Tag: Clinical-Nursing

  • NURS-6630 Approaches to Treatment quiz

    NURS-6630 Approaches to Treatment quiz QUESTION 1

    Richard is a 54-year-old male who suffers from schizophrenia. After exhausting various medication options, you have decided to start him on Clozapine. Which of the statements below is true regarding Clozapine?a.Regular blood monitoring must be performed to monitor for neutropenia.b.Clozapine can only be filled by a pharmacy that participates in the REMS program.c.Bradycardia is a common side effect of Clozapine.d.A & Be.All of the above

    3.75 points  

    QUESTION 2

    Which of the following statements are true?a.First-generation (typical) antipsychotics are associated with a higher incidence of EPS.b.Second-generation (atypical) antipsychotics are associated with a higher risk of metabolic side effects.c.There is evidence that atypical antipsychotics are significantly more effective than typical antipsychotics in the treatment of cognitive symptoms associated with schizophrenia.d.A & Be.A, B, and C

    3.75 points  

    QUESTION 3

    Cindy is a 55-year-old patient who presents with symptoms consistent with Generalized anxiety disorder. The patient has an unremarkable social history other than she consumes two or three glasses of wine per night. Which of the following would be an appropriate therapy to start this patient on?a.Xanax 0.25mg BID PRN Anxietyb.Escitalopram 10mg dailyc.Buspirone 10mg BIDd.Aripiprazole 10mg daily

    3.75 points  

    NURS-6630 Approaches to Treatment quiz QUESTION 4

    Mirza is a 75-year-old patient with a long history of schizophrenia. During the past 5 years, she has shown significant cognitive decline consistent with dementia. The patient has been well controlled on a regimen of risperidone 1mg BID. As the PMHNP, the most appropriate course of action for this patient is:a.Increase the risperidone to 1mg QAM, 2mg QPMb.Discontinue risperidone and prescribe a long-acting injectable such as Invega Sustenna.c.Discontinue risperidone and initiate therapy with clozapine.d.Augment the patient’s risperidone with brexpiprazole.

    3.75 points  

    QUESTION 5

    The patient in the previous question states, “I can’t even last 1 more day without feeling like my insides are going to explode with anxiety.” The most appropriate course of action would be:a.Inform the patient to try yoga or other natural remedies until the vortioxetine takes effect.b.Prescribe a short-term course of low dose benzodiazepine, such as alprazolam.c.Prescribe an SNRI, such as venlafaxine, in addition to the vortioxetine.d.Recommend in-patient mental health for the foreseeable future.

    3.75 points  

    QUESTION 6

    Thomas is a 28-year-old male who presents to the clinic with signs and symptoms consistent with MDD. He is concerned about starting antidepressant therapy, however, because one of his friends recently experienced erectile dysfunction when he was put on an antidepressant. Which of the following would be the most appropriate antidepressant to start Thomas on?a.Vilazodoneb.Sertralinec.Paroxetined.Citalopram

    3.75 points  

    QUESTION 7

    Stephanie is a 36-year-old female who presents to the clinic with a history of anxiety. Social history is unremarkable. For the last 4 years, she has been well controlled on paroxetine, however she feels “it just doesn’t work anymore.” You have decided to change her medication regimen to vortioxetine 5mg, titrating up to a max dose of 20mg per day based on tolerability. The patient asks, “When can I expect this to start kicking in?” The best response is:a.3 or 4 daysb.1 or 2 weeksc.3 or 4 weeksd.10 weeks

    3.75 points  

    QUESTION 8

    Jane is a 17-year-old patient who presents to the office with signs consistent with schizophrenia. She states multiple times that she is concerned about gaining weight, as she has the perfect prom dress picked out and she finally got a date. Which of the following is the least appropriate choice to prescribe Jane?a.Aripiprazoleb.Olanzapinec.Haloperidold.Brexpiprazole

    3.75 points  

    NURS-6630 Approaches to Treatment quiz QUESTION 9

    John is a 41-year old-patient who presents to the clinic with diarrhea, fatigue, and recently has been having tremors. He was diagnosed 19 years ago with bipolar disorder and is currently managed on Lithium 300mg BID. As the PMHNP, you decide to order a lithium level that comes back at 2.3mmol/l. What is the most appropriate course of action?a.Investigate other differential diagnoses for his symptoms.b.Tell John to skip his next four Lithium doses and resume therapy.c.Tell John he needs to go to the hospital and call an ambulance to bring him.d.Prescribe loperamide to treat the diarrhea and ropinirole to treat the tremors

    3.75 points  

    QUESTION 10

    Jordyn is a 27-year-old patient who presents to the clinic with GAD. She is 30 weeks pregnant and has been well controlled on a regimen of sertraline 50mg daily. Jordyn says that “about once or twice a week my husband really gets on my nerves and I can’t take it.” She is opposed to having the sertraline dose increased due to the risk of further weight gain. You have decided to prescribe the patient a short-term course of benzodiazepines for breakthrough anxiety. Which of the following is the LEAST appropriate benzodiazepines to prescribe to this patient?a.diazepamb.alprazolamc.clonazepamd.lorazepam

    3.75 points  

    QUESTION 11

    Rebecca is a 32-year-old female who was recently prescribed escitalopram for MDD. She presents to the clinic today complaining of diaphoresis, tachycardia, and confusion. The differential diagnosis for this patient, based on the symptoms presenting, is:a.Panic disorderb.Gastroenteritisc.Abnormal gaitd.Serotonin syndrome

    3.75 points  

    QUESTION 12

    Mark is a 46-year-old male with treatment-resistant depression. He has tried various medications, including SSRIs, SNRI, and TCAs. You have decided to initiate therapy with phenelzine. Which of the following must the PMHNP take into consideration when initiating therapy with phenelzine?a.There is a minimum 7-day washout period when switching from another antidepressant to phenelzine.b.Patient must be counseled on dietary restrictions.c.MAOIs may be given as an adjunctive therapy with SSRIs.d.A & Be.All of the above

    3.75 points  

    QUESTION 13

    Melvin is an 89-year-old male who presents to the clinic with signs/symptoms consistent with MDD. Which of the following would be the LEAST appropriate medication to prescribe to this elderly patient?a.nortriptylineb.amitriptylinec.desipramined.trazodone

    3.75 points  

    QUESTION 14

    Earle is an 86-year-old patient who presents to the hospital with a Community Acquired Pneumonia. During stay, you notice that the patient often seems agitated. He suffers from cognitive decline and currently takes no mental health medications. Treatment for the CAP include ceftriaxone and azithromycin. The LEAST appropriate medication to treat Earle’s anxiety is:a.sertralineb.duloxetinec.citalopramd.venlafaxine

    3.75 points  

    NURS-6630 Approaches to Treatment quiz QUESTION 15

    Martin is a 92-year-old male who presents to the clinic with signs/symptoms consistent with MDD. The patient suffers from glaucoma and just recently underwent surgery for a cataract. Which of the following is the LEAST appropriate course of therapy when treating the MDD?a.sertralineb.amitriptylinec.duloxetined.vilazodone

    3.75 points  

    QUESTION 16

    Sam is a 48-year-old male who presents to the clinic with signs and symptoms consistent with GAD & MDD. Which of the following medications would be the LEAST appropriate choice when initiating pharmacotherapy?a.duloxetineb.sertralinec.mirtazapined.buproprion

    3.75 points  

    QUESTION 17

    Steve is a 35-year-old male who presents to the primary care office complaining of anxiety secondary to quitting smoking cold turkey 2 weeks ago. The patient has a 14-year history of smoking two packs per day. The patient has an unremarkable social history other than a recent divorce from his wife, Brittany. Which of the following would be the LEAST effective medication to treat Steve’s anxiety?a.Buproprionb.Sertralinec.Vareniclined.Alprazolam

    3.75 points  

    QUESTION 18

    Amber is a 26-year-old female who presents to the clinic 6 weeks postpartum. The patient states that she has been “feeling down” since the birth of her son. She is currently breastfeeding her infant. You diagnose the patient with Postpartum depression. Which of the following is the LEAST appropriate option in treating her PPD?a.paroxetineb.escitalopramc.citalopramd.sertraline

    3.75 points  

    QUESTION 19

    Which of the following medications, when given intramuscularly, is most likely to cause severe postural hypotension?a.haloperidolb.lorazepamc.benztropined.chlorpromazine

    3.75 points  

    NURS-6630 Approaches to Treatment quiz QUESTION 20

    Jason is a 6-year-old child whose mother presents to the clinic with him. The mother says that “he’s not himself lately.” After a thorough workup, you diagnose the patient as having GAD. Which of the following medications would be the LEAST appropriate to prescribe to this child?a.Sertralineb.Paroxetinec.Venlafaxined.Buspirone

  • Developmental markers for a 9-month-old discussion post

    Re: Topic 1 DQ 2 – Developmental markers for a 9-month-old discussion post

    Developmental markers for a 9-month-old include transfers objects from one hand to another, feeds self finger foods, sits without support, pulls self to standing position and stands while holding on to a support. At this age they will also be beginning to drink from a cup with assistance, poke at objects with a finger, take objects out of a container, stand alone, cruise along furniture, and potentially take steps while hold on. (Green 2018) Although the nurse may not be able to personally assess all these areas in person, they can interview the parent to find out what the baby is doing at home. Developmental markers for a 9-month-old discussion post. During the interview, the nurse will assess the baby’s behavior in the office. Between 4 to 6 months, the infant makes vocalizations that sound like
    ah
     or 
    oo
    . Babbling, laughing, and blowing bubbles characterize the vocalizations of a 6- to 9-month-old. By 9 to 12 months, the infant responds to simple verbal commands from others, such as 
    no
    , and imitates sounds, such as 
    mama
     or 
    dada
    , but does not initially associate the sound with a mom or dad (CDC, 2017b). (Green 2018) Parent should also be informed what to do if their baby does not meet certain mild stones such as does not respond to own name, doesn’t seem to recognize familiar people, doesn’t look where you point, and can’t sit up with help or bear weight on legs with support. (CDC 2020)Nutrition wise the parents should be advised on what types of food and drink are age appropriate. Juice is not recommended for babies under one year old. Juice may make babies less hungry for healthy foods. It may also be bad for new teeth that are forming. Your baby’s main drink should still be breastmilk or formula but give your baby a little water in a cup to practice drinking from a cup. (Child profile 2020) A 9-month-old baby should have small, soft, finger foods that are easily chewed. Grapes and hotdogs should not be given to a baby as they pose a big choking hazard Developmental markers for a 9-month-old discussion post.

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    At any age, but certainly during infancy and toddler ages the nurse will discuss safety issues with the parents or caregivers. Along with choking hazards, at 9 months key talking points will include car seat safety, preventing falls, staying with the baby during bath time the entire time to avoid a drowning accident.

    As far as immunizations, there are not any due at this visit unless previously missed and this time should be used to make them up. Influenza vaccine is the only one that may come up if it is the appropriate time of the year. Developmental markers for a 9-month-old discussion post

     

    References:

    Green, S. (2018). Health assessment, Foundations for effective practice 
    Health Assessment of the Infant
    . Grand Canyon University. 
    https://lc.gcumedia.com/nrs434vn/health-assessment-foundations-for-effective-practice/v1.1/#/chapter/1

     

    CDC 
    Important Milestones: Your Baby By Nine Months
    . (2020) retrieved from; 
    https://www.cdc.gov/ncbddd/actearly/milestones/milestones-9mo.html

     

    Child profile 
    Nutrition at 9 mont
    hs retrieved from: 
    https://cp.doh.wa.gov/

     

    Topic 1 DQ 2

     

    Consider the following patient scenario:

    A mother comes in with 9-month-old girl. The infant is 68.5cm in length (25th percentile per CDC growth chart), weighs 6.75kg (5th percentile per CDC growth chart), and has a head circumference of 43cm (25th percentile per CDC growth chart) Developmental markers for a 9-month-old discussion post.

    Describe the developmental markers a nurse should assess for a 9-month-old female infant. Discuss the recommendations you would give the mother. Explain why these recommendations are based on evidence-based practice.

