Tag: Clinical-Nursing

NURS 6521 Pharmacokinetics and Pharmacodynamics Discussion

NURS6521 Module 1 week1 discussion Main Post

Case Study: A 65 year old obese female presents to the ED via ambulance with a compound fracture of the Left ankle. VS: BP= 175/92, HR= 110, RR=26, O2 sats= 95% on RA. Pt is diaphoretic and hollering in pain. Pulse +1 at site of injury. Unable to get PMH.  2mg Morphine given in the field.  Total of 1.5mg of Dilaudid given in ED. Routine lab drawn which indicates the patient has liver disease and a blood glucose of 365.  All other lab WNL.  X-ray tech is present to take film.  While adjusting left foot, patient experiences a level of conscious change. Patient becomes lethargic.  Arousable to stimulation but returns to previous state almost immediately.  VS: BP= 90/50, HR= 82.  Patient is apneic with sats 87% on RA.  When family arrived you learn that the patient takes Gabapentin daily for neuropathy.  The family thinks it is 300mg BID but can not remember for sure. NURS 6521 Pharmacokinetics and Pharmacodynamics Discussion

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Disease can effect the pharmacokinetics of drugs.  The liver disease noted in this case study can change the kinetics of drugs the liver has biotransformed (Rodighiero, 1999).  The metabolism and excretion of drugs can be delayed.  With these delays you can see a compounded and extended effect on the patient.  When administering medication, especially narcotics, one should be mindful of the presence of disease and how the patient will be affected.  According to one article, the author stated “the clearance of these drugs is reduced in patients with liver failure; thus, the initial dose may need to be lower, the interval between the doses may need to be increased, and such patients will need to be assessed on a regular basis” (Swetz et al., 2010, p. 959).

In this case, where pharmacodynamics are concerned, one must remember that all drug responses are not created equal.  One patient’s pain may respond significantly to 1 mg of morphine while another patient may not have the same effect until 2 mg of morphine have been given.  With this scenario, age and pathophysiological changes can contribute to increased effects and slow metabolism and excretion.  According to an article in 
The American Geriatrics Society, 
mixing opioids and gabapentin can produce overdose in patients indicating that substantial harm can occur (American Geriatrics Society 2019 Beers Criteria Update Expert Panel, 2019).

In developing a plan of care for this patient, education is key using a multidisciplinary approach.  If available and possible, having a family member present for teaching would be beneficial.  Providing information and teaching on each diagnosis will be beneficial and key to a successful management plan.  Having a pharmacist on the team that can evaluate current medications and provide necessary education can help prevent drug interactions that can cause adverse reactions.  I would have case management involved so they could identify areas of need that might affect good quality care and/or the ability to access resources needed.  Once the big picture is reviewed, there could be a need for referrals to other doctors, facilities, or disciplines.

References

American Geriatrics Society 2019 Beers Criteria Update Expert Panel. (2019). American Geriatrics Society 2019 Updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. 
The American Geriatrics Society
, 
67
(4), 674–694. 
https://doi.org/10.1111/jgs.15767

Rodighiero, V. (1999). Effects of liver disease on pharmacokinetics. 
Clinical Pharmacokinetics
, 
37
(5), 399–431. 
https://doi.org/10.2165/00003088-199937050-00004

Swetz, K. M., Carey, E. C., Rho, R. H., Mauck, W. D., Whitford, K. J., Moynihan, T. J., Kaur, J. S., Coyne, P. J., & Smith, T. J. (2010). Safe use of opioids to manage pain in patients with cirrhosis. 
Mayo Clinic Proceedings
, 
85
(10), 959. 
https://doi.org/10.4065/mcp.2010.0294

Thank you for your post.

With these patients that have liver failure it is important to get some specific labs that will give the clinicians an idea of the extent of the liver failure. This is an important addition to the care plan. These liver function and bilirubin levels will tell us a lot about the disease. Patients with severe liver disease, are on medications that lower the Bili levels. One example is taking Colace three times a day.This is given to bind some of the excess bilirubin in their stool. This causes frequent bowel movements. Patients complain about this effect because it disrupts their activities of daily living. So many patients omit a dose or omit all of the doses. This can increase  their Bili levels and their chances of hepatic encephalopathy. They can become unconscious. We need to know what has caused them to be unconscious.  When a patient is unconscious or is sub optimally breathing they can become acidotic. When these patients have frequent bowel movements, this puts them at risk for metabolic alkalosis. Whether a patient is in an acidotic or alkaline state, the medications they take can be greatly effected . They could overdose or underdose depending on their PH and coupled with the metabolism deficiency they have from hepatic failure.  Also when a patient has liver failure they have decreased albumin (M.Z.,n.d.) This can cause low blood pressure, increasing the likelihood of a patient passing out and becoming unconscious. When patients with liver failure have less circulating albumin this effects the medications that they may take that are protein bound medications (Rosenthal, &Burchum, 2021).This scenario can become even more dire if the patient is much older than 65 when liver clearance and renal function have a tendency to decline. NURS 6521 Pharmacokinetics and Pharmacodynamics Discussion

Another addition to the care plan for this patient would be to get a Medic Alert bracelet indicating the patient has liver failure. This will alert medical staff that special precautions need to be taken.

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Reference

LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD):

National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Acute Liver Failure. [Updated 2019 Dec 11]. Available from: 
https://www.ncbi.nlm.nih.gov/books/NBK548171/

 

M;, Z. (n.d.). The role and indications of albumin in advanced liver disease. Retrieved September 05, 2020, from 
https://pubmed.ncbi.nlm.nih.gov/31314192/

Rosenthal, L. D., & Burchum, J. R. (2021). 
Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants
. St. Louis, MO: Elsevier.

Discussion: Pharmacokinetics and Pharmacodynamics

As an advanced practice nurse assisting physicians in the diagnosis and treatment of disorders, it is important to not only understand the impact of disorders on the body, but also the impact of drug treatments on the body. The relationships between drugs and the body can be described by pharmacokinetics and pharmacodynamics.

Pharmacokinetics describes what the body does to the drug through absorption, distribution, metabolism, and excretion, whereas pharmacodynamics describes what the drug does to the body. NURS 6521 Pharmacokinetics and Pharmacodynamics Discussion

Photo Credit: Getty Images/Ingram Publishing

When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. These patient factors include genetics, gender, ethnicity, age, behavior (i.e., diet, nutrition, smoking, alcohol, illicit drug abuse), and/or pathophysiological changes due to disease.

For this Discussion, you reflect on a case from your past clinical experiences and consider how a patient’s pharmacokinetic and pharmacodynamic processes may alter his or her response to a drug.

To Prepare

Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.

Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug.

Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease. NURS 6521 Pharmacokinetics and Pharmacodynamics Discussion

Think about a personalized plan of care based on these influencing factors and patient history in your case study.

By Day 3 of Week 1

Post
 a description of the patient case from your experiences, observations, and/or clinical practice from the last 5 years. Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient you identified. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case. Be specific and provide examples.

By Day 6 of Week 1

Read
 a selection of your colleagues’ responses and 
respond
 to 
at least two
 of your colleagues on 
two different days
 by suggesting additional patient factors that might have interfered with the pharmacokinetic and pharmacodynamic processes of the patients they described. In addition, suggest how the personalized plan of care might change if the age of the patient were different and/or if the patient had a comorbid condition, such as renal failure, heart failure, or liver failure.

Note:
 For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit! NURS 6521 Pharmacokinetics and Pharmacodynamics Discussion

 

 

WK1 Main post.

Rosenthal states that the to better understand and properly prescribe medication to our patients one must understand the pharmacokinetics, or drugs movement throughout the body, as well as pharmacodynamics, or the drugs physiological or biological effect on the body. (Rosenthal, 2021) Both pharmacokinetics and pharmacodynamics are dependents upon the patient’s comorbidities as well as other pharmacological treatment, as many drugs could have a synergistic or antagonistic affect.

There is a growing concern of opioid use and subsequent tolerance this patient population can experience. “The term 
pharmacodynamic tolerance refers to the familiar type of 
tolerance associated with long-term administration of drugs such as morphine and heroin.” (Rosenthal, 2021) This result is an adaptation to the receptors for this type of medication as a result of long term or chronic exposure to the opioid narcotic. This forces the provider to administer more frequent and often higher dose levels to attain the desired effect.

This brings to mind one of many examples that I have encountered throughout my career. This particular patient was a 42-year-old white male with a history of uncontrolled hypertension, polysubstance abuse and bipolar disorder. This patient received coronary artery bypass surgery and was extubated post-operative day zero following an uneventful surgery. NURS 6521 Pharmacokinetics and Pharmacodynamics Discussion

This patient did require higher than normal levels of sedation while conducting the weaning process from the ventilator. Following the patient’s removal from the ventilator, pain management remained the focal point and largest obstacle for this patient. Anxiety levels where also of concern as the lack of pain control contributed higher levels of anxiety. In order to affectively manage this patient level of comfort a continuous of morphine was ordered to achieve a baseline level of comfort. Dilaudid pushes where ordered at a frequency of every hour for breakthrough pain as well as Ativan pushes to assist with rising anxiety levels.

Opioid tolerance and subsequent lack of pain management often delays recovery for patients as they are less likely to adhere to treatment pathways due to the increased levels of discomfort NURS 6521 Pharmacokinetics and Pharmacodynamics Discussion. (Owodunni, 2019) It is important that providers understand that opioid tolerance affects the pharmacodynamics of prescribed medications for pain management.

 

References

Owodunni, O. P., Zaman, M. H., Ighani, M., Grant, M. C. Bettick, D., Sateri, S., Magnuson, T., & Gearhart, D. (2019). Opioid tolerance impacts compliance with enhanced recovery pathway after major abdominal surgery, 
166
(6), 1055-1060. https://doi-org.ezp.waldenulibrary.org/10.1016/j.surg.2019.08.001 NURS 6521 Pharmacokinetics and Pharmacodynamics Discussion

Rosenthal, L.D., & Burchum, J. R. (2021). 
Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants 
(2
nd
 ed.) St. Louis, MO: Elsevier Retrieved September 2, 2020 from https://mbsdirect.vitalsource.com/#/books/9780323598125/cfi/6/34!/4/2/4/2/2@0:45.7

Villegas-Pineda, M. H., & Palacio-Garcia, C. A. (2017). Case report: Opioid tolerance and hyperalgesia after abdominal injury. 
Colombian Journal of Anesthesiology, 45
(Supplement 1), 12-15. Retrieved September 2, 2020 https://doi-org.ezp.waldenulibrary.org/10.1016/j.rcae.2016.03.005 NURS 6521 Pharmacokinetics and Pharmacodynamics Discussion

Week 1 Main Post Discussion: Pharmacokinetics and Pharmacodynamics

Understanding how prescription and non-prescription influences the body, first a clear understanding is needed to the function of pharmacokinetics and pharmacodynamics and how these components how any drugs that maybe administered and interact in the body.  Pharmacokinetics refers to movement of drug into and out of the body by absorption, metabolism, excretion, and distribution the amount of time it takes for a drug to be utilized by the body.  Also, pharmacokinetics determines the onset, duration, and intensity of a drug effect Discussion: Pharmacokinetics and Pharmacodynamics.  Pharmacodynamics described what a drug does to the body once it attaches to the appropriate receptor site.  Pharmacodynamics also involves the molecular effect of the drug to bind with the receptors site of the cell to cause a reaction. (Farinde, 2019).

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A drug pharmacodynamic and pharmacokinetic effect centers around many factors concerning the patient for example, the age of the patient, hepatic, and renal function, other drug – drug interaction competing for receptor binding sites.  Looking at the current pandemic of Coronavirus many different anti-viral medications was used to reverse the effect of acute respiratory syndrome that affect the patient from the coronavirus.  Some of these medications such as lopinavir, remdesivir, azithromycin, and chloroquine was used to help combat or reverse the effect of coronavirus Discussion: Pharmacokinetics and Pharmacodynamics.

The pharmacokinetic process for each of these drugs are the same but the pharmacodynamics may differ depending on their molecular structure and the receptors site which they bind and how they cross the cell membrane.  As stated by Srivalli & Lakshmi, (2012) these drugs are substrates of P-glycoprotein an efflux membrane transporter and a member of the ATP-binding transporter found primarily in epithelial cells which are inhibitors.  Which means these drugs stop the progress of the coronavirus from attacking the cells or other cell which mostly affect respiratory function.

During this pandemic I worked in the ICU and saw the affects the positive and not so positive effects that chloroquine has in response to patients being removed from the ventilators with a lower peep and FIO2 level.   Depending on the co-morbidity’s patient has and how soon the antiviral medication was started the patient had a fair chance for being extubated.  If a child was given an overdose of antiviral medication to combat the coronavirus that was meant for adult many rapid action steps need to be executed.  Looking at azithromycin administration in children is given by body for 3-5 days an overdose of this medication causes prolongation of QT complex, Torsade de point, and unresponsiveness.  Reason, azithromycin in the tissue has an extreme high plasma and high lipid solubility and its half-life is 68 hours and excretion or elimination is characteristic of this drug remain unchanged. (Tijjani, Ishola 2020).     The APRN must take in account that a children body surface is must smaller than an adult and over medicating disaster can occur quickly.  Administering any medications understanding the pharmacokinetic and pharmacodynamic properties is a must to assure patient safety and ethical practice.

References

Farinde, A. (2019). Overview of Pharmacodynamics – Clinical Pharmacology: Merck Manual Professional Version Retrieved from: Merck Manuals >professional > overview

Srivalli, K. Lakshmi, P. (2012). Overview of P-glycoprotein inhibitors: A rational outlook. Brazilian Journal of Pharmaceutical Science 48(3) 353-367

Tijjani, H. Ishola, A. (2020). Repurposing of choloroquine and some clinically approved antiviral  drugs as effective therapeutics to prevent cellular entry and replication of coronavirus Retrieved from: 
https://www.researchgate.net/publication/341601496

 

Response

Good post

Chloroquine (CQ) and hydroxychloroquine (HCQ) are old drugs used in the treatment of malaria. Moreover, their antiviral properties have been previously studied, including against coronaviruses, where evidence of efficacy has been found. In the current race against time triggered by the COVID-19 pandemic, the search for new antivirals is very important. However, consideration are given to old drugs with known anti-coronavirus activity, such as CQ and HCQ. These could be integrated into current treatment strategies while novel treatments are awaited, also in light of the fact that they display an anticoagulant effect that facilitates the activity of low-molecular-weight heparin, aimed at preventing acute respiratory distress syndrome (ARDS)-associated thrombotic events.

