Monthly Archives: May 2023

editing the file 

CASE STUDY # 2

CHEIF OF COMPLAIN: A 45-year-old female presents with a complaint of an itchy red rash on her arms and legs for about two weeks.

SUBJECTIVE:She has been going on a daily basis to the local YMCA with children for Summer camp.

OBJECTIVE:

VS: (T) 98.3°F; (RR) 18; (HR) 70, regular; (BP) 118/74

GENERAL: healthy-appearing female in no acute distress

HEENT: EYES: no injection, no increase in lacrimation or purulent drainage; EARS: normal TM: Normal

SKIN: CTA AP&L

NECK/ THOAT: mild edema with inflammation located on forearms, upper arms, and chest wall, thighs and knees; primary lesions are a macular papular rash with secondary linear excoriations on forearms and legs

Answer the following questions:

1. What other subjective data would you obtain?
2. What other objective findings would you look for?
3. What diagnostic exams do you want to order?
4. Name 3 differential diagnoses based on this patient presenting symptoms?
5. Give rationales for your each differential diagnosis.

Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.

HA3220D – Health Information Systems

 Topic 4 Assignment: Interview with a Healthcare Professional (VoiceThread)

This course uses an online tool called VoiceThread, which makes it easy for you have a discussion using audio or video comments.Assignment instructions appear on the slides for this VoiceThread. As long as you click “save” on your comments

I need it by Saturday.

Compare the two grand nursing theories explored with the middle range theory you have chosen for your presentation. How are the middle range theory and the grand theories similar? different?

Research topic: ”Obesity among adults worldwide.”

P.S please follow the instructions in the instructions box images. This paper is very important. Use the scholarly articles that are less than 5 years published.  Don’t forget to go over the rubric while you write the paper. I need 4 pages not including title and references page

Thank you 

How healthy is your workplace?

You may think your current organization operates seamlessly, or you may feel it has many issues. You may experience or even observe things that give you pause. Yet, much as you wouldn’t try to determine the health of a patient through mere observation, you should not attempt to gauge the health of your work environment based on observation and opinion. Often, there are issues you perceive as problems that others do not; similarly, issues may run much deeper than leadership recognizes.

There are many factors and measures that may impact organizational health. Among these is civility. While an organization can institute policies designed to promote such things as civility, how can it be sure these are managed effectively? In this Discussion, you will examine the use of tools in measuring workplace civility.

To Prepare:

• Review the Resources and examine the Clark Healthy Workplace Inventory, found on page 20 of Clark (2015).
• Review and complete the Work Environment Assessment Template in the Resources.

By Day 3 of Week 7

Post a brief description of the results of your Work Environment Assessment. Based on the results, how civil is your workplace? Explain why your workplace is or is not civil. Then, describe a situation where you have experienced incivility in the workplace. How was this addressed? Be specific and provide examples.

Hi

I already completed my research paper for my advanced pathophisiology with the question below:

” What is the pathophysiologic difference between stable angina and unstable angina? “

Please make correction with grammar and sentences structure.  Thank you very much for your help!

Angina is a coronary artery disease that occurs when there is an imbalance between oxygen supply and demand in the myocardium (McCance & Huether, 2019). When supply is impaired and doesn’t meet demand, myocardial ischemia happens (McCance & Huether, 2019). There are two important concepts of accumulation of fatty streaks and endothelial dysfunction that explain the process of coronary artery disease (McCance & Huether, 2019). The coronary artery is made up of vascular smooth muscle and lined with vascular endothelium (McCance & Huether, 2019). 

With normal function, low-density lipoproteins (LDL) circulate throughout the arteries and deliver triacylglycerol fuel to tissues (McCance & Huether, 2019). However, when under abnormal circumstances, a certain percentage of LDLs are mutated by oxidative damage (McCance & Huether, 2019). Normally, macrophages ingest the oxidized LDL, and the body wants to get rid of waste. However, macrophages become engorged and become foam cells (McCance & Huether, 2019).  The foam cells become very big and accumulate and lodge in the layer of the vascular smooth muscle (McCance & Huether, 2019). When the foam cells accumulate, it displays the fatty steaks in the artery (McCance & Huether, 2019). The foam cells and lipid deposits will burst through the endothelial lining of the artery and cause a break in the artery. Besides the accumulation of fatty streaks, the dysfunctional endothelial cells have been damaged for many years and are result in the development of atherosclerosis (McCance & Huether, 2019). They cannot produce nitric oxide and cause the reduction of vasodilatation (McCance & Huether, 2019). As a result, the blood blow through the artery becomes restricted, oxygen supply to the distal tissues is diminished, and causing angina and heart attack.