     

     Topic 1 DQ 2

    Most babies by age 9 months for socialization and vocalization assessments “are able to clap hands, responds to own name, imitates gestures and sounds and begin to fear strangers” ( Ward, 2016) Developmental markers for a 9-month-old discussion post. Under motor, ward states that most children can sit without support, pull self-upright, feed self a cracker and can hold a bottle. In assition a 9 month old child should be able to control lips around a cup and use pincer grasp reflex ( ward, 2016). For cognitive and emotional the child will begin to imitate show interest in picture booksm ebhiy achievements, have strong urge toward independence.For the nutritional assessment, the child should be able to use a cup, hold own bottle, feed self a cracker, pick up cheerios using pincer grasp reflex (Ward, 2016). The child should be able to eat pureed foods and small cut up pieces of food as well. It is important to assess dietary intake such as eating behaviors and feeding problems. Usual appetite and preferences chewing, and swallowing problems should be evaluated. The child should also still be receiving either breastmilk or formula. It is important to also screen for anemia and lead blood test. According to CDC immunizations needed by 9 month are the 3rd dose of Hep B and inactivated poliovirus and influenza vaccine if in the flu season ( Sept-Oct) Developmental markers for a 9-month-old discussion post.The biggest concern for the 9 month old girl is her low weight. Disproportionate to her head size and length a look at eating habits should be questioned with the mother. Evaluating the other’s socioeconomic status and ability to provide ample nutrition for herself and her child. If there is an issue with finances the nurse should refer mother to health department for resources like WIC ( women, infant and children). Developmental markers for a 9-month-old discussion post

     

    References:

    cdc.gov/vaccines/schedules/hcp/imz/child-adolescent-shell.html#birth-15

    Green, S. (2020). Health Assessment: Foundations for Effective Practice. Retrieved January 16, 2021 from:https://lc.gcumedia.com/nrs434vn/health-assessment-foundations-for-effective-practice/v1.1/#/chapter/1

    Ward, S. L., Hisley, S. M., & Kennedy, A. M. (2016). 
    Maternal-child nursing care: Optimizing outcomes for Mothers, children, and families
    . Philadephia, Pa: F. A. Davis Company. Developmental markers for a 9-month-old discussion post

  • Asthma Exacerbation Gabriel Martinez shadow health Objective Data

    Asthma Exacerbation Gabriel Martinez shadow health Objective Data

    Objective Data Collection: 9.6 of 11 (87.27%)

     Correct

     Partially correct

     Incorrect

     Missed

     Assessed Vitals – Pre-Intervention

    0.8 of 1 point

    Temperature 
    (1/5 point)

     Normothermic

     Hyperthermic

     Hypothermic

    Blood Pressure 
    (1/5 point)

     Normotensive

     Hypertensive

     Hypotensive

    Heart Rate 
    (1/5 point)

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     No abnormal findings

     Tachycardia

     Bradycardia

    Respiratory Rate 
    (1/5 point)

     No abnormal findings

     Tachypnea

     Bradypnea

    Oxygen Saturation 
    (No point)

     No abnormal findings

     Hypoxemia

     Auscultated Breath Sounds – Pre-Intervention

    Asthma Exacerbation Gabriel Martinez shadow health Objective Data

    1 of 1 point

    Breath Sounds 
    (1/1 point)

     Normal Breathing

     Expiratory wheezing

     Inspiratory wheezing

     Diminished breath sounds

    Asthma Exacerbation Gabriel Martinez shadow health Objective Data

     Inspected Chest – Pre-Intervention

    1 of 1 point

    Sites Of Retraction 
    (1/1 point)

     No visible abnormal findings

     Superclavicular

     Supersternal

     Substernal

     Subcostal

     Intercostal

     Assess Dyspnea – Pre-Intervention

    1 of 1 point

    Speech Characteristics 
    (1/1 point)

     Speaks full sentences

     Speaks partial sentences

     Speaks short phrases OR single words

     Assessed PAS – Pre-Intervention

    0 of 1 point

     Assessed Vitals

    0.8 of 1 point

     Auscultated Breath Sounds

    1 of 1 point

     Inspected Chest

    1 of 1 point

    Symmetry 
    (1/3 point)

     Symmetric

     Asymmetric

    Appearance 
    (1/3 point)

     No visible abnormal findings

     Rash

     Barrel chest

     Excessive use of accessory muscles while breathing

     Skin growths (freckles or moles)

    Asthma Exacerbation Gabriel Martinez shadow health Objective Data

    Sites Of Retractions 
    (1/3 point)

     No visible abnormal findings

     Superclavicular

     Supersternal

     Substernal

     Subcostal

     Intercostal

     Assess Dyspnea

    1 of 1 point

     Assessed PAS

    1 of 1 point

     Assessed Growth

    1 of 1 point Asthma Exacerbation Gabriel Martinez shadow health Objective Data

  • NRS-434VN Topic 1: The Health Assessment of Infants

    NRS-434VN Topic 1: The Health Assessment of Infants

    Objectives:

    Apply evidence-based practice to health promotion for infants.

    Examine environmental factors that increase risk to infant health.

    Propose health promotion strategies for the infant.

    NRS-434VN Topic 1 DQ 1

    Premature birth is birth that happens too soon, before 37 weeks of pregnancy. Babies born this early may have more health problems or may need to stay in the hospital longer than babies born later. Each year in the United States, about 1 in 10 babies is born prematurely NRS-434VN Topic 1: The Health Assessment of Infants. Prematurity can cause long-term health problems for babies. This can have long-lasting financial effects and can affect a person’s education and ability to work. ( Marchofdimes.org)

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    According to marchofdines, in 2007 the IOM reported the cost associated with premature birth in the United States was $26.2 billion each year and $16.9 billion went into medical and health care costs, $ 1.9 billion in labor and delivery costs for mom, $ 611 milllion for early intervention services for children from birth to age 3 with disabilities and developmental delays. $ 1.1 billion for special education services and $5.7 billion in lost work and pay for people born prematurely. The impact economically on the society is huge in that these funds could have gone into developing the society in other ways. Interesting enough, the cause of these extremely low birth weight are mostly modifiable ones like smoking, alcohol and/ or drug use, poor nutrition, chronic illness, hormone imbalance among others that mother can be educated to not to engage in if they have the desire to be pregnant and have babies. This information to the potential parent is extremly important because of the effects on the babies, parents and the society/ community NRS-434VN Topic 1: The Health Assessment of Infants.

    According to Center for American Progress, pregnancy-related complications are closely tied to infant deaths and nearly two-thirds of infants deaths occur during the first month after birth, often from congenital abnormalities and complications from preterm births. African Americans have the highest infact mortality rate of any racial or ethnic group in the United States and higher rates of preterm births explain more than half of the difference, relative to non- Hispanic white women.

    March of Dimes is a support group that fight for the health of all moms and babies. They adcocate for policies to protect and work to improve the health care they receive. They also pioneer research to find solutions by empowering families with the knowledge and tools to have healtheir pregnancies by uniting communities and building a brighter future for all.

     

    References

    March of Dimes. (n.d). Retrieved January 16, 2021, 
    https://www.marchofdimes.org/mission/the-economic-and-societal-costs.aspx?gclid=EAIaIQobChMIkoG5vLWg7gIVuv_jBx0zjgAqEAAYAiAAEgJ6dPD_BwE

    Birth Defect Research for children (n.d). Retreived January 17, 2021 from 

    Premature Births: Causes & Prevention

    Taylor, J., Novoa, C., Hamm, K., and Phadke, S., (2019). Eliminating Racial Disparities in Maternal and Infant Mortality. Retrieved January 16, 2021 from: https://www.americanprogress.org/issues/women/reports/2019/05/02/469186/eliminating-racial-disparities-maternal-infant-mortality/

    Environmental Factors and Health Promotion Presentation: Accident Prevention and Safety Promotion for Parents and Caregivers of Infants

     

    You are required to submit this assignment to LopesWrite. Refer to the 
    LopesWrite Technical Support articles
     for assistance.

    The growth, development, and learned behaviors that occur during the first year of infancy have a direct effect on the individual throughout a lifetime. For this assignment, research an environmental factor that poses a threat to the health or safety of infants and develop a health promotion that can be presented to caregivers.

    Create a 10-12 slide PowerPoint health promotion, with speaker notes, that outlines a teaching plan. For the presentation of your PowerPoint, use Loom to create a voice over or a video. Include an additional slide for the Loom link at the beginning, and an additional slide for references at the end.

    In developing your PowerPoint, take into consideration the health care literacy level of your target audience, as well as the demographic of the caregiver/patient (socioeconomic level, language, culture, and any other relevant characteristic of the caregiver) for which the presentation is tailored.

    Include the following in your presentation:

    Describe the selected environmental factor. Explain how the environmental factor you selected can potentially affect the health or safety of infants.

    Create a health promotion plan that can be presented to caregivers to address the environmental factor and improve the overall health and well-being of infants.

    Offer recommendations on accident prevention and safety promotion as they relate to the selected environmental factor and the health or safety of infants.

    Offer examples, interventions, and suggestions from evidence-based research. At least three scholarly resources are required. Two of the three resources must be peer-reviewed and no more than 6 years old.

    Provide readers with two community resources, a national resource, and a Web-based resource. Include a brief description and contact information for each resource. NRS-434VN Topic 1: The Health Assessment of Infants

    Refer to the resource, “Creating Effective PowerPoint Presentations,” located in the Student Success Center, for additional guidance on completing this assignment in the appropriate style.

    Refer to the resource, “Loom,” located in the Student Success Center, for additional guidance on recording your presentation.

    While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

    This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion NRS-434VN Topic 1: The Health Assessment of Infants.

    You are required to submit this assignment to LopesWrite. Refer to the 
    LopesWrite Technical Support articles
     for assistance.

    Shadow Health: Digital Clinical Experience Orientation

     

    Within the Shadow Health platform, complete the Digital Clinical Experience Orientation. Upon completion, submit the lab pass through the assignment dropbox. NRS-434VN Topic 1: The Health Assessment of Infants

    You are not required to submit this assignment to LopesWrite.

    Topic 1 DQ 1

     

    Describe the effect of extremely low birth weight babies on the family and community. Consider short-term and long-term impacts, socioeconomic implications, the need for ongoing care, and comorbidities associated with prematurity. Explain how disparities relative to ethnic and cultural groups may contribute to low birth weight babies. Identify one support service within your community to assist with preterm infants and their families and explain how the service adequately addresses the needs of the community, or a population in your community. Provide the link to the resource in your post NRS-434VN Topic 1: The Health Assessment of Infants.

    Topic 1 DQ 2

     

    Consider the following patient scenario:

    A mother comes in with 9-month-old girl. The infant is 68.5cm in length (25th percentile per CDC growth chart), weighs 6.75kg (5th percentile per CDC growth chart), and has a head circumference of 43cm (25th percentile per CDC growth chart).

    Describe the developmental markers a nurse should assess for a 9-month-old female infant. Discuss the recommendations you would give the mother. Explain why these recommendations are based on evidence-based practice.

    Developmental markers for a 9 -month- old infant include; Social and Emotional: may be afraid of strangers, may be clingy with familiar adults, has favorite toys. Language/Communication: understands “no”, makes a lot of different sounds like “mama” and “baba”, copies sounds and gestures of others, and uses fingers to point at things. Cognitive: watches the path of something as it falls, looks for things she sees you hide, plays peek-a-boo, puts things in his mouth, can move things smoothly from one hand to the other, picks up things between thumb and index finger. Movement/Physical Development: stands, holding on, can get into sitting position, sits without support, pulls to stand, and crawls (CDCa, 2018) NRS-434VN Topic 1: The Health Assessment of Infants.

    With the information provided regarding a 9 – month -old female infant, the 25th percentile of height and weight for age is on the low end of the spectrum but still may be appropriate for this infant. The head circumference is concerning at the 5th percentile. Based on this information questions to the caregiver would relate to how the baby is feeding. Has the caregiver introduced pureed foods one at a time such as fruits and vegetables? Is the baby breast-feeding and if so, is the mother producing adequate milk? Is the baby latching? Have you introduced finger foods? Also included in the interview would be any family stressors on the primary caregiver to assess for adaptation problems (CDCb, 2018).

    Evidenced based practice for infant nutrition recommends exclusive breast feeding to the age of 6months and then introducing complementary foods such as infant cereals, fruits and vegetables. Finger foods may also be introduced. Teaching the caregiver proper techniques for breastfeeding or the need to feed the baby breast milk from a bottle may be required. In addition to proper feeding, care of the supplies for feeding such as, breast pumps and bottles should be included. Vitamin D and iron supplements are typically required for infants and should be introduced. Following assessment of the infant and education for the caregiver, appropriate resources within the community should be provided (CDCb, 2018). NRS-434VN Topic 1: The Health Assessment of Infants

    Reference:

    CDCa., Centers for Disease Control. (2018). Growth charts. Retrieved from 
    https://www.cdc.gov/growthcharts/who_charts.htm

    CDCb., Centers for Disease Control. (2018) Infant and Toddler Nutrition. Retrieved from: 
    https://www.cdc.gov/nutrition/InfantandToddlerNutrition/index.html

    Grand Canyon University. (2018). Health Assessment of the Infant. In Health Assessment Foundation for Effective Practice (1.1 ed.). :

    Important Milestones: Your Baby By Nine Months. (2014). Retrieved from 
    https://www.acf.hhs.gov/sites/default/files/ecd/screening_compendium_march2 014.pdf
        NRS-434VN Topic 1: The Health Assessment of Infants

  • Gabriel Martinez Focused Exam: Asthma Exacerbation shadow health Subjective Data

    Gabriel Martinez Focused Exam: Asthma Exacerbation shadow health Subjective Data

    Subjective Data Collection: 31 of 31 (100.0%)

    Hover To Reveal…

    Hover over the 
    Patient Data
     items below to reveal important information, including 
    Pro Tips
     and 
    Example Questions
    .