There has been significant research on the possible antiviral actions of CQ/HCQ. Their safety aspects have been studied extensively for over 50 years, but the evidence is not necessarily applicable to those most at risk of mortality from COVID-19 (e.g. frail older people), who at the same time are most vulnerable to drug side effects. The challenge that SARS-CoV-2 launches into science is to create new specific drugs. However, because COVID-19 causes cardiac problems, the cardiac toxicity of HCQ can be enhanced in the short-term.

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References

Liu J, Cao R, Xu M, Wang X, Zhang H, Hu H. Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro. 
Cell Discov. 
2020;
6
:16. doi: 10.1038/s41421-020-0156-0. 

Zhu RF, Gao RI, Robert SH, Gao JP, Yang SG, Zhu C. Systematic review of the registered clinical trials of coronavirus disease 2019 (COVID-19) 
medRxiv. 
2020 Mar 17 doi: 10.1101/2020.03.01.20029611. 

 

Discussion: Pharmacokinetics and Pharmacodynamics

As an advanced practice nurse assisting physicians in the diagnosis and treatment of disorders, it is important to not only understand the impact of disorders on the body, but also the impact of drug treatments on the body. The relationships between drugs and the body can be described by pharmacokinetics and pharmacodynamics.

Pharmacokinetics describes what the body does to the drug through absorption, distribution, metabolism, and excretion, whereas pharmacodynamics describes what the drug does to the body.

Photo Credit: Getty Images/Ingram Publishing

When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. These patient factors include genetics, gender, ethnicity, age, behavior (i.e., diet, nutrition, smoking, alcohol, illicit drug abuse), and/or pathophysiological changes due to disease.

For this Discussion, you reflect on a case from your past clinical experiences and consider how a patient’s pharmacokinetic and pharmacodynamic processes may alter his or her response to a drug.

To Prepare

Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.

Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug.

Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease. Discussion: Pharmacokinetics and Pharmacodynamics

Think about a personalized plan of care based on these influencing factors and patient history in your case study.

By Day 3 of Week 1

Post
a description of the patient case from your experiences, observations, and/or clinical practice from the last 5 years. Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient you identified. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case Discussion: Pharmacokinetics and Pharmacodynamics. Be specific and provide examples.

By Day 6 of Week 1

Read
 a selection of your colleagues’ responses and 
respond
 to 
at least two
 of your colleagues on 
two different days
by suggesting additional patient factors that might have interfered with the pharmacokinetic and pharmacodynamic processes of the patients they described. In addition, suggest how the personalized plan of care might change if the age of the patient were different and/or if the patient had a comorbid condition, such as renal failure, heart failure, or liver failure. Discussion: Pharmacokinetics and Pharmacodynamics.

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

 

 

Week 1 Discussion post

Case: A person on medication for weight loss. States she has taken it for numerous years to get her through the hard times and curbed her appetite so she can continue to look the way she does.

Prescription medicine has the potential to change the practice of medicine by tailoring treatments to individuals (Grottick, A., Whelan, K., Sanabria, E., Behan, D., Morgan, M., & Sage, C. (2015). We have all been taught the medication rights- right medication, dose, route, time, and reason. Even though this client is a friend, and I have known her to be on this medication for years Discussion: Pharmacokinetics and Pharmacodynamics. I have watched her take it, also know she has a ton of underlying medical problems such as thyroid disease, PCOS, lupus, and has pulmonary hypertension that is poorly managed. I realize that Adipex is a medication that has both positive and negative effects (depending on the person and the situation). It may be used to help with concentration, decrease appetite, and used as a stimulant, but is often given to individuals that have not had a complete physical. For someone that has chronic illnesses, filtration and absorption mechanisms are vastly reduced and have multiple allergies to medications due to autoimmune disorders- supplying the medication without continued to follow up, a proper assessment would be negligent. Discussion: Pharmacokinetics and Pharmacodynamics This patient has an issue with fluid retention at baseline, takes Bumex twice a day, and has a difficult time urinating at times. Shortness of breath is part of her daily life, and increasing heart rate, on a pump that already fails would be disastrous.

Pharmacokinetics and pharmacodynamics determine the clinical effects of drug therapy. It is necessary to know what the body specifically does to the drug, how it is absorbed, distributed, metabolized, and eliminated. To further understand medication choice, usage, and dosage, the physiological effects on the body must be known. If an individual has chronic medical conditions, including those listed on the contraindications and or side effects sections, prescribing with caution would be the best practice or not prescribing at all. We as providers must deliver care with accuracy, precision, and efficiency (Grottick, A., Whelan, K., Sanabria, E., Behan, D., Morgan, M., & Sage, C., 2015). Practitioners are being held to high standards based on prescribing guidelines that have been made more readily accessible thanks to upgraded technology (Durney, P. M., & Lebov, H. L., 2019) Discussion: Pharmacokinetics and Pharmacodynamics.

Things that we, as prescribers should consider when writing for medications: documenting medication indications on the prescription. Cross-checking through computer data bases also allow for further verification of the medication, dosing, and determine if the medication is questionable with other prescribed medications. This will be a more efficient way to tailor patient-centered care, and to perform safety checks (Kron, Myers, Volk, Nathan, Neri, Salazar, Amato, Wright, Karmiy, McCord, Seoane-Vazquez, Eguale, Rodriguez-Monguio, Bates, & Schiff, 2018)

 

Durney, P. M., & Lebov, H. L. (2019). The Perils of Prescribing Medication and the Goldilocks

Principle: Defending Related Claims of Malpractice. 
Defense Counsel Journal
, 
86
(4), 1–

20.

Grottick, A., Whelan, K., Sanabria, E., Behan, D., Morgan, M., & Sage, C. (2015). Investigating

interactions between phentermine, dexfenfluramine, and 5-HT agonists, on food intake in

the rat. 
Psychopharmacology
, 
232
(11), 1973–1982. Discussion: Pharmacokinetics and Pharmacodynamics

Kron, K., Myers, S., Volk, L., Nathan, A., Neri, P., Salazar, A., Amato, M. G., Wright, A.,

Karmiy, S., McCord, S., Seoane-Vazquez, E., Eguale, T., Rodriguez-Monguio, R., Bates,

D. W., & Schiff, G. (2018). Incorporating medication indications into the prescribing

process. 
American Journal of Health-System
Pharmacy : AJHP : Official Journal of the

American Society of Health-System Pharmacists
, 
75
(11), 774–783.

response 1

I enjoyed reading your post.  I do not know too much about weight loss medication, but I do know that they can affect how other medications are absorbed within the body.  Makiani, Nasiripour, Hosseini, & Mahbubi (2017) state that “knowing about medications mechanisms of action and where and how they are absorbed is important, especially when other medications are being given at the same time”.  I know the medication that you speak of is not over the counter, however, some weight loss supplements are and can affect the patient’s other medications.  One thing that really came to mind for me was that CAM therapies can have negative effects on patients and their medications. Discussion: Pharmacokinetics and Pharmacodynamics National Cancer Institute (2019) states “not all-natural materials are safe; vitamins can have unwanted effects within your body.”  There are also food and drinks that can alter medications for example, Rosenthal & Burchum (2020), state that “grapefruits can cause major issues with patients and their medications”.  I really enjoyed your post, did you feel that because of this discussion board you were forced to think through patient medication the next time you worked?  Thanks for creating a great discussion.

 

References

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

Makiani, M., Nasiripour, S., Hosseini, M., & Mahbubi, A. (2017). Drug-drug Interactions: The Importance of Medication Reconciliation. Retrieved September 05, 2020, from 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5348861/

National Cancer Institute. (2019). Complementary and Alternative Medicine (CAM). Retrieved September 05, 2020, from 
https://www.cancer.gov/about-cancer/treatment/cam

National Caregivers Library. (2019). Caregivers Resources. Retrieved September 05, 2020, from http://www.caregiverslibrary.org/Caregivers-Resources/GRP-Home-Care/HSGRP-Medications/Understanding-Drug-Interactions-Article Discussion: Pharmacokinetics and Pharmacodynamics

 

response 2

I’ve enjoyed reading your discussion. The most commonly used weight‐loss medication in the United States is phentermine, a sympathomimetic amine that acts by inhibiting appetite and that was originally approved for weight loss in 1959 (Ard et., 2019). Like you, I’ve also known many individuals who’ve taken phentermine. Several months later, the weight was regained. This caused them to remain on the medication longer, or use it “off and on. “Given the physical and psychological harms related to weight regain, weight cycling should be considered as an adverse effect of therapy (Murali, 2019). Discussion: Pharmacokinetics and Pharmacodynamics Recently, many studies have shown that longer‐term phentermine users experienced greater weight loss without apparent increases in cardiovascular risk as mentioned by (Ard et al., 2019). Addressing chronic illnesses and disease care maintenance is critical for medication safety. Existing pharmacotherapies continue to focus on winning the battle of weight loss while progress toward winning the war of weight loss maintenance remains stagnant (Murali, 2019). Discussion: Pharmacokinetics and Pharmacodynamics

References

Ard, J., Lewis, K. H., Arterburn, D. E., Fischer, H., Barton, L., Koebnick, C., Yamamoto, A., Young, D. R., Bessesen, D. H., Daley, M. F., Desai, J., Fitzpatrick, S. L., Horberg, M., & Oshiro, C. (2019). Safety and Effectiveness of Longer-Term Phentermine Use: Clinical Outcomes from an Electronic Health Record Cohort. Obesity (19307381), 27(4), 591–602. 
https://doi-org.ezp.waldenulibrary.org/10.1002/oby.22430

Murali, S. (2019). Knowledge Gaps in Long-Term Phentermine Use: Making the Case for Maintenance. Obesity (19307381), 27(8), 1219. https://doi-org.ezp.waldenulibrary.org/10.1002/oby.22516 Discussion: Pharmacokinetics and Pharmacodynamics

Assessing the Head, Eyes, Ears, Nose, and Throat Episodic/Focused SOAP Note Case Study Assignment

Episodic/Focused SOAP Note Template

Patient Information:

Initials, RB.

Age 50, Sex

Male, Race. Caucasian

Subjective

CC
 (chief complaint); nasal congestion and itchy eyes, nose, and palate for five days

HPI
: Mr. Brown is a 50-year-old white male presenting with a complaint of nasal congestion, sneezing, rhinorrhea, nasal drainage, itchy nose, eyes, and palate for five days Assessing the Head, Eyes, Ears, Nose, and Throat Episodic/Focused SOAP Note Case Study Assignment. He states that he has been taking Mucinex for the past two nights with minimal relief. He denies a headache or pain.

Current Medications
:

Mucinex OTC at bedtime

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Hydralazine 25mg TID

Allergies: 
NKDA

-reports seasonal allergies

-denies environmental allergy

PMHx
: has a history of hypertension. Denies other illnesses. Immunizations are up to date; he received a flu shot this season. He Received a Tetanus booster last year. Hospitalized in 2018 for left femur fracture repair from a fall. No other significant medical or surgical history Assessing the Head, Eyes, Ears, Nose, and Throat Episodic/Focused SOAP Note Case Study Assignment

Soc Hx
: Mr. Brown lives in a one-story single-family home with his wife and three children. He has his master’s degree in business administration and works in a consulting firm where he has worked for 15 years. He is a former smoker, smoked cigarette from 17-38 years, and marijuana from the age of 18-30. He drinks socially about 1-2 drinks weekly. He states that he does not exercise but takes a walk around the neighborhood about three times weekly. He is a Christian and sometimes attends church on Sundays if he is not too tired. His wife is a beautician who enjoys making healthy meals for the family.

Include occupation and major hobbies, family status, tobacco & alcohol use (previous and current use), any other pertinent data. Always add some health promo question here – such as whether they use seat belts all the time or whether they have working smoke detectors in the house, living environment, text/cell phone use while driving, and support system.

Fam Hx
:

-Father has a history of hypertension and BPH

-Mother died at 78 from a stroke.

-Two sisters with no significant medical history

-Three children aged 15, 17, and 20 with no significant medical history.

-Maternal Grandparents died from a car accident when he was 18. He does not remember their ages at death.

-Paternal grandparents are deceased, but he doesn’t remember the ages and cause of death

ROS
:

GENERAL: Alert and oriented to person, place, situation, and time. Denies recent weight changes. Denies fatigue, fever, chills, and weakness.

HEENT: Denies headache. Eyes are itchy and red. No visual loss, blurred vision, double vision or yellow sclerae. States that Ears are itchy, erythematic, and inflamed, denies hearing loss and discharge from the ear. The nose is itchy with sneezing, congestion, and runny nose. Clear nasal discharge. Reports sore throat. Denies difficulty swallowing.

SKIN: No changes in pigmentation. No discoloration, moles, rash, or itching. Denies any other skin abnormalities.

CARDIOVASCULAR: Denies chest pain, chest pressure, or chest discomfort. No palpitations or edema.

RESPIRATORY: Denies shortness of breath or cough

GASTROINTESTINAL: Denies anorexia, nausea, vomiting, or diarrhea. No abdominal pain or discomfort. Reports regular daily bowel movements.

GENITOURINARY: Denies burning or pain on urination. Denies urinary tract infection.

NEUROLOGICAL: Denies headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.

MUSCULOSKELETAL: Denies muscle, back pain, joint pain, fatigue, or stiffness.

LYMPHATICS: No enlarged nodes. No history of splenectomy.

PSYCHIATRIC: No history of depression or anxiety.

ENDOCRINOLOGIC: No reports of sweating, cold, or heat intolerance. No polyuria or polydipsia.

ALLERGIES: No history of asthma, hives, eczema or rhinitis. Reports seasonal allergies.

Objective

Physical Exam: 

General: Alert and oriented to person, place, situation, and time. Appears well groomed and nourished. Eyes are itchy and red. PERRLA

V/S: Temp: 97.9 degrees Fahrenheit, Pulse:72 beats per minute and regular. Resp:18 beats per minute, Blood Pressure: 141/76, weight: 185 pounds Height: 68 inches

HEENT: Head is normocephalic. Eyes are itchy and red, with no discharge noted in eyes. No vision changes. Ears are red and inflamed. Nasal mucosa is pale and edematous with enlarged nasal turbinate. Clear thin secretions noted in nasal cavities. The throat is mildly erythematous, with no purulent discharge or bleeding noted. Tonsils are symmetrical and pink, no swelling noted.

