Tag: Clinical-Nursing

Gregor Mendel Essays

Mendel’s Discoveries

Gregor Mendel, the father of modern genetics, discovered the mechanism of inheritance.

Today, scientists know that organisms have many units of heritable material that code for particular traits, each called a 
gene
. Each 
trait
, or characteristic, is determined by an organism’s genes. Two hundred years ago, however, the mechanisms of inheritance were not known. 
Gregor Mendel
(1822–84) is an Austrian monk credited with discovering the principles underlying genes and inheritance. Mendel performed a series of experiments with pea plants in the 19th century Gregor Mendel Essays. These led to the discovery of the genetic basis of inheritance (the traits that are received by offspring from parents) and resulted in him being posthumously considered the father of modern genetics.

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The Pea Plant Experiments

Mendel used pea plants to learn the genetic basis of inheritance.

Since childhood, Mendel had been a gardener. In the monastery, he set up a series of experiments using pea plants. Mendel observed that pea plants could vary in terms of seven different characteristics:

flower color (purple or white)

flower position (axial, on the shoot where a branch begins; or terminal, at the end of the shoot)

pea color (green or yellow)

pea shape (round or wrinkled)

plant size (tall or short)

pod color (green or yellow)

pod shape (constricted or inflated)

Gregor Mendel Essays

In his experiments Mendel cross-fertilized plants with different characteristics and observed the resulting 
offspring.
He noticed that patterns emerged; some of these patterns were immediately evident and others required multiple generations to emerge. Mendel concluded that each plant had factors that determined how the plant would look. Today, Mendel’s factors are known as 
genes. 

To better understand Mendel’s experiments, one can follow an example using pea color as the selected characteristic. Mendel observed that peas could be green or yellow. He began by crossing a plant with green peas and a plant with yellow peas. The original two organisms that are crossed to produce offspring are called the 
parent generation (P)
. The first offspring resulting from a parental cross are called the 
first filial generation (F
1
)
. Gregor Mendel Essays. Mendel’s first generation plants all had yellow peas. He then pollinated one of these offspring plants with itself. The offspring of a cross between individuals of the first generation are called the
second filial generation (F
2
)
. Mendel’s second generation plants had a mixture of green and yellow peas. In fact, the ratio of plants with yellow peas to plants with green peas was 3:1. Mendel then pollinated each plant in the second generation with itself, and he found that one plant with yellow peas gave only plants with yellow peas, while others continued to give plants showing the 3:1 ratio. The plant with green peas gave only plants with green peas. This is the basis for Mendel’s law of segregation. Gregor Mendel Essays.

Mendel’s Pea Plant Experiments

“Mendel crossed a plant with yellow peas and a plant with green peas in the parent generation (P). This produced all yellow peas (F
1
). One of these plants was self-pollinated, giving a 3:1 ratio of yellow to green peas in the F
2
generation. Gregor Mendel Essays.

type 2 diabetes, hypertension, hyperlipidemia, and ischemic heart disease essay example

MODULE 2: Cardiovascular / Respiratory Systems, Week 2 Assignment

CASE  STUDY 2: Patient HM has a history of atrial fibrillation and a  transient ischemic attack (TIA). The patient has been diagnosed with  type 2 diabetes, hypertension, hyperlipidemia, and ischemic heart  disease.

Drugs currently prescribed include the following:

• Warfarin 5 mg po daily MWF and 2.5 mg daily T, TH, Sat, Sun

• Aspirin 81 mg po daily

• Metformin 1000 mg po bid

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• Glyburide 10 mg po bid

• Atenolol 100 mg po daily

• Motrin 200 mg 1–3 tablets every 6 hours as needed for pain

type 2 diabetes, hypertension, hyperlipidemia, and ischemic heart disease essay example

 

o Prepare

Review the Resources for this module and consider the impact of  potential pharmacotherapeutics for cardiovascular disorders introduced  in the media piece.

Review the case study assigned by your Instructor for this Assignment.

Select one the following factors: genetics, gender, ethnicity, age, or behavior factors. type 2 diabetes, hypertension, hyperlipidemia, and ischemic heart disease essay example.

Reflect on how the factor you selected might influence the patient’s pharmacokinetic and pharmacodynamic processes.

Consider how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy.

Think about how you might improve the patient’s drug therapy plan  based on the pharmacokinetic and pharmacodynamic changes. Reflect on  whether you would modify the current drug treatment or provide an  alternative treatment option for the patient.

By Day 7 of Week 2

Write
 a 2- to 3-page paper that addresses the following:

Explain  how the factor you selected might influence the pharmacokinetic and  pharmacodynamic processes in the patient from the case study you were  assigned.

Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples.

Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements. type 2 diabetes, hypertension, hyperlipidemia, and ischemic heart disease essay example.

Pharmacotherapy for Cardiovascular Disorders

Cardiovascular diseases (CVDs) refer to numerous conditions that interfere with the functioning of the heart/or blood vessels. Some of the common CVDs include hypertension, heart failure, stroke, and coronary artery disease (CAD). In a case scenario where Patient AO is diagnosed with hypertension and hyperlipidemia, and has a history of obesity, understanding the genetics can help in the diagnosis and treatment of CVDs. High blood pressure or (hypertension) is manifested through a force exerted by the blood against the walls of the blood vessels while hyperlipidemia is the presence of too many lipids in the blood, which leads to the blockage of arteries after an increase in fatty deposits. Advanced practice nurses should understand the pharmacokinetic and pharmacodynamic processes of CVD in order to enhance drug therapy plan for their patients. type 2 diabetes, hypertension, hyperlipidemia, and ischemic heart disease essay example.