    Found:

     Indicates an item that you found.

    Available:

     Indicates an item that is available to be found.

    Gabriel Martinez Focused Exam: Asthma Exacerbation shadow health Subjective Data

    Category

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    Scored Items

    Experts selected these topics as essential components of a strong, thorough interview with this patient.

    Patient Data

    Not Scored

    A combination of open and closed questions will yield better patient data. The following details are facts of the patient’s case.

    Chief Complaint Patient

    Finding:

    Asked about patient’s status

    Finding:

    Reports breathing is better

    (Found)

    Pro Tip: Assessing a pediatric patient’s status involves asking about their current comfort, needs, and chief complaint. It’s important to check in with a patient’s status, because it may reveal insight into their current condition.

    Gabriel Martinez Focused Exam: Asthma Exacerbation shadow health Subjective Data

    Example Question:

    How are you?

    Finding:

    Reports chest soreness

    (Found)

    Pro Tip: Assessing a pediatric patient’s status involves asking about their current comfort, needs, and chief complaint. It’s important to check in with a patient’s status, because it may reveal insight into their current condition.

    Example Question:

    How are you?

    Finding:

    Followed up on symptoms

    Finding:

    Reports wheezing

    (Found)

    Pro Tip: Assessing a pediatric patient’s status involves asking about their current comfort, needs, and chief complaint. It’s important to check in with a patient’s status, because it may reveal insight into their current condition.

    Gabriel Martinez Focused Exam: Asthma Exacerbation shadow health Subjective Data

    Example Question:

    What is your chief complaint?

    Finding:

    Reports coughing is less frequent

    (Found)

    Pro Tip: Assessing a pediatric patient’s status involves asking about their current comfort, needs, and chief complaint. It’s important to check in with a patient’s status, because it may reveal insight into their current condition.

    Example Question:

    What is your chief complaint?

    Finding:

    Reports chest does not feel as tight

    (Found)

    Pro Tip: Assessing a pediatric patient’s status involves asking about their current comfort, needs, and chief complaint. It’s important to check in with a patient’s status, because it may reveal insight into their current condition.

    Gabriel Martinez Focused Exam: Asthma Exacerbation shadow health Subjective Data

    Example Question:

    What is your chief complaint?

    History of Present Illness Patient

    Finding:

    Followed up on onset of symptoms

    Finding:

    Reports symptoms started after playing kickball

    (Found)

    Pro Tip: Asking a pediatric patient about the duration and onset of their current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing.

    Example Question:

    What brings you to the hospital?

    Finding:

    Reports full-on asthma attack began when he got home

    (Found)

    Pro Tip: Asking a pediatric patient about the duration and onset of their current health issues solicits information relevant to the history of their present illness.

    Gabriel Martinez Focused Exam: Asthma Exacerbation shadow health Subjective Data

    Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing.

    Example Question:

    What brings you to the hospital?

    Finding:

    Followed up on aggravating factors

    Finding:

    Reports secondhand smoke exposure

    (Found)

    Pro Tip: Asking a pediatric patient about the duration and onset of their current health issues solicits information relevant to the history of their present illness

    Gabriel Martinez Focused Exam: Asthma Exacerbation shadow health Subjective Data

    . Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing.

    Example Question:

    What triggers your asthma?

    Finding:

    Denies being around secondhand smoke normally

    (Found)

    Pro Tip: Asking a pediatric patient about the duration and onset of their current health issues solicits information relevant to the history of their present illness.

    Gabriel Martinez Focused Exam: Asthma Exacerbation shadow health Subjective Data

    Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing.

    Example Question:

    What triggers your asthma?

    Home Medications Patient

    Finding:

    Followed up on rescue inhaler adherence

    Finding:

    Reports carrying rescue inhaler with him in the past

    (Found)

    Pro Tip: A pediatric patient’s home medications can provide insight into the patient’s current treatment and its efficacy. Inquiring into medication history, dosage, and frequency will help you understand the patient’s background and how it may affect their current situation.

    Example Question:

    What is the name of the rescue inhaler you are currently using?

    Finding:

    Reports throwing away the rescue inhaler a few weeks ago

    (Found)

    Pro Tip: A pediatric patient’s home medications can provide insight into the patient’s current treatment and its efficacy.

    Gabriel Martinez Focused Exam: Asthma Exacerbation shadow health Subjective Data

    Inquiring into medication history, dosage, and frequency will help you understand the patient’s background and how it may affect their current situation.

    Example Question:

    What is the name of the rescue inhaler you are currently using?

    Finding:

    Reports disliking rescue inhaler because of side effects

    (Found)

    Pro Tip: A pediatric patient’s home medications can provide insight into the patient’s current treatment and its efficacy. Inquiring into medication history, dosage, and frequency will help you understand the patient’s background and how it may affect their current situation.

    Example Question:

    What do you take for your asthma?

    Finding:

    Asked about side effects of rescue inhaler

    Finding:

    Reports rescue inhaler made him feel shaky

    (Found)

    Pro Tip: A pediatric patient’s home medications can provide insight into the patient’s current treatment and its efficacy. Inquiring into medication history, dosage, and frequency will help you understand the patient’s background and how it may affect their current situation.

    Example Question:

    Have you experienced medication side effects before?

    Finding:

    Reports rescue inhaler made his heart beat fast

    (Found)

    Pro Tip:

    Gabriel Martinez Focused Exam: Asthma Exacerbation shadow health Subjective Data

    A pediatric patient’s home medications can provide insight into the patient’s current treatment and its efficacy. Inquiring into medication history, dosage, and frequency will help you understand the patient’s background and how it may affect their current situation.

    Example Question:

    Have you experienced medication side effects before?

    Social History Patient

    Finding:

    Asked about exercise

    Finding:

    Reports being mostly sedentary

    (Found)

    Pro Tip: A pediatric patient’s social history encompasses their family and support system, living situation, and daily behaviors such as diet and exercise. Even though you are working with pediatric patients, it is important to ask about sexual activity and substance use. These factors can influence their current health and wellness. Asking about a pediatric patient’s social history can also unveil the influence of their present illnesses in their social lives.

    Example Question:

    Do you exercise?

    Finding:

    Asked about living situation

    Finding:

    Reports living with mother in an apartment

    (Found)

    Pro Tip: A pediatric patient’s social history encompasses their family and support system, living situation, and daily behaviors such as diet and exercise. Even though you are working with pediatric patients, it is important to ask about sexual activity and substance use. These factors can influence their current health and wellness.

    Gabriel Martinez Focused Exam: Asthma Exacerbation shadow health Subjective Data

    Asking about a pediatric patient’s social history can also unveil the influence of their present illnesses in their social lives.

    Example Question:

    Where do you live?

    Finding:

    Asked about patient’s substance use

    Finding:

    Denies alcohol use

    (Found)

    Pro Tip: A pediatric patient’s social history encompasses their family and support system, living situation, and daily behaviors such as diet and exercise. Even though you are working with pediatric patients, it is important to ask about sexual activity and substance use. These factors can influence their current health and wellness. Asking about a pediatric patient’s social history can also unveil the influence of their present illnesses in their social lives.

    Example Question:

    Do you drink alcohol?

    Finding:

    Denies using tobacco products

    (Found)

    Pro Tip: A pediatric patient’s social history encompasses their family and support system, living situation, and daily behaviors such as diet and exercise. Even though you are working with pediatric patients, it is important to ask about sexual activity and substance use. These factors can influence their current health and wellness.

    Gabriel Martinez Focused Exam: Asthma Exacerbation shadow health Subjective Data

    Asking about a pediatric patient’s social history can also unveil the influence of their present illnesses in their social lives.

    Example Question:

    Do you smoke cigarettes?

    Finding:

    Asked about education

    Finding:

    Reports being in 3rd grade

    (Found)

    Pro Tip: A pediatric patient’s social history encompasses their family and support system, living situation, and daily behaviors such as diet and exercise. Even though you are working with pediatric patients, it is important to ask about sexual activity and substance use. These factors can influence their current health and wellness. Asking about a pediatric patient’s social history can also unveil the influence of their present illnesses in their social lives.

    Example Question:

    What education do you have?

    Review of Relevant Systems Patient

    Finding:

    Asked about cardiovascular system

    Finding:

    Reports heart is racing

    (Found)

    Pro Tip: Understanding a pediatric patient’s health involves a comprehensive overview of their physiological systems. This is necessary to understand what symptoms may indicate larger issues, and what treatments the patient may require.

    Gabriel Martinez Focused Exam: Asthma Exacerbation shadow health Subjective Data

    Example Question:

    Is your heartbeat normal?

    Finding:

    Asked about integumentary system

    Finding:

    Denies current skin problems

    (Found)

    Pro Tip: Understanding a pediatric patient’s health involves a comprehensive overview of their physiological systems. This is necessary to understand what symptoms may indicate larger issues, and what treatments the patient may require.

    Example Question:

    Do you have skin problems? Gabriel Martinez Focused Exam: Asthma Exacerbation shadow health Subjective Data

    Finding:

    Reports using prescription cream to treat skin

    (Found)

    Pro Tip: Understanding a pediatric patient’s health involves a comprehensive overview of their physiological systems. This is necessary to understand what symptoms may indicate larger issues, and what treatments the patient may require.

    Example Question:

    Do you have skin problems?

    Finding:

    Asked about mental health

    Finding:

    Reports frustration with diagnosis

    (Found)

    Pro Tip: Understanding a pediatric patient’s health involves a comprehensive overview of their physiological systems. This is necessary to understand what symptoms may indicate larger issues, and what treatments the patient may require. Gabriel Martinez Focused Exam: Asthma Exacerbation shadow health Subjective Data

    Example Question:

    Are you depressed?

    History of Present Illness Guardian

    Finding:

    Followed up on patient’s asthma diagnosis

    Finding:

    Reports patient has mild asthma

    (Found)

    Pro Tip: Asking a pediatric patient’s guardian about the duration and onset of the patient’s current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing. Gabriel Martinez Focused Exam: Asthma Exacerbation shadow health Subjective Data

    Example Question:

    What are your son’s symptoms

    Finding:

    Reports patient was diagnosed at age 5

    (Found)

    Pro Tip: Asking a pediatric patient’s guardian about the duration and onset of the patient’s current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing.

    Example Question:

    Does your child have any health issues?

    Finding:

    Asked guardian to elaborate on severity of symptoms

    Finding:

    Reports peak flow meter readings at home were 55%, 59%, and 60%

    (Found)

    Pro Tip: Asking a pediatric patient’s guardian about the duration and onset of the patient’s current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing.

    Example Question:

    Do you use a peak flow meter?

    Finding:

    Asked guardian about pharmacological relieving factors for current exacerbation

    Finding:

    Reports giving patient an extra dose of daily maintenance inhaler

    (Found)

    Pro Tip: Asking a pediatric patient’s guardian about the duration and onset of the patient’s current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing Gabriel Martinez Focused Exam: Asthma Exacerbation shadow health Subjective Data.

    Example Question:

    Have you tried treatments at home?

    Home Medications Guardian

    Finding:

    Confirms home medications with guardian

    Finding:

    Confirms patient is prescribed a rescue inhaler

    (Found)

    Pro Tip: A pediatric patient’s home medications can provide insight into their current treatment and its efficacy. Asking their guardian about medication history, dosage, and frequency will help you understand the patient’s background and how it may affect their current situation.

    Example Question:

    Does your son have an inhaler for exacerbations?

    Finding:

    Confirms patient is prescribed a maintenance inhaler

    (Found)

    Pro Tip: A pediatric patient’s home medications can provide insight into their current treatment and its efficacy. Asking their guardian about medication history, dosage, and frequency will help you understand the patient’s background and how it may affect their current situation.

    Example Question:

    What is the prescription for your son’s daily inhaler?

    Finding:

    Followed up on rescue inhaler

    Finding:

    Reports rescue inhaler is albuterol

    (Found)

    Pro Tip: A pediatric patient’s home medications can provide insight into their current treatment and its efficacy. Asking their guardian about medication history, dosage, and frequency will help you understand the patient’s background and how it may affect their current situation. Gabriel Martinez Focused Exam: Asthma Exacerbation shadow health Subjective Data

    Example Question:

    What is the name of your son’s rescue inhaler?

