Pain in Gerontology

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Directions:
With the realization that pain is highly prevalent among older adults, please answer the following questions.

150+ words at least per question

Cite resources

Questions:
1. What are some ways you as the nurse can utilize to determine pain in the older adult?
2. What are some of the potential barriers related to self-reporting of pain in the older adult?
3. What is the prevalence of pain in the older adult?
4. Describe and compare your findings for each of the following:
a. Numeric rating scale
b. Visual analog scale
c. McGill pain questionnaire
d. Pain in dementia patients

Evidence Translation and Change

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Diabetes Mellitus is chosen as a selected problem for promoting a better patient outcome and improve the standard of care since this is a chronic condition and has long-term effects that cause an increase in mortality rate. Evidence is one of the keys to providing a vision on the ways to improve the quality of care and bridging the knowledge gap.

The first common barriers to evidence translation in addressing this practice problem is knowledge and awareness. Patients should get an education on keeping the blood sugar levels on target and be aware of the ways of keeping track of their blood glucose levels. On the other hand, it is also important for the health care professional to have adequate knowledge of providing diabetic education for the patient during discharge to prevent readmission. Skills are necessary for the patients who are discharged and need insulin administration and therefore if the patient is not practiced in skills it can lead to uncontrolled diabetes and patients often get readmitted with the complications associated with diabetes mellitus. Acceptance and beliefs could be one of the barriers which are in the patients as well as with the health care professionals. Patients with a multicultural background with certain beliefs often practice herbal medicines or any traditional methods to control blood sugar which causes a drug to drug interactions. To accept a new change is difficult for the patient and therefore will see fewer effects in controlling blood sugar levels. Health care professionals should collaborate with the diabetic educators and should bring new practices based on new evidence.

The strategies which we can apply in this practice problem could be first with an Inter-Professional Collaboration (IPC) with the stakeholders specifically with the diabetic educator. Interprofessional collaboration is the key to attain the goal specifically for chronic care conditions which includes diabetes mellitus. According to Van, D. G et al,. (2020), IPC between physicians, physicians’ trainees, nurses which includes senior staff nurses, and diabetic educators has provided a better training program that helps the patient to improve their diabetic health. Stakeholders can be well engaged for further exploration by sharing the information, gathering the research and evidence, consultation, participation, and collaboration (White, K. M et al,. 2016).

To determine which evidence to implement is the most challenging implementation, however, it is also important to get the evidence and follow the interventions based on the purpose and outcome of the interventions.  The research data would provide the evidence on a practice which is followed and so the first vital source is finding out the research questions and the outcome. The two most important diabetic intervention includes diet and exercises in different forms such as aerobic, tai chi, yoga, swimming.

Change is not easy and if a change has happened, I believe the appropriate rational and a tentative outcome is essential to be informed for creating team effort and motivation. To determine continuity and sustainability of the change, the DNP scholar should assess the educational programs and should promote adequate resource to educational meetings, team huddle to assess the pros and cons, meetings and getting opinion with the nurse leaders, clinical audit and feedback is also needed and provide complete information on the new evidence provided (Dang, et al. 2018)

Please make a comment for this discussion board with at least 2 paragraphs and 2 sources no later than 5 years

response

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I need a response to the following 2 peers

Peer 1

 

Elements of Malpractice in Nursing

A nursing intervention may result to a medical error, and this error may occur due to the nurse’s failure to competently treat a patient. This occurrence constitutes a case of malpractice, and it is associated with various elements including negligence. As one of these elements, negligence involves failing to follow the due clinical procedures or directives for performing an intervention. This is noticeable in a scenario where a nurse, instead of examining a patient and performing diagnosis tests, puts a patient on a medication regimen (Cheluvappa & Selvendran, 2020). This amounts to negligence because the nurse fails to perform diagnosis, which is necessary to inform the kind of treatment to administer.

Breach of duty, still, is an element linked to the act of malpractice. It is characterized by a provider failing to meet the required standards of caring for patients. A nurse has a duty of preventing injury of the patient by administering the correct medication. If a nurse receives instructions from a physician to administer a certain medication, and the nurse instead of administering the medication, administers another medication that serves the same purpose, this amounts to breach of duty (Kim, 2017). This is because they go against the physicians’ decisions to have the patient receive a particular treatment that might be less risky. 

