NR 661 Alternative Assignment
Table of Contents
Introduction
Disease Presentations
HEENT ( Mastoiditis, Corneal Abrasion)
Pulmonary (Pertussis, Cystic Fibrosis)
Hematology (Lead Toxicity, RH Incomparability)
Neurology (Carpal Tunnel Syndrome, Meningitis)
Gastrointestinal (Hirschsprung’s Disease, Appendicitis)
Cardiovascular (Heart Murmurs, Kawasaki Syndrome)
Orthopedic (Rotator Cuff Syndrome, Gout)
Endocrinology (Addison’s Disease, Precocious Puberty)
Dermatology (Fifth Disease, Herpangina)
Urology and STD (Trichomoniasis, Urinary Incontinence)
Pregnancy (Incompetent Cervix, Acute Cystitis)
NR 661 Alternative Assignment
Men’s Health ( Testicular Cancer, Erectile Dysfunction)
Psychiatry ( Bulimia Nervosa, Anorexia Nervosa)
Growth and Development ( Down Syndrome, Failure to Thrive)
Health promotion
Depression Screening in Adolescents
Prostate Cancer Screening
Conclusion
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Introduction:
As a future Nurse Practitioner, I know I will encounter countless patients whom will present an array of disease signs and symptoms. While I understand that I cannot be fully and completely prepared for what I will encounter, I do understand that I must prepare myself as much as I can. Based on the results from my predictor exam and recounting the information I have reviewed, I know there are several diseases that need I need to understand better. Therefore, I will base this paper on those diseases. Furthermore, I will discuss health promotion in areas that I am less familiar, and I will justify why health promotion is needed in such areas. The last portion of this paper will consist of presenting the common signs and symptoms patients exhibit that make it appropriate for screening to be done. NR 661 Alternative Assignment.
Disease Presentations
HEENT (Mastoiditis, Corneal Abrasion)
Mastoiditis is a bacterial infection affecting the Mastoid Process-more specifically, the mastoid cells and the mastoid antrum. This infection usually results from an untreated or inadequate treated Acute Otitis Media. The common organisms causing this infection are: Haemophilus Influenzae, Streptococcus Pneumoniae, Moraxella Catarrhalis, Staphylococcus Aureus, Pseudomonas Aeruginosa, some Mycobacterium species and some fungi as well. The course of this infection begins when the bacteria causing the Acute Otitis Media (AOM) invades this region causing the air cells to become filled with blood and pus. NR 661 Alternative Assignment. The increased blood and pus causes cell to coalesce (fused together) forming abscesses and decreasing circulation. The fusing together of cells contributes to decreased blood supply to the bone cells leading to cell death (bone death).
The common signs and symptoms for this infection include a spiking fever, postauricular pain, erythema, tenderness; a bulging tympanic membrane, profuse otorrhea, possible hearing loss, possible evidence of a protruding or displace pinna, and headache. A small percentage of patients may be asymptomatic. To make the definite diagnosis Otoscopic examination is a must. In addition, labs (CBC, ESR, fluid aspiration and culture) are necessary; plus, a CT of the temporal bone may be obtained, and patient may also have Audiometry. NR 661 Alternative Assignment.
Preventing this condition by ensuring that it does not develop should be the first goal and this may be achieved by providing the appropriate interventions when treating AOM. However, once the condition has developed-treatment option depend on the length of the infection, severity, and the insulting pathogen. The University of San Francisco provides treatment guidelines for head and neck infections. The guideline states that for an acute infection (< 1 month), the best antibiotic would be Ampicillin to treat against Step Pneumo and to treat against Staph Aureus the antibiotic choice is Vancomycin. Now, in a chronic infection (> 1 month), to treat against Pseudomonas Aeruginosa and Staphylococcus Aureus Piperacillin-tazobactam (Zosyn) should be administered. In addition, when severe infection is present Vancomycin may be added, and to treat against Anaerobes Ofloxacin Otic Solution should be prescribed. For those patients who do not respond to antibiotic treatment, surgery might have to be considered. Patients should also be assessed for the need to receive topical steroids, analgesics, and antipyretic. One last important point to mentioned is that treatment should not be delayed; in the event the infective pathogen is unknown the patient should receive a broad-spectrum antibiotic. Once the culture results are available if the antibiotic selected is not appropriate; this should be replaced with the indicated antibiotic.