NECK: Trachea in the midline, no deviation noted. No swollen Lymph nodes noted.

CARDIOVASCULAR: No palpitations or edema. Bilateral radial and dorsalis pedis pulse 2+ and regular.

RESPIRATORY: No shortness of breath, cough, or sputum noted. Lung sounds are clear anteriorly, posteriorly, and laterally. Respirations are even and unlabored.

NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.

MUSCULOSKELETAL: No muscle, back pain, joint pain, or stiffness.

LYMPHATICS: No enlarged nodes. No history of splenectomy.

Diagnostic results
:

Allergy Skin tests:
This can be done for this patient in this scenario. The test is done by introducing an allergen into the body intradermally to determine if there is an immune reaction (Nelvis, 2016). This test will help diagnose allergic rhinitis and determine what allergen the patient is reacting to (Health Quality Ontario, 2016). In this case, the patient tested positive for pollen, hence indicative of allergic rhinitis.

Radioallergosorbent test
: (RAST) is an antibody blood test that can be performed in this scenario. Testing for immunoglobulin E antibody in the blood will help determine if there has been an immune response; this is because the body produces antibodies in response to allergens (NHS, 2016).

Sinus CT scan:
A Sinus CT scan can be performed to rule out Sinusitis. CT scan of the sinus will reveal inflammation of the sinuses (Alam, 2020).

Throat culture:
A sputum culture can be performed to test for the presence of infectious microorganisms in the throat that may be responsible for an upper respiratory tract infection (Arberfeville et al., 2018). The test is done by swabbing the back of the throat after which the secretions are cultured, the test result for a throat culture takes days but is effective in identifying the presence of microorganisms in the upper respiratory tract and in this scenario may be useful in diagnosing tonsillopharyngitis.

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Differential Diagnoses

 Allergic Rhinitis:  
Allergic rhinitis is an allergic response characterized by sneezing, itchy, watery eyes, congestion, and clear nasal discharge in response to exposure to allergens such as dust, chemicals, or pollen (American College of Allergy, Asthma & Immunology, 2015). When allergens are inhaled, it triggers an immunoglobulin E (IgE) mediated reaction, which then causes the symptoms (Wheatley & Alkis, 2015). This is the most likely diagnosis due to the positive skin test for pollen allergen and the presenting symptoms.

Nonallergic Rhinitis: 
Nonallergic rhinitis is the inflammation of the nasal tissues causing sneezing, congestion, and runny nose. It is not caused by allergens rather by a build of fluid due to inflamed blood vessels due to viral infections, hormonal imbalances, or environmental factors (NHS, 2019). It is often diagnosed with history, negative tests for allergens, and a lack of improvement when treated like allergic rhinitis (NHS, 2019). Nonallergic rhinitis is a possible diagnosis for this patient; however, the presence of a positive pollen test suggests that allergic rhinitis is a more likely diagnosis. This patient also has itchy eyes, nose, and throat, which are symptoms more suggestive of allergic rhinitis.

Sinusitis: 
Sinusitis is the inflammation of the tissue lining the sinuses due to viral, bacteria, fungal infections, or allergic reactions. When Sinusitis occurs, the sinus becomes filled and is unable to drain due to sinus blockage. Sinus blockage may be caused by smoking, weakened immune system, structural problems with the sinus, or following a cold (CDC, 2019b). It is characterized by cough, congestion, purulent rhinorrhea, facial pain, or pressure; It is sometimes accompanied by headache, malaise, and fever (Marvin, 2017). Symptoms usually diagnose it; however, a sinus CT scan may be used to ascertain the extent of infection if it persists (CDC, 2019b). Although there are similar symptoms such as congestion and rhinorrhea, Sinusitis is a less likely diagnosis in this scenario because rhinorrhea in Sinusitis is often purulent. This patient also lacks pertinent symptoms such as headaches, facial pain, or pressure.

Common cold: 
Common cold is an acute viral infection of the upper respiratory tract. It usually affects the nose, sinuses, larynx, and pharynx, causing symptoms such as cough, sore throat, runny nose, malaise, headache, mild fever, and sneezing (Solo-Josephson, 2017). It is usually transmitted by direct or indirect contact with the cold virus into the eyes or nose; symptoms usually appear within two to three days after exposure to the virus (CDC, 2019a). It is usually self-limiting in generally healthy people, clearing up after 7-10 days (CDC, 2019a). It is often diagnosed using symptoms and history. The common cold is unlikely for this scenario due to the absence of sore throat, headache, malaise, and fever.

Tonsillopharyngitis. 
Tonsillopharyngitis is an acute inflammation of the tonsils, pharynx, or both. It may also be caused by bacteria. It is transmitted through direct or indirect contact with the secretions of an infected person (Marvin, 2016). Symptoms include rhinorrhea, cough, sore throat, diarrhea, and conjunctivitis (Marvin, 2016). Symptoms usually start about two to seven days after exposure. There is often fever in bacterial tonsillopharyngitis; there may be no fever in viral tonsillopharyngitis. Although some of these symptoms are present in Mr. Brown, the absence of enlarged tonsils and sore throat makes this diagnosis less likely.

 

References

American College of Allergy, Asthma & Immunology (2015). Allergic rhinitis. Retrieved from 
https://acaai.org/allergies/types/hay-fever-rhinitis

Alam, R. (2020). Allergic Rhinitis (Hay Fever): Diagnosis. Retrieved from   
https://www.nationaljewish.org/conditions/allergic-rhinitis-hay-fever/diagnosis

Arbefeville, S., Nelson, K., Thonen-Kerr, E., & Ferrieri, P. (2018). Prospective postimplementation study of Solana group A streptococcal nucleic acid amplification test vs conventional throat culture.
American journal of clinical pathology
,
150
(4), 333-337.

Centers for Disease Prevention and Control (2019). Common colds: Protect yourself and others. Retrieved from  
https://www.cdc.gov/features/rhinoviruses/index.html

CDC (2019). Sinus Infection (Sinusitis). Retrieved from  
https://www.cdc.gov/antibiotic-use/community/for-patients/common-illnesses/sinus-infection.html

Delves, P. J. (2016). Allergic Rhinitis. 
Merck Manual Professional Version. 
Retrieved from 
https://www.merckmanuals.com/professional/immunology-allergic-disorders/allergic,-autoimmune,-and-other-hypersensitivity-disorders/allergic-rhinitis#v651577

Health Quality Ontario (2016). Skin Testing for Allergic Rhinitis: A Health Technology Assessment. 
Ontario health technology assessment series
, 
16
(10), 1–45. Assessing the Head, Eyes, Ears, Nose, and Throat Episodic/Focused SOAP Note Case Study Assignment

Marvin, P. F. (2016). Sore Throat. 
Merck Manual Professional Version. 
Retrieved from 
https://www.merckmanuals.com/professional/ear,-nose,-and-throat-disorders/approach-to-the-patient-with-nasal-and-pharyngeal-symptoms/sore-throat

Marvin, P. F. (2017). Sinusitis. 
Merck Manual Professional Version. 
Retrieved from 
https://www.merckmanuals.com/professional/ear,-nose,-and-throat-disorders/nose-and-paranasal-sinus-disorders/sinusitis

Nelvis, F. I., Binkley, K., and Kabali, C. (2016). Diagnostic accuracy of skin-prick testing for allergic rhinitis: a systematic review and meta-analysis. 
Allergy, Asthma & Clinical Immunology 12
(20). Retrieved from https://aacijournal.biomedcentral.com/articles/10.1186/s13223-016-0126-0

NHS (2016). Allergic rhinitis: diagnosis. Retrieved from 
https://www.nhs.uk/conditions/non-allergic-rhinitis/

NHS (2019). Nonallergic rhinitis. Retrieved from 
https://www.nhs.uk/conditions/non-allergic-rhinitis/

Solo-Josephson, P. (2017). Colds. Retrieved from  
https://kidshealth.org/en/parents/cold.html
 Wheatley, L. M., & Togias, A. (2015). Allergic Rhinitis. 
The New England Journal of Medicine
, 372(5), 456–463. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4324099/

Assignment 1: Case Study Assignment: Assessing the Head, Eyes, Ears, Nose, and Throat

Photo Credit: Getty Images/Blend Images

Most ear, nose, and throat conditions that arise in non-critical care settings are minor in nature. However, subtle symptoms can sometimes escalate into life-threatening conditions that require prompt assessment and treatment.

Nurses conducting assessments of the ears, nose, and throat must be able to identify the small differences between life-threatening conditions and benign ones. For instance, if a patient with a sore throat and a runny nose also has inflamed lymph nodes, the inflammation is probably due to the pathogen causing the sore throat rather than a case of throat cancer Assessing the Head, Eyes, Ears, Nose, and Throat Episodic/Focused SOAP Note Case Study Assignment. With this knowledge and a sufficient patient health history, a nurse would not need to escalate the assessment to a biopsy or an MRI of the lymph nodes but would probably perform a simple strep test.

In this Case Study Assignment, you consider case studies of abnormal findings from patients in a clinical setting. You determine what history should be collected from the patients, what physical exams and diagnostic tests should be conducted, and formulate a differential diagnosis with several possible conditions.

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.

Also, your Case Study Assignment should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style format Assessing the Head, Eyes, Ears, Nose, and Throat Episodic/Focused SOAP Note Case Study Assignment. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP Notes have specific data included in every patient case.

With regard to the case study you were assigned:

Review this week’s Learning Resources and consider the insights they provide.

Consider what history would be necessary to collect from the patient.

Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?

Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

The Assignment

Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis and justify why you selected each. Assessing the Head, Eyes, Ears, Nose, and Throat Episodic/Focused SOAP Note Case Study Assignment

By Day 6 of Week 5

Submit
 your Assignment.

Submission and Grading Information

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

Please save your Assignment using the naming convention “WK5Assgn1+last name+first initial.(extension)” as the name.

Click the 
Week 5 Assignment 1 Rubric 
to review the Grading Criteria for the Assignment.

Click the 
Week 5 Assignment 1 
link. You will also be able to “View Rubric” for grading criteria from this area.

Next, from the Attach File area, click on the 
Browse My Computer
 button. Find the document you saved as “WK5Assgn1+last name+first initial.(extension)” and click 
Open
.

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

Click on the 
Submit
 button to complete your submission.

NURS_6512_Week_5_Assignment_1_Rubric

Excellent

Good

Fair

Poor

Using the Episodic/Focused SOAP Template:

· Create documentation or an episodic/focused note in SOAP format about the patient in the case study to which you were assigned.

·  Provide evidence from the literature to support diagnostic tests that would be appropriate for your case.

45 
(45%)
 – 50 
(50%)

The response clearly, accurately, and thoroughly follows the SOAP format to document the patient in the assigned case study. The response thoroughly and accurately provides detailed evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study. Assessing the Head, Eyes, Ears, Nose, and Throat Episodic/Focused SOAP Note Case Study Assignment

39 
(39%)
 – 44 
(44%)

The response accurately follows the SOAP format to document the patient in the assigned case study. The response accurately provides detailed evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study.

33 
(33%)
 – 38 
(38%)

The response follows the SOAP format to document the patient in the assigned case study, with some vagueness and inaccuracy. The response provides evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study, with some vagueness or inaccuracy in the evidence selected.

0 
(0%)
 – 32 
(32%)

The response incompletely and inaccurately follows the SOAP format to document the patient in the assigned case study. The response provides incomplete, inaccurate, and/or missing evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study.

·   List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.

30 
(30%)
 – 35 
(35%)

The response lists five distinctly different and detailed possible conditions for a differential diagnosis of the patient in the assigned case study, and provides a thorough, accurate, and detailed justification for each of the five conditions selected. Assessing the Head, Eyes, Ears, Nose, and Throat Episodic/Focused SOAP Note Case Study Assignment

24 
(24%)
 – 29 
(29%)

The response lists four or five different possible conditions for a differential diagnosis of the patient in the assigned case study and provides an accurate justification for each of the five conditions selected.

18 
(18%)
 – 23 
(23%)

The response lists three to five possible conditions for a differential diagnosis of the patient in the assigned case study, with some vagueness and/or inaccuracy in the conditions and/or justification for each.

0 
(0%)
 – 17 
(17%)

The response lists two or fewer, or is missing, possible conditions for a differential diagnosis of the patient in the assigned case study, with inaccurate or missing justification for each condition selected.

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 Assessing the Head, Eyes, Ears, Nose, and Throat Episodic/Focused SOAP Note Case Study Assignment 5  (5%)  – 5  (5%) Uses correct grammar, spelling, and punctuation with no errors. 4  (4%)  – 4  (4%) Contains a few (1 or 2) grammar, spelling, and punctuation errors. 3  (3%)  – 3  (3%) Contains several (3 or 4) grammar, spelling, and punctuation errors. 0  (0%)  – 2  (2%) Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list. 5  (5%)  – 5  (5%) Uses correct APA format with no errors. 4  (4%)  – 4  (4%) Contains a few (1 or 2) APA format errors. 3  (3%)  – 3  (3%) Contains several (3 or 4) APA format errors. 0  (0%)  – 2  (2%) Contains many (≥ 5) APA format errors.   Total Points: 100 Name: NURS_6512_Week_5_Assignment_1_Rubric Assessing the Head, Eyes, Ears, Nose, and Throat Episodic/Focused SOAP Note Case Study Assignment

.

NURS-6512 Differential Diagnosis for Skin Conditions SOAP note

Comprehensive SOAP Template

Patient Initials: AC                             Age: 68                                   Gender: Male

 

SUBJECTIVE DATA: “
About a week ago, I noticed some rash on my right chest, back, and neck. I thought it would get better, but the rash is itchy and painful, it has also gotten worse. I also feel a little feverish.” NURS-6512 Differential Diagnosis for Skin Conditions SOAP note

Chief Complaint (CC): 
The patient reported noticing skin abnormality about a week ago, “I have an itchy rash on my neck, chest, and back that is peeling and getting worse.” The rash is swollen with clear liquid and painful.