Angina is a type of chest pain caused by reduced blood flow to the heart with a condition called myocardial ischemia and is a symptom of coronary artery disease (Mayo Clinic, 2020). Stable angina is not a heart attack and association with transient ischemia and no permanent damage and no infarction (American Heart Association, 2020). Patients usually feel uncomfortable pressure, fullness, squeezing, and pain at the center of the chest (American Heart Association, 2020). Stable angina is caused by fixed obstruction with a high cholesterol level (Huff, Boyd, & Jialal, 2020). Stable angina can be predictable, and patients are familiar with pain patterns, prompted by physical exertion such as exercise, emotional stress, cold temperatures, and having heavy meals (American Heart Association, 2020). Stable angina is not happened at rest, subsides with rest, and responds well to medications (American Heart Association, 2020).

On the other hand, unstable angina is unpredictable, even at rest, with unexpected chest pain (American Heart Association, 2020). It changes pain patterns, more severe, lasts longer and doesn’t respond well to medications (American Heart Association, 2020). As the coronary arteries are narrowed by fatty buildups, they can rupture, causing blood clots and blockage the flow of the heart muscle (American Heart Association, 2020). When having plaque ruptured, patients could have a heart attack and should be treated as a medical emergency (American Heart Association, 2020). 

Patients with angina is usually having ST-segment depression during attacks that display on the electrocardiograms (Ginghina, Ungureanu, Vladaia, Popescu, & Jurcut, (2009).). Providers can refer patients to have a stress test to perform during exercise (Mayo Clinic, 2020). Using an angiogram can also help detect obstruction and show the abnormal coronary (Mayo Clinic, 2020). The treatment of angina by relieving symptoms reduces the frequency of future anginas and reduces the risks of heart attacks. Patients can take nitroglycerin, long-lasting nitrates, antiplatelet drugs such as aspirin to relieve and prevent the symptoms (Mayo Clinic, 2020). They should also have lifestyle changes that include stop smoking, limit alcohol, keep a healthy weight, healthy diet, and regular exercise, but avoid exertion, avoid stress, and avoid large meals (Mayo Clinic, 2020). There are surgical procedures to restore normal blood flow, including a balloon or stent, coronary bypass, to wider the effective artery (Mayo Clinic, 2020). 

Research one of the following incidents.

• Hurricane Andrew
• The Northridge Earthquake
• The 2001 postal anthrax attacks
• Hurricane Katrina
• The Joplin Tornado
• The Tuscaloosa Tornado (see https://www.youtube.com/watch?v=MQbACBXWCG0 for a fascinating first person account)
• Superstorm Sandy
• The 2014 Ebola outbreak

How did the event impact the hospital and health community? What steps could have been taken to better prepare? To better respond? Does your institution or workplace have a continuity of operations (COOP) plan? Do you test it regularly?