Cases of malpractice can be costly to the nurses and the organizations they work for, and this warrants the need for nurses as well as hospitals to prevent these cases. For nurses, adopting measures or practices such as documentation medical information in clear and accurate manner, can help limit their risks of making mistakes. Being consistent in observing the protocols of administering care, still, can limit the occurrence of negligence (Hågensen et al.,2018). 

PEER 2

 Advanced nurse practitioners work in complex healthcare environment vulnerable to malpractice lawsuits. Over the past years, malpractice lawsuits have increased as healthcare consumers become informed (Myers, Sawicki, Heard, Camargo Jr & Mort, 2020). Medical malpractice is defined as any act or omission by a physician during treatment of a patient that deviates from accepted norms of practice in the medical community and causes an injury to the patient. it is a subset of tort law that deals with professional negligence. Professional negligence is defined as conduct that fall short of a standard by a reasonable professional (Cooper, 2016). Negligence can be a result in diagnosis errors, errors in treatment, aftercare, or management. The four core elements of medical malpractice personal injury include duty, breach of duty, damage, and cause (Joel, 2017). For a patient to claim malpractice, they must demonstrate that a healthcare practitioner owed them a duty to care. Duty of care is based on nurse-patient or physician-patient relationship. The healthcare practitioner who had the duty of care must have failed n their duty by not exercising the expected degree of care that another professional in the same capacity and specialty would have used in an equal situation. In this case, an expert must testify as to what constitutes appropriate standard of care. The expert must hold the same or higher qualification in the same field or be a professional or regulatory body. The patient must demonstrate that the breach of duty resulted to damage, including emotion or physical injury. The breach of duty may cause a new injury or worsen an existing injury. Finally, it must be proven beyond reasonable doubt that the breach of duty by the practitioner caused the injury. For instance, the patient or plentiful must demonstrate that a medical error led to injury or harm.  

quantitative or qualitative

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  • Do you think there is one type of research (quantitative or qualitative) that is inherently more rigorous than the other? If so, identify which one and why. If not, discuss your reasoning.
  • a brief summary of your research article analysis and the correct APA citation for the article.
  • Outline how the study’s qualitative data collection and analysis did, or did not, promote rigor, provide scientific or systematic scaffolding, and/or generate a more thorough analysis of the research topic.

Nursing and the Aging Family

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  1. Chapter 19: Circulation:- Identify two of the normal common changes of aging related to the heart and list one appropriate nursing intervention for each of the changes noted.
  2. Chapter 20: Chapter 20:- Digestion and Bowel Elimination

         Describe one normal age-related changes of digestion and elimination in the older adult and the impact on

health functions.

Please use the following 3 x 3 rule: when writing your weekly discussions: – A minimum of three paragraphs per DQ. Each paragraph should have a minimum of three sentences.

All answers or discussions comments submitted must be in APA format according to Publication Manual American Psychological Association (APA) (6th ed.) 2009 ISBN: 978-1-4338-0561-5

Discussions must have a minimum of two references, not older than 2015.

Kc

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Quick Links
QUESTION 1
1. A 67-year-old Caucasian woman was brought to the clinic by her son who stated that his mother had become slightly confused over the past several days. She had been stumbling at home and had fallen once but was able to ambulate with some difficulty. She had no other obvious problems and had been eating and drinking. The son became concerned when she forgot her son’s name, so he thought he better bring her to the clinic.  
PMH-Type II diabetes mellitus (DM) with peripheral neuropathy x 20 years. COPD. Depression after death of spouse several months ago 
Social/family hx – non contributary except for 30 pack/year history tobacco use.  
Meds: Metformin 500 mg po BID, ASA 81 mg po qam, escitalopram (Lexapro) 5 mg po q am started 2 months ago 
Labs-CBC WNL; Chem 7- Glucose-92 mg/dl, BUN 18 mg/dl, Creatinine 1.1 mg/dl, Na+120 mmol/L, 
K+4.2 mmol/L, CO237 m mol/L, Cl-97 mmol/L.  
The APRN refers the patient to the ED and called endocrinology for a consult for diagnosis and management of syndrome of inappropriate antidiuretic hormone (SIADH). 
Question:
Define SIADH and identify any patient characteristics that may have contributed to the development of SIADH.
  