History of Present Illness (HPI):  
Mr. Alexander Cortez is a 58-year-old Hispanic male. Presents with a patchy rash on the neck, chest, and back region. He states that the rash started about two weeks ago and has progressively gotten worse. He denies changing skin routine or location within the last two weeks, no history of environmental allergies, no known allergy to dye, or latex. Mr. Cortez states he has not tried any treatment for the rash, no worsening, or alleviating factors noted. He complained of pain level 7 on a scale of 1-10. He describes the pain as sharp and states Tylenol 1000mg has helped relieve the pain. He is worried about the rash getting worse and states that the rash and its associated pain interferes with his daily activities and quality of life. NURS-6512 Differential Diagnosis for Skin Conditions SOAP note

Medications:  

– Acetaminophen 1000mg

PO Q 6 HRS for pain

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– Metformin 500mg daily for diabetes

– Atorvastatin 40mg at bedtime for high cholesterol

– Hydralazine 10mg BID for Hypertension

– Amlodipine 5mg daily for hypertension

Allergies: 

– Penicillin Reaction (itching)

Past Medical History (PMH): 

Hypertension-diagnosed at 43 years old

Hyperlipidemia- diagnosed at 45 years old

Diabetes Mellitus Type 2 diagnosed at 38 years old

Chickenpox: 7 years old

Appendicitis – hospitalization at 28 years old

Past Surgical History (PSH): 

Appendectomy 1992

Sexual/Reproductive History: 

Currently sexually active with his wife, he denies sexual/reproductive issues. Heterosexual and currently using no barrier methods, no past history of STDs.

Personal/Social History: 

The patient is a non-smoker, never smoked. His wife smokes 1pack/day. Mr. Cortez drinks alcohol occasionally, about 1-2 drinks a week. He denies the use of recreational drugs.

Immunization History: 

Received flu shot last season

Received pneumococcal vaccine 8/12/2019 during the annual check-up

He does not remember the last tetanus vaccination.

Significant Family History:

-Mother had diabetes mellitus type 2 and died from diabetes complication at 81

-Father had chronic hypertension and died at the age of 78 from a stroke

-Patient does not recall the medical history of grandparents

-Denies any noted illness for his siblings and children.

Lifestyle: 
Mr. Cortez runs a small family construction business, which he runs with his son. He is a Christian and attends church with his family every Sunday. The highest level of education is high school with certifications in HVAC and plumbing. He lives at home with his wife, daughter, who is a single mother and grandson. His wife works full time as a secretary, and his health coverage is through his wife’s job. He states he is too busy to exercise, and his diet comprises mainly of heavy meals due to his job. Reports drinking socially, about 2-3 drinks weekly, mostly beer. Never smoked, denies the use of recreational or illicit drugs

Review of Systems

General: 
Mr. Cortez appears well dressed and well-nourished. Denies weakness and fatigue. No recent weight changes or changes in appetite. No apparent signs of distress.

HEENT: 
The patient uses glasses, denies vision changes, discharge from eyes, tinnitus, hearing loss, and discharge from ears. Denies loss or decreased sense of smell, nasal drainage, or congestion.

Neck: 
The patient denies any injury to the neck, swelling, or history of compression. Rash currently present in the neck region.

Breasts: 
denies lump, discharge, or rash

Respiratory: 
denies shortness of breath, denies cough or respiratory distress, no history of respiratory disorders except occasional seasonal allergies

Cardiovascular/Peripheral Vascular: 
Denies chest pain, reports history of hypertension and high cholesterol. He denies history of stroke, edema or heart failure.

Gastrointestinal: 
Denies nausea or vomiting, and diarrhea. Reports consistent bowel movement every two days.
 
He also reported that his wife occasionally gives him prune juice to aid his
 
occasional constipation.

Genitourinary: 
Pt denies any feeling of urgency or urinary retention. No history of UTI or incontinence denies burning sensation when urinating, denies frequency, and urgency.

Musculoskeletal: 
The patient reported a history of fall six months ago when he woke up and could not find his cane at the bedside. The patient stated that he takes 30 mins to walk in the evenings three times per week with his wife.

Psychiatric: 
The patient denies any history of mental illness, no suicidal or homicidal ideations. Reports no history of mental illness in his family.

Neurological: 
The patient reported feeling lightheaded after his fall 6 months ago but was seen by the ER doctor and has not had any dizziness episodes since then. Denies any headaches or sudden/abnormal movements.

Skin: 
The patient reports a red rash with blisters filled with clear fluid on his right torso and neck. Patient denies any other skin issues, a history of chickenpox when he was eight years old

Hematologic: 
Denies any abnormal bleeding. Denies any history of bleeding disorder in his family. Never been diagnosed with anemia, no history of incidents with significant blood loss.

Endocrine: 
Denies any use of hormonal therapies, denies a history of thyroid disorders.

Allergic/Immunologic: 
Patient denies any history of allergies, reported that he and his children often have seasonal allergies but usually resolves within a few days

OBJECTIVE DATA:

Physical Exam:

Vital signs:

– Blood Pressure: 148/93 mmHg -Weight.: 285 lbs

– Pulse: 76 BPM -Height: 170 cm

– Respiratory Rate: 18 – Blood glucose: 148 mg/dl

– Temperature: 98.9 F

General: 
The patient is alert and oriented, able to communicate clearly, posture, and gesture appropriately, maintains eye contact. Well dressed and groomed, appropriate affect, and reaction. Ambulates independently, gait even and steady

HEENT: 
Head, Face is symmetrical, bilateral eyes, ears, and nose symmetrical. No drainage or foul odor noted, no discoloration noted.

Neck: 
No swelling or deviation was noted. No Jugular Vein Distention noted that the carotid artery is palpable bilaterally, rash noted on the right side, and able to move from side to side.

Chest: 
Equal rise and fall of chest noted. Clear to auscultation Anterior, Posterior and Lateral

Lungs: 
Lung sounds clear, bilaterally anteriorly, posteriorly, and laterally. The respiratory pattern regular, the chest wall is symmetrical, no cough is noted.

Heart: 
No murmurs or palpitations noted

Peripheral Vascular: 
symmetrical, No edema or discoloration noted in extremities, Pulse regular 2+ pulse in the bilateral pedal, and 2+ in bilateral radial.

Abdomen:  
Abdomen soft, flat, and non-tender, no distention noted, no organomegaly noted.

Genital/Rectal: 
External genitalia intact, no swelling or discoloration noted

Musculoskeletal: 
Uneven gait noted; the patient uses a cane for balance.

Neurological:  
Alert and oriented to person, place, time, and situation. CN I – XII intact

Skin: 
Patients’ skin is generally warm, intact, and dry. Red raised vesicles with clear fluids on the right chest, underarms, neck, and back. Site warm to touch. No other skin abnormality was noted.

Clinical Terminology for Skin Condition in Graphic five

The skin condition in graphic five presents as a rash, which is red in color. The rash is present on the right lateral side of the patient’s chest and back. Some of the rashes are fluid-filled and appears blistering.

Differential Diagnosis

Contact Dermatitis
: Contact dermatitis is a common skin disorder that occurs after exposure to allergens or irritants (World, Allergy Organization, 2015). Irritants such as soaps, detergents, stool, and urine trigger irritant contact dermatitis while cosmetics, drugs, food, or dye in people genetically predisposed or sensitized triggers allergic contact dermatitis.

The skin condition is characterized by red vesicles that are itchy (World, Allergy Organization, 2015). The location of the rash depends on the exposure to allergens. It is often diagnosed with history and physical (American Academy of Allergy Asthma & Immunology, 2019).

Psoriasis
: Psoriasis is an autoimmune skin condition characterized by dry, red, and scaly rash (Nair & Badri, 2018). There are different types of psoriasis, however, psoriasis in general, is often seen with red scales covered with silver scales (Nair & Badri, 2018). The exact etiology of psoriasis is unknown; however, it has been seen to be genetically transmitted (Nair & Badri, 2020). the rash can appear anywhere in the body, including the eyes and scalp; it is also commonly seen in the knees and elbows; thus, the rash location and progression are often used when diagnosing the condition (Nair & Badri, 2020).

Shingles
: Shingles is a skin condition also called Herpes Zoster caused by the varicella-zoster virus; it usually occurs in a patient who has previously had chickenpox virus or people older people with weakened immunity. The shingles rash are blistering red vesicles that usually appear in the face and torso (Carter, 2020). The rash may be itchy and painful with a burning or stinging sensation. It commonly affects one side of the body. It is usually diagnosed by the characteristics of the rash (National Institute of Neurological Disorders and Stroke, 2020).

Most Likely Diagnosis

Like many other conditions, diagnosing skin conditions starts with a good assessment, history, and physical (Ball, 2019). Assessment of Certain criteria is critical in helping a provider diagnose a skin disorder. For example, location, color, shape, measurement, surrounding skin, and texture of skin disorders will provide insight and help with accurate diagnosis (Ball, 2019). Other presenting symptoms, including systemic symptoms, are also used to identify and diagnose skin conditions (Ball, 2019) NURS-6512 Differential Diagnosis for Skin Conditions SOAP note. When collecting history and physical for skin conditions, it is important to collect a focused history that helps in diagnosing the skin conditions for example, the onset of skin condition, changes, presence of itch or discharge are some of the histories that help to diagnose skin conditions (Ball, 2019). Diagnostic tests can also help providers rule out certain conditions when diagnosing skin disorders. For example, shingles can be identified by testing for herpes or varicella-zoster virus. (Centers for Disease Control and Prevention, 2019).

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The skin condition presented in this graphic is seen on the torso’s right lateral side; the rash appears to be red, fluid-filled, and blistering. Mr. Cortez states that the rash began about a week ago and is present only on his right side; he denies change in routine or exposure to irritants that could suggest allergic or irritant contact dermatitis. Also, the rash seen in contact dermatitis is scaly (Dains et al., 2019). Psoriasis rash, in this case, is unlikely because while psoriasis rash is red, it is also scaly and often appears on the knees, elbows, lower back, and scalp (Roland, 2018). Also, psoriasis is characterized by unique systemic symptoms such as swollen and painful joints, which Mr. Cortez denies (Davis, 2020). Shingles are the most likely diagnosis in this case because the rash, in this case, is red vesicles clustered together, appears in a linear arrangement, and is located on the right side of the torso without crossing the midline. According to Carter (2020), shingles rash are red lesions that are usually unilateral. During history, Mr. Cortez denies systemic symptoms that may suggest psoriasis; he also denies history, suggesting contact dermatitis. NURS-6512 Differential Diagnosis for Skin Conditions SOAP note

 

References

American Academy of Allergy Asthma & Immunology (2019). Contact dermatitis overview. Retrieved from 
https://www.aaaai.org/conditions-and-treatments/library/allergy-library/contact-dermatitis

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

Carter, T. M. (2020). Shingles: Not Just a Rash. Journal for Nurse Practitioners, 16(2), 111–115.

https://doi-org.ezp.waldenulibrary.org/10.1016/j.nurpra.2019.10.013

Centers for Disease Control and Prevention (2019). Laboratory Testing for VZV. Retrieved from 
https://www.cdc.gov/shingles/lab-testing/index.html

Conceicao, V. (2018). Prevention and management of shingles and associated

complications.
Journal of Community Nursing, 32
(6), 40–43. NURS-6512 Differential Diagnosis for Skin Conditions SOAP note

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and

clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.

Nair, P. A. & Badri, T. (2020). Psoriasis. Retrieved from 
https://www.ncbi.nlm.nih.gov/books/NBK448194/

National Institute of Neurological Disorders and Stroke (2020). Shingles Information Page. Retrieved from 
https://www.ninds.nih.gov/Disorders/All-Disorders/Shingles-Information-Page

Roland, J. (2018). Shingles vs. psoriasis: What’s the difference? Retrieved from  
https://www.healthline.com/health/psoriasis/shingles-vs-psoriasis#symptoms

World, Allergy Organization (2015). Contact dermatitis: Synopsis. Retrieved from 
https://www.worldallergy.org/education-and-programs/education/allergic-disease-resource-center/professionals/contact-dermatitis-synopsis

 

 

Assignment 1: Lab Assignment: Differential Diagnosis for Skin Conditions

Properly identifying the cause and type of a patient’s skin condition involves a process of elimination known as differential diagnosis. Using this process, a health professional can take a given set of physical abnormalities, vital signs, health assessment findings, and patient descriptions of symptoms, and incrementally narrow them down until one diagnosis is determined as the most likely cause. NURS-6512 Differential Diagnosis for Skin Conditions SOAP note

In this Lab Assignment, you will examine several visual representations of various skin conditions, describe your observations, and use the techniques of differential diagnosis to determine the most likely condition.

To Prepare

Review the Skin Conditions document provided in this week’s Learning Resources, and select one condition to closely examine for this Lab Assignment.

Consider the abnormal physical characteristics you observe in the graphic you selected. How would you describe the characteristics using clinical terminologies?

Explore different conditions that could be the cause of the skin abnormalities in the graphics you selected.

Consider which of the conditions is most likely to be the correct diagnosis, and why.

Search the Walden library for one evidence-based practice, peer-reviewed article based on the skin condition you chose for this Lab Assignment. NURS-6512 Differential Diagnosis for Skin Conditions SOAP note

Review the Comprehensive SOAP Exemplar found in this week’s Learning Resources to guide you as you prepare your SOAP note.

Download the SOAP Template found in this week’s Learning Resources, and use this template to complete this Lab Assignment.

The Lab Assignment

Choose one skin condition graphic (identify by number in your Chief Complaint) to document your assignment in the SOAP (Subjective, Objective, Assessment, and Plan) note format rather than the traditional narrative style. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in this week’s Learning Resources for guidance. Remember that not all comprehensive SOAP data are included in every patient case.

Use clinical terminologies to explain the physical characteristics featured in the graphic. Formulate a differential diagnosis of 
three to five 
possible conditions for the skin graphic that you chose. Determine which is most likely to be the correct diagnosis and explain your reasoning using at least three different references, one reference from current evidence-based literature from your search and two different references from this week’s Learning Resources. NURS-6512 Differential Diagnosis for Skin Conditions SOAP note

By Day 7 of Week 4

Submit
 your Lab Assignment.

Submission and Grading Information

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

Please save your Assignment using the naming convention “WK4Assgn1+last name+first initial.(extension)” as the name.

Click the 
Week 4 Assignment 1 Rubric 
to review the Grading Criteria for the Assignment.