 Case 3

Frailty can impact an older adult’s ability to recover from an acute illness, injury and other stresses on the body.  Incorporating physical therapy and physical activity into a patient’s daily regimen, adjusting daily nutritional requirements, advising of necessary home modifications and conducting a comprehensive geriatric assessment are all interventions that can be ordered by providers in order to help prevent complications that can occur with concerns of frailty.  Older adults are more inclined to sustaining fractures due to age-related loss of muscle mass.  Physical activity and physical therapy that is age-appropriate can be very beneficial for older adults as it helps with maintaining the current muscle mass of the elderly person and they both synergistically work to reduce the risk for falls and injuries in this patient population (Cacchione, 2020).Young adults should be educated on all contraceptive options that are available so that they can decide which option will suit them best.  It is best for the individual to make their own choice on contraceptive options after being educated on all options because naturally an individual would be more likely to stay compliant with their own choice/option as opposed to one that is selected for them.  The provider’s duty to the patient is to provide accurate information to their patients and answer questions and concerns that they may have, along with remaining nonjudgmental during their interactions during the teaching sessions with the patient (Chilton, 2017).  Personally, I do not hold any convictions and judgements with regards to options that persons choose because I am a staunch believer in that we are not here to judge others.  Patients have the right to make their own personal choices as they will be living through and with the choices that they make.  As a provider, I will remain neutral with regards to patient interactions and teaching sessions on all subject matters; trust is very hard to earn and as a provider, it is imperative to gain and keep the trust of clients so that they can be cared for effectively and efficiently.A smoking cessation plan should entail the following: developing a plan with a set “quit” date; researching and selecting a nicotine replacement and other aids to help quit the habit; the individual should be able to identify and be aware of their nicotine triggers and cravings; the individual should be able to quit in the manner in which they choose to do so; and the patient should also continuously speak with their provider regarding any concerns and obstacles they may face along the way while going through the process of quitting smoking.  A great support system can aid in the person’s efforts to quit smoking (Smith, 2015).Poverty is hard on every population and can be even more so on the elderly.  Elderly adults will not be as physically healthy and/or may not have full and intact mental faculties as they once had when they were younger.   A disposition such as poverty can only make life much harder for the elderly person living in and going through this situation.  An elderly person who is on medications and needs to be monitored frequently in terms of medical management, may run into issues regarding their health if they are living in poverty.  The elderly person may also be severely depressed due to their disposition which is also of great concern as mental health conditions can be even more debilitating and wearing on the person than other physiological health conditions. Community healthcare professionals can work with political figures collectively to establish programs and resources that can help elderly constituents who are of lower socioeconomic statuses.  Community healthcare professionals know the specific needs of their patient population and they can communicate these needs directly to political figures so that resolutions to concerns can be achieved (Chilton, 2017).

ReferencesCacchione, P. Z. (2020).  Innovative care models across settings: Providing nursing care to older adults.  Geriatric Nursing, 41(1), 16-20. doi:10.1016/j.gerinurse.2020.01.011Chilton, S. (2017).  Nursing in a community environment.  A Textbook of Community Nursing, 1-24. doi:10.1201/9781315157207-1Smith, K. (2015).  NHS Quit Smoking.  Nursing Standard, 29(32), 29-29. doi:10.7748/ns.29.32.29.s34 

Ashley AdamsPosted Date:November 30, 2020 11:25 AMStatus:Published

The patient in this scenario is displaying the clinical manifestations of rhabdomyolysis, which is the breakdown of muscle from various causes which leads to the shift of intracellular components into vascular and extracellular compartments(McCance & Huether, 2018). Clinical signs include pain, weakness, and tea-colored urine (myoglobinuria) along with elevated serum K+ and creatine kinase (CK) levels (Hocagil et al., 2019). While the roommate in the scenario does not know how long the patient was in the unresponsive state, lack of oxygen and energy to the muscle tissue in a dependent state can rapidly lead to ischemia and necrosis (Hocagil et al., 2019). 

At the cellular level, anoxia leads to the cessation of aerobic metabolism and reduced generation of ATP, ultimately causing the failure of the NA+-K+ pump (McCance & Huether, 2018). Na+ accumulates in the ICF while K+ accumulates in the ECF, causing the cell to swell and damaging the cell membrane, while increased calcium in the ICF leads to further cell damage (McCance & Huether, 2018). If oxygenation is not restored quickly, cell death will occur (McCance & Huether, 2018).

The patient is presenting with the symptoms of hyperkalemia, marked by the elevated serum K+ levels and EKG abnormalities. Common EKG alterations in hyperkalemia are prolonged PR intervals, wide QRS complexes, and ST segment depression (Roberts, 2020). Left uncorrected, severe dysrhythmias may occur up to and including ventricular fibrillation and cardiac arrest (McCance & Huether, 2018). 

While much more specific research is needed, early studies are pointing to a correlation between genetics and substance abuse or addiction disorders (Hancock et al., 2018). Several replicable genomic variables have been identified among individuals with various addictive disorders that could lead to early and targeted prevention measures (Hancock et al., 2018).  

In this scenario, different patient demographics could lead to different causes of rhabdomyolysis. In addition to tissue ischemia, rhabdomyolisis can result from the ingestion of certain drugs and toxins, trauma such as a crush injury, physical overexertion, infections, and metabolic imbalances (McCance & Huether, 2018). 