According to Hollier (2016), 8 to 13% of patients presenting with eye/vision complaints have suffered sustained a corneal abrasion. This can occur do to trauma to the eye or a foreign body such as contact lenses. The patient will usually present with complaints of feeling something in the eye which may be causing significant pain, increased lacrimation, photophobia, redness, and a constricted pupil NR 661 Alternative Assignment. To make the proper diagnosis vision test should be done; the fundus should be carefully examined. If the patient’s history and examination are indicative that this is the problem; fluorescein staining should be done to confirm the diagnosis. This procedure will allow for tissue damage to be visualized when exposed to a Wood’s lamp.
Treatment plan should include irrigation with normal saline to try to flush out the material and a topical anesthetic to allow for examination. Next the patient should receive Antibiotics-(Erythromycin ophthalmic, Sulfacetamine Ophthalmic, and Neomycin or Bacitracin Ophthalmic)-may be prescribed to prevent infection. Additionally, the patient should receive medication for pain such as an NSAID. Moreover, referral to an Ophthalmologist should be consider when the injury is the result of chemical or thermal exposure and when the injury has caused significant damage or when vision has been impaired. It is important to notify the patient that these injuries usually resolved within 3 to 5 days; once the cells have regenerated. NR 661 Alternative Assignment. The patient should wear a patch or protective dressing if there is a possibility that the patient will be touching the eye; for example, young children or confused patients. Education should also include preventing future injuries (American Association for Pediatric Ophthalmology and Strabismus, 2017).
Pulmonary (Pertussis, Cystic Fibrosis)
The incidents of Pertussis (Whooping Cough) increased steadily between the year 2000 to 20015; this according to data collected by the United States National Library of Medicine National Institute of Health (Bozio, Skoff, Pondo & Liang (2017) NR 661 Alternative Assignment. This disease is caused by the gram-negative bacteria Bordetella Pertussis. Incidents of this infection are higher in children younger than 18 years old and those who are not immunized or are only partially immunized. However, incidents have also increased in older adults and this is believed to be the result of decreased immunity. The infection is characterized by three stages: Catarrhal stage; for approximately 1to 2 weeks the patient will experience fever, rhinorrhea, nasal congestion, conjunctival irritation and redness, and cough. The second stage-paroxysmal stage is characterized by intensive cough on inspiration which can last for several minutes. This last for 2 to 4 weeks and the third stage is known as the convalescent stage- the patient has persistent cough that last for 1 to 2 weeks. In total the symptom last about 6 weeks. The CDC recommends a nasopharyngeal culture to be obtained along with a PCR; this should be done during the 0 to 3 weeks of the infection. In addition, a CBC should be done which should demonstrate a WBC of >20,000. A chest x-ray may be done; if that is the case, it will demonstrate atelectasis. Treatment plan will include antibiotics such as Azithromycin or Clarithromycin (Macrolide). In addition, patient should be place in airborne isolated for 5 days after antibiotics were initiated. Close contacts should receive antibiotics prophylactically NR 661 Alternative Assignment.
Immunization is the first prevention for this disease. The CDC recommends that children should receive 4 doses of the DTaP vaccine starting with the first dose at 2 to 4 months and receiving the last does by age 6. Children 7 years of age or older, preteens, pregnant women and any adult who has not received the vaccine at all should receive the Tdap vaccine (Centers for Disease Control and Prevention, 2018).
Cystic Fibrosis is a very difficult condition to manage. This is an autosomal recessive disorder that causes impair in what is known as the Cystic Fibrosis Transmembrane Regulator (CFTR) enzyme. This enzyme abnormal function is responsible for altering the chloride and water transport across epithelial cells resulting in cell dehydration. In exocrine glands this leads to thick secretions which lead to the formation of plugs. The most affected organs are the lungs, pancreas, Gastrointestinal and urogenital organs ( Hollier, 2016).
The most common test administered to make a diagnosis is what is known as the sweat test. Genetic testing can also be done but to make a definite diagnosis in addition to a positive sweat test or a positive genetic test one other conditions must be present. These include: COPD, pancreatic insufficiency, or a sibling also affected with the condition. An array of symptoms take place in this condition. The patient usually has re-current respiratory infections with mucopurulent sputum production, GI symptoms such as failure to thrive, hepatosplenomegaly, and fatty liver. As the condition progresses the patient will exhibit barrel chest, hypoxemia, delayed growth, and electrolyte imbalances. There is no cure for the condition; the goal is to decrease the symptoms and to prevent infections. Because the main issue with this condition is recurrent respiratory infections and impair nutrition treatment plan should focus on addressing these issues. Patients should be prescribed breathing treatment via which hypertonic solution mucolytics, antibiotics, and bronchodilators can be given. The patient also needs to have a diet high in fat and protein, pancreatic enzyme to break down fats; this will help in nutrition. Moreover, several conditions can arise from this disorder and each should be treated in accordance with approved guidelines. In addition, extensive education needs to be provided to the patient-if possible-and to the caregiver. The patient should receive all scheduled vaccines. And parents should receive genetic counseling (American Academy of Pediatrics, 2018).