CVD present complex traits, and understanding the genetics of CVD requires consideration of interactions among genetic sex, race, as well as hormonal status. Genetics affect pharmacokinetics and pharmacodynamics process of CVD through controlling all features of cardiovascular system. Heritable risk factors contribute to higher blood pressure (BP) levels while genetic variants tend to create a cumulative effect of about 10 mmHg higher systolic BP levels before an individual attains the age of 50 years (Pazoki et al., 2018). A genetic variation may interfere with how the protein works in the body, leading to the accumulation of cholesterol in the arteries. Genetic risks are known since birth; hence, impossible to modify them (Pazoki et al., 2018). If a family member is found to be having CVD, other family members should go for screening, as they may be having the same disease without showing symptoms. Individuals with genetic risk can be identified early in life and are encouraged to undergo lifestyle modification. type 2 diabetes, hypertension, hyperlipidemia, and ischemic heart disease essay example.

However, evaluations into the genetics of CVD among men and women are hindered by the failure to incorporate the sex chromosomes within genome-wide association studies (Winham, De Andrade & Miller, 2015). Sex differences in cardiovascular disorders emanate from interactions among genetic, hormonal, as well as environmental factors, which create individual risks of the diseases. Although hypertension is one of the major risk factors for developing CVD, there is no sufficient information on the ideal dosage of antihypertensive drugs, especially for the elderly. Accepting to change some lifestyle habits, in addition to having healthy dietary patterns can assist in counteracting genetic variations linked to obesity and CVD (Heianza & Qi, 2018).

Prescribing the right dose is critical in the treatment of cardiovascular diseases, as it relieves patients from a hospital stay, hospital readmission, and saving the costs of seeking medical attention. type 2 diabetes, hypertension, hyperlipidemia, and ischemic heart disease essay example. Due to changes in pharmacokinetics and pharmacodynamics processes, experts recommend on starting dosages, and later a stepwise increase of dosages, which would lead to enhanced BP control, as well as less adverse drug reactions among the elderly patients (Peeters et al., 2019). The changes happen because the disease is capable of transforming receptor binding, adjusting the binding proteins, as well as reducing receptor sensitivity.

The patient in this scenario was prescribed with Atenolol, Doxazosin, Hydralazine, Sertraline, and Simvastatin to manage cardiovascular disorders. Atenolol is mainly utilized as first-line treatment for hypertension, and can be used alone or with other medications (Wiysonge et al., 2017). Both Doxazosin and Hydralazine are vital in calming the arterial pressure. The use of Simvastatin is meant to lower the cholesterol by blocking the production of cholesterol while Sertraline is an antidepressant. Simvastatin will assist in reducing fats, which have made the patient gain nine pounds. The medications are likely to alter the pharmacokinetic and pharmacodynamic processes within the body, leading to the recovery from cardiovascular disorders. type 2 diabetes, hypertension, hyperlipidemia, and ischemic heart disease essay example.

Patient AO is under medications but may require an improved drug therapy plan in order to detect and prevent medication-related problems. As an advanced practice nurse, I should improve the drug therapy plan by educating the patient concerning his/her therapy, any adverse effect, as well as actions to take in case a problem emerges. I should evaluate the patient’s drug therapy by checking whether he/she has taken the medications as prescribed by the pharmacist. Most medications should be utilized with caution due to age-related changes pharmacokinetics (Rochon, Schmader & Givens, 2019). Drug therapy problems require an assessment for severity, acuteness, as well as how fast the resolution of a particular problem should occur. type 2 diabetes, hypertension, hyperlipidemia, and ischemic heart disease essay example.

If there were a need to adjust the drug therapy, I would do so and explain to the patient the need to adjust the therapy. Polypharmacy, which involves taking multiple medications simultaneously, should be treated with caution, as it is linked to increased incidences of an adverse drug event, as well as increased hospital readmission (Rochon, Schmader & Givens, 2019). Genetically-determined hypertension and its complications are managed through adopting healthy lifestyle. Thus, I would recommend a change in behavior and adopting a lifestyle that encourages physical activity and healthy eating. Developing a pharmaceutical opinion program can help in reaching patients who seem to be at a higher risk of medication-related problems. type 2 diabetes, hypertension, hyperlipidemia, and ischemic heart disease essay example.

References

Heianza, Y., & Qi, L. (2018). Impact of genes and environment on obesity and cardiovascular disease.
Endocrinology
,
160
(1), 81-100.

Pazoki, R., Dehghan, A., Evangelou, E., Warren, H., Gao, H., Caulfield, M., … & Tzoulaki, I. (2018). Genetic predisposition to high blood pressure and lifestyle factors: associations with midlife blood pressure levels and cardiovascular events.
Circulation
,
137
(7), 653-661.

Peeters, L. E. J., Kester, M. P., Feyz, L., Van Den Bemt, P. M. L. A., Koch, B. C. P., Van Gelder, T., & Versmissen, J. (2019). Pharmacokinetic and pharmacodynamic considerations in the treatment of the elderly patient with hypertension.
Expert opinion on drug metabolism & toxicology
,
15
(4), 287-297. type 2 diabetes, hypertension, hyperlipidemia, and ischemic heart disease essay example

Rochon, P. A., Schmader, K., & Givens, J. (2019). Drug prescribing for older adults.
UpToDate
. Retrieved from https://www.uptodate.com/contents/drug-prescribing-for-older-adults#H32

Winham, S. J., De Andrade, M., & Miller, V. M. (2015). Genetics of cardiovascular disease: the importance of sex and ethnicity.
Atherosclerosis
,
241
(1), 219-228.

Wiysonge, C. S., Bradley, H. A., Volmink, J., Mayosi, B. M., & Opie, L. H. (2017). Beta‐blockers for hypertension.
Cochrane database of systematic reviews
, (1).

 

Write
 a 2- to 3-page paper that addresses the following:

Explain  how the factor you selected might influence the pharmacokinetic and  pharmacodynamic processes in the patient from the case study you were  assigned.

Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples.

Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements. type 2 diabetes, hypertension, hyperlipidemia, and ischemic heart disease essay example

Chromosomes and Cell Division Essay Assignments

Chapter 6

Chromosomes and Cell Division

Learning Objectives

Identify different types of cell division and their purpose(s)

-Mitosis-replaces worn-out old cells with fresh new duplicates.

-Meiosis- generates sperm and eggs and a great deal of variation.

Explain the process by which prokaryotic cells divide

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-Binary Fission

Describe the major phases of the cell cycle

– Interphase: In Preparation for Mitosis, the Chromosomes Replicate

-Prophase- following replication, the sister chromatids condense. The spindle forms and the nuclear envelope breaks down. Chromosomes and Cell Division Essay Assignments.

 

-Metaphase- Metaphase: the chromatids congregate at the cell center. After condensing, the     pairs of sister chromatids seem to move aimlessly around the cell, but eventually they line up at                 the cell’s center.

– Anaphase: the chromatids separate and move in opposite directions

-Telophase: new nuclear membranes form around the two complete chromosome sets.

(Followed by cytokinesis).

 

Describe the process of DNA replication

, and enzymes link the nucleotides of the new strand together. Unwinding and separation. Replication begins at a specific site, called the origin of replication, where the coiled,  Chromosomes and Cell Division Essay Assignments                                                                                                                                                                                                                                                                                   double-stranded DNA molecule unwinds and separates into two strands, like a zipper unzipping. In prokaryotes, there is a single origin of replication, while eukaryotes have multiple origin sites on each chromosome. At the origin of replication, a complex of proteins binds to the DNA. One of the proteins, an enzyme called DNA helicase, unwinds the coiled DNA and separates the two complementary strands. The unwinding and separating of the two DNA strands creates what is called a replication fork.

 

Reconstruction and elongation. In the reconstruction and elongation process, each of the single strands becomes a double strand as the appropriate complementary base of a nucleotide pairs with the exposed base

 

Explain how the cell cycle and cancer are related

Cancer is an example of cell division out of control. Chromosomes and Cell Division Essay Assignments.

Define cancer -an unrestrained cell growth and division.

Can damage adjacent tissues.

Some can metastasize.

Can cause serious health problems and is the second leading cause of death in the United States!

Explain how cancer can be treated

-To treat cancer, the rapidly dividing cells must be removed surgically or killed, or their division at least slowed down. Currently, the killing and slowing down are done in two ways: by chemotherapy and by radiation.

Explain the steps of meiosis

– Unlike mitosis, which has only one cell division, cells undergoing meiosis divide twice. In the first division, the homologues separate. In other words, for each of the 23 chromosome pairs, the maternal sister chromatid pairs and the paternal sister chromatid pairs separate into two new cells. In the second division, each of the two new cells divides again, so that each of the four daughter cells contains a single chromosome from the homologous pair. At the end of meiosis, there are four new cells, each of which has 23 strands of DNA—that is, 23 chromosomes Chromosomes and Cell Division Essay Assignments

Compare and contrast meiosis in males versus females

-The female gamete is larger than the male gamete because it has more cytoplasm.

Understand the differences in asexual and sexual reproduction

-Asexual reproduction involves only one individual.

 

Explain the impact of having an abnormal number of chromosomes

 

-They can lead to chromosomal disorders such as Down syndrome. Chromosomes and Cell Division Essay Assignments.

Transient ischemic attack (TIA) essay

MODULE 2: Cardiovascular / Respiratory Systems, Week 2 Assignment

CASE  STUDY 2: Patient HM has a history of atrial fibrillation and a  transient ischemic attack (TIA). The patient has been diagnosed with  type 2 diabetes, hypertension, hyperlipidemia, and ischemic heart  disease.

Drugs currently prescribed include the following:

• Warfarin 5 mg po daily MWF and 2.5 mg daily T, TH, Sat, Sun

• Aspirin 81 mg po daily

• Metformin 1000 mg po bid

• Glyburide 10 mg po bid

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• Atenolol 100 mg po daily

• Motrin 200 mg 1–3 tablets every 6 hours as needed for pain

Transient ischemic attack (TIA) essay

o Prepare

Review the Resources for this module and consider the impact of  potential pharmacotherapeutics for cardiovascular disorders introduced  in the media piece.

Review the case study assigned by your Instructor for this Assignment.

Select one the following factors: genetics, gender, ethnicity, age, or behavior factors.

Reflect on how the factor you selected might influence the patient’s pharmacokinetic and pharmacodynamic processes.

Consider how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy. Transient ischemic attack (TIA) essay.

Think about how you might improve the patient’s drug therapy plan  based on the pharmacokinetic and pharmacodynamic changes. Reflect on  whether you would modify the current drug treatment or provide an  alternative treatment option for the patient.

By Day 7 of Week 2

Write
 a 2- to 3-page paper that addresses the following:

Explain  how the factor you selected might influence the pharmacokinetic and  pharmacodynamic processes in the patient from the case study you were  assigned. Transient ischemic attack (TIA) essay.

Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples.

Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements. Transient ischemic attack (TIA) essay.

VARK Questionnaire Essay assignment

Learning styles represent the different approaches to learning based on preferences, weaknesses, and strengths. For learners to best achieve the desired educational outcome, learning styles must be considered when creating a plan. Complete “The VARK Questionnaire,” located on the VARK website, and then complete the following:

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Click “OK” to receive your questionnaire scores.

Once you have determined your preferred learning style, review the corresponding link to view your learning preference.

Review the other learning styles: visual, aural, read/write, kinesthetic, and multimodal (listed on the VARK Questionnaire Results page). VARK Questionnaire Essay assignment.

Compare your current preferred learning strategies to the identified strategies for your preferred learning style.

Examine how awareness of learning styles has influenced your perceptions of teaching and learning.

In a paper (750‐1,000 words), summarize your analysis of this exercise and discuss the overall value of learning styles. Include the following:

Provide a summary of your learning style according the VARK questionnaire.