    Finding:

    Reports rescue inhaler dose is two puffs as needed

    (Found)

    Pro Tip: A pediatric patient’s home medications can provide insight into their current treatment and its efficacy. Asking their guardian about medication history, dosage, and frequency will help you understand the patient’s background and how it may affect their current situation.

    Example Question:

    what dose is your son’s rescue inhaler

    Finding:

    Followed up on maintenance inhaler

    Finding:

    Reports maintenance inhaler is fluticasone propionate

    (Found)

    Pro Tip: A pediatric patient’s home medications can provide insight into their current treatment and its efficacy. Asking their guardian about medication history, dosage, and frequency will help you understand the patient’s background and how it may affect their current situation.

    Example Question:

    What is your son’s maintenance inhaler called?

    Finding:

    Reports patient takes 2 puffs twice a day

    (Found)

    Pro Tip: A pediatric patient’s home medications can provide insight into their current treatment and its efficacy. Asking their guardian about medication history, dosage, and frequency will help you understand the patient’s background and how it may affect their current situation.

    Example Question:

    What is the dosage for your son’s maintenance inhaler?

    Finding:

    Asked about medication adherence

    Finding:

    Reports patient takes maintenance inhaler as directed

    (Found)

    Pro Tip: A pediatric patient’s home medications can provide insight into their current treatment and its efficacy. Asking their guardian about medication history, dosage, and frequency will help you understand the patient’s background and how it may affect their current situation. Gabriel Martinez Focused Exam: Asthma Exacerbation shadow health Subjective Data

    Example Question:

    How is your son’s medication adherence?

    Finding:

    Reports patient has not needed rescue inhaler in the past year

    (Found)

    Pro Tip: A pediatric patient’s home medications can provide insight into their current treatment and its efficacy. Asking their guardian about medication history, dosage, and frequency will help you understand the patient’s background and how it may affect their current situation.

    Example Question:

    When was the last time your son used the rescue inhaler?

    Finding:

    Asked about over the counter medications

    Finding:

    Reports occasional antihistamine use for allergy symptom treatment

    (Found)

    Pro Tip: A pediatric patient’s home medications can provide insight into their current treatment and its efficacy. Asking their guardian about medication history, dosage, and frequency will help you understand the patient’s background and how it may affect their current situation.

    Example Question:

    What over the counter medications has your son had?

    Past Medical History Guardian

    Finding:

    Asked about patient’s general allergies

    Finding:

    Denies patient has food allergies

    (Found)

    Pro Tip: Asking a guardian about the pediatric patient’s relevant medical history can reveal past diagnoses and previous conditions or concerns. Information about the patient’s existing health conditions, a timeline of diagnosis, symptoms, and allergies can indicate where you should follow-up for further care and treatment. Gabriel Martinez Focused Exam: Asthma Exacerbation shadow health Subjective Data

    Example Question:

    What allergies does your son have?

    Finding:

    Denies patient has a latex allergy

    (Found)

    Pro Tip: Asking a guardian about the pediatric patient’s relevant medical history can reveal past diagnoses and previous conditions or concerns. Information about the patient’s existing health conditions, a timeline of diagnosis, symptoms, and allergies can indicate where you should follow-up for further care and treatment.

    Example Question:

    What allergies does your son have?

    Finding:

    Denies patient has medication allergies

    (Found)

    Pro Tip: Asking a guardian about the pediatric patient’s relevant medical history can reveal past diagnoses and previous conditions or concerns. Information about the patient’s existing health conditions, a timeline of diagnosis, symptoms, and allergies can indicate where you should follow-up for further care and treatment.

    Example Question:

    What allergies does your son have?

    Finding:

    Reports environmental allergies

    (Found)

    Pro Tip: Asking a guardian about the pediatric patient’s relevant medical history can reveal past diagnoses and previous conditions or concerns. Information about the patient’s existing health conditions, a timeline of diagnosis, symptoms, and allergies can indicate where you should follow-up for further care and treatment.

    Example Question:

    What allergies does your son have?

    Finding:

    Followed up on environmental allergies

    Finding:

    Reports patient has allergies to tree pollen, pet dander, and dust mites

    (Found)

    Pro Tip: Asking a guardian about the pediatric patient’s relevant medical history can reveal past diagnoses and previous conditions or concerns. Information about the patient’s existing health conditions, a timeline of diagnosis, symptoms, and allergies can indicate where you should follow-up for further care and treatment. Gabriel Martinez Focused Exam: Asthma Exacerbation shadow health Subjective Data

    Example Question:

    What environmental allergies does your son have?

    Finding:

    Followed up on impact of allergies on asthma

    Finding:

    Reports allergies have caused previous exacerbations

    (Found)

    Pro Tip: Asking a guardian about the pediatric patient’s relevant medical history can reveal past diagnoses and previous conditions or concerns. Information about the patient’s existing health conditions, a timeline of diagnosis, symptoms, and allergies can indicate where you should follow-up for further care and treatment.

    Example Question:

    How do your son’s environmental allergies impact his asthma?

    Finding:

    Reports high pollen count traditionally worsens asthma symptoms

    (Found)

    Pro Tip: Asking a guardian about the pediatric patient’s relevant medical history can reveal past diagnoses and previous conditions or concerns. Information about the patient’s existing health conditions, a timeline of diagnosis, symptoms, and allergies can indicate where you should follow-up for further care and treatment.

    Example Question:

    How do your son’s environmental allergies impact his asthma?

    Finding:

    Asked about previous hospitalizations

    Finding:

    Reports one previous hospitalization for moderate asthma exacerbation

    (Found)

    Pro Tip: Asking a guardian about the pediatric patient’s relevant medical history can reveal past diagnoses and previous conditions or concerns. Information about the patient’s existing health conditions, a timeline of diagnosis, symptoms, and allergies can indicate where you should follow-up for further care and treatment.

    Example Question:

    Has your son been hospitalized before?

    Finding:

    Reports hospitalization was one year ago

    (Found)

    Pro Tip: Asking a guardian about the pediatric patient’s relevant medical history can reveal past diagnoses and previous conditions or concerns. Information about the patient’s existing health conditions, a timeline of diagnosis, symptoms, and allergies can indicate where you should follow-up for further care and treatment. Gabriel Martinez Focused Exam: Asthma Exacerbation shadow health Subjective Data

    Example Question:

    Has your son been hospitalized before?

    Finding:

    Followed up on factors leading to prior hospitalization

    Finding:

    Reports patient had been exposed to smoke the night before hospitalization

    (Found)

    Pro Tip: Asking a guardian about the pediatric patient’s relevant medical history can reveal past diagnoses and previous conditions or concerns. Information about the patient’s existing health conditions, a timeline of diagnosis, symptoms, and allergies can indicate where you should follow-up for further care and treatment.

    Example Question:

    Why was your son last hospitalized?

    Finding:

    Reports rescue inhaler was not effective in managing symptoms

    (Found)

    Pro Tip: Asking a guardian about the pediatric patient’s relevant medical history can reveal past diagnoses and previous conditions or concerns. Information about the patient’s existing health conditions, a timeline of diagnosis, symptoms, and allergies can indicate where you should follow-up for further care and treatment.

    Example Question:

    Why was your son last hospitalized?

    Social History Guardian

    Finding:

    Asked about patient’s activity level

    Finding:

    Reports preventing patient from performing aerobic exercise

    (Found)

    Pro Tip: A patient’s and their guardian’s social history encompasses their family and support system, living situation, and daily behaviors such as diet, exercise, and substance use. These factors can influence their current health and wellness. Asking a guardian about a pediatric patient’s social history can also unveil the influence of their present illnesses on their social lives.

    Example Question:

    How does exercise impact your son’s asthma?

    Finding:

    Asked about patient’s exposure to secondhand smoke

    Finding:

    Denies using tobacco products

    (Found)

    Pro Tip: A patient’s and their guardian’s social history encompasses their family and support system, living situation, and daily behaviors such as diet, exercise, and substance use. These factors can influence their current health and wellness. Asking a guardian about a pediatric patient’s social history can also unveil the influence of their present illnesses on their social lives. Gabriel Martinez Focused Exam: Asthma Exacerbation shadow health Subjective Data

    Example Question:

    Does anyone in your family use tobacco?

    Finding:

    Asked about childcare

    Finding:

    Reports working around 55 hours per week

    (Found)

    Pro Tip: A patient’s and their guardian’s social history encompasses their family and support system, living situation, and daily behaviors such as diet, exercise, and substance use. These factors can influence their current health and wellness. Asking a guardian about a pediatric patient’s social history can also unveil the influence of their present illnesses on their social lives.

    Example Question:

    What is your childcare situation?

    Finding:

    Reports utilizing after-school programs during the school year

    (Found)

    Pro Tip: A patient’s and their guardian’s social history encompasses their family and support system, living situation, and daily behaviors such as diet, exercise, and substance use. These factors can influence their current health and wellness. Asking a guardian about a pediatric patient’s social history can also unveil the influence of their present illnesses on their social lives.

    Example Question:

    What is your childcare situation?

    Finding:

    Reports patient’s maternal grandparents care for him once a weekend

    (Found)

    Pro Tip: A patient’s and their guardian’s social history encompasses their family and support system, living situation, and daily behaviors such as diet, exercise, and substance use. These factors can influence their current health and wellness. Asking a guardian about a pediatric patient’s social history can also unveil the influence of their present illnesses on their social lives.

    Example Question:

    What is your childcare situation?

    Family Medical History Guardian

    Finding:

    Asked about relevant family medical history

    Finding:

    Denies family history of respiratory illness

    (Found)

    Pro Tip: A patient’s family medical history can indicate if the patient is at a higher risk for certain illnesses and disorders. Gathering this information from a guardian can contextualize a pediatric patient’s current complaint and how their family’s health history might be influencing it. Gabriel Martinez Focused Exam: Asthma Exacerbation shadow health Subjective Data

    Example Question:

    What health problems run in your family?

    Review of Relevant Systems Guardian

    Finding:

    Followed up on patient’s integumentary system

    Finding:

    Reports patient is diagnosed with eczema Gabriel Martinez Focused Exam: Asthma Exacerbation shadow health Subjective Data

  • NURS 6053 week 1 Discussion: Review of Current Healthcare Issues

    NURS 6053 week 1 Discussion: Review of Current Healthcare Issues Discussion – Week 1

    Main Post-

        In healthcare there are many healthcare issues and/or stressors that impact nearly everyone in some manner.  As

    healthcare professionals, we deal with the impact of various healthcare issues and stressors everyday.  However, as

    healthcare professionals, we are in a unique position to help identify healthcare issues and stressors and develop response strategies to these. NURS 6053 week 1 Discussion: Review of Current Healthcare Issue.

    It can be seen that there is no shortage of healthcare issues and a need for change.  One healthcare issue of great

    discussion currently that is impacting healthcare work settings is the COVID-19 pandemic. The COVID-19 pandemic has greatly impacted how we as a nation how we both receive and provide care.  The pandemic has greatly impacted how my organization provides care to those in our community, leading to the evaluation and change of many of our previous policies and processes.

    BUY A CUSTOM-WRITTEN, PLAGIARISM-FREE PAPER HERE

    I work in a high-acuity CVICU-MSICU and as a unit to help prepare for the influx of patients related to the COVID-19 pandemic, we split our CVICU and MSICU to help prevent cross-contamination of non-COVID patients.  This change has caused increased stress, as we were moved to our old ICU unit which is extremely dated, lacks storage, room space and often necessary supplies and equipment to provide patient care.  According to Vahedian-Azimi, et al., (2017) stress has anegative impact on both nurses and patient outcomes; with a grater impact to those working in critical care areas.NURS 6053 week 1 Discussion: Review of Current Healthcare Issues

    Another process change implemented in preparation was the deployment of nursing staff from areas affected by

    restrictions implemented, to work in other areas such as the ICU to help combat increased patient volume and patient

    shortages.  This has lead to added stress, due to taking non-ICU trained nurses and putting them in an unfamiliar

    environment that they often lack the necessary skill-set to provide care to the critical care population.  To help combat this we have switched focus to a team or “pod nursing”. While staffing needs is a moving target, adopting team-based care and task shifting based on the principal of practicing at the top of license and education to help with the variance in skill-matrix to meet the needs of our patients (Pittman & Scully-Russ, 2016).

    While the duration of the COVID-19 pandemic and the process changes associated with this is unknown, I feel that as a nation we are better prepared if something such as this occurs again.  I am also hopeful for our “new normal” and that there have been positive changes that have occurred, that we will continue to utilize on a daily basis even after the pandemic is over.

