Category: Nursing

Differential diagnosis for skin conditions soap note example

SOAP NOTE

Differential Diagnosis for Skin Conditions

 

 

Skin Condition Picture # 2

 

 

Patient Initials: __JB___                     Age: __47___                         Gender: __M___

 

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SUBJECTIVE DATA: 

 

Chief Complaint (CC): 
Red lesions on trunk of body

 

History of Present Illness (HPI): 
Joe Brown is a 47-year-old Caucasian male who presents to practice with complaints of red lesions on the trunk area. The red lesions developed two weeks ago

of his body. The patient has not reported any irritating or soothing factors, and he has not tried any treatment for the lesions. Joe Brown reports the lesion does not affect his daily lifestyle and in not impacting in a negative way. Joe is just worried it could be something more severe. differential diagnosis for skin conditions soap note example

 

Medications: 

Lopressor 25mg twice daily

Lovastatin 40mg at bedtime

Xarelto 20mg daily with dinner

 

 

Allergies: 
Penicillins- rash,

 

Past Medical History (PMH): 

Hypertension diagnosed at 44

Atrial Fibrillation diagnosed at 46

Dyslipidemia diagnosed at 42

 

Past Surgical History: 

Vasectomy (2010)

herniorrhaphy (2008)

 

Sexual/Reproductive History: 
Patient denies any issues reproductively. Patient is currently divorced with 2 children and had a vasectomy in 2010. Patient has no history STDs and all sexual encounters have heterosexual.

 

Personal/Social History: 
Patient smoked 1 packs of cigarette/day x 10 years and drinks 2 bottles of beer a week for 26 year. Patient denies ever using recreational drugs. Patient does not exercise regularly but considers himself active due to the nature of his job (construction worker). Patient admits he does not follow a prescribed diet he still consume food high in fat and salt.

 

Immunization History: 
His immunization is up to date. He received his last flu shot and pneumonia vaccines in 2017 differential diagnosis for skin conditions soap note example

 

Significant Family History:

Father- Father is deceased, age 70, complications of type 2 diabetes

Mother- mother is deceased, 64, from hemorrhagic stroke

 

Siblings- two brothers with history of hypertension.

 

Children-2 children alive and well no significant medical issues.

 

Lifestyle: 
He currently works in the construction industry and has worked for in constructions for the past 20 years. He has been married once but currently is divorced and has 2 children with his wife. He lives in a middle-class neighborhood in the suburbs. He enjoys barbequing during his free time. He has a strong support system through his family and friends. Patient get a yearly physical check up but not vision and dental.

 

 

Review of Systems: 
From head-to-toe, include each system that covers the Chief Complaint, History of Present Illness, and History (this includes the systems that address any previous diagnoses).
 
Remember that the information you include in this section is based on what the patient tells you so ensure that you include all essentials in your case (refer to Chapter 2 of the Sullivan text).

General: 
Mr. Brown is well-developed, well nourished Caucasian male who is alert and cooperative. He is negative for recent changes in weight, fever, chills or night sweats.

 Respiratory: 
He denies SOB or exposure to tuberculosis.

 Cardiovascular/Peripheral Vascular: 
Mr. Brown denies chest pain, palpitation or irregular rhythm. No history of edema, exercise intolerance and claudication.

 Gastrointestinal: 
negative for heartburn; negative for nausea, vomiting, bowel changes. Bowel movements are solid and negative for frank blood.

  Skin: 
Presence of ruby red papules on trunk, denies pruritus or pain.

Hematologic: 
Mr. Brown denies prolonged bleeding times and easy bruising. No history of anemia.

Allergic/Immunologic: 
Mr. Brown is allergic to penicillin. No asthma or atopy. Patient has never been tested for HIV. Patient denies any recurrent infections.

 

OBJECTIVE DATA:

 

Physical Exam:

Vital signs:
 Temp 97.0; P78 and regular; R 18 and regular BP 138/72 right arm. His weight is currently 190. Height 6’2”. BMI is 25.

 

General: 
Mr. Brown is well-developed, well nourished Caucasian male who is alert and cooperative.

Chest/Lungs: 
Breath sounds clear to auscultation in all lung fields. There is symmetry in chest wall expansion and diaphragmatic excursion.

Breast:
No masses or sign of gynecomastia

Neck:
Presesnce of full range of motion. Absence of carotid bruit and absence of mass.

HEENT:

Heart/Peripheral Vascular: 
Heart regular rate and rhythm. No heart murmur, rub, or gallop. Pulses +2 bilateral radials and +2 bilateral pedals. Absence of peripheral edema.

Abdomen: 
Bowel sounds present x4 quadrants. Soft, non-tender, non-distended abdomen. Absence of organomegaly or masses.

Skin: 
Tiny bright ruby-red, round papules on the trunk of Mr. Joe’s body. Turgor is good, no cyanosis or jaundice.

 

Lab Tests and Results:

CBC- RBC 4.7, PLT 200, HGB 13, HCT 44

Chemistry: triglycerides 455, LDL 198, Total cholesterol 234; otherwise WNL.

 

ASSESSMENT: 

 

Priority Diagnosis: 
Cherry Angioma

 

Differential Diagnoses:

Drug eruption

Pityriasis Rosea

Thrombocytopenic purpura

 

The primary diagnosis selected in this patient is cherry angioma, as the clinical presentation and history best supports this diagnosis.  The patient presented with a non-painful, non-pruritic papular rash limited to the trunk of the body with no other negative symptoms.  A drug eruption could be responsible for a red rash on the patient’s trunk, but the patient denies any use of new medications and the rash is not generalized, pink, and morbilliform, how drug rashes usually are presented (Ball et al., 2015).  Pityriasis Rosea meets some of the criteria, but the rash is not itchy, scaly, or in oval patches, and the patient denies any recent illnesses (Dains, Baumann, & Scheibel, 2016).  Thrombocytopenic purpura is a contender for a priority diagnosis since the patient is on blood thinners and at risk for increased bleeding, but lab results show that platelet and other blood counts are within normal limits, and the rash is not generalized (Ball et al., 2015).

 

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). 
Seidel’s guide to physical examination
 (8th ed.). St. Louis, MO: Elsevier Mosby.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). 
Advanced health assessment and clinical diagnosis in primary care 
(5th ed.). St. Louis, MO: Elsevier Mosby.

Ely, J. W., & Stone, M. S. (2010). The generalized rash: Part I. Differential diagnosis. 
American Family Physician
, 81(6), 726-734. Retrieved from http://www.aafp.org/afp/2010/0315/p726.html

 

Comprehensive SOAP

 

 

Patient Initials
:           JS                   
Age
:    58yo               
Gender:
          Male

 

SUBJECTIVE DATA:

 

Chief Complaint (CC):
Skin abnormality appearance of a wide array of firm red bumps on chest and upper stomach (Slide #2) differential diagnosis for skin conditions soap note example

 

History of Present Illness (HPI):
JS is a 58-year-old white male who appears today to address numerous red bumps on his chest that spreads down to his abdomen. He reports there is a gradual onset over the past few months and he did not have this many a few years ago. He is concerned he may have cancer since he asked some friends and they said it could be start of it. He denies any pain to the areas, exudate, bleeding, or change in shape. He denies any fever and no presentation to contact aggravations such as chemicals. States his job can be a little stressful at times but not too significant. No changes in lifestyle. He does not have any personal history of skin growths before other than moles but there is a family history of skin cancer.

 

Medications:

Celexa 20mg daily

Metoprolol 25mg BID

 

Allergies:

Amoxicillin

 

Past Medical History (PMH):

Depression: diagnosed at age 37

Hypertension: diagnosed at 46

 

Past Surgical History (PSH):

Lasik Eye Surgery (Dr. John Stefano, MD), age 47

Cholecystectomy (Dr. Anil Makani, MD), age 54

Appendectomy (Surgeon Unknown), age 16

 

Sexual/Reproductive History:

Heterosexual, he is currently sexually active with one partner.  He uses no barrier

methods and his wife has entered menopause.

 

Personal/Social History:

Never smoked, occasional ETOH use (5 wine coolers per month), denies any use of illicit drugs

 

            Immunization History:

His immunizations are up to date.  He has not received the flu vaccination since last year and the Pneumococcal vaccine has not been administered. differential diagnosis for skin conditions soap note example

 

            Significant Family History:

Mother deceased in February 2018 due to acute lung injury, father is still living; history of hypertension, skin cancer and prostate enlargement, two siblings who are without any medical issues. He has two sons and two daughters ages 34, 31, 21, and 18. All healthy and living nearby.

 

            Lifestyle:

He is currently employed selling life insurance from his home office. He is married to his wife of 28 years and lives in his own home with her. He is currently sexually active. He has four children and four grandchildren, all live in close proximity. He is active to some degree.  He takes walks with his wife 2-3 days a week. He attends chapter meetings monthly for his place of employment.  He visits his father on a daily basis to assist him with any needs that he may have around his home.

 

            Review of Systems:

 

General:

Mr. Shockey is a well-appearing Caucasian male who presents alert. He appears to have good hygiene. Denies fatigue, fever, chills, recent weigh gain or loss, or loss of appetite.  Answers questions appropriately.

 

HEENT:

No vision or hearing impairments; he does not wear glasses other than for reading,
+ history of cataracts.
His last eye exam was approximately one year ago. No recent hearing changes, discharge, ringing in the ears, or ear infections.  He revealed his sense of smell is unblemished. No nasal or sinus issues. Nasal mucosa is pink without rhinorrhea or sinus delicacy. Oral mucosa clean, moist and intact. His last dental exam was 05/2018. Denies any concerns with chewing or swallowing.

 

Neck:

Supple, full scope of movement. No thyromegaly. No carotid bruits. No masses or tracheal deviation noted.

 

Breasts:

N/A

 

Respiratory:

Breath sounds are clear upon auscultation. Diaphragmatic excursion appears symmetrical. Denies any dyspnea on exertion, increased sputum production or cough. Denies ever having positive PPD.

 

Cardiovascular:

No chest pain, palpitations,
+ history of murmur as a child
; no history of arrhythmias, edema, or pain with walking or varicosities.

 

Gastrointestinal:

No nausea, vomiting;
+ for occasional reflux
. No abdominal discomfort, no changes in bowel pattern, denies any diarrhea, or constipation.

 

Genitourinary:

Urinary pattern is normal, denies any inability to urinate, or any form of incontinence, urgency or difficulty starting stream. He is heterosexual and is currently sexually active. No history of STDs.

 

Musculoskeletal:

Denies any bone or joint pain, no arthritis, gout and reports full ROM. No history of fractures or osteoporosis.

 

Psychiatric:

No history of anxiety.
+ history of depression for a number of years
. No sleep disturbances or hallucinations.
+ for hospitalization to a psychiatric ward for symptom control of his depression and has received electrical shock therapy
. He denies suicidal/homicidal ideation.

 

Neurological:

No syncopal episodes,
+ for dizziness when taking Celexa
. No tingling or numbness, no headaches.
+ for change in thinking patterns and memory after his electrical shock therapy about 8 years ago
. No tremors or abnormal movements; no history of gait issues or problems with coordination; he has been without falls and denies any type of seizure activity. differential diagnosis for skin conditions soap note example

 

Integumentary/Hematologic/Lymphatic: 

+ for multiple 1-2 mm firm, elevated papules
, appearing bright red, diffuse over his chest and upper abdomen, non-blanchable. No rashes, itching, or bruising. Denies any bleeding disorders, excessive bruising or blood transfusions.