Describe your preferred learning strategies. Compare your current preferred learning strategies to the identified strategies for your preferred learning style. VARK Questionnaire Essay assignment.

Describe how individual learning styles affect the degree to which a learner can understand or perform educational activities. Discuss the importance of an educator identifying individual learning styles and preferences when working with learners.

Discuss why understanding the learning styles of individuals participating in health promotion is important to achieving the desired outcome. How do learning styles ultimately affect the possibility for a behavioral change? How would different learning styles be accommodated in health promotion?

VARK means visual, auditory, read/write and kinesthetic. MY VARK SCORE: HIGHT SCORE Visual 6 AND KINESTHETIC 6  COMPARED TO  AUDITORY AND AUDITORY AND RED/WRITE WITH LOW SCORE 2.

In formal writing you should avoid personal references and use of first person. This assignment does make this more difficult. There are ways to write without saying “I”. Work to limit the use of “I statements” in this paper. VARK Questionnaire Essay assignment.

Try: The writer of this paper found that the visual learning style had the highest score….

Or: According to the findings of this author….

Or: After taking the VARK questionnaire the author of this paper was surprised to find the results included a strong preference for aural learning. This is not a strategy often used

 

www.vark-learn.com

Learning Styles: A Guide to the 4 VARK Styles

https://www.definedstem.com/wp-content/uploads/2017/05/VARK.pdf

https://www.verywellmind.com/vark-learning-styles-2795156

 

Cite to at least three peer‐reviewed or scholarly sources to complete this assignment. Sources should be published within the last 5 years and appropriate for the assignment criteria.  VARK Questionnaire Essay assignment.

Prepare this assignment according to the guidelines found in the APA Style. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

RUBRIC: Personal learning style according to the VARK questionnaire is identified and described in detail. Summary offers examples that display personal insight or reflection.

Personal learning strategy is clearly described. A comparison of current preferred learning styles and VARK identified learning styles is detailed. Overall discussion demonstrates insight into preferred learning strategies and how these support preferred learning styles.

Importance of learning styles for a learner, and importance of educator identifying individual learning styles and preferences when working with learners, is thoroughly discussed. The importance of learning styles for learners participating in healthy promotion, and identifying them as an educator, is clearly established. Strong rationale and evidence support discussion.

Understanding the learning styles of individuals participating in a health promotion, and the correlation to behavioral change and achieving desired outcomes is discussed in detail. A strong correlation has been established. Accommodation of different learning styles is discussed. The narrative demonstrates insight into the importance of learning styles to health promotion and behavioral outcome VARK Questionnaire Essay assignment

Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.

Clear and convincing argument that presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative. Writer is clearly in command of standard, written, academic English. All format elements are correct. Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error. VARK Questionnaire Essay assignment

Primary Care III

In our last week will review  Educational Advancement:  The DNP (Doctor of Nursing Practice)/PhD . This topic will guide you and encourage you to take a next step to advance on your professional life. 

Topics to review: Joel chapter 4

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Suggested readings and Video
: 
 Why should you get a Doctorate in nursing?  

Assignment:

1-Search in scholarly sources the similarities and difference between PhD and DNP.  
Post three similarities and three differences found on your research.  Do not forget to include your reference. Primary Care III

Developing A Shared Vision nursing essay

Choose two issues or challenges that the leaders of today’s health care organizations face. Select from among the following topics:

Staff Shortage (Physicians, Nurses, Allied Health Providers, Ancillary Services)

Reorganization in Response to Merger or Consolidation of Services

Layoffs as a Result of Declining Revenues

Influx of Registry, Part-Time, and Temporary Contract Staff

Poor Performance Outcomes Leading to a Reduction in Medicare Reimbursement Dollars

Poor Job Satisfaction Rates Resulting in Turnover

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You are the manager of an ancillary service department at a large, 500+ bed hospital. Develop a proposal (750-1,200 words) that is directed toward your staff, in which you address the following:

Inform the staff of the two issues (from the topics provided) your organization is facing.

Describe the impact of these issues on your department. Developing A Shared Vision nursing essay.

Describe how improved communication, collaboration, and teamwork can improve conditions in your department.

Identify at least two examples from the required or recommended readings of techniques found to foster inclusion and improve communication and collaboration.

A minimum of three academic references from credible sources are required for this assignment.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.

You are required to submit this assignment to LopesWrite. Refer to the 
LopesWrite Technical Support articles
for assistance. Developing A Shared Vision nursing essay

Practicum Journal Entry: Safe Prescribing

There is probably no greater responsibility that the psychiatric mental health nurse practitioner assumes than the responsibility of prescribing medications. While someone can be harmed by psychotherapy, the level and intensity of the harm generally does not come to the same level of harm that can occur from improper prescribing. The PMHNP must understand his/her responsibility both at a state and federal level when it comes to prescribing medications. Practicum Journal Entry: Safe Prescribing.

In this Practicum Journal Assignment, you will explore the legalities associated with prescribing controlled substances, as well as what a DEA number is, how to obtain one, and, most importantly, how to prescribe controlled substances in your state. Practicum Journal Entry: Safe Prescribing.

Learning Objectives

Students will:

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Analyze roles of the Drug Enforcement Administration

Analyze PMHNP responsibilities when issued a DEA number

Analyze DEA number application procedures

Analyze state requirements for safe prescribing and prescription monitoring

Analyze PMHNP responsibilities for safe prescribing and prescription monitoring

Analyze Schedule II-V drug levels

** Assigned in Week 2 and submitted in Week 4.

To prepare for this Practicum Journal:

Review the Learning Resources. Practicum Journal Entry: Safe Prescribing.

In 2-3 pages:

Describe the role of the Drug Enforcement Administration (DEA) as it pertains to the PMHNP.

Explain your responsibilities when having a DEA number.

Explain how you apply for a DEA number.