Hematology (Lead Toxicity, RH Incompatibility)
Lead toxicity results from exposure to items that contain lead or form working in occupation where lead exposure is a risk. Commonly children under 5 years of age are affected; however, it can affect anyone at any stage in life. Lead attaches to red blood cell causing hypochromic microcytic anemia. Increased levels of lead leads to irreversible damage to several organs; especially the brain. Blood is usually obtained to check for lead levels; a level of > 10 mg/dl is abnormal. Depending on the level of toxicity symptoms may range from abdominal pain, headaches, tremors, nausea, to lethargy, seizures, and encephalopathy-just to mentioned some (Knollmann-Ritschel, & Markowitz, 2017).
Per CDD guidelines no safe level of lead has been determine but treatment should be initiated when level is 10mg/dl or more. Treatment consist of administering a chelating agent. Penicillamine and Dimercaptosuccinic Acid (Succiner) are two of those agents. Lead will bind to these agents and then it will be removed through the renal system. It is important to know that this procedure requires referral to a specialist trained in caring for this condition such as a Hematologist. In addition, it is imperative that the patient is removed from the source of exposure. Lastly, extensive education on possible signs and symptoms of permanent damage should be discussed with the patient and caregivers.
Rh Incompatibility results when an RH negative mother is carrying an RH positive fetus. It usually does not take place during the first pregnancy unless the mother has been previously exposed. In this case the mother’s IgG antibodies will attack the fetus or newborn. The infant will usually develop Jaundice, congenital anemia, of fetal hydrops. To make the diagnosis the mother will have prenatal antibodies identification then the mother and the infant-once born-should have Coombs’ test. Other diagnostic tests include: CBC with differential. Prevention is the initial treatment. Mothers who have this condition must receive RhoGAM at 28 weeks of gestation and within 72 hours post-delivery. The infant has to be watched carefully for symptoms. In the event the child develops symptoms-blood transfusion and hydration are the first steps to take. In addition, the mother should be monitor throughout the pregnancy. It is important that the mother understand what this condition is and why it can possibly be very dangerous to the baby (CDC, 2018).
Neurology (Carpal Tunnel Syndrome, Meningitis)
Carpal Tunnel Syndrome a condition that develops as a result of inflammation of the synovium that surrounds ligaments and tendon in the carpal tunnel. This inflammation causes narrowing and compression of the median nerve. As the median nerve becomes compressed the person will experience numbness, tingling, pain, and weakness in the wrist, hand, at times in the entire arm. It is believed that is caused by repetitive motion such as typing but it also can be cause by other conditions that cause inflammation. Diagnosis will be based on patient’s history and it can also be supported by performing a Phalen’s test and/or a Tinel’s test. Diagnostic studies such as Electromyogram and nerve conduction studies are recommended. To treat the condition a splint can be apply to the affected wrist, NSAIDs to treat pain; pain and inflammation can also be treated by corticosteroids injections to the affected the wrist. Also, the patient should limit activities that contribute to the condition. Referral to neurology and/or surgery should be done if patient does not experience significant relief with the mentioned interventions (American Academy of Orthopaedic Surgeons, 2018).
Meningitis is an inflammation of the meninges in brain and the spinal cord. The infection may be cause by bacteria, viruses, Fungi, parasites, and from brain injuries or diseases such as cancer. The condition may be highly contagious such as in the case of Meningococcal meningitis. The very young, very old, and immunocompromised are at highest risk for becoming infected. Sings and symptom include: headache, nausea and vomiting, nuchal rigidity, irritability, and there may be recent history of URI. Severe symptoms include: seizures, decrease level of consciousness, and respiratory symptoms. A kernig and Brudzinski sign may be done as part of the assessment. To make a definite diagnosis the patient needs to CSF aspiration through via lumbar puncture. CFS is analyzed for presence of infection. Treatment will depend on the type of infection present and the type of symptoms that need to be managed. A primary care provider who encounter a patient who demonstrates signs and symptoms of meningitis must send the patient to the hospital immediately (Hollier, 2016).