Click the 
Week 4 Assignment 1
 link. You will also be able to “View Rubric” for grading criteria from this area.

Next, from the Attach File area, click on the 
Browse My Computer
 button. Find the document you saved as “WK4Assgn1+last name+first initial.(extension)” and click 
Open
.

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

Click on the 
Submit
 button to complete your submission.

NURS_6512_Week_4_Assignment_1_Rubric

Grid View

List View

Excellent

Good

Fair

Poor

Using the SOAP (Subjective, Objective, Assessment, and Plan) note format:

·  Create documentation, following SOAP format, of your assignment to choose one skin condition graphic (identify by number in your Chief Complaint). ·   Use clinical terminologies to explain the physical characteristics featured in the graphic.

30 
(30%)
 – 35 
(35%)

The response clearly, accurately, and thoroughly follows the SOAP format to document one skin condition graphic and accurately identifies the graphic by number in the Chief Complaint. The response clearly and thoroughly explains all physical characteristics featured in the graphic using accurate terminologies.

24 
(24%)
 – 29 
(29%)

The response accurately follows the SOAP format to document one skin condition graphic and accurately identifies the graphic by number in the Chief Complaint. The response explains most physical characteristics featured in the graphic using accurate terminologies.

NURS-6512 Differential Diagnosis for Skin Conditions SOAP note

18 
(18%)
 – 23 
(23%)

The response follows the SOAP format, with vagueness and some inaccuracy in documenting one skin condition graphic, and accurately identifies the graphic by number in the Chief Complaint. The response explains some physical characteristics featured in the graphic using mostly accurate terminologies.

0 
(0%)
 – 17 
(17%)

The response inaccurately follows the SOAP format or is missing documentation for one skin condition graphic and is missing or inaccurately identifies the graphic by number in the Chief Complaint. The response explains some or few physical characteristics featured in the graphic using terminologies with multiple inaccuracies.

·   Formulate a different diagnosis of three to five possible considerations for the skin graphic.    ·   Determine which is most likely to be the correct diagnosis, and explain your reasoning using at least three different references from current evidence-based literature.

45 
(45%)
 – 50 
(50%)

The response clearly, thoroughly, and accurately formulates a different diagnosis of five possible considerations for the skin graphic. The response determines the most likely correct diagnosis with reasoning that is explained clearly, accurately, and thoroughly using three or more different references from current evidence-based literature.

39 
(39%)
 – 44 
(44%)

The response accurately formulates a different diagnosis of three to five possible considerations for the skin graphic. The response determines the most likely correct diagnosis with reasoning that is explained accurately using at least three different references from current evidence-based literature.

NURS-6512 Differential Diagnosis for Skin Conditions SOAP note

33 
(33%)
 – 38 
(38%)

The response vaguely or with some inaccuracy formulates a different diagnosis of three possible considerations for the skin graphic. The response determines the most likely correct diagnosis with reasoning that is explained vaguely and with some inaccuracy using three different references from current evidence-based literature.

0 
(0%)
 – 32 
(32%)

The response formulates inaccurately, incompletely, or is missing a different diagnosis of possible considerations for the skin graphic, with two or fewer possible considerations provided. The response vaguely, inaccurately, or incompletely determines the most likely correct diagnosis with reasoning that is missing or explained using two or fewer different references from current evidence-based literature.

Written Expression and Formatting – Paragraph Development and Organization:

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

5 
(5%)
 – 5 
(5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

4 
(4%)
 – 4 
(4%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.

3 
(3%)
 – 3 
(3%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment are vague or off topic.

0 
(0%)
 – 2 
(2%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided. Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation 5  (5%)  – 5  (5%) Uses correct grammar, spelling, and punctuation with no errors. 4  (4%)  – 4  (4%) Contains a few (1 or 2) grammar, spelling, and punctuation errors. 3  (3%)  – 3  (3%) Contains several (3 or 4) grammar, spelling, and punctuation errors. 0  (0%)  – 2  (2%) Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list. 5  (5%)  – 5  (5%) Uses correct APA format with no errors. 4  (4%)  – 4  (4%) Contains a few (1 or 2) APA format errors. 3  (3%)  – 3  (3%) Contains several (3 or 4) APA format errors. 0  (0%)  – 2  (2%) Contains many (≥ 5) APA format errors. Total Points: 100 Name: NURS_6512_Week_4_Assignment_1_Rubric NURS-6512 Differential Diagnosis for Skin Conditions SOAP note

Discussion: Diversity and Health Assessments

May 2012, Alice Randall wrote an article for 
The New York Times
on the cultural factors that encouraged black women to maintain a weight above what is considered healthy. Randall explained—from her observations and her personal experience as a black woman—that many African-American communities and cultures consider women who are overweight to be more beautiful and desirable than women at a healthier weight. As she put it, “Many black women are fat because we want to be” (Randall, 2012) Discussion: Diversity and Health Assessments.

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Randall’s statements sparked a great deal of controversy and debate; however, they emphasize an underlying reality in the healthcare field: different populations, cultures, and groups have diverse beliefs and practices that impact their health. Nurses and healthcare professionals should be aware of this reality and adapt their health assessment techniques and recommendations to accommodate diversity. Discussion: Diversity and Health Assessments.

In this Discussion, you will consider different socioeconomic, spiritual, lifestyle, and other cultural factors that should be taken into considerations when building a health history for patients with diverse backgrounds. Your Instructor will assign a case study to you for this Discussion.

To prepare:

Reflect on your experiences as a nurse and on the information provided in this week’s Learning Resources on diversity issues in health assessments.

By Day 1 of this week, you will be assigned a case study by your Instructor. 
Note
: Please see the “Course Announcements” section of the classroom for your case study assignment.

Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient assigned to you. Discussion: Diversity and Health Assessments

Consider how you would build a health history for the patient. What questions would you ask, and how would you frame them to be sensitive to the patient’s background, lifestyle, and culture? Develop five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

Think about the challenges associated with communicating with patients from a variety of specific populations. What strategies can you as a nurse employ to be sensitive to different cultural factors while gathering the pertinent information?

By Day 3 of Week 2

Post
 an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

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

Read
 a selection of your colleagues’ responses.

By Day 6 of Week 2

Respond on or before Day 6
 
on 2 different days
 to at least
 two
of your colleagues who were assigned a different patient than you. Critique your colleague’s targeted questions, and explain how the patient might interpret these questions. Explain whether any of the questions would apply to your patient, and why. Discussion: Diversity and Health Assessments

Use of Prostate-Specific Antigen Test in Healthcare Essay

The Use of Prostate-Specific Antigen Test in Healthcare

Introduction

Various diagnostic tests are performed by healthcare personnel to confirm or determine a disease’s presence in patients suspected to have it. Diagnostic tests protect patients by finding potential health problems in their early stages of development that are easily treatable and prevent health complications that result from the later stages of disease development. Also, diagnostic tests help patients minimize their healthcare spending by finding potential ailments sooner, which can be treated under minimal costs. Some of the diseases whose negative impact can be considerably reduced if identified in their early development stages include various forms of cancer. Prostate cancer is the second most common type of cancer among men in the world. Use of Prostate-Specific Antigen Test in Healthcare Essay Screening performed using the Prostate-Specific Antigen Test is used to detect prostate cancer at an early stage where treatment can efficiently intervene and reduce mortality among male patients. This purpose of this paper is to describe how the Prostate-Specific Antigen test is used in healthcare.

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The Purpose of the Prostate-Specific Antigen Test

The Prostate-Specific Antigen Test is primarily used to confirm prostate cancer in men in its early stages of development. The Test is used to measure the amount of Prostate-Specific Antigens [PSA] in the blood. PSA refers to proteins made by normal and malignant tissues of the prostate gland. High levels of Protein-Specific Antigens in the blood may suggest the presence of prostate cancer (Tikkinen et al., 2018). Prostate-Specific Antigen tests can also be used to identify other prostate gland problems, including inflammation and enlargement of the prostate. Besides, Prostate-Specific Antigen tests can be used to monitor prostate cancer treatment and find out whether the disease is under control or reoccurring (Lawrenson, et al., 2015). Prostate cancer is usually treated through radiation, surgery, chemotherapy, and hormone therapy. These treatments make the amounts of protein-specific Antigens circulating in the bloodstream significantly. Physicians perform regular testing to determine the level of Protein-Specific Antigens circulating in the bloodstream to determine whether cancer has reoccurred. If the disease reoccurs, additional screening using protein-specific Antigen tests are performed to make recommendations that will aid in the additional treatment and control of the disease. Use of Prostate-Specific Antigen Test in Healthcare Essay

How the Test is conducted

The Prostate-Specific Antigen test is performed by removing some blood from the patient, usually from the arm. The blood samples are then taken to the laboratory to determine the amount of PSA in the blood. The diagnostic test results may take several days, such as one week, before the results come out. Healthcare personnel reports the Test results as the ratio of nanograms of PSA per milliliters of blood [ng/ml]. Even though Prostate-Specific Antigen tests are used to screen for prostate cancer, their results cannot indicate an absolute confirmation of prostate cancer’s presence or absence (Ilic et al., 2018). Consequently, male patients who have high PSA amounts are required to undertake a prostate biopsy to make the absolute confirmation for prostate cancer. Prostate biopsy refers to the procedure of removing small samples of prostate tissues and observing them using a microscope to confirm whether the patient has or lacks prostate cancer. If it is confirmed the patient has prostate cancer, the biopsy also reveals the likelihood of the cancer growing and spreading rapidly.

Reliability and Validity

The use of PSA tests to perform prostate cancer screenings is not highly reliable or valid. Even though most people with prostate cancer have high PSA levels in their bloodstream, other non-malignant conditions might also contribute to the increase in the levels of PSA. Consequently, the PSA test does not provide precise information concerning prostate cancer disease in individuals. At best, using PSA tests to perform prostate cancer screenings results in a small reduction in the mortality risks caused by prostate cancer. Screening using PSA tests might help people detect prostate cancer in the early stages of development. The diagnosis of cancer at an early stage might make it easy to treat and cure, unlike in the later developed stages of the disease. However, prostate cancer screening using PSA tests does not affect the disease’s overall mortality rates (Martin et al., 2018). Prostate cancer develops slowly over many years. Consequently, people may have prostate cancer that does not reveal any symptoms or cause health problems during their lifetimes.

Also, the harms of conducting prostate cancer screenings using PSA tests outweigh the benefits. Male patients who partake PSA tests for prostate cancer screenings risk getting over-diagnosed and over-treated (Ilic et al., 2018). Patients might be over-diagnosed when the PSA tests detect tumors that lack symptoms during their lifetime. Due to over-diagnosis, these harmless tumors might be subjected to various cancer treatments such as chemotherapy and radiation. These treatments have accompanying complications and harmful side effects, including pain, incontinence, bleeding, infections, and erectile dysfunction. Use of Prostate-Specific Antigen Test in Healthcare Essay. Again, PSA tests can make some people experience negative psychological effects. For instance, people with high PSA levels in their blood might suffer from anxiety and distress if they conduct biopsy tests that fail to confirm the presence of prostate cancer (Biddle et al., 2017). Besides, some patients might experience anxiety because of knowing they have slow-growing tumors even though they are harmless.

Conclusion

In conclusion, PSA tests are used to perform prostate cancer screenings and enable early detection of the disease. The early detection of prostate cancer makes it easy for the disease to be treated and eliminate more healthcare spending that might have taken place in the later developed stages. PSA tests can also detect other prostate gland related problems such as inflammation and enlargement. Besides, PSA tests are used to monitor the treatment and recurrence of prostate cancer. The PSA tests are conducted by removing blood, especially from the arm of the patients. The blood samples are tested in the labs for about one week. The results reveal PSA’s level in the blood and are used to indicate whether the patient might have prostate cancer. Since the PSA tests are not precise, further tests such as a prostate biopsy to confirm the presence of the disease. The PSA tests are not reliable in reducing the overall mortality rates of people having prostate cancer. At best, they help people detect cancerous tumors’ growth at an early stage, enabling them to get interventional treatment. However, these tumors grow at a slow rate and might lack to show any symptoms. Besides, these tumors might be harmless and fail to affect the patients in their lifetime. The PSA tests might result in more harm than good by over-diagnosing and over-treating patients, making them experience harmful side effects and complications such as erectile dysfunctions, infections, and pain. Use of Prostate-Specific Antigen Test in Healthcare Essay.

 

References

Biddle, C., Brasel, A., Underwood III, W., & Orom, H. (2017). Experiences of uncertainty in men with an elevated PSA. 
American journal of men’s health
, 
11
(1), 24-34.

Ilic, D., Djulbegovic, M., Jung, J. H., Hwang, E. C., Zhou, Q., Cleves, A., & Dahm, P. (2018). Prostate cancer screening with prostate-specific antigen (PSA) test: a systematic review and meta-analysis. 
bmj
, 
362
, k3519.

Lawrenson, R., Lao, C., Obertová, Z., Brown, C., Holmes, M., Tyrie, L., … & Laking, G. (2015). Management and characteristics of patients with metastatic prostate cancer in a cohort of New Zealand men. 
Oncology
, 
88
(3), 157-163.

Martin, R. M., Donovan, J. L., Turner, E. L., Metcalfe, C., Young, G. J., Walsh, E. I., … & Sterne, J. A. (2018). Effect of a low-intensity PSA-based screening intervention on prostate cancer mortality: the CAP randomized clinical trial. 
Jama
, 
319
(9), 883-895.

Tikkinen, K. A., Dahm, P., Lytvyn, L., Heen, A. F., Vernooij, R. W., Siemieniuk, R. A., … & Junod, N. (2018). Prostate cancer screening with prostate-specific antigen (PSA) test: a clinical practice guideline. 
Bmj
, 
362
, k3581. Use of Prostate-Specific Antigen Test in Healthcare Essay
 

 

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Assignment 1: Case Study Assignment: Assessment Tools and Diagnostic Tests in Adults and Children

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

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

Photo Credit: Getty Images/Hero Images

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

To Prepare

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

By Day 1 of this week, you will be assigned to one of the following Assignment options by your Instructor: Adult Assessment Tools or Diagnostic Tests (option 1), or Child Health Case (Option 2). 
Note:
 Please see the “Course Announcements” section of the classroom for your assignments from your Instructor.