QUESTION 2
1. A 43-year-old female presents to the clinic with a chief complaint of fever, chills, nausea and vomiting and weakness. She has been unable to keep any food, liquids or medications down. The symptoms began 3 days ago and have not responded to ibuprofen, acetaminophen, or Nyquil when she tried to take them. The temperature has reached as high as 102˚F.  
 Allergies: none known to drugs or food or environmental  
 Medications-20 mg prednisone po qd, omeprazole 10 po qam 
 PMH-significant for 20-year history of steroid dependent rheumatoid arthritis (RA). GERD. No other significant illnesses or surgeries. 
Social-denies alcohol, illicit drugs, vaping, tobacco use 
Physical exam 
Thin, ill appearing woman who is sitting in exam room chair as she said she was too weak to climb on the exam table. VS Temp 101.2˚F, BP 98/64, pulse 110, Resp 16, PaO2 96% on room air.  
ROS negative other than GI symptoms. 
Based on the patient’s clinical presentation, the APRN diagnoses the patient as having secondary hypocortisolism due to the lack of prednisone the patient was taking for her RA secondary to vomiting.
Question:
Explain why the patient exhibited these symptoms? 
QUESTION 3
1. A 64-year-old Caucasian female presents to the clinic with vague symptoms of non- specific abdominal pain, myalgias, constipation, polyuria, and says she feels “fuzzy headed” much of the time. She had about of kidney stones a few weeks ago and she fortunately was able to pass the small stones without requiring lithotripsy or other interventions. She was told by the urologist to follow up with her primary care provider after the kidney stones has resolved.  
The APRN examining the patient orders a Chem 7 which revealed a serum Ca++ of 13.1 mg/dl. The APN believes the patient has primary hyperparathyroidism and refers the patient to an endocrinologist who does a complete work up and concurs with the APRN’s diagnosis. 
Question:
What is the role of parathyroid hormone in the development of primary hyperparathyroidism? 
 
  
QUESTION 4
1. A 64-year-old Caucasian female presents to the clinic with vague symptoms of non- specific abdominal pain, myalgias, constipation, polyuria, and says she feels “fuzzy headed” much of the time. She had a fracture of her right metatarsal without trauma and currently is wearing a walking boot. She also had a bout of kidney stones a few weeks ago and she fortunately was able to pass the small stones without requiring lithotripsy or other interventions. She was told by the urologist to follow up with her primary care provider after the kidney stones has resolved.  
The APRN examining the patient orders a Chem 12 which revealed a serum Ca++ of 13.1 mg/dl. The APRN believes the patient has primary hyperparathyroidism and refers the patient to an endocrinologist who does a complete work up and concurs with the APRN’s diagnosis. 
Question 1 of 2:
Explain the processes involved in the formation of renal stones in patients with hyperparathyroidism. 
   
QUESTION 5
1. A 64-year-old Caucasian female presents to the clinic with vague symptoms of non- specific abdominal pain, myalgias, constipation, polyuria, and says she feels “fuzzy headed” much of the time. She had a fracture of her right metatarsal without trauma and currently is wearing a walking boot. She also had a bout of kidney stones a few weeks ago and she fortunately was able to pass the small stones without requiring lithotripsy or other interventions. She was told by the urologist to follow up with her primary care provider after the kidney stones has resolved.  
The APRN examining the patient orders a Chem 12 which revealed a serum Ca++ of 13.1 mg/dl. The APRN believes the patient has primary hyperparathyroidism and refers the patient to an endocrinologist who does a complete work up and concurs with the APRN’s diagnosis. 
Question 2 of 2:
Explain how a patient with hyperparathyroidism is at risk for bone fractures.  
   
QUESTION 6
1. A 64-year-old Caucasian female who is 4 weeks status post total parathyroidectomy with forearm gland insertion presents to the general surgeon for her post-operative checkup. She states that her mouth feels numb and she feels “tingly all over. The surgeon suspects the patient has hypoparathyroidism secondary to the parathyroidectomy with delayed vascularization of the implanted gland. She orders a Chem 20 to determine what electrolyte abnormalities may be present. The labs reveal a serum Ca++ of 7.1 mg/dl (normal 8.5 mg/dl-10.5 mg/dl) and phosphorous level of 5.6 mg/dl (normal 2.4-4.1 mg/dl).  
Question:
What serious consequences of hypoparathyroidism occur and why? 
QUESTION 7
1. A 17-year-old boy is brought to the pediatrician’s office by his parents who are concerned about their son’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with his school/work activities. He had been seemingly healthy until about 3 months ago when his parents started noticing these symptoms but put these symptoms down to his busy schedule including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.  
PMH-noncontributory. No surgeries or major medical problems. Usual colds and ear infections as a child  
Allergies-none know  
Family history- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process 
Social-denies alcohol, tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast food store after school and on weekends. 
Labs in office: random glucose 220 mg/dl.  
Based on his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up and management plan.  
Question 1 of 6:
The patient exhibited classic signs of Type 1 diabetes. Explain the pathophysiology of “polydipsia.”
   