 

Endocrine:

No endocrine issues or hormonal disorder.

 

Allergic/Immunologic:

+ history of generalized
hives as a child after ingestion of amoxicillin.

 

            OBJECTIVE DATA:

 

                        Physical Exam:

 

Vital signs: B/P 122/78, right arm, sitting, adult regular cuff; P 74 and regular; T 97.6 orally; RR 19; non-labored; Wt: 193 lbs; Ht: 6’1; BMI 25.5

 

General:

A&O x3, NAD, does not appear uncomfortable

 

HEENT:

PERRLA, Extra Ocular Muscle Intact, Ear canals patent.  Nasal mucosa

pink, normal turbinates.  No septal deviations.  Oral mucosa pink and moist.  Pharynx is nonerythematous and without exudate.  Teeth in good repair.

 

Neck:

Carotids no bruit, jugular vein distention or t-megally, Full ROM

 

Chest/Lungs:

Clear to auscultation AP&L, Symmetric chest wall, respirations non-

labored.

 

Heart/Peripheral Vascular:

RRR without murmur, rub, or gallop; S1 S2; +2 peripheral pulses bilaterally, no edema

 

Abdomen:

benign, normal bowel sounds in all 4 quadrants, no rebound tenderness, no masses.

 

Genital/Rectal:

Deferred at this time.

 

Musculoskeletal:

Symmetric muscle development; muscle strengths 5/5 all groups

 

Neurological:

CN II – XII intact, DTR’s intact, speech clear and in good tone.

 

Skin/Lymph Nodes
: multiple 1-2 mm firm, elevated papule, color appears bright red, diffuse over the chest and upper abdomen, non-blanchable.

 

ASSESSMENT:

 

                        Diagnostics:

None required

 

                        Differential Diagnosis (DDx):

 

Glomeruloid hemangioma-Small, firm, red-to-violaceous, vault formed papules, papulonodules, subcutaneous pale blue compressible tumors, wine-red sessile or pedunculated papules, or injuries with cerebriform morphology. They extend in estimate, estimating couple of millimeters to couple of centimeters in distance across, and are found essentially on the storage compartment and proximal appendages and is portrayed by lone or numerous blue-red papules (Gupta, et al., 2013).

Petechiae is red to purple injuries showing up on the mucous films and skin. Injuries can be macular and discernable (American Academy of dermatology, n.d.). Petechiae is little sores estimating under 0.5 cm (Ball et al., 2015). differential diagnosis for skin conditions soap note example

Cherry angioma-Cutaneous vascular expansion which shows as single or different spots and happens transcendently on the upper trunk and arms. They regularly show up as round-to-oval, splendid, red, arch formed papules and pinpoint macules measuring up to a few millimeters in distance across. The histopathologic discoveries of a cherry angioma are steady with a genuine slim hemangioma, which is shaped by various, recently created vessels with thin lumens and unmistakable endothelial cells organized in a lobular manner in the papillary dermis. The etiology of cherry angiomas isn’t outstanding. In any case, since cherry angiomas tend to increment in number as the patient’s age expands, 75% of grown-ups more than 75 years old were seen in an ongoing report, the maturing process may assume a part in the pathogenesis of cherry angiomas (Sanz, et al., 2017).

 

Diagnosis/Client Problems:

 

Cherry Angioma – Cutaneous vascular expansion which shows as single or different spots and happens transcendently on the upper trunk and arms. They regularly show up as round-to-oval, splendid, red, arch formed papules and pinpoint macules measuring up to a few millimeters in distance across (Sanz, et al., 2017). Glomeruloid hemangioma is vascular multiplication and shows up all of a sudden on the storage compartment, furthest points, head, and neck area in this way it is discounted (Gupta, et al., 2013). Red to purple, hyperkeratotic and combining papules, happens most regularly on the lower locale of the trunk, hindquarters, and thighs and is normally connected with Lyosomal storage diseases. This was not observed at all and therefore is precluded.

 

Plan:
Findings were presented to Mr. Shockey. In the event that treatment is wanted for corrective appearance, disturbance or bleeding; may allude to dermatology for electrocautery or laser treatment (Kim, 2009). Patient refuses as of now but may consider if any issues arise.

 

 

 

 

References

 

American Academy of Dermatology. (n.d.). Petechiae, purpura, and vasculitis.

Retrieved from file:///C:/Users/User/Downloads/Petechiae–Purpura-and-Vasculitis.pdf

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015).

Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.

Gupta, J., Kandhari, R., Ramesh, V., & Singh, A. (2013). Glomeruloid

hemangioma in normal individuals.
Indian Journal of Dermatology
, 58(2), 160. doi:10.4103/0019-5154.108088

Kim, J., Park, H., & Ahn, S. K. (2009). Cherry Angiomas on the Scalp.
Case

Reports In Dermatology,
1(1), 82-86. Retrieved from Walden Library database

Sanz, V., Martorell, A., Alegria-Landa, V., Diaz, F. J., Torrelo, A., Alfaro-Rubio,

A., & Kutzner, H. (2017). Cherry hemanginomas and lipomas with peculiar distribution.
Journal of the American Academy of Dermatology
. 76(6). DOI: https://doi.org/10.1016/j.jaad.2017.04.280 differential diagnosis for skin conditions soap note example

NURS 6630 Week 1 discussion – Agonist to antagonist spectrum of action of psychopharmacologic agents Sample essay

Week 1 Discussion: Initial Post

Foundational Neuroscience

Agonist to antagonist spectrum of action of psychopharmacologic agents

Agonist of psychopharmacologic agents binds to neurotransmitter and caused an activation of receptors; whereas, antagonist agents then binds to those receptors that are activated by agonists, thus preventing them from being in an inactivated state; thus, causing them to be in the state that is desirable (Stahl, 2013). One such example can be seen from the neurotransmitter receptors dopamine, serotonin and norepinephrine.

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G-protein is a protein that binds energy molecules, they are the biggest and most versatile of proteins, their job is to activate intracellular action by signaling pathways and modulate activities of ion channel (Gohar, 2018). Ion channels are transmembrane proteins that regulates the movement of ions across cell membranes and then divide them into groups according to their specificity, some of which includes sodium channels, potassium channels and calcium channels (Gohar, 2018). NURS 6630 Week 1 discussion – Agonist to antagonist spectrum of action of psychopharmacologic agents Sample essay

Ion channel receptors are mostly multimeric proteins that are found in the plasma membrane, they form pathways from one membrane to the next; they are able to open and close chemical and mechanical signals; when these ion channels are in an open site, then they move in and out of the cell, they each have a specific allowing only one ion to pass through (Suitable by Nature, n.d).

G-protein receptors are receptors that interact with neurotransmitters as well as psychotropic medication.  G-protein and ion channel are triggered by neurotransmitters; both starts with a different messenger that binds to a specific receptor that causes activation of different downstream chemical messenger; both G-protein and Ion channels signals transduction; G-protein uses protein kinase, its job is to activate or inactive ion channels or open and close the sequence to regulate ion concentration (Stahl, 2013).

Epigenetics

Epigenetics is described as the formation of genetics that above information coded exclusively by one’s genetic code (Stefanska & MacEwan, 2015).  Epigenetics is a system that determine if there are any gene that is made into RNA and protein specific to that gene, if is silenced; it turns genes on and off by the modification of chromatin structure that is in the cell nucleus (Stahl, 2013).  There are circumstances in which epigenetics pattern of gene activation may change from stabilization  of a silenced gene making it active or an active one, silenced based on what happens to a neuron; where pharmacologic agent can be a factor; it may cause a favorable or unfavorable response; a favorable response can be the good/therapeutic epigenetic effect where one is triggered to learn something or unfavorable effect where one is triggered to e addicted to drugs or develops conditions like anxiety disorder (Stahl, 2013). NURS 6630 Week 1 discussion – Agonist to antagonist spectrum of action of psychopharmacologic agents Sample essay

How we respond to pharmacological agents can be affected by epigenetics; drugs that are epigenetic may help in drug therapies as well as operations and management of pain (Stefanska & MacEwan, 2015).

An example is how those with a diagnosis of schizophrenia is treated; the pharmacological agent that is used to treat it, acts by reducing dopamine levels in the brain; the antagonist of dopamine works by binding the receptors causing a deactivation (Stahl, 2013).

References

Gohar, O. (2018). Ion channel modulation by g-protein coupled receptors. Alomone Labs. Retrieved from https://www.alomone.com/article/issue-no-21?cn-reloaded=1

Stefanska, B., & MacEwan, D. J. (2015). Epigenetics and pharmacology. 
British Journal of Pharmacology
, 
172
(11), 2701–2704. http://doi.org/10.1111/bph.13136

Stahl, S. M. (2013). 
Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications
 (4th ed.). New York, NY: Cambridge University Press

Suitable by Nature. (n.d.). Ion Channel | Learn science at suitable. Retrieved from https://www.nature.com/scitable/topicpage/ion-channel-14047658

 

agonist is a drug that activates certain receptors in the brain. An antagonist drug blocks opioids by attaching to the opioid receptors without activating them. Antagonists cause no opioid effect and block full agonist opioids (Stahl, 2013). A GTP-binding protein that relays signals from a plasma membrane signal receptor, known as a G protein-coupled receptor, to other signal transduction proteins inside the cell( Stahl,2013). A protein pore in cellular membranes that opens or closes in response to a signaling chemical (its ligand), allowing or blocking the flow of specific ions. Ion channel receptors are usually multimeric proteins located in the plasma membrane (Stahl, 2015). Each of these proteins arranges itself so that it forms a passageway or pore extending from one side of the membrane to the other. These passageways, or ion channels, have the ability to open and close in response to chemical or mechanical signals. When an ion channel is open, ions move into or out of the cell in single-file fashion. Individual ion channels are specific to particular ions, meaning that they usually allow only a single type of ion to pass through them ( Stahl, 2015).                                                                                                                        Epigenetics is the study of heritable changes in gene expression (active versus inactive genes) that do not involve changes to the underlying DNA sequence — a change in phenotype without a change in genotype — which in turn affects how cells read the genes(  Deans, C. & Maggert ,2015 ). Epigenetic change is a regular and natural occurrence but can also be influenced by several factors including age, the environment/lifestyle, and disease state. Epigenetic modifications can manifest as commonly as the manner in which cells terminally differentiate to end up as skin cells, liver cells, brain cells, etc. Or, epigenetic change can have more damaging effects that can result in diseases like cancer. At least three systems including DNA methylation, histone modification and non-coding RNA (ncRNA)-associated gene silencing are currently considered to initiate and sustain epigenetic change ( Deans, C. & Maggert , 2015 ). NURS 6630 Week 1 discussion – Agonist to antagonist spectrum of action of psychopharmacologic agents Sample essay

Psychotropic drugs are valuable resources in treating many mental health illnesses, but inappropriate prescribing can cause serious harm or possible death. The high numbers of inappropriate prescribing is associated with increased morbidity, mortality and decrease in quality of life ( Curkovic, Dodig-Curkovic , Eric, Kralik & Pivac, 2016  ). It is estimated that 30% of elderly people’s admissions in hospitals is due to problems related to drugs or to toxic effects of drugs ( Curkovic, Dodig-Curkovic , Eric, Kralik & Pivac, 2016 ). The elderly population is at great risk of adverse drug effects. The elderly experience altered pharmacokinetics and pharmacodynamics, which result in prolonged and increased effects of many drugs. The altered pharmacodynamics of the aging brain leads to a higher sensitivity to central nervous system acting agents ( Curkovic, Dodig-Curkovic , Eric, Kralik & Pivac, 2016        ).