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

Also, as you search the Walden library and credible sources, consider what the literature discusses regarding the validity, reliability, sensitivity, specificity, predictive values, ethical dilemmas, and controversies related to the test or tool.

If you are assigned Assignment Option 2 (Child), consider what health issues and risks may be relevant to the child in the health example.

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

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

The Assignment

Assignment
 (3–4 pages, not including title and reference pages)
:

Assignment Option 1: Adult Assessment Tools or Diagnostic Tests:

Include the following:

A description of how the assessment tool or diagnostic test you were assigned is used in healthcare.

What is its purpose?

How is it conducted?

What information does it gather?

Based on your research, evaluate the test or the tool’s validity and reliability, and explain any issues with sensitivity, reliability, and predictive values. Include references in appropriate APA formatting.

Assignment Option 2: Child Health Case:

Include the following:

An explanation of the health issues and risks that are relevant to the child you were assigned.

Describe additional information you would need in order to further assess his or her weight-related health.

Identify and describe any risks and consider what further information you would need to gain a full understanding of the child’s health. Think about how you could gather this information in a sensitive fashion.

Taking into account the parents’ and caregivers’ potential sensitivities, list at least three specific questions you would ask about the child to gather more information.

Provide at least two strategies you could employ to encourage the parents or caregivers to be proactive about their child’s health and weight.

By Day 6 of Week 3

Submit
 your Assignment.

Submission and Grading Information

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

Please save your Assignment using the naming convention “WK3Assgn1+last name+first initial.(extension)” as the name.

Click the 
Week 3 Assignment 1 Rubric 
to review the Grading Criteria for the Assignment.

Click the 
Week 3 Assignment 1 
link. You will also be able to “View Rubric” for grading criteria from this area.

Next, from the Attach File area, click on the 
Browse My Computer
 button. Find the document you saved as “WK3Assgn1+last name+first initial.(extension)” and click 
Open
.

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

Click on the 
Submit
 button to complete your submission.

NURS_6512_Week_3_Assignment_1_Rubric_Option_1

 

Excellent

Good

Fair

Poor

In 3–4 pages, address the following:

A description of how the assessment tool or diagnostic test you were assigned is used in healthcare.

o What is its purpose?

o How is it conducted?

o What information does it gather?

30 
(30%)
 – 35 
(35%)

The response clearly, accurately, and with specific detail describes how the assessment tool or diagnostic test assigned is used in healthcare, including its purpose, how it is conducted, and what information it gathers.

24 
(24%)
 – 29 
(29%)

The response accurately describes how the assessment tool or diagnostic test assigned is used in healthcare, including its purpose, how it is conducted, and what information it gathers.

18 
(18%)
 – 23 
(23%)

The response vaguely and/or with some inaccuracy describes how the assessment tool or diagnostic test assigned is used in healthcare, including its purpose, how it is conducted, and what information it gathers.

0 
(0%)
 – 17 
(17%)

The response is inaccurate or missing descriptions of how the assessment tool or diagnostic test assigned is used in healthcare, including its purpose, how it is conducted, and what information it gathers.

Based on your research, evaluate the test or the tool’s validity and reliability, and explain any issues with sensitivity, reliability, and predictive values.

45 
(45%)
 – 50 
(50%)

The response accurately and thoroughly evaluates the test or tool’s validity and reliability, and explains any issues with clear sensitivity, reliability, and predictive values. Student’s research is clear, accurate, and appropriate for the evaluation.

39 
(39%)
 – 44 
(44%)

The response accurately evaluates the test or tool’s validity and reliability, and explains any issues with sensitivity, reliability, and predictive values. Student’s research is somewhat clear, accurate,and appropriate for the evaluation.

33 
(33%)
 – 38 
(38%)

The response vaguely and/or with some inaccuracy evaluates the test or tool’s validity and reliability, and explains any issues with some sensitivity, reliability, and predictive values. Student’s research is vague or inaccurate for the evaluation.

0 
(0%)
 – 32 
(32%)

“The response is inaccurate and/or missing evaluations of the test or tool’s validity and reliability, with explanations of any issues missing or lacking sensitivity, reliability, and predictive values. Student’s research is missing, inaccurate, or lacking for the evaluation.

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.

Use of Prostate-Specific Antigen Test in Healthcare Essay

3 
(3%)
 – 3 
(3%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment are vague or off topic.

0 
(0%)
 – 2 
(2%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided. Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation 5  (5%)  – 5  (5%) Uses correct grammar, spelling, and punctuation with no errors. 4  (4%)  – 4  (4%) Contains a few (1 or 2) grammar, spelling, and punctuation errors. 3  (3%)  – 3  (3%) Contains several (3 or 4) grammar, spelling, and punctuation errors. 0  (0%)  – 2  (2%) Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list. 5  (5%)  – 5  (5%) Uses correct APA format with no errors. 4  (4%)  – 4  (4%) Contains a few (1 or 2) APA format errors. 3  (3%)  – 3  (3%) Contains several (3 or 4) APA format errors. 0  (0%)  – 2  (2%) Contains many (≥ 5) APA format errors. Use of Prostate-Specific Antigen Test in Healthcare Essay Total Points: 100 Name: NURS_6512_Week_3_Assignment_1_Rubric_Option_1 NURS_6512_Week_3_Assignment_1_Rubric_Option_2 Grid View List View Excellent Good Fair Poor In 3–4 pages, address the following: An explanation of the health issues and risks that are relevant to the child you were assigned. 20  (20%)  – 25  (25%) The response clearly, accurately, and in detail explains the relevant health issues and risks for the assigned child. 19  (19%)  – 24  (24%) The response accurately explains the relevant health issues and risks for the assigned child. 18  (18%)  – 23  (23%) The response vaguely and with some inaccuracy explains the relevant health issues and risks for the assigned child. 0  (0%)  – 17  (17%) The response is inaccurate and/or missing explanations of the relevant health issues and risks for the assigned child. Describe additional information you would need in order to further assess his or her weight-related health. 20  (20%)  – 25  (25%) The response clearly and accurately describes detailed additional information needed to further assess the child’s weight-related health. 19  (19%)  – 24  (24%) The response accurately describes additional information needed to further assess the child’s weight-related health. 18  (18%)  – 23  (23%) The response vaguely and with some inaccuracy describes additional information needed to further assess the child’s weight-related health. 0  (0%)  – 17  (17%) The response is inaccurate and/or missing a description of additional information needed to further assess the child’s weight-related health. Identify and describe any risks, and consider what further information you would need to gain a full understanding of the child’s health. Think about how you could gather this information in a sensitive fashion. 18  (18%)  – 20  (20%) The response clearly and accurately identifies and describes in detail any risks to the child’s health. The response clearly and accurately identifies and describes in detail further information needed to gain a full understanding of the child’s health, with a detailed explanation of how to gather that information in a way that is sensitive to the child. 16  (16%)  – 17  (17%) The response accurately identifies and describes any risks to the child’s health. The response accurately identifies and describes further information needed to gain a full understanding of the child’s health, with a clear explanation of how to gather that information in a way that is sensitive to the child. Use of Prostate-Specific Antigen Test in Healthcare Essay 14  (14%)  – 14  (14%) The response vaguely and with some inaccuracy identifies and describes any risks to the child’s health. The response vaguely identifies and describes further information needed to gain a full understanding of the child’s health, with a vague explanation of how to gather that information in a way that is sensitive to the child. 0  (0%)  – 13  (13%) The response identifies inaccurately and/or is missing descriptions of any risks to the child’s health. The response identifies inaccurately and/or is missing descriptions of further information needed to gain a full understanding of the child’s health, with an inadequate or missing explanation of how to gather that information in a way that is sensitive to the child. Taking into account the parents’ and caregivers’ potential sensitivities, list at least three specific questions you would ask about the child to gather more information. 10  (10%)  – 10  (10%) The response clearly and accurately lists three or more specific questions that would gather more information about the child. Specific questions are carefully worded to clearly demonstrate sensitivity to the parent(s) or caregiver(s) of the child. 9  (9%)  – 9  (9%) The response lists three specific questions that would gather more information about the child. Specific questions are worded to demonstrate sensitivity to the parent(s) or caregiver(s) of the child. 8  (8%)  – 8  (8%) The response lists three questions with wording that is vague and lacking specificity for gathering more information about the child. Some wording of the questions lacks sensitivity to the parent(s) or caregiver(s) of the child. 0  (0%)  – 7  (7%) The response lists two or fewer confusing or inadequate questions, or is missing questions, for gathering more information about the child. Wording of questions provided lacks sensitivity to the parent(s) or caregiver(s) of the child. Provide at least two strategies you could employ to encourage the parents or caregivers to be proactive about their child’s health and weight. 5  (5%)  – 5  (5%) The response clearly describes two or more detailed strategies to encourage the parent(s) or caregiver(s) to be proactive about the child’s health and weight. 4  (4%)  – 4  (4%) The response describes at least two strategies to encourage the parent(s) or caregiver(s) to be proactive about the child’s health and weight. 3  (3%)  – 3  (3%) The response vaguely describes two strategies to encourage the parent(s) or caregiver(s) to be proactive about the child’s health and weight. 0  (0%)  – 2  (2%) The response inadequately describes one strategy or is missing strategies to encourage the parent(s) or caregiver(s) to be proactive about the child’s health and weight. 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. Use of Prostate-Specific Antigen Test in Healthcare Essay 0  (0%)  – 2  (2%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided. Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation 5  (5%)  – 5  (5%) Uses correct grammar, spelling, and punctuation with no errors. 4  (4%)  – 4  (4%) Contains a few (1 or 2) grammar, spelling, and punctuation errors. 3  (3%)  – 3  (3%) Contains several (3 or 4) grammar, spelling, and punctuation errors. 0  (0%)  – 2  (2%) Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list. 5  (5%)  – 5  (5%) Uses correct APA format with no errors. 4  (4%)  – 4  (4%) Contains a few (1 or 2) APA format errors. 3  (3%)  – 3  (3%) Contains several (3 or 4) APA format errors. 0  (0%)  – 2  (2%) Contains many (≥ 5) APA format errors. Total Points: 100 Name: NURS_6512_Week_3_Assignment_1_Rubric_Option_2 Use of Prostate-Specific Antigen Test in Healthcare Essay

NURS 6512 Diversity and Health Assessments Discussion Essay

Module 2: Functional Assessments and Assessment Tools

Health disparities affect just a segment of the population differently. Attitudes toward health care and treatment can also vary among different populations. Therefore, nurse practitioners, as well as medical professionals, need to provide custom care that acknowledges and recognizes these differences in order to serve its diverse patient population. Nurse practitioners becoming more self-aware of themselves can help them realize new things about their own culture which in turn, can open their eyes to appreciating cultural differences. NURS 6512 Diversity and Health Assessments Discussion Essay. Medical teams’ understanding of patients’ beliefs and values, will aid in providing a better care because when a patient cannot find providers that resemble them, their beliefs, their culture, or other facets of their life, it may delay or prevent them from seeking care. As a health care team, it is important that we are diverse in large part just like our patients are diverse. A lack of cultural understanding increases negative attitudes towards cross-cultural care and affects healthcare professionals’ perceived preparedness to take care of culturally diverse patients. Anxiety when combined with uncertainty, can further decrease effective communication leading to increased use of stereotypes. Nurse practitioners need to have an increased awareness about the sociocultural. NURS 6512 Diversity and Health Assessments Discussion Essay.

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I choose the case study number one; EB is a 68-year-old black female who comes in for follow-up of hypertension. She has glaucoma and her vision has been worsening during the past few years. She lives alone and is prescribed four hypertension medications (Hydralazine 50 mg PO Q8H, Metoprolol XL 200 mg PO Q12H, Lisinopril 40 mg PO daily, and HCTZ 25mg PO daily) NURS 6512 Diversity and Health Assessments Discussion Essay. Poor adherence to antihypertensives has been shown to be a significant factor in poor blood pressure (BP) control. A good communication with patients about her medication-taking behavior may be central to improving adherence “A patient-centered approach in which the provider engages the patient in a process of shared decision making has been identified as an important factor in improving patient adherence” (Kaihlanen, Hietapakka & Heponiemi, 2019). Example, the use of “Open-Ended Strategies” and your patients feel comfortable and address them by their preferred names. Hypertension (HTN) affects more than 29% of the adult population and increases the risk for adverse outcomes. Poorly controlled or managed HTN can lead to stroke, kidney damage, vision loss, fluid in the lungs, memory loss, and erectile dysfunction (AHA, 2010) . Research studies have consistently shown that” most patients with established HTN have poorly controlled blood pressure (BP) and that 30% to 70% of patients do not take their BP medications as prescribed” as seen in the case of this patient (Bokhour, Berlowitz, Long  & Kressin, 2006). NURS 6512 Diversity and Health Assessments Discussion Essay.

The nurse practitioner understanding that development of hypertension is related to both genetic and lifestyle factors such as genetic, age, gender, body shape, and family history, and lifestyle factors of excessive drinking, smoking, poor eating habits, and reduced physical activity will help in the management of this patient problems. As health care team, it is important that we are diverse in large part just like our patients are diverse “A lack of cultural understanding increases negative attitudes towards cross-cultural care and also affects healthcare professionals’ perceived preparedness to take care of culturally diverse patients” (Kaihlanen, Hietapakka & Heponiemi, 2019). Also, research shows that African Americans are genetically more at risk for glaucoma, making early detection and treatment more important. Early diagnosis and treatment and medication adherence are key in preventing vision loss from glaucoma “High BP could increase intraocular pressure (IOP)  by increased production of aqueous humor by means of elevated ciliary blood flow and capillary pressure and decrease of aqueous outflow as a result of increased episcleral venous pressure” (Leeman & Kestelyn, 2019) NURS 6512 Diversity and Health Assessments Discussion Essay.

A low BP, whether spontaneous or secondary to antihypertensive therapy, can play a part in reducing OP intraocular pressure (IOP). Therefore, antihypertensive treatment has shown have a preventive effect on the development of glaucoma and both high BP and low BP having been associated with an increased risk of glaucoma (Leeman & Kestelyn, 2019). Patients with high BP should be screened for glaucoma, and patients with glaucoma should be screened for arterial hypertension. Patients with coexisting glaucoma and high BP should undergo closer ophthalmologic examinations. This patient requires close ambulatory BP monitoring be performed with the deterioration her vision and a referral to an eye doctor initial and then every six months subsequently will be recommended for treatment and management of her glaucoma.