QUESTION 8
1. A 17-year-old boy is brought to the pediatrician’s office by his parents who are concerned about their son’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with his school/work activities. He had been seemingly healthy until about 3 months ago when his parents started noticing these symptoms but put these symptoms down to his busy schedule including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.  
PMH-noncontributory. No surgeries or major medical problems. Usual colds and ear infections as a child  
Allergies-none know  
Family history- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process 
Social-denies alcohol, tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast food store after school and on weekends. 
Labs in office: random glucose 220 mg/dl.  
Based on his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up and management plan.  
Question 2 of 6:
The patient exhibited classic signs of Type 1 diabetes. Explain the pathophysiology of “polyuria.”
 
QUESTION 9
1. A 17-year-old boy is brought to the pediatrician’s office by his parents who are concerned about their son’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with his school/work activities. He had been seemingly healthy until about 3 months ago when his parents started noticing these symptoms but put these symptoms down to his busy schedule including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.  
PMH-noncontributory. No surgeries or major medical problems. Usual colds and ear infections as a child  
Allergies-none know  
Family history- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process 
Social-denies alcohol, tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast food store after school and on weekends. 
Labs in office: random glucose 220 mg/dl.  
Based on his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up and management plan.  
Question 3 of 6:
The patient exhibited classic signs of Type 1 diabetes. Explain the pathophysiology of “polyphagia.”
QUESTION 10
1. A 17-year-old boy is brought to the pediatrician’s office by his parents who are concerned about their son’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with his school/work activities. He had been seemingly healthy until about 3 months ago when his parents started noticing these symptoms but put these symptoms down to his busy schedule including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.  
PMH-noncontributory. No surgeries or major medical problems. Usual colds and ear infections as a child  
Allergies-none know  
Family history- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process 
Social-denies alcohol, tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast food store after school and on weekends. 
Labs in office: random glucose 220 mg/dl.  
Based on his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up and management plan.  
Question 4 of 6:
The patient exhibited classic signs of Type 1 diabetes. Explain the pathophysiology of “weight loss.”
0.5 points   
QUESTION 11
1. A 17-year-old boy is brought to the pediatrician’s office by his parents who are concerned about their son’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with his school/work activities. He had been seemingly healthy until about 3 months ago when his parents started noticing these symptoms but put these symptoms down to his busy schedule including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.  
PMH-noncontributory. No surgeries or major medical problems. Usual colds and ear infections as a child  
Allergies-none know  
Family history- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process 
Social-denies alcohol, tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast food store after school and on weekends. 
Labs in office: random glucose 220 mg/dl.  
Based on his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up and management plan.  
Question 5 of 6:
The patient exhibited classic signs of Type 1 diabetes. Explain the pathophysiology of “fatigue.”
 
QUESTION 12
1. A 17-year-old boy is brought to the pediatrician’s office by his parents who are concerned about their son’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with his school/work activities. He had been seemingly healthy until about 3 months ago when his parents started noticing these symptoms but put these symptoms down to his busy schedule including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.  
PMH-noncontributory. No surgeries or major medical problems. Usual colds and ear infections as a child  
Allergies-none know  
Family history- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process 
Social-denies alcohol, tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast food store after school and on weekends. 
Labs in office: random glucose 220 mg/dl.  
Based on his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up and management plan.  
Question 6 of 6:
How do genetics and environmental factors contribute to the development of Type 1 diabetes?
1 points   
QUESTION 13
1. A 17-year-old boy recently diagnosed with Type I diabetes is brought to the pediatrician’s office by his parents with a chief complaint of “having the flu”. His symptoms began 2 days ago, and he has vomited several times and has not eaten very much. He can’t remember if he took his prescribed insulin for several days because he felt so sick. Random glucose in the office reveals glucose 560 mg/dl and the pediatrician made arrangements for the patient to be admitted to the hospitalist service with an endocrinology consult.  
BP 124/80mmHg; HR 122bpm; Respirations 32 breaths/min; Temp 97.2˚F; PaO297% on RA 
Admission labs: Hgb 14.6 g/dl; Hct 58% 
CMP- Na+ 122mmol/L; K+ 5.3mmol/L; Glucose 560mg/dl; BUN 52mg/dl; Creatinine 4.9mg/dl;  
Cl- 95mmol/L; Ca++ 8.8mmol/L; AST (SGOT) 248U/L; ALT 198U/L; CK 34/35 IU/L; Cholesterol 198mg/dl;  
Phosphorus 6.8mg/dl; Acetone Moderate; LDH38U/L; Alkaline Phosphatase 132U/L. 
Arterial blood gas values were as follows: pH 7.09; Paco220mm Hg; Po2100mm Hg; Sao2 98% (room air) 
HCO3-7.5mmol/L; anion gap 19.4 
A diagnosis of diabetic ketoacidosis was made, and the patient was transferred to the Intensive Care Unit (ICU) for close monitoring.  
Question:
The hormones involved in intermediary metabolism, exclusive of insulin, that can participate in the development of diabetic ketoacidosis (DKA) are epinephrine, glucagon, cortisol, growth hormone. Describe how they participate in the development of DKA. 
   