Explain your state’s requirements for a safe prescribing and prescription monitoring program. Explain your responsibility as a PMHNP to follow these requirements.

Provide an example of a drug you may prescribe from each of the Schedule II-V drug levels.

 

Practicum Journal Entry-NP, not above

My practicum experience has been important to me given that it has enabled me to link theoretical learning from the classroom to real clinical settings Practicum Journal Entry: Safe Prescribing. As an aspiring geriatric nurse practitioner, the practicum experience has enabled me to apply the knowledge that I acquire in the classroom in a clinical setting. Essentially, this has helped my transition process from a registered nurse to a nurse practitioner. This paper is a reflection of my practicum experiences and how they relate them to my professional goals and self-assessment of clinical skills that I identified in week 1. Practicum Journal Entry: Safe Prescribing.

The practicum learning agreement between the instructor and the masters of learning in science was approved for the goal to conduct my role as a nurse practitioner. To this point, the practicum experience has been very fascinating and exciting for me. It has enabled me to gain some level of understanding of my role as a geriatric nurse practitioner. Apparently, over the past one week, I had the opportunity to meet my preceptor, who explained some of the roles that I should expect as an adult-gerontology nurse practitioner. Additionally, it has helped me to gain a new mindset as my role changes from a registered nurse to an NP (Thomas et al., 2012). Practicum Journal Entry: Safe Prescribing.

The practicum experience has enabled me to enhance my skills for completing as well as conducting a physical examination for patients. Over the last one week, I had the opportunity to write a SOAP note for an elderly patient. Such skills are vital to nursing practitioners considering that they enable them to obtain data from patients to facilitate diagnosis (Tabloski, 2013). This has also helped me to transit the knowledge learned in class concerning comprehensive assessments in real clinical settings. As I continue with my practicum, I also to continue practicing this skill regularly to ensure that I master it to improve the care I offer elderly patients. Additionally, as I progress with the practicum, I hope to enhance my skill of conducting differential diagnoses accurately, which has been a difficult area for me.

Health promotion is a vital aspect of nurse practitioners (Thomas et al., 2012). The practicum experience has offered me the opportunity to provide an elderly patient with education on heart failure including the causes, management, and treatment. I hope to master this skill by practicing and researching more on the various methods that can enhance my provision of education to elderly patients (Tabloski, 2013) Practicum Journal Entry: Safe Prescribing. The practicum experience has somewhat enabled me to develop a sense of patient panel as well as understanding my daily duties as a nurse practitioner and scope of practice. This has been one of my major weaknesses as an aspiring NP Practicum Journal Entry: Safe Prescribing. With the help of my preceptor, I aspire to familiarize myself with the legal and ethical compliance in my state. To this point, my preceptor has enabled me to gain some understanding on some of these ethical and legal issues, especially when dealing with elderly patients (Buppert, 2018).

Prescribing medications is among the major competencies of a nurse practitioner (Buppert, 2018). By observing my preceptor, I have acquired some level of understanding on the process of prescribing medications as well as some of the techniques that I can apply to prevent medication errors, which can be detrimental for elderly patients, and a major ethical and legal issue for NPs (Buppert, 2018). Even though I have not had the opportunity to prescribe and titrate medications, I believe the experience of observing has been vital in preparing me for the future. Besides, it has also enabled me to observe the application of the theoretical aspect that I have learned in class for prescribing medications particularly to prevent legal and ethical implications.

 

 

References

Buppert, C. (2018). Nurse practitioner’s business practice and legal guide (6th ed.). Sudbury, MA: Bartlett & Jones Learning.

Tabloski, P. A. (2013). Gerontological nursing. Pearson Higher Ed.

Thomas, A. C., Crabtree, M. K., Delaney, K. R., Dumas, M. A., Kleinpell, R., Logsdon, C.,…Nativio, D. G. (2012). Nurse practitioner core competencies Practicum Journal Entry: Safe Prescribing.

NURS 6051 Essay – Treatment of hypoglycemia in Adult: Flowchart

Introduction

Hypoglycemia protocol; and treatment algorithm is developed to provide safe and effective management for the hypoglycemic episode throughout the hospital to achieve blood glucose control under the standards care from the American Diabetic Association,2015. Hypoglycemia occurs when blood glucose (BG ) level drop below 70mg/dl. Most of the patient start developing the symptoms below the blood glucose serum 70, the symptoms include tachycardia, diaphoresis, palpitation, nausea, hunger, irritability, confusion, blurred vision, tiredness, difficulty speaking, and headaches(Service,1995).BG level less than 40 can cause severe, life-threatening complication like seizure and coma. Hypoglycemia is one of the associated cause of death in the critically ill patient.

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Hospital-acquired hypoglycemic coma, hyperglycemic coma, or diabetic ketoacidosis
has financial consequence because Medicare plan does not cover expenses related to this. So, most of the hospital have a nurse-driven protocol for treating hypoglycemia. The purpose of initiating nurse-driven hypoglycemia is to manage the hypoglycemia without delay for patient’s experiencing hypoglycemia, with or without symptoms and this protocol is based on evidence-based treatment. NURS 6051 Essay – Treatment of hypoglycemia in Adult: Flowchart.

 Policies and rules

My facility(Unity Point Health) the hypoglycemia protocol we use is an IQ4 Type 2 protocol. IQ4 Type 2 protocols may be initiated by authorized personnel not meeting the definition of a licensed independent practitioner (i.e., an RN) by an order mode that does not require prior licensed independent practitioner (i.e., an MD) authorization.IQ4 protocols will be reviewed annually at the Medical Staff meeting to comply with CMS (Centers for Medicare and Medicaid Services) regulations and guidelines. This protocol is strictly for all non-pregnant Adults.

How, when, why, or where the step is executed for the initation of hypoglycemia protocol

As a nurse we have to keep the following patient populations in mind to evaluate the risk for hypoglycemia.