    References

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

    Vahedian-Azimi, A., Hajiesmaeili, M., Kangasniemi, M., Fornes-Vives, J., Hunsucker, R. L., Rahimibashar, F., … Miller, A. C. (2017). Effects of Stress on Critical Care Nurses: A National Cross-Sectional Study. 
    Journal of Intensive Care Medicine
    , 
    34
    (4), 311–322. doi: 10.1177/0885066617696853

    BUY A CUSTOM-WRITTEN, PLAGIARISM-FREE PAPER HERE

    Discussion: Review of Current Healthcare Issues

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

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

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

    To Prepare:

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

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

    By Day 3 of Week 1

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

    Discussion Week One

    Laureate education (2015) states, that one thing that individuals and leaders can do to be prepared for healthcare challenges of the future is to develop cultural competency, gain skills to view multiple perspectives, and develop greater understanding the survival side of any healthcare organization. 
     
    I can’t think of better wisdom while in the midst of the worldwide COVID-19 pandemic. 
     
    This healthcare crisis has, for better or worse, brought out a side of healthcare that no one could have ever imagined. Everything from massive amounts of casualties all over the world to shortages on equipment, that just months ago were in abundant excess. Healthcare workers around the globe are learning new and creative ways to evaluate and treat patients. 
     
    According to the Centers for Disease Control and Prevention (2020), the death toll in the United States as of this week is 88,243 people (Table 2).

    In my work setting the dealing of this virus has been like receiving a slow-motion form of whip lash for the last three months. 
     
    The initial shock of the virus instilled fear and out of fear came administrative decisions of great impact. 
     
    With resources immediately being used and unavailable for reorder, special equipment had to be purchased to protect the staff. 
     
    After shelter in place orders went out, people stopped coming into the hospitals and therefore the problems began. 
     
    With outpatient day surgery being canceled, limited census on hospital floors, and spending what’s left of the budget on PPE stockpiles, money ran out quickly. 
     
    Last week at my organization laid off 22 employees permanently and another 57 furloughed for a month. 
     

    The American Hospital Association (2020),
     
    stated
     
    hospitals and health systems all over are facing catastrophic financial challenges in light of the COVID-19 pandemic (para 3). 
     
    The impact of the virus has had a full circle effect; impacting every person sick and every person caring for the sick in different horrible ways. 
     
    My organization guaranteed our pay from May 1
    st
    , 2020 to June 8
    th
    , 2020. 
     
    After June 8
    th
    , the furloughs will begin. 
     
    Another wonderful thing my organization did was protect us. 
     
    Not one staff member from my hospital got the virus and I believe it is because they went over and above to protect the staff. 
     
    I know the layoffs and furloughs are necessary for survival but seeing coworkers and friends being sent home is painful; opening my mind to the survival aspect of healthcare is necessary for my future in it. NURS 6053 week 1 Discussion: Review of Current Healthcare Issues

     

    References

    American Hospital Association. (2020). Hospital and health systems face unprecedented
     

    financial pressures due to COVID-19. Retrieved June 2, 2020 from

    https://www.aha.org/guidesreports/2020-05-05-hospitals-and-health-systems-face-unprecedented-financial-pressures-due

    Centers for Disease Control and Prevention. (2020). Daily updates of totals by week and state.
     

    Retrieved June 2, 2020 from,
     
    https://www.cdc.gov/nchs/nvss/vsrr/covid19/index.htm

    Laureate Education (Producer). (2015). Leading in Healthcare Organizations of the Future

    [Video file]. Baltimore, MD: Author.
     

    By Day 6 of Week 1

    Respond
     to at least 
    two
     of your colleagues 
    on two different days
    who chose a different national healthcare issue/stressor than you selected. Explain how their chosen national healthcare issue/stressor may also impact your work setting and what (if anything) is being done to address the national healthcare issue/stressor.NURS 6053 week 1 Discussion: Review of Current Healthcare Issues

    It is unfortunate how much impact the COVID-19 crisis has had on every single person in this country and across the world.  it has been very scary for health care providers especially nurse to provide direct care to patients.  with limited PPEs and personnel, nurses risk their lives each day when they step out to care for their patients.  Despite all these dedications, health care workers are laid off as a result of low patient Census.  I believe that there must be a system where jobs are protected for health care workers in any crisis.  the federal government needs to work with each state to ensure job protection for our health care workers.  Another important issue to address is that, there must be federal. state and local regulations that will mandate hospitals and other health care institutions to have surplus PPEs in stock to be used in times of crisis-at least 3 months supply of PPEs.  The federal and state government need to make provision of these PPEs to the various institutions.  Job security and availability of PPEs for health care workers is important especially during this time of uncertainties.

     

    thank you for your post

    Reference

    Marshall, E., & Broome, M. (2017). Transformational leadership in Nursing: From Expert Clinician to Influential Leader (2
    nd
     ed). New York, NY: Springer

     

    True to your statement, the COV:ID-19 pandemic is affecting everyone, especially the healthcare workers. The healthcare settings are faced with increased exposure, stress and patient load. In addition to their human toll, epidemics and pandemics can have enormous social and economic consequences in a closely interconnected and interdependent world.

    In a novel virus outbreak such as COVID-19, there is no existing antiviral drugs nor vaccine available. Police departments, local utility companies and mass transit authorities experience significant personnel shortages that result in severe disruption of routine services. Several major airports close because of high absenteeism among air traffic controllers and risk of passengers contracting the disease. Health and other essential community services deteriorate further as the pandemic sweeps across the world. NURS 6053 week 1 Discussion: Review of Current Healthcare Issues

    As what you have stated, hospitals and outpatient clinics are critically short-staffed as doctors, nurses and other healthcare workers themselves become ill or are afraid to come to work. Intensive care units at local hospitals are overwhelmed, and soon there are insufficient ventilators for the treatment of viral complications such as pneumonia patients.

    Fearing infection, elderly patients with chronic medical conditions do not dare to leave home. Parents are distraught when their healthy young adult sons and daughters die within days of first becoming ill.

    Pandemics, whether mild, moderate or severe, affect a large proportion of the population and require a multisectoral response over several months or even years. For this reason, plans need to be developed by healthcare organizations describing strategies for responding to a pandemic supported by operational plans at the local, national and subnational levels. Great post!

     

    Response.

    I can totally relate to the feeling of uncertainty during COVID-19 early staffing days in the ICU.
     
    I am cath lab nurse that frequently rotates in and out of the ED or ICU. 
     
    Being sent back to the ICU while outpatient procedures were on hold and taking a team of med-surg nurses helping for the day was an overwhelming feeling. Laureate education (2015) states, that one thing that individuals and leaders can do to be prepared for healthcare challenges of the future is to develop cultural competency, gain skills to view multiple perspectives, and develop greater understanding the survival side of any healthcare organization. 
     
    Having non-ICU trained RNs helping was a blessing and a curse, but all the while knowing that it was vital to the care of these patients. Now that we are on this side of COVID -19 I also feel, as you stated, more comfortable for the future should we be put in this position again, but the learning process was hard, and involved an extensive learning curve of trial and error. 
     
    The stressors you talked about on nurses directly effecting patient care is now the situation we have found ourselves in at my organization. 
     
    Everyone is exhaling a bit now that the virus is seeming to be on the decline. 
     
    The scary and stress filled portion of that is nurses are now losing their jobs due to poor organizational leadership of organizations or that there just aren’t enough people to be taken care of right now coming into the hospital. 
     
    I think it is safe to say that there is not one aspect of patient care or one healthcare worker around the globe that hasn’t been touched by this virus! Thanks for sharing your post, it was a great read!

    -Kelly
     

    References

    American Hospital Association. (2020). Hospital and health systems face unprecedented
     

    financial pressures due to COVID-19. Retrieved June 6, 2020 from

    https://www.aha.org/guidesreports/2020-05-05-hospitals-and-health-systems-face-unprecedented-financial-pressures-due

    Laureate Education (Producer). (2015). Leading in Healthcare Organizations of the Future

    [Video file]. Baltimore, MD: Author. NURS 6053 week 1 Discussion: Review of Current Healthcare Issues

  • COVID-19 NURS 6053 national healthcare issue/stressor discussion

    Discussion – Week 1 -COVID-19 NURS 6053 national healthcare issue/stressor discussion

    A national healthcare issue that immediately comes to mind is the ongoing battle against COVID-19. As states across the country (and countries across the world) entered into various versions of lockdown and stay-at-home orders, medical facilities were also impacted by more than simply treated patients. The entire hospital healthcare plan had to be reevaluated, reassessed, and many aspects of daily operations were impacted. Analyzing who was most at risk, the populations such as the elderly and those with compounding comorbidities was first in-line in assessing how the hospital would interact with and protect these individuals (Long, Vo, & Vuong, 2020). COVID-19 NURS 6053 national healthcare issue/stressor discussion. At the same time, another, perhaps more immediate problem were hospitals being overwhelmed by the sheer volume of patients, the need (and lack of) adequate personal protective equipment, and equipment and staffing shortages (Long, Vo, & Vuong 2020).

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    For the hospital I work for in particular, I am an Emergency Room Nurse, and as COVID-19 cases began to arrive in our area, there was an overwhelming rush of individuals to our hospital. It didn’t take long for the hospital to realize that we had a major nursing shortage in the ER. While there were other nurses on furlough or shortened hours in other departments, the ER was in a constant state of need. As the volume of patients flooded the emergency room doors, it did not take long to realize the shortage of nurses. Before COVID-19 the hospital system I work for joined a national movement toward seeking higher educated nurses- requiring all nursing staff to obtain their BSN (if they only had their RN) within five years or be terminated (regardless of years of service). Many of those with more than 20 years experience retired, others shifted career fields, or some simply went to other networks that did not have the same requirements. The push for a higher educated staff is not new as is stated in Gerardi, Farmer, and Hoffman (2018); however, this push for higher standards also came at a price in losing experienced and knowledgeable staff that our department, and those across the health care system have acutely felt during this pandemic. COVID-19 NURS 6053 national healthcare issue/stressor discussion

    The department I work for has tried to manage patient care through not allowing any visitors, if it is a pediatric patient (only one parent at a time), COVID-19 positive patients are placed in isolation rooms with negative pressure, we are given one set of PPE to last us the entire time however, and that has caused a significant amount of controversy as to why we are not able to have adequate equipment. Our ER has hired traveling nurse practitioners (increase need for provider services) nurses, new graduates, and is offering many paid overtime shifts to current staff (Auebach, Staiger, & Buerhaus 2018). We are screened every day about arrival and must document all of our interactions with COVID-19 patients. COVID-19 will not be leaving anytime soon however; and the hospital and health care system as a whole will need to continue to adapt as we work through the months to come. COVID-19 NURS 6053 national healthcare issue/stressor discussion

    References

    Auerbach, D. I., D. O., & Buerhaus, P. I. (2018). Growing ranks of advanced practice clinicians-

    Implications for the physician workforce.
    New England Journal of Medicine, 378
    (25),

    2358-2360.
    doi:10.1056/NEJMp181869

    Gerardi, T., Farmer, P., & Hoffman, B. (2018). Moving closer to the 2020 BSN workforce goal.
    American Journal of Nursing
    , 118(2), 43-45
    . doi:10.1097/01.NAJ.0000530244.15217.aa

     

    Thanh-Long, G., Dinh-Tri Vo., & Quan-Hoang Vuong, (2020). COVID-19: A relook at

    Healthcare system and aged populations. Sustainability, 12 (10), 4200.

    doi:http://dx.doi.org.ezproxy.gardner-webb,edu/10.3390/su12104200

     

    Response

    Great insights, True to your statements, with the advent of the COVID-19 pandemic and the volume of patients flooding not only the ER but the great number of hospitals in the health care system,  it did not take long to realize the on-going issue of shortage of nurses.

    The Registered Nurse Safe Staffing Act of 2013 (H.R. 1821) has been introduced by the ANA to Congress last May 8, 2013 which empowers registered nurses (RNs) to drive staffing and scheduling decisions in hospitals and, consequently, protect patients and improve the quality of care.

    Staffing has a direct impact on patient safety. Research has shown that inadequate nurse-patient ratios are linked to higher rates of patient falls, injuries, infections, medications, and even death. Determining the appropriate number and mix of nursing staff is critical to the delivery of quality patient care and positive outcomes.

    In addition, as what you have stated,  the lack of healthcare providers directly impacts the care able to be given and the quality of life of many patients. The addition of nurse practitioners and physician assistants to the workforce is certainly a viable partial solution.

    Likewise, poor management could result to rapid turn-over of staff and contributory to the rapid turnover of staff are pay and benefits, workload and poor relationship with other staff due to intergenerational gap.

    The push for a higher educated staff is not new, however, everyone it is a common fact that understaffing is not caused by non-enrollment of nursing students, rather, there is also an existing problem of lack of faculty to teach in the nursing schools because of low wages as compared to the nurses working in clinical practice.