QUESTION 14
1. A 67-year-old African American male presents to the clinic with a chief complaint that he has to “go to the bathroom all the time and I feel really weak.” He states that this has been going on for about 3 days but couldn’t come to the clinic sooner as he went to the Wound Care clinic for a dressing change to his right great toe that has been chronically infected, and he now has osteomyelitis. Patient with known Type II diabetes with poor control. His last HgA1C was 10.2 %. He says he can’t afford the insulin he was prescribed and only takes half of the oral agent he was prescribed. Random glucose in the office revealed glucose of 890 mg/dl. He was immediately referred to the ED by the APRN for evaluation of suspected hyperosmolar hyperglycemic non ketotic syndrome (HHNKS). Also called hyperglycemic hyperosmolar state (HHS).  
Question:
Explain the underlying processes that lead to HHNKS or HHS.
QUESTION 15
1. A 32-year-old woman presented to the clinic complaining of weight gain, swelling in her legs and ankles and a puffy face. She also recently developed hypertension and diabetes type 2. She noted poor short-term memory, irritability, excess hair growth (women), red-ruddy face, extra fat around her neck, fatigue, poor concentration, and menstrual irregularity in addition to muscle weakness. Given her physical appearance and history, a tentative diagnosis of hypercortical function was made. Diagnostics included serum and urinary cortisol and serum adrenocorticotropic hormone (ACTH). MRI revealed a pituitary adenoma.  
Question:
How would you differentiate Cushing’s disease from Cushing’s syndrome? 
QUESTION 16
1. A 47-year-old female is referred to the endocrinologist for evaluation of her chronically elevated blood pressure, hypokalemia, and hypervolemia. The patient’s hypertension has been refractory to the usual medications such as beta blockers, diuretics, and angiotensin-converting enzyme (ACE) inhibitors. After a full work up including serum and urinary electrolyte levels, aldosterone suppression test, plasma aldosterone to renin ratio, and MRI which revealed an autonomous adenoma, the endocrinologist diagnoses the patient with primary hyper-aldosteronism.  
Question:
What is the pathogenesis of primary hyper-aldosteronism? 
QUESTION 17
1. A 47-year-old African American male presents to the clinic with chief complaints of polyuria, polydipsia, polyphagia, and weight loss. He also said that his vison occasionally blurs and that his feet sometimes feel numb.  He has increased hunger despite weight loss and admits to feeling unusually tired. He also complains of “swelling” and enlargement of his abdomen.  
Past Medical History (PMH) significant for HTN fairly well controlled with and ACE inhibitor; central obesity, and dyslipidemia treated with a statin, Review of systems negative except for chief complaint. Physical exam unremarkable except for decreased filament test both feet. Random glucose in office 290 mg/dl. The APRN diagnoses the patient with type II DM and prescribes oral medication to control the glucose level and also referred the patient to a dietician for dietary teaching. 
Question:
What is the basic underlying pathophysiology of Type II DM? 
   
QUESTION 18
1. A 21-year-old male was involved in a motorcycle accident and sustained a closed head injury. He is waking up and interacting with his family and medical team. He complained of thirst that doesn’t seem to go away no matter how much water he drinks. The nurses note that he has had 3500 cc of pale-yellow urine in the last 24 hours. Urine was sent for osmolality which was reported as 122 mOsm/L. A diagnosis of probable neurogenic diabetes insipidus was made.  
Question:
What causes diabetes insipidus (DI)? 
  