Any patient taking glucose lowering agents including:

Injectable:
Subcutaneous or IV insulin, or an insulin pump,Non-insulin diabetes injection medications including exenatide or pramlintide

Non-Injectable
: Orals: A. Insulin Secretagogues: Sulfonylureas such as glimiperide, glyburide, glipizide or Glinides such as Repaglinide or Nateglinide

Alpha-Glucosidase Inhibitors such as carobs or miglitol, Inhaled insulin: Afrezza

patient with or without diabetes who has:

an insulinoma

history of gastric bypass surgery

changes in nutritional status: emesis, NPO, reduced PO intake, changes in enteral or parenteral nutrition.

system (organ) failure and fluctuation in function

tapering of corticosteroids

changes in other medications that alter blood glucose

infection, stress, pain, sepsis

 
Information for the execution Hypoglycemia protocol

 
Nurses  can initiate adult hypoglycemia treatment protocol if blood glucose is below 70 mg/dL in the following condition:

If not already ordered in EPIC, the nurse initiates by: a. Placing a single order for “Initiate Adult Hypoglycemia Treatment Protocol” with order mode of “Hospital policy – Cosign required.”

Placing the Order Set for Adult Hypoglycemia Treatment Protocol using the ordering mode “Protocol Orders.” NURS 6051 Essay – Treatment of hypoglycemia in Adult: Flowchart

Documentation

The documentation is an integral part of hypoglycemia event as I mentioned earlier all the hypoglycemia is reviewed by the medical staff meeting to comply with Centre of Medicare and Medicaid Services(CMS). RN will document the entire hypoglycemic episode in EPIC in Flowsheets called as Hypoglycemia flowsheet.

1 Once: Initial assessment, treatment

Each: 15-minute post-treatment reassessment, treatment (if applicable)

Each: provider notification and

Once: Hypoglycemia resolution assessment at 1 hr recheck

Include probable causes of the hypoglycemic episode

Additional relevant details can be charted as needed in a Significant Event Note. If a rapid response (emergency process) is called, pertinent document details of the Rapid Response Navigator is significant. Not only this we do document hypoglycemia event in the hospital’s incident reporting system

Effectiveness of the Nurse Driven Hypoglycemia protocol

The Nurse-driven protocol is very feasible  It helps in controlling and preventing both mild and severe hypoglycemic episodes. Moreover, nurses particularly appreciated the gain in autonomy and involvement in the management of diabetic patients.

Shortcomes

A common error I personally felt when treating the patient with hypoglycemia is to overtreat hypoglycemia with an excess of carbohydrate. This, in combination with the counterregulatory hormone response to hypoglycemia, facilitates subsequent hyperglycemia. After treatment of any hypoglycemic episode, frequent bedside glucose monitoring should be continued until a stable glucose level is achieved. Depending on the time of day and insulin peak times, a balanced snack with carbohydrate, protein, and fat (i.e., peanut butter and crackers, or milk) can prolong treatment effectiveness (Tomky,2015) NURS 6051 Essay – Treatment of hypoglycemia in Adult: Flowchart

Conclusion

There is an evidence-based research shows that simple nurse-managed hypoglycemia protocol measures significantly reduced hypoglycemia in diabetic hospitalized patients. NURS 6051 Essay – Treatment of hypoglycemia in Adult: Flowchart. We cannot deny the fact that hypoglycemic events are frequent in the hospital setting and have adverse prognostic implications.Close attention and monitoring are needed to ensure patients have intravenous glucose infused during prolonged fasting; Patient dietary intake also should be monitored This should become an in-hospital routine preventive strategy with insulin treatment(Tomky,2015).

References

American Diabetes Association Workgroup on Hypoglycemia 2005. Diabetes Care.2005;28(5):1245-1249.

American Diabetes Association. 2015 Standards of Medical Care in Diabetes. DiabetesCare. 2015;38(Suppl. 1):S38-40, S80-85.

(2015, April 16). Effectiveness of a Nurse-Managed Protocol to Prevent Hypoglycemia in Hospitalized Patients with Diabetes. Retrieved October 23, 2017, from https://www.hindawi.com/journals/jdr/2015/173956/cta/ NURS 6051 Essay – Treatment of hypoglycemia in Adult: Flowchart

http://care.diabetesjournals.org/content/38/Supplement

Service, F. J. (1995). Hypoglycemic Disorders. 
Handbook of Diagnostic Endocrinology,
 193-212. doi:10.1385/1-59259-293-7:193

Tomky, D. (2005, January 01). Detection, Prevention, and Treatment of Hypoglycemia in the Hospital. Retrieved October 23, 2017, from http://spectrum.diabetesjournals.org/content/18/1/39

UnityPoint Health Trinity’s Hypoglycemia Protocol NURS 6051 Essay – Treatment of hypoglycemia in Adult: Flowchart

Assignment: Adaptive Response

Introduction

All humans are designed with two types of immunity; innate and adaptive. The innate immune system can distinguish between different classes of pathogens and recruit the most effective form of adaptive immune response to eliminate them. Adaptive responses are a response that the body adapts to certain injuries or insults. Innate responses are non-specific to the insult. Unlike innate immune responses, the adaptive responses are highly specific to the particular pathogen that induced them (Alberts et al, 2004). Injured tissue cells release chemicals that cause inflammation called “chemical mediators of inflammation.”  These chemicals primarily produce their effects in the localized areas where they are released (Alberts et al, 2004).  It is extremely important that health care professionals are familiar with innate and adaptive responses to correctly treat the condition and symptoms a presenting patient may be experiencing. Assignment: Adaptive Response.