    The value hospitals place on their people will have a direct correlation to their commitment, confidence and engagement. Therefore, leaders and managers must enhance the organizational culture and develop orientation programs, provide availability of resources, promote camaraderie empowerment and autonomy among the staff and reinforce these values that are critical to encourage staff’s retention. COVID-19 NURS 6053 national healthcare issue/stressor discussion

    True to your statements, the organizational management and nursing leaders need to create ways and means in promoting adequate staffing and scheduling, promoting staff accountability and collaboration among the team, uplift the organizational culture, and enhance autonomy and empowerment among frontline staff to ensure safe quality care of patients. Great post!

     

    Response

    Great post Marie, I agree I think nobody was prepared for this pandemic nor do I think we are prepared for a second wave either any time soon. I remember thinking it this pandemic will not come to US and if it does we have the resources and supplies to be able to defeat it but I was wrong. The stress of nursing shortage was so bad that I remember when I was working five or six days a week in the ICU. We all know the stress of ICU without a pandemic. The rapid acceleration of transmission, and the lack of preparedness to prevent and treat this virus, the negative impacts of COVID-19 are rippling through every facet of society (Brown & Horesh, 2020). Hospitals did try to accommodate all the patients but it was too much. We did not have enough negative pressure rooms nor did we have enough PPEs, Everything they used to teach us about the spread of infection and PPEs did not apply. Staff would re-use PPEs and N95s because of the shortage. A critical shortage of all of gloves, face masks, air-purifying respirators, goggles, face shields, respirators, and gowns is projected to develop or has already developed in areas of high demand (Desai & Livingston, 2020). COVID-19 NURS 6053 national healthcare issue/stressor discussion

    References

    Brown, A., & Horesh, D., (2020). Traumatic stress in the age of COVID-19: A call to close

    critical gaps and adapt to new realities. Psychological Trauma: Theory, Research,

    Practice, and Policy, 12(4), 331–335. COVID-19 NURS 6053 national healthcare issue/stressor discussion

    https://doi-org.ezp.waldenulibrary.org/10.1037/tra0000592

    Desai A., & Livingston, E., (2020). Sourcing Personal Protective Equipment During the

    COVID-19 Pandemic. 
    JAMA.
     2020; 323(19):1912–1914. doi:10.1001/jama.2020.5317

     

     

    Discussion: Review of Current Healthcare Issues

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

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

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

    To Prepare:

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

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

    By Day 3 of Week 1

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

    By Day 6 of Week 1

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

     

    NURS_6053_Module01_Week01_Discussion_Rubric

    Grid View

    List View

    Excellent

    Good

    Fair

    Poor

    Main Posting

    45 
    (45%)
     – 50 
    (50%)

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

    Supported by at least three current, credible sources.

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

    40 
    (40%)
     – 44 
    (44%)

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

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

    Supported by at least three credible sources.

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

    35 
    (35%)
     – 39 
    (39%)

    Responds to some of the discussion question(s).

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

    Is somewhat lacking reflection and critical analysis and synthesis.

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

    Post is cited with two credible sources.

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

    Contains some APA formatting errors.

    0 
    (0%)
     – 34 
    (34%)

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

    Lacks depth or superficially addresses criteria.

    Lacks reflection and critical analysis and synthesis.

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

    Contains only one or no credible sources.

    Not written clearly or concisely.

    Contains more than two spelling or grammatical errors.

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

    Main Post: Timeliness

    10 
    (10%)
     – 10 
    (10%)

    Posts main post by day 3.

    0 
    (0%)
     – 0 
    (0%)

    0 
    (0%)
     – 0 
    (0%)

    0 
    (0%)
     – 0 
    (0%)

    Does not post by day 3.

    First Response

    17 
    (17%)
     – 18 
    (18%)

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

    Responds fully to questions posed by faculty.

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

    Demonstrates synthesis and understanding of learning objectives.

    Communication is professional and respectful to colleagues.

    Responses to faculty questions are fully answered, if posed.

    Response is effectively written in standard, edited English.

    15 
    (15%)
     – 16 
    (16%)

    Response exhibits critical thinking and application to practice settings.

    Communication is professional and respectful to colleagues.

    Responses to faculty questions are answered, if posed.

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

    Response is effectively written in standard, edited English.

    13 
    (13%)
     – 14 
    (14%)

    Response is on topic and may have some depth.

    Responses posted in the discussion may lack effective professional communication.

    Responses to faculty questions are somewhat answered, if posed.

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

    0 
    (0%)
     – 12 
    (12%)

    Response may not be on topic and lacks depth.

    Responses posted in the discussion lack effective professional communication.

    Responses to faculty questions are missing.

    No credible sources are cited.

    Second Response

    16 
    (16%)
     – 17 
    (17%)

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

    Responds fully to questions posed by faculty.

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

    Demonstrates synthesis and understanding of learning objectives.

    Communication is professional and respectful to colleagues.

    Responses to faculty questions are fully answered, if posed.

    Response is effectively written in standard, edited English.

    14 
    (14%)
     – 15 
    (15%)

    Response exhibits critical thinking and application to practice settings.

    Communication is professional and respectful to colleagues.

    Responses to faculty questions are answered, if posed.

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

    Response is effectively written in standard, edited English.

    12 
    (12%)
     – 13 
    (13%)

    Response is on topic and may have some depth. COVID-19 NURS 6053 national healthcare issue/stressor discussion

    Responses posted in the discussion may lack effective professional communication.

    Responses to faculty questions are somewhat answered, if posed.

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

    0 
    (0%)
     – 11 
    (11%)

    Response may not be on topic and lacks depth.

    Responses posted in the discussion lack effective professional communication.

    Responses to faculty questions are missing.

    No credible sources are cited.

    Participation

    5 
    (5%)
     – 5 
    (5%)

    Meets requirements for participation by posting on three different days.

    0 
    (0%)
     – 0 
    (0%)

    0 
    (0%)
     – 0 
    (0%)

    0 
    (0%)
     – 0 
    (0%)

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

    Total Points: 100

    Name: NURS_6053_Module01_Week01_Discussion_Rubric COVID-19 NURS 6053 national healthcare issue/stressor discussion

  • NURS 6053 national healthcare issue/stressor

    : Discussion – Week 1
    NURS 6053 national healthcare issue/stressor

    There is a higher level of physical, emotional, and mental stress associated with critical care areas of healthcare. The work demand in critical care areas such as intensive care or post-anesthesia care units directly affects the overall well-being of individuals who work in these areas NURS 6053 national healthcare issue/stressor. A major healthcare stressor that has severely heighten the stress level in these areas is the current Coronavirus pandemic. Covid-19 has made working in critical care areas the most stressful it has been in decades past. Stress negatively impacts nurses and patient outcomes; however, those practicing in critical care areas experience high levels of burnout and other negative health issues (Vahedian-Azimi, et al., 2017).

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    I currently work in the second busiest intensive care unit in the state of Maryland. Covid-19 has increased the work-related stress level on the unit tenfold. Covid-19 has caused a rapid spike in individuals admitted to the ICU, increasing the workload of all members on the unit, especially nurses. Covid-19 has had a devastating impact on the unit with increased negative patient outcomes, unsafe working conditions, and even dire staffing issues. Since the beginning of the year, the unit has had five different unit managers, three different directors, and within the past couple months, a significant loss of staff, including fatality. NURS 6053 national healthcare issue/stressor Obesity, cardiovascular disease, decreased mental health, emotional exhaustion, anxiety, and depression are all linked to work-related stress (Alenezi, Aboshaiqah, & Baker, 2018). Each of these work-related stresses has been noticeable throughout the entire unit.

    The healthcare system has responded to the current healthcare issue/stressor by implementing new infection control protocols. The new protocols include increased hand cleansing stations as well as shutting off visitation privileges to family members. Furthermore, they have designated areas for donning and doffing all PPE. Lastly, the hospital has created three aromatherapy rooms for staff to utilize when feeling overwhelmed. The rooms are filled with soothing sounds and an array of aromas to help with stress management. Aromatherapy may contribute to a healthy work environment and decrease nurse anxiety associated with occupational stress (Donaldson, Ingrao, & Ocampo, 2017) NURS 6053 national healthcare issue/stressor.

     

    References

    Alenezi, A. M., Aboshaiqah, A., & Baker, O. (2018). Work‐related stress among nursing staff working in government hospitals and primary health care centres. 
    International Journal of Nursing Practice
    , 
    24
    (5). doi: 10.1111/ijn.12676

    Donaldson, J., Ingrao, C., Drake, D., & Ocampo, E. (2017). The Effect of Aromatherapy on Anxiety Experienced by Hospital Nurses. 
    Medsurg Nursing
    , 
    26
    (3).

    Vahedian-Azimi, A., Hajiesmaeili, M., Kangasniemi, M., Fornes-Vives, J., Hunsucker, R. L., Rahimibashar, F., … Miller, A. C. (2017). Effects of Stress on Critical Care Nurses: A National Cross-Sectional Study. 
    Journal of Intensive Care Medicine
    , 
    34
    (4), 311–322. doi: 10.1177/0885066617696853

    responses

    When the World Health Organization (WHO) reported the COVID-19 pandemic in January 2020 it seemed like the bottom fell out everywhere (Long, Vo, and Vuong, 2020). If you were like me, you found yourself exhausted and baffled about what was happening around you and quickly realized that the ever-increasing talk about nursing shortages was in fact true. What has happened to the nursing field of health care workers? What once was a traditional life-long career is now seen as an end to a mean- to spend a year or two in a hospital setting for experience and then continue one’s education to be a Nurse Practitioner, or Doctor of Nurse Practitioner, or leave the field all together (Palumbo, Rambur & Hart 2017). NURS 6053 national healthcare issue/stressor

    In the second largest ICU in Maryland I cannot imagine the impact of patients that came through the ICU and that are still coming into the ICU setting. One must look at what causes the shortage of nurses on a larger scale as well as on a local scale; is management effective at a system or site-specific hospital, how is the direct leadership within that department; are there other hospitals or areas with better pay or benefits, (Pittman, & Russ 2016). NURS 6053 national healthcare issue/stressor In the end I think the larger questions are what factors contribute to the nursing shortage crisis and how can we address these factors?

     

    References

     

     

    Palumbo, M., Rambur, B., & Hart, V. (2017). Is health care payment reform impacting nurses’                work settings, roles, and education preparation?
    Journal of Professional Nursing, 33
    (6),           400-404.
    doi:10.1016/j.profnurs.2016.11.005

     

    Pittman, P., & Scully-Russ, E. (2016). Workforce planning and development in times of delivery                            system transformation. Human Resources for Health, 14(56), 1-15. Doi:10.1186/s12960-                             016-0154-3. Retrieved from
    https://human-resources-health.biomedcentral.com/track/
                                   
    pdf/10.1186/s12960-016-0154-3

     

    Thanh-Long, G., Dinh-Tri Vo., & Quan-Hoang Vuong, (2020). COVID-19: A relook at

    Healthcare system and aged populations. Sustainability, 12 (10), 4200.

    doi:http://dx.doi.org.ezproxy.gardner-webb,edu/10.3390/su12104200

    I agree with your post regarding critical care nursing  and the stress and emotional trauma it creates for nurses. This already stressful arena was exacerbated with the COVID-19 pandemic. As you related in your post, nurses were put under significant amount of added stress in addition the stress we already faced on a daily basis. The Quadruple Aim in Healthcare was launched to take care of the provider, well before the COVID-19 pandemic. It was recognized years ago that there was a significant need to take care of the provider. With the additional stress faced by health care workers today, the American Nurses Association (ANA) launched the well-being initiative for nurses to help manage and overcome the stress of COVID-19. It is important that we take care of ourselves and each other. There are many resources available to nurses and healthcare workers to seek help to deal with the trauma and stress that we have been facing. NURS 6053 national healthcare issue/stressor

    American Nurses Association. (2019, May 19).  
    American Nurses Foundation Launches National Well-being Initiative for Nurses
    . Retrieved June 4, 2020, from https://www.nursingworld.org/news/news-releases/2020/american-nurses-foundation-launches-national-well-being-initiative-for-nurses/

    Bodenheimer, T., Sinsky, C. (2014). From triple to Quadruple Aim: Care of the patient requires care of the provider. 
    Annuals of Family Medicine, 12
    (6), 573-576. DOI: 10.1370/afm.171

     

    Discussion: Review of Current Healthcare Issues

    If you were to ask 10 people what they believe to be the most significant issue facing healthcare today, you might get 10 different answers. Escalating costs? Regulation? Technology disruption? NURS 6053 national healthcare issue/stressor

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

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

    To Prepare:

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

    Reflect on the current national healthcare issue/stressor you selected and think about how this issue/stressor may be addressed in your work setting. NURS 6053 national healthcare issue/stressor

    By Day 3 of Week 1

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

    By Day 6 of Week 1

    Respond
     to at least 
    two
     of your colleagues 
    on two different days
    who chose a different national healthcare issue/stressor than you selected. Explain how their chosen national healthcare issue/stressor may also impact your work setting and what (if anything) is being done to address the national healthcare issue/stressor. NURS 6053 national healthcare issue/stressor

     

    Response

    I could not agree more with you that the COVID-19 pandemic has shaken the United States healthcare system to its core.
    NURS 6053 national healthcare issue/stressor.
    Everything about healthcare practice has changed and I don’t think there is one healthcare worker in the entire world that could say that it hasn’t affected some part of their practice. 
     