In the case of this 68-year-old AA female who presented to the clinic with elevated BP in clinic with a BP of 182/99 with HR of 84. When developing strategic measures for medication adherence and planning for this patient findings suggestive should include barriers due to self-efficacy, time with hypertension diagnosis, medication inefficiency and age are critical factors to consider “Racial-ethnic minorities are less often engaged in decision on their treatment than white adults, which may be a contributing factor to lower adherence in the former” (Bokhour, Berlowitz, Long, & Kressin, 2006). Some patients do not accept the diagnosis, which is obviously a major impediment to adherence as well. Lack of knowledge about hypertension and its consequences are logically linked to suboptimal adherence. Diversity in health care goes far beyond a language barrier “It’s about understanding the mindset of a patient within a larger context of culture, gender, sexual orientation, religious beliefs, and socioeconomic realities” (Bokhour, Berlowitz, Long, & Kressin, 2006).

As a future nurse practitioner, I can empower this patient to take her medications as Prescribed by doing effective two-way communication to doubles the odds of taking her medications properly. Try to understand the barriers and address them honestly to build that trust. I will develop simple method and directions to help improve medication adherence by simplify the regimen. Talk to her, show empathy and address her concerns or fears. Encourage the use of adherence tools, like day-of-the-week pill boxes or mobile apps such that will work to match the action of taking medications on daily routine example, mealtime or bedtime.  To help impart knowledge, I will write down prescription instructions clearly, and reinforce them verbally. Modify patients’ beliefs and behavior by providing positive reinforcement such as offering incentives when medications are taken successfully. Always ask for patients’ input when discussing recommendations and making decisions and remind patient to call the office with any questions or concerns “Interventions to promote adherence require several components to target these barriers, and health professionals must follow a systematic process to assess all the potential barriers” (Burnier & Egan, 2019).  Also, a healthy lifestyle modification example, healthy eating habits, engaging in enough physical activity, abstaining from tobacco use, and limiting alcohol intake can help with blood pressure control.

Using multiple strategies, the nurse practitioner can assess the patients’ medication-taking behavior, and to identify potential reasons for the lack of BP control, and plan intervention accordingly. NURS 6512 Diversity and Health Assessments Discussion Essay

What Are Your Medical and Surgical Histories?

What Prescription and Non-Prescription Medications Do You Take? …

What Allergies Do You Have? …

What Is Your Smoking, Alcohol, and Illicit Drug Use History?

Did you take all your pills?

When was the last time you see eye doctor?

Socioeconomic, lifestyle, religion and other cultural factors especially religious doctrine among African American community has a lengthy traditional belief. This is because, spiritual or religious experiences of African Americans may shape beliefs about the causes of illness, as well as treatment decisions. There is also a tendency for religious faith and prayer to be having substantial potential for healing and may serve as an alternative to medical care for serious illnesses. Among African Americans, it is generally expected that family members, including extended family members, will play an important role in treatment decisions.  With this patient, it is critical to increase family education about disease states and the benefits of compliance in achieving successful outcomes (Purnell, & Fenkl, 2019).

Conclusion.

Patient poor adherence may be partially due to problems of access and cost of medication, however, patients’ beliefs about HTN and medication may also play a significant role. Not all patients treated for hypertension follow their health care professional’s advice especially when it comes to long-term medication therapy. Medication adherence is very important and non-adherence increases patients risks for death. Most patient stooped taking their prescription drugs they believed that they were cured or thought that they had been advised to stop by their provider.  Some nonadherence to medications has been attributed to both intentional meaning a conscious decision not to take medications and unintentional, a failure to take medications due to poor understanding or forgetfulness. Socioeconomic, lifestyle, religion and other cultural factors especially religious doctrine among African American community has a lengthy traditional belief. This is because, spiritual or religious experiences of African Americans may shape beliefs about the causes of illness, as well as treatment decisions. Medical teams understanding of patients belief and values, will aid in providing a better care  because when a patient cannot find providers that resemble them, their beliefs, their culture, or other facets of their life, it may delay or prevent them from seeking care.

 

References

Bokhour, B. G., Berlowitz, D. R., Long, J. A., & Kressin, N. R. (2006). How do providers assess antihypertensive medication adherence in medical encounters? Journal of General Internal Medicine, 21(6), 577-583. doi:10.1111/j.1525-1497.2006. 00397.x

Burnier, M., & Egan, B. M. (2019). Adherence in Hypertension. Circulation Research, 124(7), 1124-1140. doi:10.1161/circresaha.118.313220

Kaihlanen, A., Hietapakka, L., & Heponiemi, T. (2019). Increasing cultural awareness: Qualitative study of nurses’ perceptions about cultural competence training. BMC Nursing, 18(1). doi:10.1186/s12912-019-0363-x

Leeman, M., & Kestelyn, P. (11 mar 2019). AHA, 73, NO. 5. doi: https://doi.org/10.1161/HYPERTENSIONAHA.118.11507

Purnell, L. D., & Fenkl, E. A. (2019). Barriers to Culturally Competent Health Care. Handbook for Culturally Competent Care, 19-26. doi:10.1007/978-3-030-21946-8_3 NURS 6512 Diversity and Health Assessments Discussion Essay

NURS 6512 Diversity and Health Assessments Discussion Post

Week 2 Discussion

            When working as a healthcare provider in any setting, it is important to be aware of different aspects that could interfere with patient outcomes. This would include socioeconomic, spiritual concerns, lifestyle considerations, and cultural factors. It is important as a provider/practitioner to be aware of these to better gain the trust and respect from your patients and in return provide high quality outcomes. NURS 6512 Diversity and Health Assessments Discussion Post.

The scenario I chose was AG the 54-year old Caucasian male with history of alcohol and cocaine abuse, and hypertension. While I currently work with a lot of patients who are alcoholics and homeless, it is important to not target these individuals. One thing we always say in my current area of employment is that addiction does not discriminate. “Developing an addiction to drugs isn’t a character flaw or a sign of weakness, and it takes more than willpower to overcome the problem” (Smith, Robinson, & Segal, 2019)

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Some specific things to be careful when interviewing and establishing the trust with this patient is that we do not know the history of this patient and what lead them to become an addict. It is important to know that everyone comes from different backgrounds and has different experiences in life to get them to where they are today. Unfortunately, when one chooses the lifestyle of drugs and alcohol, there tends to be a target on them as a bad individual NURS 6512 Diversity and Health Assessments Discussion Post. However, there are many different addicts out there that have a great soul and are down right a great person, but the addiction is hiding this.

Many addictions need the right support, along with many medical diagnoses. The United States Preventive Services Task Force helps to make recommendations about counseling and preventative medications (Dains, Baumann, & Sheibel, 2019). By having the right resources patients’ overall outcomes, quality, and outlook on life can significantly improve. NURS 6512 Diversity and Health Assessments Discussion Post

It is also important to educate to every patient the importance of controlling health concerns such as hypertension listed in this scenario and what effects it has on the body if such things are not being controlled. However when one is homeless and does not have the ability at the current time to help support the needs for healthcare or medications, it is important to work with them to establish a plan that will be able to be followed through and help be successful for the patient. Education regarding the use of tobacco to abstain from his addiction is important as the health impact that smoking has on the body is significant as well and can affect many things. NURS 6512 Diversity and Health Assessments Discussion Post

When interacting with a patient such as the one in this scenario, it is important to be sensitive to the fact that addiction is hard to overcome, and without the right support and access to interventions it can overtake ones ability to overcome such addictions.  It is also important to be sensitive of one’s family dynamics and work-ethic or employment status. It is important to realize that addiction can occur for a long period of time and is a lifestyle that some get used to. With making a huge change in one’s life this can in return cause of mental concerns such as depression, anxiety, etc.

Although the majority of the scenario speaks to the patient overcoming addiction and being homeless, it is extremely important as a provider or practitioner to look at everyone as equal. Preventative care is just as important for the homeless as it is for any other individual. Statistics show that the homeless have a lower life expectancy than those who are not, so education to these patients is key to help improving lifestyle and outcomes of these patients (Preventive Care for People Experiencing Homelessness, 2017). NURS 6512 Diversity and Health Assessments Discussion Post

 

Questions:

1.)  Is there any family history of addiction including drugs or alcohol, and if so who and what type of addiction?

2.) What resources are you currently connected with to support your desire to abstain from drugs and alcohol, and do you feel they are beneficial and enough support for you? NURS 6512 Diversity and Health Assessments Discussion Post

3.) Do you feel your current group of friends and/or family help to support your desire to abstain or do you feel that the current situation you are in will only hinder from abstinence?

4.)  Are you experiencing any feelings of being down or depressed, or any thoughts of hurting yourself or others?

5.) How long have you been out of your medication, and what barriers do you have to being able to refill and follow up with a primary provider?

 

References

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). 
Advanced Health Assessment and Clinical Diagnosis in Primary Care
 (6
th
 ed.). St. Louis, MO: Elsevier Mosby

Preventive Care for People Experiencing Homelessness. (2017). 
Healing Hands,
 
21
(2). Retrieved from https://nhchc.org/wp-content/uploads/2019/08/healing-hands-preventative-care-finalized.pdf NURS 6512 Diversity and Health Assessments Discussion Post

Smith, M., Robinson, L., & Segal, J. (2019, October). Overcoming Drug Addiction. Retrieved from https://www.helpguide.org/articles/addictions/overcoming-drug-addiction.htm

 

Discussion: Diversity and Health Assessments

May 2012, Alice Randall wrote an article for 
The New York Times
on the cultural factors that encouraged black women to maintain a weight above what is considered healthy. Randall explained—from her observations and her personal experience as a black woman—that many African-American communities and cultures consider women who are overweight to be more beautiful and desirable than women at a healthier weight. As she put it, “Many black women are fat because we want to be” (Randall, 2012). NURS 6512 Diversity and Health Assessments Discussion Post

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Randall’s statements sparked a great deal of controversy and debate; however, they emphasize an underlying reality in the healthcare field: different populations, cultures, and groups have diverse beliefs and practices that impact their health. Nurses and healthcare professionals should be aware of this reality and adapt their health assessment techniques and recommendations to accommodate diversity.

In this Discussion, you will consider different socioeconomic, spiritual, lifestyle, and other cultural factors that should be taken into considerations when building a health history for patients with diverse backgrounds. Your Instructor will assign a case study to you for this Discussion.

To prepare:

Reflect on your experiences as a nurse and on the information provided in this week’s Learning Resources on diversity issues in health assessments.

By Day 1 of this week, you will be assigned a case study by your Instructor. 
Note
: Please see the “Course Announcements” section of the classroom for your case study assignment. NURS 6512 Diversity and Health Assessments Discussion Post

Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient assigned to you.

Consider how you would build a health history for the patient. What questions would you ask, and how would you frame them to be sensitive to the patient’s background, lifestyle, and culture? Develop five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

Think about the challenges associated with communicating with patients from a variety of specific populations. What strategies can you as a nurse employ to be sensitive to different cultural factors while gathering the pertinent information?

By Day 3 of Week 2

Post
 an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

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

Read
 a selection of your colleagues’ responses.

By Day 6 of Week 2

Respond on or before Day 6
 
on 2 different days
 to at least
 two
of your colleagues who were assigned a different patient than you. Critique your colleague’s targeted questions, and explain how the patient might interpret these questions. Explain whether any of the questions would apply to your patient, and why. NURS 6512 Diversity and Health Assessments Discussion Post

 

Excellent post. Working detox for the past several years, I agree with you regarding the stigma of addiction and the lack of discrimination addiction carries. I have seen people struggle with addictions in various socioeconomic, race, and age groups; which makes it important to determine the individual’s needs to provide effective holistic patient-centered care.

Your assessment questions were great for this patient, I feel they will help in developing an accurate profile history.

 1.)”Is there any family history of addiction including drugs or alcohol, and if so who and what type of addiction?”

I feel this is an excellent leading question regarding the patient’s history of family addiction, the patient may interpret this question as being an inquiry on genetics and/or learned behaviors.

2.) “What resources are you currently connected with to support your desire to abstain from drugs and alcohol, and do you feel they are beneficial and enough support for you?”

This is a great question to determine the patient’s needs. Recent evidence suggests using a tool called Brief Interventions (BI) for assessing a patient regarding substance use, motivation, and options tailored to the patient  (Alexander, 2016).This intervention used to engage the individual and increase their understanding of risks and problems related to substance use, and motivate change  (Alexander, 2016).

Brief Intervention Steps:

Step 1. Build rapport; getting to know the patient  (Alexander, 2016).

Step 2. Inquire; What substances do you use? Consumption use? Is there anything you want to change about this habit? (Alexander, 2016)

Step 3. Determine where the individual is in the “stages of change”  (Alexander, 2016).

Stage 1: Pre-contemplation- The patient has not considered or is unwilling to change and the provider is to educate and raise awareness  (Alexander, 2016).

Stage 2: Contemplation- The patient considered change with uncertainty/ambivalence and the provider is to aid in resolving the patient’s hesitations  (Alexander, 2016). NURS 6512 Diversity and Health Assessments Discussion Post

Stage 3: Determination- The patient is considering how to implement change and the provider aids in strategizing  (Alexander, 2016).

Stage 4: Action: The patient begins to make changes, but needs help in process stabilization; the provider aids in implementation strategies and relapse reduction  (Alexander, 2016).

Stage 5: Maintenance- The patient has reached their substance abstinence goal and continues to work on maintaining goals; the provider continues to support in positive feedback  (Alexander, 2016).

Stage 6: Recurrence- The patient and provider work through the consequences  (Alexander, 2016) NURS 6512 Diversity and Health Assessments Discussion Post.

Step 4: Keep track of the patient’s current stage and advice given and follow up, providing support and positive reinforcement  (Alexander, 2016).

3.) “Do you feel your current group of friends and/or family help to support your desire to abstain or do you feel that the current situation you are in will only hinder from abstinence?”

This question is excellent in regard to determining the risk of relapse.

4.)  “Are you experiencing any feelings of being down or depressed or any thoughts of hurting yourself or others?”

This is an important factor, especially since many of those with substance abuse disorders tend to have multiple mental health diagnoses.

5.) How long have you been out of your medication, and what barriers do you have to being able to refill and follow up with a primary provider?

Patient AG has a history of hypertension and is currently homeless, this is a vital question due to this comorbidity and can aid in future care.