Antidepressants, anxiolytics and antipsychotics are the most common potentially inappropriate psychotropics. Tricyclic antidepressants can causes dementia, cardiac conductive abnormalities, chronic constipation, and other adverse reactions (Sharma, Loh,., Nightingale, Mohile, & Holmes,2016 ). Tricyclic antidepressants should be avoided due to the anticholinergic, sedating and orthostatic hypotension   Selective serotonin reuptake inhibitors (SSRIs) should be used with caution, as they may exacerbate or cause syndrome of inappropriate antidiuretic hormone secretion or hyponatremia. Also, some drug-interactions involving antidepressants offer risks, i.e. tricyclic antidepressants and SSRIs, shows increased risk of falls (Sharma, Loh,., Nightingale, Mohile, & Holmes,2016 ). NURS 6630 Week 1 discussion – Agonist to antagonist spectrum of action of psychopharmacologic agents Sample essay

 

 

NURS 6630

Foundational Neuroscience

Explain the agonist-to-antagonist spectrum of action of psychopharmacologic agents

Psychopharmacologic agents induce changes in people’s thinking, mood, and behavior. They act through interaction with target receptors or sites in the nervous system to induce changes in patient’s psychological or physiological functions. According to Stahl (2013), most psychopharmacological drugs target ion channels or enzymes where they lead to production of biological responses among patients. This process is achieved through binding of pharmacological agents to receptors.

In pharmacology, ligands are molecules which bind to receptors. Once they bind to receptors, ligands can lead to production of biological responses or block the production of biological responses. Agonists are ligands responsible for activating receptors to produce biological response. On the other hand, antagonists are ligands which block agonist mediated responses. While agonists execute their task by activating receptors to produce biological responses, the antagonists block receptor activation, thus making it impossible to produce any biological responses.

Compare and contrast the actions of g couple proteins and ion gated channels

G couple proteins transmit signals from stimuli outside the interior of the cell to its interior. They act as molecular switches inside the cell. Action of G couple proteins is controlled by factors that regulate their ability to bind and hydrolyze guanosine triphosphate (GTP) to guanosine diphosphate (GDP) (Lodish et al, 2000). G couple proteins are turned off when bound to GDP and are turned on when bound on GTP. According to Lodish et al (2000), different mammalian cell-surface receptors have a trimeric signal transducing G protein. Ligands which bind to these receptors activate their relevant G protein, which in turn activates the effector enzyme to produce intracellular second massager (Lodish et al, 2000). It is worth noting that all G protein coupled receptors have 7-membrane spanning areas within their N-terminal segment. NURS 6630 Week 1 discussion – Agonist to antagonist spectrum of action of psychopharmacologic agents Sample essay. On the other hand, ion gated channels are transmembrane proteins of excited cells which only allow ions to pass under specific circumstances (Stahl, 2013). Gated ion channels may be either sodium channels of neurons or voltage gated channels like the acetylcholine

Explain the role of epigenetics in pharmacologic action

Epigenetics are changes occurring in human beings as a result of modifications of gene expression rather than alteration of the real genetic code. According to Stahl (2013), epigenetics affects ways in which cells read genes and produce proteins. Through epigenetics, some genes can be expressed over time or become dormant. Epigenetics makes each person unique and is reversible. It is worth noting that there are many different combinations of genes that can be turned on or off through pharmacologic action thus impacting the health outcome of an individual. For example, if genetic combinations leading to bad states in human health can be eliminated while only maintaining the gene’s states that foster good health, then some health conditions can be successfully eliminated.

According to Lundstrom (2015), epigenetic mechanisms which focus on miRNAs are important as diagnostic biomarkers. The reversible nature of epigenetic modifications makes the inhibition of DNA methylation possible against psychiatric diseases such as bipolar disorders and schizophrenia as well as some forms of cancers and other terminal illnesses. It is important for nurse practitioners to understand how medications impact on the patient’s gene expression among psychiatric patients. Some medications may suppress certain types of gene expression responsible for aggression among mentally ill patients and make them dormant while others may enhance gene expression and result to exacerbation of patient’s symptoms. NURS 6630 Week 1 discussion – Agonist to antagonist spectrum of action of psychopharmacologic agents Sample essay.

C791 Advanced Information Management

Advanced Information Management C791

The Electronic Health Record, also known as EHR is a digital database of both past and current clinical information including everything from demographics to test results and medical conditions (Tan & Payton, 2017). Health information systems have both advantages and disadvantages surrounding their usability, interoperability, scalability and compatibility. They have a direct affect on patient care and documentation and can affect the quality and delivery of nursing care and patient outcomes. Having access to patient records using an EHR allows information to be immediately available to all providers who have access to the EHR – including co-workers in other areas of the same hospital as well as in other hospitals with the same EHR. This can be extremely beneficial to the patient and health care providers alike. Unfortunately, EHRs are very expensive to implement as well as maintain – as they require multiple levels of training as well as periodic upgrades due to changes in healthcare delivery as well as system changes.

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Health Information Systems

A1. There are advantages and disadvantages of the EHR. In the area of usability, young nurses may have only been exposed to EHRs, and in fact most or all of their education may have taken place with electronic textbooks, tests and paper submission. For them, using an EHR may be very easy and they will have an advantage over older nurses, like myself, who learned nursing on pen and paper. All of my nursing schoolwork involved writing papers by hand and testing on paper. Advantages for nurses young and old, however, are the systematic charting methods provided by an EHR. Quick templates for charting  and check-box documentation on the EHR can provide reminders for the nurse to ensure that all problems that the patient is experiencing are addressed. A disadvantage can occur when the n nurse uses only the check-boxes and fails to provide to elaborate on issues occurring which are not addressed in the boxes. Without adding a narrative or written progress note in addition to the check boxes, the nurse may not truly tell the patients’ story, allowing for important details to be omitted. In the area of interoperability, one advantage is that if multiple providers use the same EHR, the patients records may be visible by all providers. For instance, if a patient sees a primary care physician who is aligned with a hospital system, then if the patient is admitted to the hospital he/she is aligned with the notes, diagnoses, lab results and demographics will all be visible by both the office staff and the hospital staff. Additionally, interoperability with lab would ensure that test results would flow into the chart rather than allowing for the chance for human error in entering lab values or times. A disadvantage would be if the patient sees a primary care physician who uses one type of EHR and presents to a hospital with another type of EHR. Most EHRs are only compatible with like EHRs, so the only way to ensure information from a physician office would not be visible by hospital staff or if one hospital system uses one type of EHR and another hospital system uses another type of EHR, there would be no visibility of information if the patient was transferred from one hospital to another. As related to scalability, an advantage would occur if the EHR chosen by a hospital is capable of expanding as healthcare regulations change and as the hospital system grows or expands to include additional service lines. A disadvantage would occur if the EHR chosen had limits on the ability to optimize the use to fit the needs of changing healthcare regulations or if it would not allow for expansion or growth throughout the system. Compatibility of the EHR would be an advantage if the current computer system of the hospital could handle the EHR without purchasing new equipment. When patients’ blood glucose levels are tested, does the information from the glucometer flow directly into the EHR? This would definitely be an advantage. Also it would be advantageous if the EHR had the ability to run on different hardware, as many people have a preference of the system they use. It would be a disadvantage if the EHR only ran on one system, or was only able to function in one area of the hospital. It would be important to ensure that the EHR had platforms for the Emergency Department, Inpatient, Outpatient, Surgery and Testing areas. If it was not capable of crossing over to any area of the hospital the patient might experience during a stay, it would be a disadvantage. C791 Advanced Information Management.

A2. Patient care and documentation can be positively impacted by implementation of an EHR. Using an EHR provides that all patient information is recorded in the exact same manner on each patient and provides continuity of care between shifts. Reminders for labs, medications, tests, and other areas of patient care can be helpful to ensure that the nurses caring for the patient provide all of the care ordered for the patient during their shift.  Additionally, if the patients chart needs to be reviewed for quality indicators or issues, the care is documented in the same manner and in the same area for each patient. If the patient seeks care from another physician or hospital system that uses the same EHR, then their care has the potential to be more appropriate because their history will be available for physicians, nurses and other caregivers with access, resulting in a higher level of care provided.

A3. The quality and delivery of nursing care and patient outcomes can be positively affected with the implementation of the EHR. Quality reviews can take place in real time – while the patient is still a patient- rather than having to wait for paper documentation to be scanned in to a record. Additionally, with paper documentation, there is no way to mine data to measure quality across a unit or a hospital. Data mining is the process of using software to discover or establish relationships (Mastrian & McGonigle, 2017).  If patient data is entered into an EHR, reports can be run to determine what treatments are being used, if they are effective and if proper documentation is happening among many other things. Patient outcomes can be positively affected because chart audits can happen in real time. C791 Advanced Information Management.

Organizational Benefits

B1. The EHR provides the opportunity to improve efficiency and quality of patient care, resulting in better outcomes (Mastrian & McGonigle, 2017). Patients come to healthcare facilities with hopes to get better. They do not plan to get sicker or to have complications, known as Hospital Acquired Conditions or HACs, resulting from treatments that they receive (or do not receive) during their hospitalization. In the facility where I work, approximately 3 years ago, a HAC known as Catheter Associated Urinary Tract Infection or CAUTI rates were high, and we set out on a mission to decrease these rates. We tracked and trended the rates of infection and the number of catheter days for each infection, from our EHR for the previous 3 years, and came up with goals for number of catheter days and diagnoses requiring catheterization vs. catheter use for nurse convenience. Additionally, we looked at where the CAUTIs were occurring (what unit), the age of the patient, what the course of treatment was (did the patient go to surgery or other diagnostic areas) and even drilled down to what nurse(s) and aide(s) cared for the patient. Nurse(s) and tech(s) caring for patients who developed a CAUTI were counseled and education was provided to all newly hired employees. Because of the information we gathered, using the EHR our nurse leadership team created a report to run each day to determine what patients might be at greatest risk for a CAUTI. The EHR allows for reports to be very in depth and include information such as what patients have catheters and how many days the catheter has been in place. Knowing the longer the catheter is in, the higher the risk of infection, we work as an interdisciplinary team to determine if the patient needs to continue with the catheter or if it could be discontinued. This, along with other actions such as implementing the use of TheraWorx cleaning have caused a significant decrease in the amount of CAUTIs. In 2015 and 2016, our hospital had seven CAUTIs during each year. In 2018 we had three CAUTIs and year to date in 2019 we have only had two. This is because of reports run and analyzed from the EHR.  HAC rates are continually measured using data from the HER to improve patient outcomes. Another way that quality improvement data collected can lead to measurable improvement is by using the EHR to review charts of patients who have had a negative outcome during a hospital stay, such as a fall with injury or a medication error. C791 Advanced Information Management. In the case of a fall with injury, our quality department will use the EHR to perform a full chart review. Then, they will use the information from the chart review to determine what co-workers were involved in the event, what medications or treatments the patient was receiving, and what the patient was doing at the time of injury. Every patient receives a fall risk assessment at the time of admit, completed in the HER, resulting in a fall risk score which is visible by the bedside nurse and others providing care to ensure the proper precautions are in place. If the patient experiences a fall, a near miss, or a change in condition, the bedside nurse is prompted to complete a new fall risk assessment in the EHR which will result in a new fall risk score. If the event is what as known as a never event, such as a death as a result of the fall, then this is reportable and the EHR will be useful to both the quality and legal department of the hospital as well as federal or state regulatory agencies or legal counsel who obtain access to the EHR.