    According to the Centers for Disease Control and Prevention (2020), the death toll in the United States as of this week is 88,243 people (Table 2). 
     
    We have never seen such great loss in one year with one illness in such a short amount of time. 
     
    It’s not only the virus itself that is causing stress and early burnout among the healthcare staff, it’s also the overall worry about job security. 
     
    The American Hospital Association (2020),
     
    stated
     
    hospitals and health systems all over are facing catastrophic financial challenges in light of the COVID-19 pandemic (para 3). 
     
    This healthcare crisis has, for better or worse, brought out a side of healthcare that no one could have ever imagined. 
     
    It sounds like your hospital has a good thing going by providing an area of escape and peace! I am hoping you have been utilizing that resource and that you are staying well and safe while on shift! 
     
    Thanks for your post, I enjoyed reading it!
    NURS 6053 national healthcare issue/stressor

    Resources

    American Hospital Association. (2020). Hospital and health systems face unprecedented
     

    financial pressures due to COVID-19. Retrieved June 4, 2020 from

    https://www.aha.org/guidesreports/2020-05-05-hospitals-and-health-systems-face-unprecedented-financial-pressures-due

    Centers for Disease Control and Prevention. (2020). Daily updates of totals by week and state.
     

    https://www.cdc.gov/nchs/nvss/vsrr/covid19/index.htm
    Retrieved June 4, 2020 from,
    NURS 6053 national healthcare issue/stressor

  • Acute Kidney Transplant Rejection (AKTR) immunosuppression Essay- NURS 6501 Module 1 Assignment: Case Study Analysis

    Acute Kidney Transplant Rejection (AKTR) immunosuppression Essay- NURS 6501 Module 1 Assignment: Case Study Analysis

    Introduction

    The kidneys are vital organs in humans. They help filter and excrete waste products from the body, remove excess fluid from the body and helps the body maintain homeostasis by regulating acid-base balance as well as fluid and electrolytes (National Institute of Diabetes and Digestive and Kidney Diseases, 2018). Loss of kidney function can alter many essential functions in the body, as seen in patients with kidney failure. End-stage renal disease (ESRD) is the final stage of Chronic Kidney Disease (CKD), resulting in kidneys that cannot independently perform its functions. Many conditions can lead to chronic kidney disease development, some of which include heart disease, hypertension, inflammation, diabetes, and hereditary traits, or some genetic disorders (John Hopkins Medicine, 2018). The treatment options for ESRD are dialysis or a kidney transplant. The purpose of this paper is to analyze a case study of a 34-year-old man diagnosed with Acute Kidney Transplant Rejection (AKTR), to understand the symptoms he presented, and the genes associated with his diagnosis. The paper would also include an analysis of the process of immunosuppression and its effect on body systems.Acute Kidney Transplant Rejection (AKTR) immunosuppression Essay- NURS 6501 Module 1 Assignment: Case Study Analysis. Acute Kidney Transplant Rejection (AKTR) immunosuppression Essay- NURS 6501 Module 1 Assignment: Case Study Analysis.

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    Analysis of Diagnosis and its Symptoms

    The treatment options for ESRD are dialysis and kidney transplants, and both have benefits and risks associated with them. Kidney transplant as a treatment choice for ESRD may be more appealing to some individuals as opposed to committing to a lifetime of dialysis. However, kidney transplants may have some serious complications, such as AKTR. AKTR is an immune response in which the body attacks the new kidneys like it was a pathogen or foreign substance causing damage or failure of the new kidney. Before a kidney transplant is done, both donor and recipient undergo a series of compatibility tests to prevent a hyperacute rejection, which may happen minutes after surgery (Naik, & Shawar, 2020). However, kidney rejection could still occur at any time, although the chances decrease with time, an AKTR can occur between days to months following surgery for various reasons.

    In this scenario, the individual exhibited weight gain, decreased urine output, fatigue, and

    fever; these are typical symptoms of AKTR which the subject experienced about six months after receiving a kidney transplant from a cadaver donor. According to Naik and Shawar (2020), there is an increased chance of rejection when receiving a kidney transplant from a cadaver donor. The authors also indicated other causes such as younger recipients, history of rejection, and inadequate immunosuppression, among others, might increase the chances of rejection post-transplant. Other symptoms of AKTR includes pain and tenderness around the kidney, flu-like symptoms including chills, headaches, elevated serum creatinine levels and nausea and vomiting (National Institute of Medicine, 2019). Another possible reason why the patient experienced symptoms of acute kidney transplant rejection is non-adherence and antibody-mediated rejection (Hucker et al.,2017).Acute Kidney Transplant Rejection (AKTR) immunosuppression Essay- NURS 6501 Module 1 Assignment: Case Study Analysis.

    Gene Associated with the Condition

    ESRD is the last phase of chronic disease. It is often caused by underlying conditions that may be inherited, such as diabetes and hypertension, which are the two leading causes of chronic kidney disease (Centers for Disease Control and Prevention, 2019). Some genetic diseases can

    also directly or indirectly lead to Chronic kidney disease and, subsequently, ESRD, for example, conditions like nephronophthisis, autosomal dominant polycystic kidney disease (ADPKD), lowe syndrome, amongst others (The University of Michigan, n.d.). ADPKD occurs as a result of an

    inherited abnormal mutation in polycystin, a kidney protein causing kidney problems that could lead to kidney failure even at birth (UNC kidney Center, 2019). a study by Canadas-Garre et al. (2019), indicated a link between shorter telomere and renal dysfunction or the progression of CKD. Abnormalities such as shorter telomer at birth are inherited due to abnormal genetic mutation of DNA predisposes individuals to certain disease conditions, for example, cardiovascular disease. Kidney transplant and how an individual’s body reacts to the new kidneys can be dependent on some genetic traits, for example, Human Leukocyte Antigen (HLA) compatibility between donor and recipient is more favorable with kidney transplant, decreasing the chances for AKTR (Dorr, Oetting, Jacobson, & Israni, 2018). The authors also indicated that high metabolic rates of immunosuppressants in the blood have been linked to an increased risk of having acute rejection.

    Immunosuppression and its Effect on the Body

    Immunosuppression is a term used to describe the suppression of the body’s immune system and its ability to defend the body against infection (National Cancer Institute, n.d.). Immunosuppression may be due to several disease conditions, genetics, or even medications such as steroids, immunosuppressants, and cancer medications. Immunosuppression therapy

    is commonly used to decrease the immune response after organ transplantation to prevent transplant rejection; it can also be used in other conditions such as autoimmune disorders such as rheumatoid arthritis. The immune system is programmed to identify and attack pathogens and foreign bodies that gain entrance to the body (McCance & Huether, 2019). Immunosuppressants work by either inhibiting calcineurin, thereby preventing T cells from activating cytokines or by inhibiting the proliferation of T cells, thereby suppressing the immune response.

    Immunosuppression related to genetics or medications generally affects the body by decreasing its immune functions and making it more susceptible to infections and cancer. However, immunosuppression also affects other systems in the body, for example, cardiovascular, respiratory, musculoskeletal, genitourinary, and central nervous systems. They affect the cardiovascular system by causing hypertension and altering the normal functions of blood vessels, which may lead to other cardiovascular diseases, affects the musculoskeletal system causing osteoporosis. It also affects the respiratory system leaving the individual susceptible to many respiratory infections, including tuberculosis (Hucker et al.,2017). Immunosuppression also affects the metabolic functions of the body, causing weight gain, and new-onset diabetes mellitus type 1 or worsening of already present diabetes (Hucker et al.,2017).

    Conclusion

    Genetics is a crucial aspect of medicine; over time, the study of genetics has been improved, helping clinicians have a better understanding of diagnosis and treatment of disease conditions. Kidney transplants’ success depends on the prevention of AKTR and kidney failure, among other complications. Transplant patients should be monitored closely to assess the effectiveness of immunosuppression therapy, adjust them as needed, and quickly identify symptoms indicating rejection for early intervention. Acute Kidney Transplant Rejection (AKTR) immunosuppression Essay- NURS 6501 Module 1 Assignment: Case Study Analysis. Acute Kidney Transplant Rejection (AKTR) immunosuppression Essay- NURS 6501 Module 1 Assignment: Case Study Analysis

     

     

     

     

    References

    Canadas-Garre, M., Anderson, K., Cappa, R., Skelly, R., Smyth, L. J., Mcknight, A. J., & Maxwell, A. P. (2019). Genetic Susceptibility to Chronic Kidney Disease – Some More Pieces for the Heritability Puzzle. Retrieved from
    https://www.frontiersin.org/articles/10.3389/fgene.2019.00453/full

    Centers for Disease Control and Prevention. (2019). Chronic kidney disease initiative. Retrieved from 
    https://www.cdc.gov/kidneydisease/publications-resources/2019-national-facts.html

    Dorr, C. R., Oetting, W. S., Jacobson, P. A., & Israni, A. K. (2018). Genetics of acute rejection after kidney transplantation. 
    Transplant international: official journal of the European Society for Organ Transplantation
    , 
    31
    (3), 263–277.
    https://doi.org/10.1111/tri.13084

    Hucker, A., Frances, B. Carpenter, L., Lawrence C., Farrington, K., & Sharma, S. (2017). Non-adherence to immunosuppressants following renal transplantation: a protocol for a systematic review.
    BMJ Open 7
    (9). Retrieved from
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5640118/

    John Hopkins Medicine (2018). End-stage Renal Disease (ESRD). Retrieved from
    https://www.hopkinsmedicine.org/health/conditions-and-diseases/end-stage-renal-failure

    McCance, K. L. & Huether, S. E. (2019).
    Pathophysiology: The biologic basis for disease in adults and children
    (8th ed.). St. Louis, MO: Mosby/Elsevier.

    Naik, R. & Shawar, S. H. (2020). Renal transplant rejection. Retrieved from
    https://www.ncbi.nlm.nih.gov/books/NBK553074/

    National Cancer Institute. (n.d.). NCI Dictionary of Cancer Terms. Retrieved from
    https://www.cancer.gov/publications/dictionaries/cancer-terms/def/immunosuppression

    National Institute of Diabetes and Digestive and Kidney Diseases (2018). Your kidneys and how they work. U.S. Department of Health and Human Services. Retrieved from

    https://www.niddk.nih.gov/health-information/kidney-disease/kidneys-how-they-work

    National Institute of Medicine. (2019). Transplant rejection. U.S. National Library of Medicine. Retrieved from
    https://medlineplus.gov/ency/article/000815.htm

    The University of Michigan (n.d.). Inherited kidney conditions. Retrieved from 
    https://www.uofmhealth.org/conditions-treatments/kidney/inherited-kidney-conditions

    UNC Kidney center, (2019). Genetics and kidney disease. Retrieved from 
    https://unckidneycenter.org/kidneyhealthlibrary/genetics-kidney-disease-1/

     

    Module 1 Assignment: Case Study Analysis

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

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

    Photo Credit: Getty Images/Hero Images

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

    In this Assignment, you examine a case study and analyze the symptoms presented. You identify cell, gene, and/or process elements that may be factors in the diagnosis, and you explain the implications to patient health. Acute Kidney Transplant Rejection (AKTR) immunosuppression Essay- NURS 6501 Module 1 Assignment: Case Study Analysis.

    To prepare:

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

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

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

    Explain why you think the patient presented the symptoms described.

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

    Acute Kidney Transplant Rejection (AKTR) immunosuppression Essay- NURS 6501 Module 1 Assignment: Case Study Analysis

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

    By Day 7 of Week 2

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

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

     

    Case Study_Assignment_Rubric

    Grid View

    List View

    Excellent

    Good

    Fair

    Poor

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

    Explain why you think the patient presented the symptoms described.

    28 
    (28%)
     – 30 
    (30%)

    The response accurately and thoroughly describes the patient symptoms.

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

    25 
    (25%)
     – 27 
    (27%)

    The response describes the patient symptoms.

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

    23 
    (23%)
     – 24 
    (24%)

    The response describes the patient symptoms in a manner that is vague or inaccurate. Acute Kidney Transplant Rejection (AKTR) immunosuppression Essay- NURS 6501 Module 1 Assignment: Case Study Analysis

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

    0 
    (0%)
     – 22 
    (22%)

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

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

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

    23 
    (23%)
     – 25 
    (25%)

    The response includes an accurate, complete, detailed, and specific analysis of the genes that may be associated with the development of the disease.