Gastroenterology (Hirschsprung’s Disease, Appendicitis)
Hirschsprung’s Disease is a congenital disorder associated with trisomy 21. Experts argue that it results when nerve cells stop reproducing in a region or regions in the colon. The absence of these cells causes the movement of stool to stop becoming leading to the affected are to become distention and enlarged. The symptoms developed a short time after birth. The infant may present delay meconium passing, vomiting, distended abdomen, and poor feeding. If the condition is undetected early; it leads to malnutrition, delayed growth, chronic constipation, and anemia. To diagnose the condition the provider may do a rectal which if positive may produce the release of stool and/or gas from the rectum. An abdominal x-ray should be done to assess for obstruction and a biopsy should be done to analyze if nerve cells are absent from the region. Another very important and positive sign is that the patient’s symptoms of obstruction will not resolve by providing stool softeners or laxatives. The condition will require surgery. Surgery will consist of removing the affected area and reconnecting non-affected tissue to each other (pull-through procedure. In the event the area affected is significantly large, an ostomy can be done. Ostomies are usually reverse once the colon has healed but, in some cases, these will be permanent. Patient should be monitor for signs of infection and obstructions. It is important to educate the patient about diet. Once part of the colon has been removed the child may need to increased fluid intake to compensate for fluid loss and the patient may need to have sodium levels checked to ensure this stay within normal limits (The National Institute of Diabetes and Digestive and Kidney Diseases, 2018).
Appendix is pouch that extends from the large intestine on the right side of the abdomen. It may become infected by bacteria, or it may become obstructed by fecal material-both conditions lead to inflammation causing an array of symptoms. Symptoms include severe abdominal pain that start around the umbilicus and moves to the right lower quadrant of the abdomen. Other symptoms include: nausea, vomiting, anorexia, fever, and diarrhea. It is clear what causes this condition to develop or what is the exact purpose of this sack; what is clear is that once it becomes inflamed and infected it may rupture producing a sever infection (Mayo Clinic, 2018). To diagnose the condition careful physical assessment should be done. Labs to evaluate for infection and a CT or KUB should be done for visual inspection of the appendix. Once the diagnosis is made-patient should be referred immediately for surgery. Also, the patient needs avoid food and water in preparation for surgery (Hollier, 2016).
Cardiovascular (Heart Murmurs, Kawasaki Syndrome)
Heart murmurs are common in infants and young children. But, these also are common in the elderly and may develop during pregnancy. In young children most of these murmurs present no threat to normal heart function. However, in the elderly almost always indicate disease valves. A murmur is a sound that occurs do to disturb blood flow through a stenotic or disease valve or it may be the result of increased flow as a response to disease such as anemia. A diastolic murmur is always considered abnormal and treatment is needed (Hollier, 2016).
A murmur is usually detected during physical exam; it can also be detected by doing an echocardiogram. Other test to make the diagnosis may include EKG, CT, and chest x-rays. The patient may present several symptoms depending on the what valve is affected and how severe is the impairment. Conditions such as Heart Failure, arrhythmias, or pulmonary symptoms may develop. Primary care should refer patient to cardiology when symptoms are present or when diastolic murmurs are present (Yurek, Jakub & Menacho, 2015).
Kawasaki Syndrome is a condition cause by an immune response; the exact cause is unknown. In this condition inflammation of the medium size vessel occurs affecting virtually any organ in the body. Children from Asian descent are at highest risk. Symptoms include: High fever, non-tender adenopathy, non-vesicular and polymorphous rash, diffused oral erythema-strawberry tongue, pharyngeal exudate, edema and erythema of the hands and feet with evidence of skin peeling and crusting of the lips. It can cause myocardial infarction and other organ disease and if untreated it can lead to death. Laboratory tests such as CBC, ESR, and C-reactive protein are done. In addition, the patient may have an EKG and chest x-ray to evaluate for cardiac complications. Treatment include bedrest, intravenous immunoglobulin which may shorten the condition and aspirin in titrated doses for 6 to 8 weeks (Hollier, 29016).