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Pathophysiology and Alteration in Case Study #1

In case study number one the child’s body is reacting to a bacterial infection in the throat. When bacteria is introduced to the body it can stimulate an immune response (Huether & McCance, 2012).  Normally there is normal flora that prevents the bacteria from attacking the host. However, for many reasons the protective mechanism may be ineffective and then the body reacts to the virus or bacteria antigen. The virus or bacteria is the antigen that activates the complement system. The activation of the complement system causes the release of cytokines. The cytokines are the mediators responsible for the symptoms the child is experiencing. The cytokines that are specifically responsible for the symptoms are prostaglandins. The release of prostaglandins causes pain, fever and inflammation of the tonsillar tissue.  When released prostaglandins are able to reset the temperature control center in the brain thus, resulting in a fever.

Pathophysiology and Alteration in Case Study #2

In this case study the body activates the innate immune system. The skin which is the first line of defense senses a insult from the abrasive chemicals. After the injury from the chemicals the body activates its second line of defense (Huether & McCance, 2012). The result of the exposure to the chemicals results in a hypersensitivity. It is considered a type IV tissue specific type of hypersensitivity. These types of reactions are mediated by T lymphocytes. When the skin on the hands became exposed over a period of time a delayed cell mediated response was triggered.

Pathophysiology and Alteration in Case Study #3

In the third case study the patient is experiencing a reaction to the influence of stress over time. The stress response is complex and involves mechanisms of both protection and injury (Huether & McCance, 2012).    In this case, the patient is experiencing two types of stress: physiological and perceived stress. Assignment: Adaptive Response. Her history of hypertension is environmental stress. This is a type of chronic stress. The emotional stress of her mother’s broken hip triggers the stress response by the body. Assignment: Adaptive Response.When the alarm reaction occurs it results in an increased secretion by the adrenal medulla of glucocorticoids, epinephrine, and norepinephrine (Huether & McCance, 2012).  The release of those substances stimulates the “fight or flight” response. The secretion of those substances are the cause of her “racing heart rate’, decreased appetite and inability to sleep.

Conclusion

The pathophysiology of the bodies’ actual or perceived threat is a complex mechanism. It may serve as a mechanism for defense, adaptation or autoimmunity when its protective mechanisms become detrimental to the bodies maintenance of homeostasis. Activation of these systems and their adaptations may manifest in many ways. It is important to understand the physiology of the immune response to adequately and accurately treat the host. Assignment: Adaptive Response.

Mind Map

References

Alberts B, Johnson A, Lewis J, et al. Molecular Biology of the Cell. 4th edition. New York: Garland Science; 2002. Chapter 24, The Adaptive Immune System. Available from: http://www.ncbi.nlm.nih.gov/books/NBK21070/

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

 

 

Assignment: Adaptive Response

As an advanced practice nurse, you will examine patients presenting with a variety of disorders. You must, therefore, understand how the body normally functions so that you can identify when it is reacting to changes. Often, when changes occur in body systems, the body reacts with compensatory mechanisms. These compensatory mechanisms, such as adaptive responses, might be signs and symptoms of alterations or underlying disorders. In the clinical setting, you use these responses, along with other patient factors, to lead you to a diagnosis.

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Consider the following scenarios:

Scenario 1:

Jennifer is a 2-year-old female who presents with her mother. Mom is concerned because Jennifer has been “running a temperature” for the last 3 days. Mom says that Jennifer is usually healthy and has no significant medical history. She was in her usual state of good health until 3 days ago when she started to get fussy, would not eat her breakfast, and would not sit still for her favorite television cartoon. Since then she has had a fever off and on, anywhere between 101oF and today’s high of 103.2oF. Mom has been giving her ibuprofen, but when the fever went up to 103.2oF today, she felt that she should come in for evaluation. A physical examination reveals a height and weight appropriate 2-year-old female who appears acutely unwell. Her skin is hot and dry. The tympanic membranes are slightly reddened on the periphery, but otherwise normal in appearance. Assignment: Adaptive Response. The throat is erythematous with 4+ tonsils and diffuse exudates. Anterior cervical nodes are readily palpable and clearly tender to touch on the left side. The child indicates that her throat hurts “a lot” and it is painful to swallow. Vital signs reveal a temperature of 102.8oF, a pulse of 128 beats per minute, and a respiratory rate of 24 beats per minute.

Scenario 2:

Jack is a 27-year-old male who presents with redness and irritation of his hands. He reports that he has never had a problem like this before, but about 2 weeks ago he noticed that both his hands seemed to be really red and flaky. He denies any discomfort, stating that sometimes they feel “a little bit hot,” but otherwise they feel fine. He does not understand why they are so red. His wife told him that he might have an allergy and he should get some steroid cream. Jack has no known allergies and no significant medical history except for recurrent ear infections as a child. He denies any traumatic injury or known exposure to irritants. He is a maintenance engineer in a newspaper building and admits that he often works with abrasive solvents and chemicals. Normally he wears protective gloves, but lately they seem to be in short supply so sometimes he does not use them. He has exposed his hands to some of these cleaning fluids, but says that it never hurt and he always washed his hands when he was finished. Assignment: Adaptive Response.

Scenario 3:

Martha is a 65-year-old woman who recently retired from her job as an administrative assistant at a local hospital. Her medical history is significant for hypertension, which has been controlled for years with hydrochlorothiazide. She reports that lately she is having a lot of trouble sleeping, she occasionally feels like she has a “racing heartbeat,” and she is losing her appetite. She emphasizes that she is not hungry like she used to be. The only significant change that has occurred lately in her life is that her 87-year-old mother moved into her home a few years ago. Mom had always been healthy, but she fell down a flight of stairs and broke her hip. Her recovery was a difficult one, as she has lost a lot of mobility and independence and needs to rely on her daughter for assistance with activities of daily living. Martha says it is not the retirement she dreamed about, but she is an only child and is happy to care for her mother. Mom wakes up early in the morning, likes to bathe every day, and has always eaten 5 small meals daily. Martha has to put a lot of time into caring for her mother, so it is almost a “blessing” that Martha is sleeping and eating less. She is worried about her own health though and wants to know why, at her age, she suddenly needs less sleep.