NURS 6512 Diversity and Health Assessments Discussion Post Another topic I would also like to bring up is smoking cessation. Although he is in a stressful situation, this can be considered a teachable moment. Smoking cessation counseling tends to be placed on the backburning in various medical settings, however, education and various intervention strategies should be offered 
(Buchbinder et al., 2014)
.

 

References

Alexander, K. (2016). Brief interventions for clients with drug and alcohol issues. 
Journal of the Australian Traditional-Medicine Society
, 
22
(1), 27–29. 
https://doi.org/https://eds-a-ebscohost-com.ezp.waldenulibrary.org/eds/pdfviewer/pdfviewer?vid=5&sid=60d70174-c64a-4cf2-b335-b95ed66582bb%40sdc-v-sessmgr02

Buchbinder, M., Wilbur, R., Zuskov, D., McLean, S., & Sleath, B. (2014). Teachable moments and missed opportunities for smoking cessation counseling in a hospital emergency department: A mixed-methods study of patient-provider communication. 
BMC Health Services Research
, 
14
(1). 
https://doi.org/10.1186/s12913-014-0651-9 
  NURS 6512 Diversity and Health Assessments Discussion Post

NRNP 6635: Psychopathology and Diagnostic Reasoning Discussion: Factors That Influence the Development of Psychopathology

Explain the biological (genetic and neuroscientific); psychological (behavioral and cognitive processes, emotional, developmental); and social, cultural, and interpersonal factors that influence the development of psychopathology
.

Psychopathology is the study of mental disorder, different approaches can be used in the development of psychopathology such as psychotherapy. Psychotherapy is an effective biological treatments for mental disorders. Factors such as cultures, religion, socioeconomics and ethics can influence a person’s view on psychotherapy. While Psychopharmacology interventions plays a role, in psychopathology, evidence also shows that psychotherapy treatments can also be effective in some mental health patients. NRNP 6635: Psychopathology and Diagnostic Reasoning Discussion: Factors That Influence the Development of Psychopathology

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Psychotherapy help improve the functioning of the emotional stimuli regions of the brain. Studies such as neuroimaging have been used to observe the relationship between response to psychotherapy and the activity in critical areas of the brain responsible for the reaction to fear, negative emotions, and emotion control (Fournier, 2014). It has been presumed to restore neural normality’s in regions that respond to emotional stimuli and reduce its psychiatric symptoms, thus improving those regions’ regulations, especially those linked to adverse personal incidents. NRNP 6635: Psychopathology and Diagnostic Reasoning Discussion: Factors That Influence the Development of Psychopathology

There is evidence that psychotherapy positively impacts brain recovery from the psychological stress response system in psychotic disorders. It re-establishes and restores the biological neural network connection of the brain regions that are dysfunctional due to dreadful life event experiences the patient undergoes and facilitates the healing of that region of the brain (Wheeler, 2014). Psychotherapy targets the part of the brain-damaged from a mental and emotional point and tries to rewire it.

Psychotherapy uses psychological methods to treat mental illness instead of a medical approach; therefore, the patient’s culture, religion, and socioeconomics can be a hindrance to getting the necessary treatment. Culture has a powerful influence on a person’s perspective of life, both consciously and unconsciously (Wheeler, 2014). Patients coming from a culture where they cannot disclose personal events or occurrences that might cause mental instability are an obstacle to psychotherapeutic treatment. The clinician must be aware of the patient’s cultural backgrounds to be rational when conducting the psychotherapy sessions.

Religion and spirituality also play an essential role in administering psychotherapy treatments to patients with strong religious beliefs. Some religions perceive that religious figures and beings should be the only ones who address talks of one’s traumas and fears. Thus becomes a deterrent for the patient to seek psychotherapy treatments (Wheeler, 2014). It also becomes difficult for patients to give clinicians critical information to assess their mental condition. For effective communication between the clinician and patients, the clinician should be aware of patients’ religious beliefs to understand and work on how to administer the treatment successfully. NRNP 6635: Psychopathology and Diagnostic Reasoning Discussion: Factors That Influence the Development of Psychopathology

The socioeconomic status of patients with a mental disorder can also influence their views on psychotherapy’s relevance. Patients with low socioeconomic status can be linked to mental illnesses such as depression, stress, anxiety, substance abuse, and mood disorders (Haltom, 2014). Low income earning patients who are part of lower socioeconomic backgrounds lack the resources to access the psychotherapeutic treatments and may find it irrelevant to allocate their minimum payment on such rather than the essential life resources they need. Mental disorder patients from this low social status are disadvantageous in receiving psychotherapy treatments and optimal care.

Ethical issues that arise from psychotherapy treatments is the confidentiality of the patient’s information. Patients might have a hard time disclosing personal information in efforts to avoid the breach of confidence (Fisher, 2016). Psychotherapists should provide clients with complete protection of their confidential information. NRNP 6635: Psychopathology and Diagnostic Reasoning Discussion: Factors That Influence the Development of Psychopathology

Psychotherapy is a primary biological treatment for mental disorders, as per the study evidence shown. Culture, religion, and socioeconomic status of individuals suffering from mental illnesses influence the person’s perspective on psychotherapy treatments and can be a barrier for the patient to receive optimal care. Therefore, psychotherapy does have a biological basis.

 

References

Fisher, M. A. (2016). Introduction. In Confidentiality Limits In Psychotherapy: Ethics Checklists For Mental Health Professionals (pp. 3–12). Washington, DC: American Psychological Association. Doi: 10.1037/14860-001

Fournier, J. C., & Price, R. B. (2014). Psychotherapy And Neuroimaging. Psychotherapy: New Evidence And New Approaches, 12(3), 290–298. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4207360/

Haltom, S. (2014). When Bad Things Happen, Our Brains Change, But Psychotherapy And Support Can Help The Recovery Of Our Brains And Our Lives. Mental Health And Social Inclusion, 18(2), 52–58. Doi: 10.1108/MHSI-02-2014-0006 NRNP 6635: Psychopathology and Diagnostic Reasoning Discussion: Factors That Influence the Development of Psychopathology

Wheeler, K. (Eds.). (2014). Psychotherapy For The Advanced Practice Psychiatric Nurse: A How-to Guide For Evidence-based Practice (2nd Ed.). New York, Ny: Springer Publishing Company.

 

response

Your post was very thorough.  I agree people with low socioeconomic statuses have a higher rate of mental illness and hospitalizations. I would like to expand on that a bit further.  It has been my experience working as a psychiatric nurse at community mental health (CMH) that access to care, ability to afford treatment and where the patient is in Maslow’s Hierarchy of Needs directly affects their mental health.  I had several patients who qualified for mental health services at CMH (they must be enrolled in MI Medicaid, either as a primary or secondary insurance) who still did not have the means to get to their appointment. The lack of reliable transportation is a huge barrier to care in our rural area that does not have public transportation. NRNP 6635: Psychopathology and Diagnostic Reasoning Discussion: Factors That Influence the Development of Psychopathology

When addressing 
The Social Determinant of Health
, the World Health Organization states “Social justice is a matter of life and death. It affects the way people live, their consequent chance of illness, and their risk of premature death. We watch in wonder as life expectancy and good health continue to increase in parts of the world and in alarm as they fail to improve in others” (Brenner, 2020).

Untreated mental illness can, and often does, snowball into more complex problems. For example, a patient with an untreated mood disorder may escalate, leading to poor hygiene, self-harm behaviors and may turn to substances to self-medicate (Brenner, 2020). Substance abuse can lead to Hepatitis C and other liver problems, it can lead to cardiovascular disease, hepatic encephalopathy, Wernicke-Korsakoff Syndrome, malnutrition, diabetes, pancreatitis and many other disease (Brenner, 2020). NRNP 6635: Psychopathology and Diagnostic Reasoning Discussion: Factors That Influence the Development of Psychopathology

Our text also reports that access to healthcare is a serious problem for those with addiction and serious mental illness (SMI). According to the National Comorbidity Study, less than 40% of those with a SMI had received treatment in the last year and those that had received inadequate treatment (Sadock, Sadock & Ruiz, 2015).

Access to care is a barrier to mental and physical health care, forcing those who cannot access the system to use the emergency rooms as their primary care, or only seek treatment when it becomes and emergency (Sadock, Sadock & Ruiz, 2015). In order to decrease these barriers to mental healthcare, funding to mental health services.

 

References:

Brenner, G. H. (2020, February 29). 
How Mental Health Links Socioeconomics with Physical Disease
. Psychology Today. https://www.psychologytoday.com/ca/blog/psychiatry-the-people/202002/how-mental-health-links-socioeconomics-physical-disease.

Sadock, B. J., & Sadock, V. A. (2015). 
Kaplan & Sadock’s synopsis of psychiatry: behavioral sciences/clinical psychiatry
 (11th ed.). Wolter Kluwer/Lippincott Williams & Wilkins.

Discussion: Factors That Influence the Development of Psychopathology

In many realms of medicine, objective diagnoses can be made: A clavicula is broken.  An infection is present. TSH levels meet the diagnostic criteria for hypothyroidism. Psychiatry, on the other hand, deals with psychological phenomena and behaviors. Can these, too, be “defined objectively and by scientific criteria (Gergen, 1985), or are they social constructions?” (Sadock et al., 2015). NRNP 6635: Psychopathology and Diagnostic Reasoning Discussion: Factors That Influence the Development of Psychopathology

Thanks to myriad advances during recent decades, we know that
psychopathology is caused by many interacting factors
. Theoretical and clinical contributions to the field have come from the neural sciences, genetics, psychology, and social-cultural sciences. How do these factors impact the expression, classification, diagnosis, and prevalence of psychopathology, and why might it be important for a nurse practitioner to take a multidimensional, integrative approach?

To Prepare:

Review this week’s Learning Resources, considering the many interacting factors that contribute to the development of psychopathology.

Consider how theoretical perspective on psychopathology impacts the work of the PMHNP.

By Day 3 of Week 1

Explain the
biological (genetic and neuroscientific); psychological (behavioral and cognitive processes, emotional, developmental); and social, cultural, and interpersonal factors that influence the development of psychopathology
.

Read
a selection of your colleagues’ responses NRNP 6635: Psychopathology and Diagnostic Reasoning Discussion: Factors That Influence the Development of Psychopathology

By Day 6 of Week 1

Respond
 to at least 
two
 of your colleagues on 
2 different days
 by explaining the implications of why, as an advanced practice nurse, it is important to adopt a multidimensional, integrative model of psychopathology.

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

 

Factors that influence the development of psychopathology;-

 

According to Jimenez, Botto & Luyten (2018), psychotherapy is an interpersonal process which modifies feelings, behaviors, attitudes, and cognitions that have been problems towards an individual seeking help from a healthcare professional. Studies related to mental disorders have linked the relationship between psychological and biological factors. There is a general agreement that psychotherapy involves a specific type of learning in the context of an emotional relationship that may lead to epigenetic modifications across different therapeutic treatments (Jimenez et al., 2018). The uniting of organic and psychological sciences it not only presents the challenges but also the structures. A proposition that humans have an innate biological aspect in the brain that processes experiences to a physiological state where information can be received for learning to occur. Studies have shown both pharmacological regimen and non-pharmacological treatment like psychotherapy is also effective in treating mental disorders (Wheeler, 2014). The data suggest that a biological basis does exist and therefore, mental health professionals should consider it when treating mental health patients. There is also a biological component that can be present and viewed as tangible evidence to support a tailored approach when treating a patient (Wheeler, 2014).

There some some child and adolescent disorders that have been associated with genetics and youth in some families are susceptible to mental illnesses through gene transmissions. For example, polygenes have been found to be associated with externalizing problems in youth (Butcher & Kendall, 2018).

Also growing up in a complex society lacking or with limited family support and economic resources can seriously and negatively impact the way in which a young person develops. Not surprisingly, there is evidence to indicate that psychological adjustment is negatively influenced by low socioeconomic status Butcher & Kendall, 2018). Poverty related stress is associated with a variety of psychological problems in youth. Financial hardship in childhood was predictive of onset of all classes of disorder across development (Butcher & Kendall, 2018).

While there are universal commonalities in mental disorders, psychopathology is embedded in social culturally based systems of meaning and values. Social and cultural variations are found in the formation, expression, labeling, and treatment of symptom experiences (Cheung & Mak, 2018). Theories of culture and psychopathology have compared diversities of psychopathology across cultures and examined the role of culture in causing or determining the conditions that lead to psychiatriatric disorders. Other than the theory of cultural determinism, the concept of cultural relativism proposed that the diversity in a mental disorder, the variability of symptoms presented in that disorder, or the judgement of what constitutes pathology may be explained by cultural diversity (Cheung & Mak, 2018). NRNP 6635: Psychopathology and Diagnostic Reasoning Discussion: Factors That Influence the Development of Psychopathology

In Conclusion, healthcare professionals should try to gain their patients’ trust regardless of the ethnic background, race, culture, religion, and socioeconomic considerations. Healthcare professionals should clear up many misconceptions individuals may have about mental health illness. NRNP 6635: Psychopathology and Diagnostic Reasoning Discussion: Factors That Influence the Development of Psychopathology

 

 

References

 

Butcher J. N., & Kendall, P. C. (2018). Introduction to childhood and adolescent

psychopathology. In J. N. Butcher & P. C. Kendall (Eds.,), APA handbook of

psychopathology: Child and adolescent psychopathology., Vol. 2. (pp. 3-14). American

 psychological Association.

https://doi-org.ezp.waldenulibrary.org/10.1037/0000065-001

 

Cheung, F.M., & Mak, W. W. S. (2018). Sociocultural factors in psychopathology. In J. N.

Butcher & J. M. Hooley (Eds.), APA handbook of psychopathology: Psychopathology:

Understanding, assessing, and treating adult mental disorders., Vol. 1. (pp. 127-147).

American Psychological Association.

https://doi-org.ezp.waldennulibrary.org/10.1037/0000064-006

 

Jimenez, J. P., Botto, A., & luyten, P. (2018). Psychotherapy and Genetic Neuroscience: An

emerging dialog.

https://www.ncbi.nih.gov/pmc/articles/PMC6056612/
.

 

Wheeler, K. (Eds.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to

guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing NRNP 6635: Psychopathology and Diagnostic Reasoning Discussion: Factors That Influence the Development of Psychopathology