B2. There are federal guidelines regarding the privacy of health information for EHRs including the Health Insurance Portability and Accountability Act (HIPAA) and Health Information Technology for Economic and Clinical Health (HITECH)  (Mastrian & McGonigle, 2017). Additionally, anyone using an EHR needs to ensure information is secure and network security is managed (Mastrian & McGonigle, 2017). In the hospital where I work, we have a unit for geriatric psychiatric patients. This is a locked unit with limited access and all patients are considered private. Their names are not visible by all on house census reports or other documents. Only co-workers who have electronic access, granted by their leader, can access the records of these patients. Because it is not practical to assume that everyone a patient on this unit comes into contact with would have this electronic access, a level of security known as “breaking the glass” exists in our EHR. C791 Advanced Information Management. This allows for anyone to access their record, but in order to do so they have to “break the glass” which requires them to state the reason they need to be in the chart and agree to quality review to ensure they have the right and the access is necessary. This insures the patients in this high security area are kept as private as possible. Data back-up is also necessary. A few years ago, a Mercy Hospital in Joplin, Missouri was completely destroyed by a tornado. Many patient records were destroyed and while patients were cared for in other facilities in the area, their information was not accessible due to the other hospitals not having compatible EHRs. This data was eventually recoverable, but not in real time. As a result, each Mercy Hospital now has all of its data backed up to a computer system offsite in a database accessible to anyone at any time. The data isn’t just stored on-site, but continually backed up offsite. These measures assure compliance with HIPAA and HITECH.

B3. Patient privacy is protected in many ways in an EHR. In the hospital where I work, a watchdog system is in place to monitor everyone who views a patient’s chart. If at any time, an employee views a patient chart and there is a match of the last name or home address, an alert is sent to the employee’s leader. It is then the leader’s role to investigate the reason the employee viewed the chart. The EHR system we use is EPIC, and the watchdog system reveals all locations in the chart viewed by the employee. If the employee had a reason to be in the patient’s chart, such as checking in the patient in the Emergency Department, but the only part of the chart viewed by the employee was the check-in screen, then there is no reason for disciplinary action. But if that same employee, responsible for checking in the patient to the Emergency Department went on to view previous visits or lab results, then they have violated HIPAA and are disciplined according to the hospital policy for privacy which aligns with HIPAA. Patient privacy is additionally protected through the process of granting employees access to the EHR. Each employee’s leader is responsible for requesting access which aligns with their training and job duties. Kitchen employees have no reason to be in a patient’s chart, so they are not trained in the EHR and do not have access. Nurses are only given access to patients on the floor(s) or department(s) where they will be working. This assures employees are not given access to patient’s private information when not required for the completion of their duties.

B4. Organizational efficiency and productivity will improved by adopting an EHR, although there have been few studies of EHRs with very little reported data (Mastrian & McGonigle, 2017). One way that efficiency is improved is standardization of charting using the EHR. Pathways can be built for standard physician orders for patients with specific conditions such as Chronic Obstructive Pulmonary Disease or COPD. Head to toe assessments are completed by multiple nurses across multiple shifts, but using the EHR, the assessments are completed the same way every time. The same documentation on each patients provides continuity of care for patients across the continuum of care, in addition to providing the ability to view data complied over a whole hospital stay on one screen in the same place every time. Productivity will be improved because the members of the care team will all be able to document at the bedside while care is being performed. In the case of a patient in cardiac arrest, where multiple members of the care team are providing care simultaneously, EPIC EHR provides a “code narrator” allowing for one point person to document all interventions during the code in real time while the code is happening. In the absence of an EHR, this documentation would be done by hand and might not be the same way every time or might cause the nurse doing the documentation to chart after the end of the event taking up time that could be used to care for other patients or to continue care on that patient if they survive. Additionally, once the documentation is entered into the EHR in real time, there is no need to scan any documents or information into the chart which provides a streamlined method of recordkeeping. If patient information is recorded on paper rather than in an EHR, there could be waste as eventually the paper would be scanned into the chart and then shredded to ensure privacy. C791 Advanced Information Management. Efficiency can also be enhanced in the area of human and capital resources. Using an EHR, each time a procedure is performed on a patient, a medication is given or a supply is used, these are recorded in the EHR and automatically charged to the patient account. This decreases the need for someone to enter charges manually into the system, thereby increasing productivity and decreasing the number of people required for care. In addition to the data listed above, there are many other ways organizational efficiency and productivity will improve with the implementation of an EHR.

Essential Stakeholder Roles for System Implementation

There are multiple layers of leadership required for implementing an EHR within a healthcare system, including but not limited to: Implementation Manager, Physician Champion, Information Technology Lead and SuperUser Lead. The Implementation Manager may be associated with the vendor of the EHR. They are responsible for making sure the project is on schedule, monitoring the work plan, maintaining a list of problems at the hospital or vendor level that need resolution, scheduling events surrounding implementation and may include communicating updates to the implementation team. Their expertise would need to be in both the inner workings and implementation of the specific EHR to be implemented (from a vendors perspective) and also in the structure of the implementation team (from the hospital perspective). This person would need to have excellent communication and organizational skills as the success of the implementation really begins and ends with them. They will also need delegation skills, as there is no way they could be expected to accomplish all facets of their role without support. It is never recommended to implement an EHR without a physician champion. A close relationship between the physician champion and the implementation team is imperative to the success of the EHR. Physicians will need the EHR to function clinically in a way that is beneficial to them as well as the patient. The Physician Champion will serve as a liaison between the implementation team and the facility physicians, so good communication skills are also required. It is essential that physicians “buy in” to the EHR, so it will be necessary for them to have a voice in the development, optimization and implementation of the EHR. The Information Technology Lead is the person that every member of the team can go to for answers related to the operation of the software and hardware of the EHR C791 Advanced Information Management. They deploy the workstations or other hardware needed, install the appropriate software and drivers on computers, tablets, scanners, printers and other hardware. They are also responsible for the operation of the software on the deployed hardware. The IT Lead will need to work with Leads from all departments within the hospital (Nurse and other Clinical Leads, Lab and other Ancillary Service Leads) so good communication skills are necessary. They will also need to understand the EHR and how the software is installed and how the hardware is intended to work once the software is installed. They will need to have a working knowledge of all areas of the EHR and what each department can expect to be required to do to login, use, and troubleshoot issues that arise. The SuperUser Lead  creates a network of Super-Users within the organization to provide continued support during and after implementation of the EHR. These SuperUsers must be recruited and trained by the SuperUser Lead. SuperUsers must be personable and willing to help employees with various skills within the organization. They will need to be able to work with very computer savvy employees as well as those who have very little computer expertise. They will provide IT support during implementation as well as assisting with new employees hired after implementation. They will be chosen based on their knowledge of different facets of the EHR so that they can provide very specific and effective assistance to employees.

Plan for Evaluation

Once an Electronic Health Record has been implemented by a team within a hospital setting, it will be important to continually evaluate the success of the EHR in the different areas of the hospital. National professional organizations have developed position papers regarding the importance of evaluation as well as methods for evaluation. One such organization, Healthcare Information and Management System Society or HIMSS, developed a position paper titled Transforming Nursing Practice Through Technology and Informatics. In this paper, they outline the value of nursing informatics, connecting with the consumer, and implications for time and plan of care (“HIMSS,” June 16, 2011). HIMSS believes that nursing should be key stakeholders in not only the development and design of EHR, but also in the evaluation and optimization of EHR (“HIMSS,” June 16, 2011) . The position statement from HIMSS is in alignment with other professional organizations such as the American Nurses Association (ANA), and the Alliance for Nursing Informatics (ANI) (“HIMSS,” June 16, 2011). Having strong nursing informatics leadership will play a key role in evaluating the success of system implementation. These leaders will orchestrate what information will be provided, how patient care is supported by the gathering and documentation of data and what financial and business implications there are as a result of implementation (“HIMSS,” June 16, 2011). National benchmarks exist in all service areas in the hospital. The EHR should allow each service area to easily compile data to measure their area against national benchmarks as well as their peers. The ease in which data is gathered from the EHR will allow more time for changes in practice guidelines or protocols to provide for safer care for the patient and a better work environment for the employee. Continual evaluation by all service areas as well as discussions between unit service area leadership and nursing informatics leadership regarding possible optimizations to the EHR are imperative to a successful EHR implementation. C791 Advanced Information Management.

 

References

Mastrian, K. G., & McGonigle, D. (2017).
Informatics for Health Professionals
(Custom WGU ed.). [Western Governors University]. Retrieved from https://wgu.vitalsource.com/#/books/9781284155402

Position statement on transforming nursing practice through technology and informatics. (June 16, 2011). Retrieved from https://www.himss.org/sites/himssorg/files/HIMSSorg/handouts/HIMSSNIPositionStatementMonographReport.pdf

Tan, J., & Payton, F. C. (2017).
Adaptive Health Management Information Systems: Concepts, Cases, & Practical Adaptions
(Custom WGU ed.). [Western Governors University]. Retrieved from https://wgu.vitalsource.com/#/books/9781284155396 C791 Advanced Information Management

Nurs 6640 week 2 discussion – Sheehan Disability Scale (SDS) Essay examples

The Sheehan Disability Scale

Assessment tools such as the Sheehan Disability Scale (SDS) are important in helping the PMHNP in assessing the functional status and functional impairment of their clients (Wheeler, 2014). The impact of mental disorders on the clients’ life does not only depend on the diagnosis of the condition but on the disability that the disorder causes (Luciano et al., 2010, p. 896). The SDS is an assessment tool that can be done in the waiting room that focuses on three groups of activities including home management, work abilities, the ability to form and maintain relationships and social life (Luciano et al., 2010, p. 897). Nurs 6640 week 2 discussion – Sheehan Disability Scale (SDS) Essay examples.

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In the case of major depressive disorder (MDD) there are associations between the mental illness and functional impairments in the affected client (Sheehan et al., 2015). The impairment associated with MDD have strong social and economic impacts causing clients to miss work, have a reduction in quality relationships, and an increase in family disruption (Sheehan et al., 2015). The SDS is a validated and accepted measure of functional outcome in clients with MDD with higher scores indicating a greater functional impairment (Sheehan et al., 2015).

Sheehan Disability Tool and Psychopharmacology

Psychopharmacology can be an important part in the client’s recovery process. The prescribing of medications for clients with mental illness is a difficult task because medications could exacerbate symptoms or even mask symptoms. It is important to be able to use a reliable assessment tool such as the SDS to determine if the medications prescribed are effective.  It is important to monitor the client’s progress early in the course of antidepressant treatment using a functional assessment such as the SDS can help clinicians determine whether or not medication adjustments are needed (Soares, Zhang, & Boucher, 2017).  Mental health recovery does not only mean symptom remission but the restoration of functional ability and that is where SDS plays a major rule in medication management. Nurs 6640 week 2 discussion – Sheehan Disability Scale (SDS) Essay examples. The SDS is among the most commonly used function scales in clinical trials of antidepressant treatment of MDD (Soares, Zhang, & Boucher, 2017). The SDS shows great potential to enhance the quality of care for mental health clients and may help clinicians determine sooner than later whether treatment adjustments are needed.