References

Hancock, D. B., Markunas, C. A., Bierut, L. J., & Johnson, E. O. (2018). Human genetics of addiction: New insights and future directions. Current Psychiatry Reports, 20(2). https://doi.org/10.1007/s11920-018-0873-3

Hocagil, H., İzci, F., Hocagil, A., Tatli, M., Sözen, S., & Akkaya hocagil, T. (2019). Detection of rhabdomyolysis in patients admitted to emergency department due to drug overdose as a suicide attempt: A propective original clinical study. Turkiye Klinikleri Journal of Medical Sciences, 39(3), 237–244. https://doi.org/10.5336/medsci.2018-64073

McCance, K. L., & Huether, S. E. (2018). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Mosby.

Roberts, D. M. (2020). Metabolic complications of poisoning. Medicine, 48(3), 169–172. https://doi.org/10.1016/j.mpmed.2019.12.005

Sara AndrewsPosted Date:November 30, 2020 6:27 PMStatus:Published

         At first glance, the necrosis discovered in the patient’s greater trochanteric area and forearm could be attributed to his unconscious state and prolonged pressure to bony prominences with resulting rhabdomyolysis.  However, the case scenario does not indicate the amount of time the patient was lying unconscious on the floor.  Opioid overdose is suspected given the patient regained consciousness after administration of the opiate receptor antagonist naloxone (Schiller &Goyal, 2020). Within 3-5 minutes, opioid overdose results in hypoxia and death (Schiller & Goyal, 2020), therefore increasing the probability that necrosis was present prior to the overdose ( as a result of tissue damage related to drug abuse) and not the result of  an extended period of unconsciousness, rhabdomyolysis, or pressure on bony prominences.  

         Musculoskeletal and vascular injury are the most common complications of toxicity related to opioid abuse (Delaney, Stanley & Bolster, 2020); specifically, necrotizing fasciitis related to soft tissue injury from needle puncture to the vessel wall or infection (Delaney, Stanley & Bolster, 2020).  Further, studies show that opioid abuse results in damage to microvasculature structures resulting in decreased blood flow and ischemic death to tissues and bone (Wu, Song, Ni, & Dai, 2015).

         Hyperkalemia is defined as potassium levels greater than 5.0 (McCance & Heuther, 2019).  The patient in the case scenario presented to the ED with a serum potassium level of 6.5.  Hyperkalemia is common in trauma since tissue damage caused by ischemic muscle cells release intracellular potassium to extracellular space (Wu, Song, Ni, & Dai, 2015).  When extracellular potassium ratios exceed intracellular, the cell membrane becomes depolarized, “excitable” and “irritable”, manifested by tall T-waves and longer PR intervals on the ECG (McCance & Huether, 2019). 

         The crux of the problem and solution lies in the disease of addiction itself.  Amid rising opioid use and overdose-related deaths, genetics, specifically D2 (dopamine) receptors is shown to have a significant role in 23-54% of opioid use disorders (Crist, Reiner, & Berrettini, 2019). Genome studies using brain tissue from the prefrontal cortex have revealed specific shared genetic loci linked to illicit drug addiction (Hancock, Markunas, Bierut, & Johnson, 2018). These studies provide valuable data and promise for developing effective treatments against the opioid epidemic and its heavy burden on the fabric of our social and healthcare systems.

Reference

Crist, R. C., Reiner, B. C., & Berrettini, W. H. (2019). A review of opioid addiction
         genetics. Current Opinion in Psychology, 27, 31–35. https://doi-
         org.ezp.waldenulibrary.org/10.1016/j.copsyc.2018.07.014

Delaney, F. T., Stanley, E., & Bolster, F. (2020). Retrieved November 30, 2020, from https://eds-a-ebscohost-com.ezp.waldenulibrary.org/eds/detail/detail?vid=4

Genes matter in addiction. (2008, June). Retrieved November 30, 2020, from https://www.apa.org/monitor/2008/06/genes-addict

Hancock, D., Markunas, C., Bierut, L., & Johnson, E. (2018, March 5). Human Genetics of Addiction: New Insights and Future Directions. Retrieved November 30, 2020, from https://www.ncbi.nlm.nih.gov/pubmed/29504045

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

2 resources for each of the discussion