Orthopedics (Rotator Cuff Syndrome, Gout)
Rotator Cuff Syndrome is considered when injuries have occurred to in any of the rotator cuff muscles. Injuries may occur do to trauma, degenerative changes, muscle strain/impingement or decreased blood supply to the site. It can affect anyone at any stage of life, but males are often more affected. Symptoms include: pain and tenderness which may be localized or travel to adjoint muscles and may travel down to the arm, limited range of motion, weakness, and a grating sensation. A positive Hawkins, Neer, Empty can and lift off test indicates muscle impingement; a positive drop arm test indicates full thickness cuff tear, and a positive cross arm test indicates disease in the acromioclavicular joint. X-rays are usually done to make the diagnosis; Ultrasound and MRI may be done to evaluate severity. Initial treatment is rest, strengthening and stretching exercises. Medications to treat pain and inflammation include NSAIDs and steroid injections. For patient who present with a full thickness tear surgery should be done within 1 to 2 weeks and for those patients who show no improvement within 3 to 6 months of therapy, referral to Orthopedics should be done for surgical evaluation (Hollier, 2016).
Gout may have several etiologies. Essentially what takes place is that there is an excess of uric acid in the blood. Uric acid is a compound form by carbon, nitrogen, oxygen, and hydrogen. It is the product of purine breakdown; organ meats, fish, and certain vegetables contain high amount of purines. Usually uric acid is excreted by the kidney-any impairment in renal function may lead to uric acid buildup. Also, other conditions such as alcoholism, hepatic dysfunction, and enzyme deficiency can cause the buildup. The increased amount leads to crystal deposits in the joint (usually the one of the toes) causing pain and inflammation. Other signs will include swelling, erythema, and skin desquamation. In advanced Gout crystals may deposit in the subcutaneous tissue- these are known as Tophi. Lab tests such as CBC, ESR, serum uric acid level and an x-ray is done. The condition is treated by avoiding foods high in purines, rest, and increased fluid intake (3 or more liters per day). Pharmacological interventions include high dose NSAIDs or corticosteroids, local steroid injections, and Colchicine during an acute attack. In addition, an evaluation of possible underline disease should be done (Singh & Edwards, 2018).
Endocrinology (Addison’s Disease, Precocious Puberty)
Decrease function of the Adrenal glands is known as Addison’s Disease. The impairment causes decreased release of glucocorticoids and mineralocorticoids. The majority of cases result from autoimmune response and in some instances, it results from long term corticoid steroid use. Also, some medications can potentiate the condition. People between the ages of 30 to 50 years old and women more than men are usually affected. Symptoms develop slowly. The patient will complain of increased fatigue, amenorrhea, depressive symptoms, skin color changes, weight loss, cold intolerance, salt craving, gastrointestinal symptoms, and hair loss. Diagnosis is made after careful assessment of symptoms and by administering Adrenocorticotropic hormone which if the adrenals are not functioning normally; cortisol levels in the blood will rise. Also, because this condition will affect electrolyte; all electrolytes should be evaluated NR 661 Alternative Assignment. An EKG may depict ST segment changes and an EEG will demonstrate slow activity. In addition, a CBC should be done to assess for anemia and an abdominal CT will allow for assessment of the glands. Treatment should include diet modification, replacement of electrolytes as necessary, glucocorticoids and mineralocorticoids; calcium and vitamin D. The patient will need to maintain this regiment for life and understand that he/she will need close monitoring of hormonal level and for any worsening of symptoms. Primary care provider should refer the patient to an Endocrinologist. It is imperative that the patient understands that without treatment death will occur (Hollier, 2016) NR 661 Alternative Assignment.
Precocious Puberty refers to the onset of puberty before the expected age. Causes may have an underline disease or may occur without know cause. Those who are at highest risks for developing this condition include those with positive family history of the disorder, exposure to radiation, congenital defects, those who suffer from hypothyroidism, and any insult to the central nervous system. NR 661 Alternative Assignment. To diagnosed care assessment of Tanner staging should be done. Blood tests will depict LH and FSH I females, and testosterone in males. In addition, TSH should be evaluated, an x-ray of the wrist and hand should be done to evaluate bone age. MRI, CT, and US may be needed to evaluate for neoplasms. Treatment will include hormone therapy (Leuprolide and Naferelin). A Histrelin implant may be implanted. Endocrinology referral is necessary-patient should be evaluated every 3 to 6 months (Hollier, 2016) NR 661 Alternative Assignment.