    20 
    (20%)
     – 22 
    (22%)

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

    18 
    (18%)
     – 19 
    (19%)

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

    0 
    (0%)
     – 17 
    (17%)

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

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

    28 
    (28%)
     – 30 
    (30%)

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

    25 
    (25%)
     – 27 
    (27%)

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

    23 
    (23%)
     – 24 
    (24%)

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

    0 
    (0%)
     – 17 
    (17%)

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

    Written Expression and Formatting – Paragraph Development and Organization:

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

    5 
    (5%)
     – 5 
    (5%)

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

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

    4 
    (4%)
     – 4 
    (4%)

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

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

    3 
    (3%)
     – 3 
    (3%)

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

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

    0 
    (0%)
     – 2 
    (2%)

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

  • Streptococcal pharyngitis (Strep Throat) Alterations in Cellular Processes Discussion Essay

    Streptococcal pharyngitis (Strep Throat) Alterations in Cellular Processes Discussion Essay

    The assigned case study is a 16y.o. male presenting with sore throat and low grade fever. There are two separate conditions or events to describe.  The patient presents with a red pharynx, enlarged tonsils, white patches, enlarged cervical lymph nodes, and low grade fever.  There are differential diagnoses, but for describing the pathophysiology, I will describe the body’s reaction to bacterial pharyngitis, specifically strep throat. Streptococcal pharyngitis (Strep Throat) Alterations in Cellular Processes Discussion Essay. The patient is exhibiting an inflammatory response to a foreign substance that has made it past one of the first lines of defense. In the case that I am describing, a bacterial agent such as group A beta hemolytic streptococcus (
    Streptococcus pyogenes
    ) may likely be the causative agent.  Findings common with this infection are the presence of tonsillar exudate, erythema, and fever (Ebell et al., 2000). Initial, non-specific attempts are made to kill the foreign matter such as mucus secretions, and proteins produced by the epithelial tissue in the pharynx. The streptococci have survived and multiplied to a point that the immune system is launching an inflammatory response. Streptococcal pharyngitis (Strep Throat) Alterations in Cellular Processes Discussion Essay

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    The bacterial microbes are now present in the tissue of the pharynx and initial immune response begins with mast cells, as well as damage to normal cells in the affected tissue. Mast cells release histamine which causes blood vessels to dilate and become somewhat permeable as the endothelial cells on the vessels separate slightly.  Plasma will leak out into the surrounding tissue. This results in edema.  The dilation of the vessels and exit of proteins and other solutes creates the red engorged appearance in the throat. The engorgement, edema, and the prostaglandin chemical mediator result in pain. Phagocytes arrive and will engulf and eliminate microbes indiscriminately. Neutrophils have also been signaled, and will enter the area from the now permeable blood vessels. As the neutrophils destroy microbes, they break down and the dead cell matter and other molecules create collections of waste material that present as pus. In the case of our patient, we see these collections as white patches or pockets on the throat. These actions are non-specific to the type of antigen. Streptococcal pharyngitis (Strep Throat) Alterations in Cellular Processes Discussion Essay

    While the non-specific processes are taking place, dendritic cells which were present along with the mast cells at the beginning of the response are also destroying the bacterial microbes. Dendritic cells break down microbe and determine if bacteria or virus. Proteins from the microbe adhere to the cell wall. If bacteria, dendritic cell travels to lymph gland to activate T cell response. The proteins on the dendritic cell surface will match up and attach to specific T cells. When one of these helper T cells is activated it quickly begins to reproduce. Some of the resulting cells stay in the lymph node and become memory T cells waiting for an attack at some point in the future. They also go to center of the node and activate B cell which begins antibody production. Antibodies travel to the area of infection and bind to surface of bacteria. Once bound by the antibodies, the bacteria are targets for macrophages, resulting in more phagocytosis. Lymph nodes in the neck as well as the tonsils have become enlarged as they hold newly created T cells as well as waste that will be eliminated by the lymphatic system. The patient’s fever, although considered low grade, is most likely related to endotoxins from damaged tissue or destroyed bacteria, or from an interleukin (IL-1) released by white blood cells and causing the hypothalamus to increase body temperature (Garner & Fendius, 2010).

    Based on clinical examination and presumptive diagnosis, the patient received a prescription for the antibiotic amoxicillin. Shortly after the first oral dose, the patient began to have signs and symptoms of allergic reaction. This is the second condition/event in the case study.  The medication amoxicillin has been introduced into the patient’s system via his gastrointestinal tract and has entered into the bloodstream. It is immediately recognized as antigen. Mast cells immediately release histamine which is the major mediator and causes another inflammatory response.  So again there is blood vessel dilation, plasma fluid leaking out of the blood vessels causing edema in lips, tongue, and possibly face and hands. More importantly, the mediator histamine acts on receptors in the bronchi of the lungs causing contraction of the smooth muscle tissue surrounding the airways. The result is difficulty breathing. Dendritic cells attach the antigen and proceed to a lymph node. Streptococcal pharyngitis (Strep Throat) Alterations in Cellular Processes Discussion Essay. Cytokines in the node called interleukins activate T cells and cause B cells to begin production of immunoglobulin E (IgE) antibodies and eosinophil leukocytes. Eosinophils release cytotoxins that cause damage to the allergen, but also to host cells. Streptococcal pharyngitis (Strep Throat) Alterations in Cellular Processes Discussion Essay

    The severity of the reaction, if not caused by previous sensitivity could be a genetic predisposition to hypersensitivity. For example, if a parent has an allergy, especially type I which is food or drug, the child is predisposed to developing allergies as well (McCance & Huether, 2019). They will likely generate greater amounts of IgE than other individuals creating the hypersensitivity (McCance & Huether, 2019).

     

    References

    Ebell MH, Smith MA, Barry HC, Ives K, Carey M, Ebell, M. H., Smith, M. A., Barry, H. C., Ives, K., & Carey, M.

    (2000). The rational clinical examination. Does this patient have strep throat? 
    JAMA: Journal of the

            American Medical Association
    , 
    284
    (22), 2912–2918.

    Garner A, & Fendius A. (2010). Temperature physiology, assessment and control. 
    British Journal of

            Neuroscience Nursing
    , 
    6
    (8), 397–400.

    McCance, K.L., & Huether, S.E. (2019). Pathophysiology The Biologic basis for desease in adults and children

    (8
    th
    ed.).  Elsiever. Streptococcal pharyngitis (Strep Throat) Alterations in Cellular Processes Discussion Essay

    REPLY 
    QUOTE 
    EMAIL AUTHOR

     

     

    9 months ago

    CHELSEY GASKIN 

    RE: Vania Lauer Week 1 Case Study Post

    COLLAPSE

    Vania your discussion post was thorough and easily understood. When discussing this infection, I forgot to mention how dendritic cells and their connection to lymph glands. Dendritic cells are “the primary phagocytic cells located in the peripheral organs and skin, where molecules released from infectious agents are encountered, recognized through PRRs, and internalized through phagocytosis” (McCance & Huether, 2019). Though the dendritic cells are phagocytic cells meant to destroy they provide information to our lymph glands to activate our T cells, which then activate out B cells. When talking about our T cells we have the cytotoxic T Cells and Helper T cells fight on our side. The cytotoxic T Cells are going to disrupt or destroy the bacteria cells were the Helper T Cells stimulate our B cells. I feel you described the function of T cells and B cells well. As for the reaction to the medication I would agree with you regarding a possible previous exposure. Cows can receive antibiotics like penicillin or amoxicillin for different types of infections that can be secreted through their milk. Which could’ve been his first exposure to the medication causing a severe reaction this time. Streptococcal pharyngitis (Strep Throat) Alterations in Cellular Processes Discussion Essay

    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.

    Soo, P. (2018, July 28). 
    Pathophysiology Ch 10 alterations in immune function

    . Retrieved from 

     

     

    Case Study

     

    A 16-year-old boy comes to clinic with chief complaint of sore throat for 3 days. Denies fever or chills. PMH negative for recurrent colds, influenza, ear infections or pneumonias. NKDA or food allergies. Physical exam reveals temp of 99.6 F, pulse 78 and regular with respirations of 18. HEENT normal with exception of reddened posterior pharynx with white exudate on tonsils that are enlarged to 3+. Positive anterior and posterior cervical adenopathy. Rapid strep test performed in office was positive. His HCP wrote a prescription for amoxicillin 500 mg po q 12 hours x 10 days disp #20. He took the first capsule when he got home and immediately complained of swelling of his tongue and lips, difficulty breathing with audible wheezing. 911 was called and he was taken to the hospital, where he received emergency treatment for his allergic reaction.

     

    The role genetics plays in the disease

    According to a study performed by La Jolla Institute of Immunology, reports show a correlation between genetic susceptibility and the predisposition of children having recurrent Group A Strep (La Jolla Institute for Immunology, 2019). Streptococcal pharyngitis (Strep Throat) Alterations in Cellular Processes Discussion Essay

     

    Why the patient is presenting with the specific symptoms described
    .

    Strep throat (Group A Streptococcal Pharyngitis) is an inflammation of the mucous membranes in the throat and tonsils caused by the bacterial streptococcus (Ahmad & Saleem, 2018). Characteristics of the illness can include pharyngeal and tonsillar erythema, tonsillar hypertrophy with or without exudates, palatal petechiae, and anterior cervical lymphadenopathy, fever, and difficulty swallowing (CDC, 2018). The virus (streptococci chains) enters the body through the respiratory system and colonizes. An inflammatory response then occurs due to the release of extracellular toxins by Group A 
    Streptococcus
     (MedScape, 2018).

     

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

    The physiologic response in this scenario was an anaphylactic response to Amoxicillin. For an allergic reaction to occur there must be prior sensitization of the immune system. After the immune system has been sensitized to a drug, reexposure to that drug can trigger an allergic response. Streptococcal pharyngitis (Strep Throat) Alterations in Cellular Processes Discussion Essay

     

    The cells that are involved in this process
    .

    B-cells and T-cells are lymphocytes that help protect your body from foreign invaders. A foreign invader causes the production of antibodies or also known as an antigen.  After the B-cell lymphocytes identify that antigen, it will change into a plasma cell and produce antibodies specifically made to kill the foreign invader identified. The antibody responsible for the allergic response is IgE. Once the B-cells identify that same foreign invader, a large quantity of IgE antibodies are produced that attach themselves to mast cells and basophils throughout the body. When the mast cells and basophils are destroyed, histamine from those cells is released into the bloodstream and body tissues. This process brings on symptoms such as hives, itching, swelling, sneezing, and wheezing (Beach, 2017).

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

     

    According to Faitelson et al., having asthma, being older, and having a family history of amoxicillin allergy are associated with higher risk of allergy (2018). Streptococcal pharyngitis (Strep Throat) Alterations in Cellular Processes Discussion Essay

    Resources

    Ahmad, S., & Saleem, M. (2018). β-hemolytic streptococcal pharyngitis; diagnosing group a β-hemolytic streptococcal pharyngitis (strep throat) by brisk antigen detection. 
    The Professional Medical Journal
    , 
    25
    (12), 1882–1886. doi: 10.29309/TPMJ/18.4585

     

    Beach, S. (2017). How allergies work. Retrieved June 3, 2020, from https://health.howstuffworks.com/diseases-conditions/allergies/allergy-basics/allergy2.htm

     

    Centers for Disease Control and Prevention. (2018). Group A strep. Retrieved June 3, 2020, from https://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html

     

    Choby, B. A. (2019). Diagnosis and treatment of streptococcal pharyngitis. Retrieved June 3, 2020, from https://www.aafp.org/afp/2019/0301/p383.html

     

    Faitelson, Y., Boaz, M., & Dalal, I. (2018). Asthma, family history of drug allergy and age predict amoxicillin allergy in children.
     Journal of Allergy and Clinical Immunology.in Practice
    , 6
    (4), 1363-1367. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1016/j.jaip.2017.11.015  Streptococcal pharyngitis (Strep Throat) Alterations in Cellular Processes Discussion Essay

    Group A Streptococcal (GAS) Infections. (2019, November 11). Retrieved from https://emedicine.medscape.com/article/228936-overview#a3

    La Jolla Institute for Immunology. (2019). Why your kid’s strep throat keeps coming back. Retrieved June 3, 2020, from https://www.lji.org/news-events/news/post/why-your-kids-strep-throat-keeps-coming-back/

     

    Rosenthal, L. D., & Burchum, J. R. (2018). 
    Lehne’s pharmacotherapeutics for advanced practice providers
    . St. Louis, MO: Elsevier. Streptococcal pharyngitis (Strep Throat) Alterations in Cellular Processes Discussion Essay