It is important for the PMHNP to understand the assessment tools that are used and their limitations. SDS may help clinicians determine sooner than later whether treatment adjustments are needed (Soares, Zhang, & Boucher, 2017). The SDS can not only be used as a primary assessment tool but can also be used to determine the efficacy of the medications being prescribed. Nurs 6640 week 2 discussion – Sheehan Disability Scale (SDS) Essay examples.

Reference

Luciano, J. V., Bertsch, J., Salvador-Carulla, L., Tomás, J. M., Fernández, A., Pinto-Meza, A., … Serrano-Blanco, A. (2010). Factor structure, internal consistency and construct validity of the Sheehan Disability Scale in a Spanish primary care sample.
Journal of Evaluation in Clinical Practice
,
16
(5), 895-901. doi:10.1111/j.1365-2753.2009.01211.x

Sheehan, D. V., Mancini, M., Wang, J., Berggren, L., Cao, H., Dueñas, H. J., & Yue, L. (2015). Assessment of functional outcomes by Sheehan Disability Scale in patients with major depressive disorder treated with duloxetine versus selective serotonin reuptake inhibitors.
Human Psychopharmacology: Clinical and Experimental
,
31
(1), 53-63. doi:10.1002/hup.2500

Soares, C. N., Zhang, M., & Boucher, M. (2017). Categorical improvement in functional impairment in depressed patients treated with desvenlafaxine.
CNS Spectrums
, 1-11. doi:10.1017/s1092852917000633

Wheeler, K. (2014).
Psychotherapy for the Advanced Practice Psychiatric Nurse, Second Edition
. Springer Publishing Company. Nurs 6640 week 2 discussion – Sheehan Disability Scale (SDS) Essay examples.

 

NURS 6640 Week 2: Assessment and Diagnosis in Psychotherapy Assignment

“A sensitively crafted intake assessment can be a powerful therapeutic tool. It can establish rapport between patient and therapist, further the therapeutic alliance, alleviate anxiety, provide reassurance, and facilitate the flow of information necessary for an accurate diagnosis and appropriate treatment plan.”

—Pamela Bjorklund, clinical psychologist

Whether you are treating patients for physical ailments or clients for mental health issues, the assessment process is an inextricable part of health care. To properly diagnose clients and develop treatment plans, you must have a strong foundation in assessment. This includes a working knowledge of assessments that are available to aid in diagnosis, how to use these assessments, and how to select the most appropriate assessment based on a client’s presentation. Nurs 6640 week 2 discussion – Sheehan Disability Scale (SDS) Essay examples.

This week, as you explore assessment and diagnosis in psychotherapy, you examine assessment tools, including their psychometric properties and appropriate use. You also develop diagnoses for clients receiving psychotherapy and consider legal and ethical implications of counseling these clients. NURS 6640 – Assessment and Diagnosis in Psychotherapy Essay Assignment Papers.

NURS 6640 Week 2: Assessment and Diagnosis in Psychotherapy Assignment

NURS 6640 – Assessment and Diagnosis in Psychotherapy Essay Assignment Papers Learning Resources

NURS 6640 Week 2: Assessment and Diagnosis in Psychotherapy Assignment Required Readings

Wheeler, K. (Ed.). (2014). 
Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice
 (2nd ed.). New York, NY: Springer Publishing Company.

Chapter 3, “Assessment and Diagnosis” (pp. 95–168)

Chapter 4, “The Initial Contact and Maintaining the Frame” (pp. 169–224)

American Psychiatric Association. (2013). 
Diagnostic and statistical manual of mental disorders
(5th ed.). Washington, DC: Author. NURS 6640 – Assessment and Diagnosis in Psychotherapy Essay Assignment Papers. Nurs 6640 week 2 discussion – Sheehan Disability Scale (SDS) Essay examples

 

Note:
 It is highly recommended that you use this resource as a reference guide throughout the course. You will access this text from the Walden Library databases.

American Academy of Child and Adolescent Psychiatry. (1995). 
Practice parameters for the psychiatric assessment of children and adolescents
. Washington, DC: Author. Retrieved from https://www.aacap.org/App_Themes/AACAP/docs/practice_parameters/psychiatric_assessment_practice_parameter.pdf

American Psychiatric Association. (2016). 
Practice guidelines for the psychiatric evaluation of adults
 (3rd ed.). Arlington, VA: Author. Retrieved from http://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760

Walden Library. (2017). NURS 6640 week 2 discussion guide. Retrieved from http://academicguides.waldenu.edu/nurs6640week2discussion

Walden University. (n.d.). Tests & measures: Home. Retrieved February 6, 2017, from http://academicguides.waldenu.edu/library/testsmeasures

Note:
This database may be helpful in obtaining assessment tool information for this week’s Discussion. Nurs 6640 week 2 discussion – Sheehan Disability Scale (SDS) Essay examples

NURS 6640 Week 2: Assessment and Diagnosis in Psychotherapy Assignment Required Media

Laureate Education (Producer). (2015a). Counseling competencies—The application of ethical guides and laws to record keeping [Video file]. Baltimore, MD: Author.

Provided courtesy of the Laureate International Network of Universities.

 

Note:
 The approximate length of this media piece is 23 minutes.

NURS 6640 Week 2: Assessment and Diagnosis in Psychotherapy Assignment Discussion: Assessment Tools

Assessment tools have two primary purposes: 1) to measure illness and diagnose clients, and 2) to measure a client’s response to treatment. Often, you will find that multiple assessment tools are designed to measure the same condition or response. Not all tools, however, are appropriate for use in all clinical situations. You must consider the strengths and weaknesses of each tool to select the appropriate assessment tool for your client. For this Discussion, as you examine the assessment tool assigned to you by the Course Instructor, consider its use in psychotherapy. Nurs 6640 week 2 discussion – Sheehan Disability Scale (SDS) Essay examples.

Learning Objectives

Students will:

Analyze psychometric properties of assessment tools

Evaluate appropriate use of assessment tools in psychotherapy

Compare assessment tools used in psychotherapy

Note:
 By Day 1 of this week, the Course Instructor will assign you to an assessment tool that is used in psychotherapy.

To prepare:

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

Consider the asessment tool assigned to you by the Course Instructor.

Review the Library Course Guide in your Learning Resources for assistance in locating information on the assessment tool you were assigned.

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 Submit, you cannot delete or edit your own posts, and cannot post anonymously. Please check your post carefully before clicking 
Submit! Nurs 6640 week 2 discussion – Sheehan Disability Scale (SDS) Essay examples

By Day 3

Post
 an explanation of the psychometric properties of the assessment tool you were assigned. Explain when it is appropriate to use this assessment tool with clients, including whether the tool can be used to evaluate the efficacy of psychopharmacologic medications. Support your approach with evidence-based literature. NURS 6640 – Assessment and Diagnosis in Psychotherapy Essay Assignment Papers.

Read
 a selection of your colleagues’ responses.

By Day 6

Respond
 to at least 
two
 of your colleagues by comparing your assessment tool to theirs.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 2 Discussion Rubric

Post by Day 3 and Respond by Day 6

To participate in this Discussion:

Week 2 Discussion

 

The assessment tool that I will use for assessing my client will be the Sheehan Disability Scale (SDS). This tool important for the PMHNP to assess the functional status and functional impairment for the clients during assessment (Wheeler, 2014). In client’s life, the impact that the mental illness cause does not just depend on the diagnosing of the condition but also on the disorder that causes disability. This tool can also be useful in the waiting room for assessment which depends on three different groups of programing such as management at home, abilities to work, and ability for a client to have a relationship and maintain it and social life. With clients with major depressive disorder (MDD), the client is effected by the mental illness and functional impairments (Sheehan et al., 2015). These impairments are associated client with MDD have impact on their social and economic affecting their work, having low quality of friendship, and has an increase in disrupting their family.

Sheehan Disability Scale and Psychopharmacology

Psychopharmacology is necessary during client’s process of recovery as a part of treatment for mental illness. For providers to prescribe medications for a mental illness client is very difficult because some medications can cause the illness to be worst or even mask the symptoms. SDS tool plays a very important part in making sure the medications prescribed by the provider will be effective. The provider needs to monitor the progress of the client’s antidepressant regimen by using the functional assessment such as the SDS to find out if the medication is working or need to be adjusted (Soares, Zhang, & Boucher, 2017). SDS plays an important role in medication management for mental illness recovery not only to symptom remission but also to restore the functional ability of the client. This tool is the only tool used in clinical trials for function scales of the antidepressant regimen and it showed a great potential in enhancing the quality of care the providers care for mental illness clients and helps the clinician in determining treatment sooner if it needs to be adjusted or not than waiting for later.

The PMHNP needs to know the and understand the assessment tools used, also know their limit but can be used the primary tool use to determine the efficacy of the medications that the provider is prescribing.

 

References;

Hodgins, D. C. (2013). Reliability and validity of the Sheehan Disability Scale modified for pathological gambling. BMC Psychiatry, 13177. doi:10.1186/1471-244X-13-177

 

Luciano, J. V., Bertsch, J., Salvador-Carulla, L., Tomás, J. M., Fernández, A., Pinto-Meza, A., … Serrano-Blanco, A. (2010). Factor structure, internal consistency and construct validity of the Sheehan Disability Scale in a Spanish primary care sample. Journal of Evaluation in Clinical Practice, 16(5), 895-901. doi:10.1111/j.1365-2753.2009.01211.x

Sheehan, D. V., Mancini, M., Wang, J., Berggren, L., Cao, H., Dueñas, H. J., & Yue, L. (2015). Assessment of functional outcomes by Sheehan Disability Scale in patients with major depressive disorder treated with duloxetine versus selective serotonin reuptake inhibitors. Human Psychopharmacology: Clinical and Experimental, 31(1), 53-63. doi:10.1002/hup.2500

Soares, C. N., Zhang, M., & Boucher, M. (2017). Categorical improvement in functional impairment in depressed patients treated with desvenlafaxine. CNS Spectrums, 1-11. doi:10.1017/s1092852917000633

Wheeler, K. (2014). Psychotherapy for the Advanced Practice Psychiatric Nurse, Second Edition. Springer Publishing Company. Nurs 6640 week 2 discussion – Sheehan Disability Scale (SDS) Essay examples

SHEEHAN, D. V., GASIOR, M., MCELROY, S. L., RADEWONUK, J., HERMAN, B. K., & HUDSON, J. (2018). Effects of Lisdexamfetamine Dimesylate on Functional Impairment Measured on the Sheehan Disability Scale in Adults With Moderate-tosevere Binge Eating Disorder: Results from Two Randomized, Placebo-controlled Trials. Innovations In Clinical Neuroscience, 15(5/6), 22-29. Nurs 6640 week 2 discussion – Sheehan Disability Scale (SDS) Essay examples

Nurs 6551 Week 1 Discussion – Political, Social, and Sociocultural Influences on Women’s Health Sample Essays

Discussion: Political, Social, and Sociocultural Influences on Women’s Health

As an advanced practice nurse, you must remain current on health issues that commonly impact women such as birth control, abortion, family planning, the human papillomavirus (HPV) vaccine, and human immunodeficiency virus (HIV). Many of these women’s health issues are heavily influenced by political, social, and sociocultural factors. These influences might not only affect a woman’s ability or desire to receive care, but also a provider’s ability or willingness to offer care. How might political, social, and sociocultural factors influence your personal perceptions of these women’s health issues? Nurs 6551 Week 1 Discussion – Political, Social, and Sociocultural Influences on Women’s Health Sample Essays

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To prepare:

·        Review this week’s media presentation, as well as Chapter 1 of the Schuiling and Likis text.