Dermatology (Fifth Disease, Herpangina)
Fifth Disease is also known as Erythema Infectoosum or Slapped-Cheek Disease. This is cause by the Parvovirus B19 and the most cases present in those between the ages of 5 to 18 years. It is uncommon to take place in infants or the elderly; none the less, it can happen in these groups. Symptoms will develop over several days (4 to 14 days). Low grade fever, flu-like symptoms, a bright rash will develop over the cheeks; rash will continue to develop on the torso and limbs. The patient will also demonstrate swelling in the knees and wrists; symptoms are symmetrical. Diagnosis is done by patient’s history and may be confirm by doing a Parvovirus viral DNA and PCR. Because this is a viral infection no medication is effective or available and the patient should receive supportive care and education. NSAIDs may be given to treat fever and pain. Pregnant women should avoid contact with anyone infected with this virus. Exposure may lead to fetal death. In eh event a fetus has been exposed-blood transfusion and IVIG may be given. The good news is the condition will resolve. Usually no follow up is necessary but education about hygiene and avoiding crowed places (Arthritis Foundation, 2018). NR 661 Alternative Assignment.
The Coxsackie A and B viruses are the most common cause of Herpangina. However, other viruses such as the B virus, Enterovirus 71 and sometimes Echovirus and Adenovirus may also cause the infection. The infection mostly occurs during the summer months; mostly children are affected. The patient will present an array of symptoms. The hallmark signs would be painful blisters in the oral mucosa and high fever-fever may be as high as 106 degrees; other symptoms will include malaise, drooling, decreased appetite and diarrhea. Diagnosis is based on physical findings-blisters are usually very distinctive in this infection. However, there is doubt the patient may a CBC with differential and lesion cultured may be done NR 661 Alternative Assignment. Treatment is directing to infection prevention. This infection is transmitted through feces, saliva and sometimes through respiratory droplets. The child and care giver need to have education on proper hygiene especially when going to the bathroom and the child should stay home from school or daycare until fever has been absent for at least 24 hours. The patient should be instructed to drink plenty of fluids and get enough rest; foods that may irritate the mucosa should be avoided. To minimize the pain the patient may receive oral solutions to dumb the tissue and/or solutions that can coat the area (Stanford Children’s Health, 2018). NR 661 Alternative Assignment.
Urology and Sexually Transmitted Diseases (Trichomoniasis, Urinary Incontinence)
Trichomoniasis is one of the most common sexually transmitted diseases. It is caused by Trichomonas vaginalis (protozoan); both women and men may become infected. Non-Hispanic black women have the highest infection rate. Once the parasite has been transmitted it has an incubation period of 4 to 28 days. Symptoms presented include: vaginal itching, significant amount of frothy discharge that may appear yellowish, grayish-green. The patient may complaint of dysuria, fishy odor, and on examination the vagina and cervix appear erythematous. However, some patients may be asymptomatic and only experience postcoital bleeding. To treat this condition antibiotics are necessary. The common antibiotic prescribed is Metronidazole (Flagyl); it may be given in a single dose (2 gm) or it can be given in 5oomg doses twice a day for 7 days. A second antibiotic that can be used is Tinidazole 2gms orally time one-time dose. The patient should be educated about STDs and the dangerous risks associated with these diseases NR 661 Alternative Assignment. Also, the partner or partners needs to receive antibiotics as well (Hollier, 2016).
Caucasian women and the elderly are at highest risk for suffering urinary incontinence, but it can happen to virtually any person; this is the case because this condition can have many underline causes. It can result from increased stress apply to the detrusor muscle such as in pregnancy or it can be the results of this muscle weakness. It is also related to advance aging, psychiatric and neurological diseases, and/or infections. Diagnosis is made by gathering patient’s history, doing a physical exam, and focusing on underline conditions. In addition, a urinalysis and a PSA should be done to ruled out infection and Prostate conditions; post void measurements may help to determine the presences of obstruction (neoplasms), and a cough stress test will help to determine that weakness in the cause for the condition. Treatment starts by focusing on the underline cause and it will include: Kegel exercises to strengthen the detrusor muscle, periodically sit to void even when there is no urge to void, practice good hygiene to protect the skin, eat a healthy diet and avoid alcohol. Some patients will need to be evaluated by a Urologist if surgery (TURP) is a possibility (Urology Health, 2018). NR 661 Alternative Assignment.