To Prepare

• Review the three scenarios, as well as Chapter 6 in the Huether and McCance text.

• Identify the pathophysiology of the disorders presented in each of the three scenarios, including their associated alterations. Consider the adaptive responses to the alterations.

• Review the examples of “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in this week’s Learning Resources. Then select one of the disorders you identified from the scenarios. Use the examples in the media as a guide to construct a mind map for the disorder you selected. Consider the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations. Assignment: Adaptive Response.

• Review the Application Assignment Rubric found under Course Information

To Complete

Write a 2- to 3-page paper excluding the title page, reference page and Mind Map that addresses the following:

• For each of the three scenarios explain the pathophysiology, associated alterations and the patients’ adaptive responses to the alterations caused by the disease processes. You are required to discuss all three scenarios within the paper component of this assignment.

• Construct one mind map on a selected disorder presented in one of the scenarios. Your Mind Map must include the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations. Assignment: Adaptive Response.

 

Introduction

With the pathogen invasion, injury or any disease process our body defense mechanism gets activated by producing antibody, phagocytes and other complimentary response (Huether, & McCance, 2017). Understanding the process of adaptive response is important for advanced practice nurse to treat patient disease and alleviate the symptoms by recognizing the right pathophysiology behind it. The purpose of this paper is to discuss the pathophysiology and the compensatory mechanism (adaptive responses) and alterations of the disease processes and other factors that need consider for Scenario 1 diagnosis.

                                                          Scenario and Possible diagnosis

Jennifer is two year old girl presented with a temperature of 102.8, Heart rate of 128 beats per minutes and respiratory rate  of 24/minutes. On assessment cervical nodes are palpable and tender to touch on the left side further assessment revealed +4 tonsils with diffuse exudates. Clinical manifestation: Jennifer clinically presented with typical symptoms of acute bacterial tonsillitis include the following:

Sore throat

Swollen and very red tonsils with a yellowish coating

Difficulty swallowing

Fever over 38°C (100.4°F)

Headache

Fatigue and tiredness

Loss of appetite

Bad breath

Swollen and painful lymph nodes in the neck

Tonsillitis can be caused by viral infection, typical cold symptoms such as a cough or a stuffy nose are likely too but there will be a low graded fever. On the other hand patient presented with pharyngitis have all this symptoms including inflammation of throats. So in above scenario Tonsilitis and dehydration secondary to poor appetite can be the most appropriate diagnosis based on the sign and symptoms.

Pathophysiology of Tonsillitis

Tonsillitis is an infection of tonsil gland caused by certain bacteria and virus. Mostly the bacteria and viruses spread through tiny droplets – in other words, when someone who is infected talks or sneezes, droplets containing the germs are released into the air (Huether& McCance, 2017). They can then come into contact with other people‘s mucous membranes, where they start multiplying.

The most common bacterial tonsillitis is caused by a specific type of streptococcus bacteria known as group A beta-hemolytic streptococcus (GABHS) (Huether& McCance, 2017).
S pyogenes
adheres to adhesion receptors that are located on the tonsillar epithelium (Shah, 2017). Immunoglobulin coating of pathogens may be important in the initial induction of bacterial tonsillitis. Sometimes tonsillitis occurs as a result of scarlet fever, which is also caused by bacteria. Viral infections like mononucleosis (also called “mono” or glandular fever) can lead to tonsillitis too. Assignment: Adaptive Response.

Epidemiology

Tonsillitis most often occurs in children; however, the condition rarely occurs in children younger than 2 years. In the above case scenario Jennifer is 2 years and at this age there are rare population are seen with bacterial tonsillitis.

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Differential Diagnosis:

As Jennifer in given scenario is just 2 years old it is good to rule out the infectious agent that cause tonsillitis. Consider infectious mononucleosis (MN) due to Epstein-Barr virus (EBV) in an adolescent or younger child with acute tonsillitis, particularly when it is accompanied by tender cervical, axillary, and inguinal nodes; splenomegaly; severe lethargy and malaise; and low-grade fever (Shah, 2017).A monospot serum test and rapid antigen test can be done to rule out and able to identify the causative agent (Shah, 2017).Throat culture help to choose provider the right sensitive antibiotic if indicated. In addition Complete blood Count and Basal metabolic panel may be necessary (Shah, 2017) Assignment: Adaptive Response.

Treatment

The main goal of treatment is to alleviate symptoms and prevent further complications. Antipyretic and analgesic drugs like ibuprofen or acetaminophen can help to alleviate pain and fever(PubMedHealth,2016).Antibiotic is standard treatment for treating  bacterial tonsillitis Throat lozenges, or using home remedies such as a neck wrap or gargling with salt water or tea can also help to alleviate the symptoms(PubMedHealth,2016).

 

Some people relieve their symptoms by sucking on Recurrent tonsillitis can also be treated with painkillers or antibiotics. The surgical removal of tonsils is a treatment option for people who frequently get tonsillitis(Shah, 2017) Assignment: Adaptive Response.

Summary

Clinical manifestations of disease processes can lead an advance practice nurse to begin to create the differential diagnosis of different pathologies of immune reactions their adaptive responses and associated alterations caused by a disease processes.  Studying immune responses allows for the advanced practitioner to think, accurately diagnosis and treat individuals critically.

Mind Map

References

Huether, S. E., & McCance, K. L. (2017). 
Understanding pathophysiology 
(6th ed.). St. Louis, MO: Mosby.

Tonsillitis: Overview. (2016, December 01). Retrieved March 07, 2018, from https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0090038/

Shah, U. (2017, December 15). Tonsillitis and Peritonsillar Abscess Workup. Retrieved March 07, 2018, from https://emedicine.medscape.com/article/871977-workup#c7 Assignment: Adaptive Response.