·        Select and research one of the following women’s health issues: birth control, abortion, family planning,
human papillomavirus (HPV) vaccine
, human immunodeficiency virus (HIV) in women, or another issue approved by the course Instructor.

·        Consider the impact of political, social, and sociocultural factors on the women’s health issue you selected.

·        Reflect on how the personal perceptions of providers might influence their ability or willingness to care for women in relation to this issue.

Post
at least 250 words APA format (no introduction or conclusion)

1.     pick on subject from above

2.     explain the political impact of this women’s health issue,

3.     social factors of this women’s health issue

4.     sociocultural factors on this women’s health issue

5.     Explain how personal perceptions of providers might influence their ability or willingness to care for women in relation to this issue. Nurs 6551 Week 1 Discussion – Political, Social, and Sociocultural Influences on Women’s Health Sample Essays

Resource

Schuiling, K. D., & Likis, F. E. (2013).
Women’s gynecologic health
(2nd ed.). Burlington, MA: Jones and Bartlett Publishers

 

NURS 6551 Week 1 Discussion – As an advanced practice nurse, you must remain current on health issues that commonly impact women such as birth control, abortion, family planning, the human papillomavirus (HPV) vaccine, and human immunodeficiency virus (HIV). Many of these women’s health issues are heavily influenced by political, social, and sociocultural factors. These influences might not only affect a woman’s ability or desire to receive care, but also a provider’s ability or willingness to offer care. How might political, social, and sociocultural factors influence your personal perceptions of these women’s health issues?

To prepare FOR NURS 6551 Week 1 Discussion:

  Review this week’s media presentation, as well as Chapter 1 of the Schuiling and Likis text.

Select and research one of the following women’s health issues: birth control, abortion, family planning, human papillomavirus (HPV) vaccine, human immunodeficiency virus (HIV) in women, or another issue approved by the course Instructor.

Consider the impact of political, social, and sociocultural factors on the women’s health issue you selected.

Reflect on how the personal perceptions of providers might influence their ability or willingness to care for women in relation to this issue.

Post
 at least 250 words APA format (no introduction or conclusion)

1.     pick on subject from above

2.     explain the political impact of this women’s health issue,

3.     social factors of this women’s health issue

4.     sociocultural factors on this women’s health issue

5.     Explain how personal perceptions of providers might influence their ability or willingness to care for women in relation to this issue.

NURS 6551 Week 1 Discussion Resource

Schuiling, K. D., & Likis, F. E. (2013). 
Women’s gynecologic health
 (2nd ed.). Burlington, MA: Jones and Bartlett Publishers

NURS 6551 Week 9 Discussion

To prepare Assignment 1: Application – Comprehensive Patient Assessment ON Abnormal Uterine Bleeding

Reflect on your Practicum Experience and select a female patient whom you have examined with the support and guidance of your Preceptor. Nurs 6551 Week 1 Discussion – Political, Social, and Sociocultural Influences on Women’s Health Sample Essays

Think about the details of the patient’s background, medical history, physical exam, labs and diagnostics, diagnosis, treatment and management plan, as well as education strategies and follow-up care.

To complete

Write an 8- to 10-page comprehensive 
soap Note paper on
 
Abnormal Uterine Bleeding
 , that addresses the following:

Age, race and ethnicity, and partner status of the patient

Current health status, including chief concern or complaint of the patient

Contraception method (if any)

Patient history, including medical history, family medical history, gynecologic history, obstetric history, and personal social history (as appropriate to current problem)

Review of systems

Physical exam

Labs, tests, and other diagnostics

Differential diagnoses

Management plan, including diagnosis, treatment, patient education, and follow-up care.

References

Schuiling, K. D., & Likis, F. E. (2013). 
Women’s gynecologic health
 (2nd ed.). Burlington, MA: Jones and Bartlett Publishers.

Chapter 5, “Gynecologic Anatomy and Physiology” (pp. 81–101)

Chapter 6, “Gynecologic History and Physical Examination” (pp. 103–131)

Tharpe, N. L., Farley, C., & Jordan, R. G. (2013).
 Clinical practice guidelines for midwifery & Women’s health
 (4th ed.). Burlington, MA: Jones & Bartlett Publishers.

Chapter 6, “Care of the Well Woman Across the Life Span

“Preventive Health Care for Well Women” (pp. 263–265)

. Retrieved from 
http://www.womenshealth.gov/screening-
tests-and-vaccines/screening
-tests-for-women/
Screening tests and vaccines
U.S. Department of Health and Human Services. (2012b). Care of the Well Woman: Health Assessment and Screening” (pp. 265–270)

Society for Reporoductive Endocrinology and Infertility. (2012). Abnormal uterine bleeding. Retrieved from 
http://www.socrei.org/BOOKLET_abnormal_uteine_bleeding/
Taran, F. A., Stewart, E. A., & Brucker, S. (2013). Adenomyosis: Epidemiology, risk factors, clinical phenotype and surgical and interventional alternative to hysterectomy. 
Geburtshilfe Frauenheilkunde, 73
(9), 924-931. Nurs 6551 Week 1 Discussion – Political, Social, and Sociocultural Influences on Women’s Health Sample Essays

Nurs 6640 week 1 discussion Post Response

Great post Daniel on the cultural beliefs effect psychotherapy. I agree when you said that it is important that the PMHNP needs to be culturally competent and aware of the different stigmas that culture can play on the perception of psychotherapy. The concept of cultural competence is especially true when dealing with the Navajo nation because even the use of the word “belief’ can cause problem because of the way their culture interprets its meaning. The Navajo regard psychotherapy as a practice pertaining to illness and healing and the terminology used becomes important (Lewis-Fernández, 2011, p. 5). When the word belief is applied to aspects of therapy it carries the connotation of falsehood, instead of saying what is your belief on mental illness and psych therapy one should use the terms values, attitudes on, view, but never beliefs (Lewis-Fernández, 2011, p. 6). Nurs 6640 week 1 discussion Post Response

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The feeling of shared cultural beliefs and values plays an important role in psychotherapy. If a client feels that you do not understand where they are coming from because of cultural differences, it can cause negative effects. There are some studies that show that ethnically similar clients and therapists can result in more favorable outcomes. The increase in more favorable outcomes could be because the ethnic minority clients may view ethnically similar psychotherapists as a more credible source of help because the assume a shared culture or values (Meyer & Zane, 2013, p. 3).

Through your research have you found any data that supports racial matching of clients causing more favorable outcomes? Do you think that racial matching is appropriate in todays society? Nurs 6640 week 1 discussion Post Response. Again Daniel this was a very informative post and I look forward to reading more from you in the future.

 

Reference

Lewis-Fernández, R. (2011). Commentary on “Elements of Psychotherapy in Navaho Religion”: A Perspective from Contemporary Cultural Psychiatry.
Psychiatry: Interpersonal and Biological Processes
,
74
(4), 293-300. doi:10.1521/psyc.2011.74.4.293

Meyer, O. L., & Zane, N. (2013). THE INFLUENCE OF RACE AND ETHNICITY IN CLIENTS’ EXPERIENCES OF MENTAL HEALTH TREATMENT.
Journal of Community Psychology
,
41
(7), 884-901. doi:10.1002/jcop.21580. Nurs 6640 week 1 discussion Post Response

Human papilloma virus (HPV) vaccine Essay – Nurs 6551 Week 1 Discussion – Political, Social, and Sociocultural Influences on Women’s Health

NURS 6551

Week 1 Discussion

Political, Social, and Sociocultural Influences on Women’s Health

Human papilloma virus (HPV) vaccine

Human papillomavirus (HPV) is the most commonly sexually transmitted infection. People who are infected remain asymptomatic but continue to spread the virus (Shuiling & Likis, 2017). Some HPV infections result in no symptoms and resolve spontaneously. Exposure to the virus can occur during intercourse, contact with infected genitals, mouth, or throat. Routine screening should be completed during Papanicolaou (PAP) smears. In people where the HPV virus persists can result in warts or precancerous lesions.  This leads to an increased risk of cancer of the cervix, vagina, penis, anus, mouth, or throat. HPV 16 and HPV18 account for 70% of cervical cancer. HPV6 and HPV 11 have been found to cause genital warts and laryngeal papillomatosis (Arnheim-Dahlstrom, Pasternak, Svanström, Sparén, Hviid, 2013). Human papilloma virus (HPV) vaccine Essay – Nurs 6551 Week 1 Discussion – Political, Social, and Sociocultural Influences on Women’s Health

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Political impact

When the HPV vaccine hit the market, it became a heated discussion in political circles. Many states proposed legislation to mandate the vaccine for school attendance (www.ncsl.org, 2015). The World Health Organization (WHO) recommends the HPV vaccine as part of routine vaccines. If all young girls received the vaccine, it would protect against 10,000 new cases of cervical cancer every year. Despite these findings, progressive and conservative groups still to this day argue the merit and intent of this vaccine.

Social impact

Research studies have proven the safety of the vaccine, but opposition still remains in regards to the sexual implications. Conservative groups are against making vaccine mandatory reporting it is a violation of parental rights and could lead to early sexual activity. The groups believe giving the vaccine to a pre-adolescent girl would give a false sense of immunity to sexually transmitted diseases resulting in having sex at a younger age (Sussman, Helitzer, Bennett, Solares, Lanoue, & Getrich, 2015).  The American Academy of Pediatrics has disagreed with the though process of the vaccine will increase sexual activity among teens. Parents have expressed concern on making the vaccine mandatory for admission to public schools. Their concerns are with the HPV vaccine is to prevent STD’s. Whereas other vaccines are given to prevent diseases passes through social contact.

Sociocultural factors

In todays society there is a movement that is supportive of greater involvement by teens in their health and wellness. However, there are still large groups of  parents that appear to make the decision about receiving the vaccine. Some parents do discuss the vaccine with their children, and there has been evidence that a higher number of teens are being vaccinated when given the choice themselves (Gilkey,  Moss, Coyne-Beasley, Hall, Shah, & Brewer, 2015). Parents understanding benefits of the HPV vaccine and decreasing the risk of cervical cancer was limited. There are government sponsored programs that  have increased awareness and helped society to understand the medical and preventative benefits of receiving the vaccine. Human papilloma virus (HPV) vaccine Essay – Nurs 6551 Week 1 Discussion – Political, Social, and Sociocultural Influences on Women’s Health

Providers influence

The conversation between the parent and provider about receiving the HPV vaccine can be a difficulty one. A 2016 study of national physician communication and support for the vaccine found the HPV vaccine not routinely being recommended (Clark, Cowan, Pilippp, Fisher, & Stokley, 2016). The physicians in the study reported the discussion with parents about the HPV vaccine was long and taxing. Parents who have refused to have the vaccine given were more likely to not have  had a discussion with the provider regarding the benefits of the vaccine. One provider who was surveyed said he would discuss preventing cervical cancer and would not address the sexual aspects surrounding the vaccine. Another study describing HPV vaccination among adolescent girls in high-risk communities found that parent awareness of the vaccine, belief in vaccine effectiveness, and doctor recommendation were positively associated with vaccine initiation. They also found that negative attitudes toward the vaccine and needing more information about the vaccine were negatively associated with vaccine being administered.