Pregnancy (Incompetent Cervix, Acute Cystitis in Pregnancy)
Pregnancy may be a time of joy for many women, but it can also potentiate several conditions. An incompetent cervix refers to the dilation of the cervix that usually takes place during the second trimester of pregnancy. This may result from underline genetic cervical anomalies or it can be related to prior cervical accidental traumas or surgical procedures. Women who have this condition often experience spontaneous abortions and may have had several spontaneous abortions in the past. The patient usually will experience uterine contractions and bulging of the cervix membranes is observed. Ultrasound to assess for the condition should be done and blood tests to rule out infections should be done as well. Treatment will consist of bedrest and cervical cerclage (stitching of the cervix) to prevent fetal loss. The procedure carries risks-it may not stop fetal loss or premature rupture of membranes can occurs. Most women will carry the pregnancy to term but other will deliver prematurely (Hollier, 2016) NR 661 Alternative Assignment.
A second condition that can develop during pregnancy is acute cystitis. Do to anatomical, physiological, and hormonal changes during pregnancy the risks for developing cystitis is high. The common pathogen causing the infection is E-coli. The patient complaints of suprapubic pain, urgency and/or frequency, dysuria; but, in some women may be asymptomatic. To make a diagnosis a urine dip stick test should demonstrate nitrates and leukocytes; a urine culture should demonstrate 25,000 to 100,00 colonies-in this case even if no symptoms are present the patient needs antibiotics. Antibiotics may include a Cephalosporin (Keflex) 500mg twice a day for 3 to 7days. Other antibiotics that also work to resolve the infection are Macrobid, Augmentin, and Amoxicillin. In the event this is not treated it can progress to Pyelonephritis and premature labor. The patient should receive education on how to avoid possible exposures, eating a healthy diet, and report any worsening of symptoms or recurrent symptoms (Hollier, 2016) NR 661 Alternative Assignment.
Men’s Health (Testicular Cancer, Erectile Disfunction)
Testicular cancer is the most common type of cancer in men between the ages of 20 to 35. Causes are unknown but it some conditions may precipitate the development. For example, those who had undecadent testicle, and family history of the disease have been found to be a greatest risk. This cancer may originate in the seminomas and no seminomas cells. Understanding which cells are involve is important because it will also dictate the treatment plan. The patient will usually report feeling a lump on the testicle, discomfort and/or fluid buildup in the scrotum, pain the in lower abdomen and/or groin, and an overall change on how the testicle feels. To make a diagnosis several test/procedures should be done. Tumor markers (Alpha-fetoprotein and Beta-human chorionic gonadotropin) should be obtained. An ultrasound of the testicles should be done, and a biopsy will need to be done as well. Treatment depends on the type of cells involved and the stage of the disease. The patient may be treated with chemotherapy drugs, radiation or surgical removal of the tumor. NR 661 Alternative Assignment. The patient should be taught how to do testicular self-exam. Teaching about avoiding exposure to substances that can increase risks (smoking and drinking alcohol) should be done. It is important to mentioned to the patient that there is always a risk of cancer returning-therefore, regular screening and tumor markers should be check at least annually (National Cancer Institute, 2017).
Many conditions (Cardiovascular, Neurologic, Hormonal, Psychogenic) can cause Erectile Dysfunction (ED). Also, medication side effects and recreational/illegal drugs can potentiate the condition. Although the incidences are significant, and it can impact the patient’s greatly, many men find it extremely difficult to discuss the condition with their doctor. However, once it is reported the common complaint is inability to maintain an erection and/or inability to ejaculate. To make a diagnosis screening questionnaires-the International Index of Erectile Dysfunction and the Sexual Health Inventory for Men-should be done. A CBC, TSH, A1C, Lipid profile, and a complete metabolic panel should be done. In addition, hormones-FSH, LH, Prolactin, testosterone- should be measured. Last, a PSA and DRE should be done to evaluate for prostate pathologies. A procedure known as Rigi scan is used to check tumescence and a doppler estimator can be done to assess for blood flow to the penis. Treatment is directed to the underline cause. However, in some cases penile implant may be an option and patient may wish to take a PDE5 inhibitor; the biggest concern with thus drug would be the development of priapism (Hollier, 2016) NR 661 Alternative Assignment.
