B., Emmett, M., Fishbane, S., & Weir, M. R. (2021). Clinical management of hyperkalemia. In Mayo Clinic Proceedings (Vol. 96, No. 3, pp. 744-762). Elsevier.