Reference

Arnheim-Dahlstrom, L.; Pasternak, B.; Svanström, H.; Sparén, P.; Hviid, A. (2013).                                  Autoimmune, neurological, and venous thromboembolic adverse events after                     immunization of adolescent girls with quadrivalent human papillomavirus vaccine in             Denmark and Sweden: Cohort study”.
BMJ.
    347: f5906. doi:10.1136/bmj.f5906

Clark, S. J., Cowan, A. E., Filipp, S. L., Fisher, A. M., & Stokley, S. (2016). Parent Perception of             Provider Interactions Influences HPV Vaccination Status of Adolescent Females. 
Clinical               Pediatrics
, 
55
(8), 701-706. doi:10.1177/0009922815610629

Gilkey, Melissa B.; Moss, Jennifer L.; Coyne-Beasley, Tamera; Hall, Megan E.; Shah, Parth D.;    Brewer, Noel T. (2015). “Physician communication about adolescent vaccination: How is                 human papillomavirus vaccine different?”.
Preventive Medicine
. 77: 181–185.         doi:10.1016/j.ypmed.2015.05.024

“HPV Vaccine: State Legislation and Statutes.” Www.ncsl.org, 15 Nov. 2018, www.ncsl.org.

Schuiling, K. D., & Likis, F. E. (2017). Women’s  gynecologic health (3rd ed.). Burlington, MA:              Jones and Bartlett  Publishers.

Sussman, A. L., Helitzer, D., Bennett, A., Solares, A., Lanoue, M., & Getrich, C. M. (2015).        Catching Up With the HPV Vaccine: Challenges and Opportunities in Primary Care.  
Annals Of Family Medicine,
13(4), 354-360. doi:10.1370/afm.1821 Human papilloma virus (HPV) vaccine Essay – Nurs 6551 Week 1 Discussion – Political, Social, and Sociocultural Influences on Women’s Health

 

Human Papilloma Virus

Human Papilloma Virus (HPV) is transmitted through close intimate contact with another individual carrying the disease and is known as the most common sexually transmitted disease according to the Centers for Disease Control and Prevention (CDC). (CDC, 2016).  Unfortunately, this condition can remain asymptomatic permitting the spread of the virus to others (Shuiling & Likis, 2017).  The virus is transmitted via sexual intercourse with a person having infected genitals, oropharynx, as well as anal.  HPV  is found during routine screening with Papanicolaou (PAP) smear which determines abnormal cells present to the cervix (CDC, 2016).  These abnormal cells frequently return to normal over a period of time, however, with some persons these cells may turn into cancer (CDC, 2016).  Unresolved lesions can lead to cancer of the cervix, vagina, penis, anus, and the oropharynx (Sasaki et al., 2017).  Nearly 70% of cervical cancer is caused by HPV 16 and 18 along with HPV 6 and 11 have been determined to cause genital warts and laryngeal papillomatosis (Sasaki et al., 2017).

Political Impact

In 2006 the U. S. Food and Drug Administration (FDA) approved the first HPV vaccine to prevent or reduce the incidence of cervical, vaginal, vulvar, penile, anal, and oropharyngeal related cancers (Keim-Malpass et al., 2017).  Unfortunately, the completion of the three-vaccination series lags far behind the Healthy People 2020 goal of 80% of males and females aged 13-15 years of age (Office of Disease Prevention and Health Promotion, 2016).

Social and Sociocultural Factors

According to Rossi, Baldacchini, and Ronco (2014), women from lower socioeconomic status along with others in disadvantaged groups had less knowledge regarding HPV and cervical cancer risks than more affluent women.  Rossi et al. (2014) also found that unvaccinated women are also underscreened for HPV.  Furthermore, Rossi et al. (2014) felt the introduction of the HPV self-testing may increase screening however inequalities continue to exist as the cost is prohibitive with some groups of at-risk women.  Rossi et al. (2014), felt HPV self-screening would increase population coverage, participation, and compliance to preventing disease transmission along with the development of newer technology in self-sampling innovation. Rossi et al. (2014) go on to say in population-based randomized trials have indicated that screening with an HPV test has greater effectiveness than the Pap test in decreasing the incidence of cervical cancer along with mortality.   There are many government-sponsored programs to increase HPV awareness to assist the public in understanding the medical and preventative benefits of utilizing vaccines to prevent cancer. Human papilloma virus (HPV) vaccine Essay – Nurs 6551 Week 1 Discussion – Political, Social, and Sociocultural Influences on Women’s Health

Provider Influence

The conversation between the provider, parent, and adolescent can be tricky.  Clark et al. (2016) found in a national study that communication and support for the HPV vaccine were not consistently recommended due to long and in-depth conversations.  A recent personal experience during a pediatric practicum, the pediatrician, routinely did not routinely recommend the HPV vaccine to adolescents unless it was felt the family and patient exhibited ‘at risk’ behaviors.  To increase the national goal of HPV vaccination, it will be essential to eliminate provider barriers to recommending vaccination in the clinical setting (Warner et al., 2017).

References

Centers for Disease Control and Prevention (CDC).  (2016).  Human Papillomavirus (HPV).

Retrieved from cdc.gov/hpv/parents/whatishpv.html

Keim-Malpass, J., Mitchell, E. M., DeGuzman, P. B., Stoler, M. H., & Kennedy, C. (2017).

Legislative activity related to the human papillomavirus (HPV) vaccine in the United States (2006-2015): A need for evidence-based policy. 
Risk Managed Healthcare Policy, 10,
29-32. doi: 10.2147/RMHP.S128247

Office of Disease Prevention and Health Promotion.  (2016).  HPV vaccine, adolescents 2008-

(2016). In
Healthy People 2020.
Retrieved from https://www.healthypeople.gov/ 2020/topics-objectives/topic/hpv/vaccines.

Rossi, P. G., Baldacchini, F., & Ronco, G. (2014).  The possible effects on socio-economic

inequalities of introducing HPV testing as primary test in cervical cancer screening programs. 
Frontiers in Oncology, 4
, 20. doi: 10.3389/fronc.2014.00020 Human papilloma virus (HPV) vaccine Essay – Nurs 6551 Week 1 Discussion – Political, Social, and Sociocultural Influences on Women’s Health

Sasaki, Y., Iwanari, O., Arakawa, I., Moriya, T., Mikami, Y., Iihara, K., & Konno, R. (2017).

Cervical cancer screening with human papillomavirus DNA and cytology in Japan. 
International Journal of Gynecological Cancer, 27
(3), 523-529. doi: 10.1097/IGC. 000000000000000898

Schuiling, K. D., & Likis, F. E. (2017). 
Women’s gynecologic health
(3
rd
ed.).  Burlington, MA:

Jones and Bartlett Publishers

Warner, E. L., Ding, Q., Pappas, L., Bodson, J., Fowler, B., Mooney, R., Kirchhoff, A. C., &

Kepka, D. (2017).  Health care providers’ knowledge of HPV vaccination, barriers, and strategies in a state with low HPV vaccine receipt:  Mixed-methods study. 
JMIR Caner, 3
(2), e12.  doi: 10.2196/cancer.7345 Human papilloma virus (HPV) vaccine Essay – Nurs 6551 Week 1 Discussion – Political, Social, and Sociocultural Influences on Women’s Health

NURS 6512 Week 1 Discussion

Understanding the Individual

The provider who can build a rapport and earn the trust of a patient will meet less resistance when gathering information for a health history.  It is important to look at the whole person, considering factors that could influence the patient’s overall health such as occupation, culture, ethnicity, and socioeconomic status (Ball, Dains, Flynn, Solomon, & Stewart,2015).  The purpose of this discussion is to identify techniques in building a health history for a 76-year-old Black man, with disabilities that lives in an urban area.

Factors for Consideration

At 76, even with known disabilities, the patient has probably outlived many in his community as the life expectancy of the American Black male, is just over 72 years of age (Arias, Heron & XU,2016).  The African-American patient might not trust health care providers based on a history of isolation and exploitation (Watts, 2003).  Until the middle of the last century, health care was often segregated, and those of African heritage were not afforded the same consideration as those of European descent (Watts,2003). The construction of a health history requires the provider to be sensitive to patient feelings and perceptions related to health care. NURS 6512 Week 1 Discussion

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The Assessment

The collection and analysis of information regarding an individual’s current and overall health is a health assessment (Ball, Dains, Flynn, Solomon, & Stewart,2015). The information provided by the individual is subjective (Ball, Dains, Flynn, Solomon, & Stewart,2015).  Due to the personal nature of the information, a patient provides it is crucial a practitioner observes and completes a physical examination providing objective data to the health assessment and the completion of the individual’s health history.  Physical exams should include inspection, auscultation, percussion, and palpation of the patient to verify the patients report objectively (Ball, Dains, Flynn, Solomon, & Stewart,2015).  A functional assessment helps to provide an understanding of an individual’s ability to perform activities of daily living (Ball, Dains, Flynn, Solomon, & Stewart,2015).  A functional assessment is particularly useful in elderly patients and those with documented disabilities. The presence of physical, cognitive and emotional limitations may restrict independence and identify areas where assistance is needed (Ball, Dains, Flynn, Solomon, & Stewart,2015). NURS 6512 Week 1 Discussion

Targeted Questions

Asking appropriate questions and avoiding stereotypes is essential to providing care that is tailored to the individual (Ball, Dains, Flynn, Solomon, & Stewart,2015).   Questions should be open ended and asked in a manner that is easily understood.  Possible targeted questions are: What brought you in to be seen today?  What kind of problems have been caused by your illness or condition?  Has this illness limited your ability to do things in your home?  Have you experienced any falls?  Do you have help available if you need it?  The questions should be relevant to the patient’s situation, so knowing if they live alone, with family or in a facility affects the types of questions asked.

Conclusion

Providing quality individualized care requires a provider to understand factors outside of the pathophysiology of illness, disease or condition. NURS 6512 Week 1 Discussion A successful interview develops the patient- provider relationship and builds trust.  Take the time to listen to your patients, and they will do the same for you.