Psychiatric (Bulimia Nervosa, Anorexia Nervosa)
Bulimia and Anorexia share similar features. Both disease affect females more than males; both occurs in teen and young adult years, and both have no specific cause. However, those who suffer either disease may suffer from low self-esteem, may have underline mental disorders or have family history of mental disorder. In anorexia the patient present symptoms of malnutrition, and metabolic disfunction. The person has a disturbed body image and is exceedingly concern with weigh gain which leads to limiting food intake. On the other hand, in Bulimia, the person engages in episodes of eating compulsively which brings feeling of loss of control and tends to regain the feeling of control by self-inducing vomiting, using laxatives, or engaging in rigorous exercises. Diagnosis is based on history. Lab (CBC, CMP, TSH, glucose level, lipid panel, drug screening and the PROMIS screening should be done. Treatment consist of psychiatric/psychology interventions. SSRI can be used if the patient is believed to be depress-this is common-nutrition education should be arranged and patient should be closely monitored to ensure treatment plan is being follow (Hollier, 2016).
Growth and Development (Down Syndrome, Failure to Thrive)
Down Syndrome is a genetic disorder associated with an extra chromosome 21(trisomy 21). The physical features are first signs to observed. A flat nasal bridge, protruding tongue, small head, low set ears, skin folds at the back of the neck and delayed development are common findings. The child will usually have other conditions such heart anomalies and gastrointestinal atresia. Diagnosis can be made in utero by doing amniocentesis evaluating or a chromosomal study can be ordered. Management for this patient will be complex. Underline conditions need to be address. The child will need to have immunizations according to schedule; nutrition should be closely monitored. Parents should receive thorough education on the condition and should be referred to genetic consoling. Information on support groups and special programs for the child should be provided (Hollier, 2016) NR 661 Alternative Assignment.
Failure to Thrive is diagnosed when the child does not grow or gain weight as expected for age and gender. The exact cause is unknown, but experts believe that it may have a genetic component. Also, studies have showed that poor family dynamics, inadequate parent baby bounding, and an array of diseases may be the cause. Careful history, and physical assessment must be done. For children whose are severely malnourished or are presenting symptoms of metabolic disfunction and dehydration, immediate admission to a hospital for intervention is a must. Underline cause assessment should include examining family dynamics and educating/supporting caregivers. The goal is to improve nutrition; thus, referrals to a nutritionist may be helpful. In addition, if family issues are present a referral for counseling should be done and family therapy should be considered (Johns Hopkins Medicine, 2018) NR 661 Alternative Assignment.
Health Promotion Topics (Depression in Adolescents, Prostate Cancer Screening)
The latest data obtained from the American Foundation for Suicide Prevention showed that suicide continues to crease in all age groups but in it is increasing more rapidly in those between the ages of 15 to 24. Moreover, a risk behavior survey done in 2015 demonstrated that children as young as 7 years old reported feelings depicting depression symptoms and Hispanic girls were found to be the highest group reporting suicide attempts and receiving medical intervention for depression. Both, U.S. National Library of Medicine (USNLM) and the United States Preventive Task Force (USPTF) have published guidelines to screen for depression. While both are similar in recommendation; age for initiating screening differs-no consensus as to at what age screening should begin. This is obviously a problem. While data clearly demonstrates that children as young as 8 years are having depression symptoms, a clearer and concusses approach should be taken. Often these younger children behavior may be mistaken as being shy when in reality the child may be experiencing depression. Depression may have many different underline causes. Often children will appear to be quiet and do not make eye contact when the provider asks questions. Subjective data will include reports of decrease appetite, fatigue, insomnia, difficulty completing school work, behavior problems and lack of interest in social activities. Physical assessment may reveal hypotension, bradycardia, signs of malnutrition if the patient is not eating well. All these findings support the need for depression screening regardless of age. If the child does not feel that someone cares about their feelings and symptoms; the condition will worsen, and suicide attempts become a reality.
The American Cancer Society repots that in 2018 about 164,000 new cases of Prostate cancers were reported and 29,430 men died from this disease. The disease is most commonly diagnosed in African American men 65 year of age or older. This is the second leading cause of death in men in the united states behind lung cancer. The typical subjective symptom will include difficulty voiding, a weak urine stream, blood in the urine or in the semen, erectile dysfunction, and/or pelvic pain. In a scenario like this, screening should be done regardless of age or race. Assessment should include prostate examination by doing a digital rectal exam, a PSA level should be done-a high value will indicate prostate disease. Anytime a patient reports symptom that may indicate prostate involvement; screening should be done regardless of age and race. As mentioned, this disease is the 2
nd
leading cause of death in men over the age of 65 in this country. This indicates that a more proactive approach should be taken. NR 661 Alternative Assignment.
Conclusion:
Completing this assignment has provided significant insight that will be invaluable as I prepare myself to become a Nurse Practitioner.
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NR 661 Alternative Assignment