References:

Arias E, Heron M, Xu JQ. (2016). United States life tables, 2012. National vital statistics reports;

vol 65 no 8. Hyattsville, MD: National Center for Health Statistics.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to

physical examination (8th ed.). St. Louis, MO: Elsevier Mosby. NURS 6512 Week 1 Discussion

 

Watts, R., (January 31, 2003). “Race Consciousness and the Health of African

Americans”. Online Journal of Issues in Nursing. Vol. 8 No. 1.  Retrieved from:

http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/

OJIN/TableofContents/Volume82003/No1Jan2003/RaceandHealth.html NURS 6512 Week 1 Discussion

NURS 6050 week 1 discussion

Patient Scenario

A 30-year-old, Caucasian female presented to the emergency room complaining of severe epigastric and right upper quadrant (RUQ) pain, nausea, vomiting, and fever. Her medical history is only significant for irritable bowel syndrome and endometriosis. The only medication the patient takes is a birth control pill daily. The patient stated that the pain started about four hours ago, but has steadily increased. She denies any significant changes in her diet or recent abdominal injuries but says she has eaten a lot more over the past week because of the Thanksgiving holiday. The patient says she is very busy between working and taking her kids to after school activities, so they often eat fast food and she requires a lot of caffeine throughout the day, so she doesn’t drink much water. Upon physical examination, bowel sounds present in all four quadrants, RUQ guarding, tenderness noted to entire abdomen upon palpation, no rebound tenderness, but Murphy’s sign was positive.

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Impacting Factors

This patient is suffering from cholelithiasis (gallstones) with an influencing factor of behavior, specifically because of dietary habits. Cholelithiasis is the process of gallstones forming (Pak & Lindseth, 2016). “Gallstones are hardened deposits of digestive fluid that can form in your gallbladder” (Mayo Clinic, 2013). Some impacting factors to this disorder are: being female, eating a high-fat, high cholesterol, low-fiber diet, and taking medications that contain estrogen (Mayo Clinic, 2013). The patient admits to eating fast food frequently which typically means the food she is eating is high in fat, high in cholesterol, and low in fiber. She also said she took a birth control pill daily. A majority of birth control pills contain estrogen and progesterone to prevent pregnancy. NURS 6050 week 1 discussion

Pathophysiology and Associated Alterations

There are two common types of gallstones: cholesterol and pigmented. “Most are composed largely of cholesterol with or without calcium deposits” (Hammer & McPhee, 2014). Cholesterol gallstones form when the cholesterol concentration in the bile is greater than its solubility percentage (Hammer & McPhee, 2014). Having a higher percentage of cholesterol causes cholesterol crystals to form called “microstones” (Huether & McCance, 2012). More crystals collect on the microstones, growing “macrostones” (Huether & McCance, 2012). This process occurs in the gallbladder because of decreased motility. “The stones may lie dormant or become lodged in the cystic or common duct, causing pain when the gallbladder contracts and cholecystitis” (Huether & McCance, 2012). If cholecystitis occurs and is left untreated, it can progress to acute pancreatitis “if a stone travels down the common bile duct but fails to clear the sphincter of Oddi, thereby blocking the pancreatic duct” (Hammer & McPhee, 2014). An infection and necrosis may also occur if the gallbladder is left untreated, putting the patient at risk of becoming septic (Hammer & McPhee, 2014). NURS 6050 week 1 discussion

References

Hammer, G. D., & McPhee, S. J. (2014).
Pathophysiology of Disease: An Introduction to Clinical Medicine
(Seventh ed.). New York, NY: McGraw Hill Education.

Huether, S. E., & McCance, K. L. (2012).
Understanding Pathophysiology
(Fifth ed.). St. Louis, Missouri: Elsevier.

Mayo Clinic. (2013, July 23).
Diseases and Conditions: Gallstones
. Retrieved from Mayo Clinic: http://www.mayoclinic.org/diseases-conditions/gallstones/basics/definition/con-20020461

Pak, M., & Lindseth, G. (2016). Risk Factors for Cholelithiasis.
Gastroenterology Nursing, 39
(4), 297-309. NURS 6050 week 1 discussion

Nurs 6501 Week 1 Discussion – Factors That Influence Disease – Cancer Essay example

Factors That Influence Disease

In clinical settings, some of the most common questions that patients ask are Why do I have this? What caused this disorder? Will it ever go away? These emotional questions can be difficult to ask and to answer. However, for patients to come to terms with their diagnoses and adhere to treatment plans, they must have an understanding of factors that might have caused, or continue to impact, their disorders. As an advanced practice nurse, it is important that you are able to explain disorders, associated alterations and symptoms, and changes that might occur within your patients’ bodies. Nurs 6501 Week 1 Discussion – Factors That Influence Disease – Cancer Essay example

To prepare:

1.      Review this week’s media presentation with Dr. Terry Buttaro. Reflect on the importance of developing an in-depth understanding of pathophysiology.

2.      Select a disorder from the following list:

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a.      Cholelithiasis (gallstones)

b.      Colon cancer

c.      Cystic fibrosis

d.      Hemophilia

e.      Nephrolithiasis (kidney stones)

f.       Osteoporosis

g.     Parkinson’s disease

h.      Tuberculosis

3.      Select one of the following patient factors: genetics, gender, ethnicity, age, or behavior. Reflect on how that factor might impact your selected disorder, as well as potential associated alterations and symptoms.

4.      Identify the pathophysiology of the associated alterations, including the normal and altered cellular function. Consider both intra- and extra-cellular changes that occur. Nurs 6501 Week 1 Discussion – Factors That Influence Disease – Cancer Essay example

Post a 1 page APA format-  (at least 2 references)

1.      A brief description of a patient scenario involving the disorder and the factor you selected.

2.      Explain how the factor might impact your selected disorder, as well as potential associated alterations and symptoms.

3.      Finally, explain the pathophysiology of the associated alterations, including changes in cellular function.

 

Class Resources

·        Huether, S. E., & McCance, K. L. (2012). 
Understanding pathophysiology
 (Laureate custom ed.). St. Louis, MO: Mosby.

o   Chapter 1, “Cellular Biology”

This chapter reviews cellular biology to establish a foundation for exploring the pathophysiology of disease. It also covers the structure and function of cellular components, cell-to-cell adhesions, cellular communication, cellular metabolism, membrane transport, the cell cycle, and tissues.

o   Chapter 2, “Genes and Genetic Diseases”

This chapter explores genetic disorders and factors that impact genetic disorders. It also examines how mutations and chromosomal abnormalities lead to transmission of genetic disorders.

o   Chapter 3, “Altered Cellular and Tissue Biology”

This chapter examines disorders related to cell adaptation, injury, and death. It also explores disorders associated with altered cellular and tissue function as a result of aging. Nurs 6501 Week 1 Discussion – Factors That Influence Disease – Cancer Essay example

·        McPhee, S. J., & Hammer, G. D. (2012). 
Pathophysiology of disease: An introduction to clinical medicine
 
(Laureate Education, Inc., custom ed.). New York, NY: McGraw-Hill Medical.

o   Chapter 2, “Genetic Disease”

This chapter reviews the clinical manifestations, pathophysiology, and genetic principles of genetic diseases. It also explores different types of genetic diseases and the mechanisms involved.

o   Chapter 5, “Neoplasia”

This chapter explores various disorders associated with neoplasia. It also covers causes and effects of common cancers and tumors resulting from neoplasia.

Media

·        Laureate Education, Inc. (Executive Producer). (2012d). 
Introduction to advanced pathophysiology
. Baltimore, MD: Author.

 

Week 1 Discussion

NURS

6501

A 60-year-old male presents to the office complaining of a change in bowel habits, and blood noted in his stool.  The patient is overweight, a smoker, and drinks alcohol on a regular basis.  The patient states he has been having abdominal cramps recently and feels as if he is bloated.  At his last office visit, the patient was recently diagnosed as pre-diabetic.  A family history reveals his sister has breast cancer, and his father died of colon cancer at the age of 57. Nurs 6501 Week 1 Discussion – Factors That Influence Disease – Cancer Essay example

Colon Cancer

Colon cancer is a cancer of the large intestine.  Most diagnosed cases start out as benign adenomatous polyps that produce little to no symptoms ( Mayo Clinic, 2017).  Colorectal cancer (CRC) is the third most common cancer and the fourth leading cause of cancer death worldwide and is diagnosed more frequently in men than women (Majek, Gondos, Jansen, & Emrich, 2013).  Because CRC usually starts out as polyps, it is recommended that patients have a colonoscopy at the age of fifty and regular screenings to obtain a baseline and to identify and remove noted polyps before they turn cancerous (American Cancer Society, 2016).

Pathophysiology

Cancer is the abnormal growth and division of cells that invade other tissues and organs in the body.  A benign tumor can easily turn into a malignant tumor.  Malignant tumors are characterized by rapid cell growth rate, the loss of cell differentiation, and the absence of normal tissue organization.  CRC is thought to have an association with a family history of cancer, environmental factors, and the mutation of tumor suppression genes.  The polyps that are associated with CRC are a protrusion from the mucosal lining of the epithelium and once defined as cancerous, called adenomatous polyps.  The polyps undergo multiple genetic changes that lead to the carcinoma.  CRC has a long pre-invasive timeframe. Tumors grow slowly and have to invade several layers of the epithelium before entering the bloodstream and lymphatic system to metastasize throughout the body (Huether & McCance, 2017). Nurs 6501 Week 1 Discussion – Factors That Influence Disease – Cancer Essay example

Associated Factors

Factors associated with CRC include age (greater than 50), family history, history of colon polyps, obesity, physical inactivity and a diet high in red meats or processed meats.  Smoking, heavy alcohol use, a history of inflammatory bowel disease or Crohn’s disease, diabetes or a previous history of cancer are also risk factors for CRC (American Cancer Society, 2016).  The patient in this scenario is over the age of 50, has a family history of cancer, smokes, and drinks alcohol, and is overweight and pre-diabetic. The patient’s behavioral risk factors put him at higher risk for CRC.  Being overweight, especially in the abdominal girth, and male, greatly increase the chances of developing CRC (American Cancer Society, 2016).  The patient has several preventable modifiable behaviors he can change.

The patient presented with a change in bowel habits, blood in his stool and abdominal discomfort.  The symptoms of CRC usually are seen later in the progression of the disease.  Besides the presented symptoms, other associated symptoms are weakness, fatigue, sudden weight loss, and a feeling of the bowel not emptying completely ( Mayo Clinic, 2017).

Diagnosis and Treatment

Regular screenings should be obtained at the age of 50 for CRC.  Changing modifiable risk factors such as starting a high fiber diet, exercising, smoking cessation, and reduction of alcohol intake decreases potential risk ( Mayo Clinic, 2017).  The staging of CRC is done through imaging and surgical exploration.  Surgery is the recommended treatment in all four stages.  Chemotherapy and radiation may be given to reduce tumor size before surgery. Nurs 6501 Week 1 Discussion – Factors That Influence Disease – Cancer Essay example

It is imperative to have an innate understanding of the disease process and the pathophysiology to correctly diagnose or refer a patient to the correct specialization (Education, 2012).  Many diseases have similar signs and symptoms, if the basic disease process is not understood, a patient could be misdiagnosed.  An advanced practice nurse should be able to differentiate between symptoms, and know why the symptoms occur during the disease process.

References

Mayo Clinic
. (2017, October 31). Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/colon-cancer/…causes/syc-20353669

American Cancer Society
. (2016, October 15). Retrieved from American Cancer Society: http://www.cancer.org

Education, L. (Director). (2012).
Introduction to Advanced Pathophysiology
[Motion Picture].

Huether, S., & McCance, K. (2017).
Understanding Pathophysiology.
St. Louis: Elsevier.

Majek, O., Gondos, A., Jansen, L., & Emrich, K. (2013). Sex Differences in Colorectal Survival.
Plos One, 8
(7), 1-7. Retrieved from http://www.plosone.org Nurs 6501 Week 1 Discussion – Factors That Influence Disease – Cancer Essay example