QUESTION 19
1. A 43-year-old female patient presents to the clinic with complaints of nervousness, racing heartbeat, anxiety, increased perspiration, heat intolerance, hyperactivity and palpitations. She states she had had the symptoms for several months but attributed the symptoms to beginning to care for her elderly mother who has Alzheimer’s Disease. She has lost 15 pounds in the last 3 months without dieting. Her past medical history is significant for rheumatoid arthritis that she has had for the last 10 years well controlled with methotrexate and prednisone. Physical exam is remarkable for periorbital edema, warm silky feeling skin, and palpable thyroid nodules in both lobes of the thyroid. Pending laboratory diagnostics, the APRN diagnoses the patient as having hyperthyroidism, also called Graves’ Disease.
Question:
Explain how the negative feedback loop controls thyroid levels.
   
QUESTION 20
1. A 43-year-old female patient with known Graves’ Disease presents to the clinic with complaints of nervousness, racing heartbeat, anxiety, increased perspiration, heat intolerance, hyperactivity and severe palpitations. She states she had been given a prescription for propylthiouracil, an antithyroid medication but she did not fill the prescription as she claims she lost it. She had been given the option of thyroidectomy which she declined. She also notes that she is having trouble with her vision and often has blurry eyes. She states that her eyes seem “to bug out of her face”. She has had recurrent outs of nausea and vomiting. She was recently hospitalized for pneumonia.  Physical exam is significant for obvious exophthalmos and pretibial myxedema. Vital signs are temp 101.2˚F, HR 138 and irregular, BP 160/60 mmHg. Respirations 24. Electrocardiogram revealed atrial fibrillation with rapid ventricular response. The APRN recognizes the patient is experiencing symptoms of thyrotoxic crisis, also called thyroid storm. The patient was immediately transported to a hospital for critical care management. 
Question:
How did the patient develop thyroid storm? What were the patient factors that lead to the development of thyroid storm? 
   
QUESTION 21
1. A 44-year-old woman presents to the clinic with complaints of extreme fatigue, weight gain, decreased appetite, cold intolerance, dry skin, hair loss, and sleepiness. She also admits that she often bursts into tears without any reason and has been exceptionally forgetful. Her vision is occasionally blurry, and she admits to being depressed without any social or occupational triggers. Past medical history noncontributory. Physicalexam Temp 96.2˚F, pulse 62 and regular, BP 108/90, respirations. Dull facial expression with coarse facial features. Periorbital puffiness noted. Based on the clinical history and physical exam, and pending laboratory data, the ARNP diagnoses the patient with hypothyroidism.  
Question:
What causes hypothyroidism? 
0.5 points   
QUESTION 22
1. A 44-year-old woman is brought to the clinic by her husband who says his wife has had some mental status changes over the past few days. The patient had been previously diagnosed with hypothyroidism and had been placed on thyroid replacement therapy but had been lost to follow-up due to moving to another city for the husband’s work approximately 4 months ago. The patient states she lost the prescription bottle during the move and didn’t bother to have the prescription filled since she was feeling better. Physical exam revealed non-pitting, boggy edema around her eyes, hands and feet as well as the supraclavicular area. The APRN recognizes this patient had severe myxedema and referred the patient to the hospital for medical management.  
Question:
What causes myxedema coma? 
QUESTION 23
1. A 53-year-old woman presents to the primary care clinic with complaints of severe headaches, palpitations, highblood pressure and diaphoresis. She relates that these symptoms come in clusters and when she has these “spells”, she also experiences, tremor, nausea, weakness, anxiety, and a sense of doom and dread, epigastric pain, and flank pain. She had one of these spells when she was at the pharmacy and the pharmacist took her blood pressure which was recorded as 200/118. The pharmacist recommended that she immediately be evaluated for these symptoms. Past medical history significant for a family history of neurofibromatosis type 1 (NF1). Based on the presenting symptoms and family history of NF1, the APRN suspects the patient has a pheochromocytoma. Laboratory data and computerized tomography of the abdomen confirms the diagnosis. 
Question 1 of 2:
What is a pheochromocytoma and how does it cause the classic symptoms?
QUESTION 24
1. A 53-year-old woman presents to the primary care clinic with complaints of severe headaches, palpitations, highblood pressure and diaphoresis. She relates that these symptoms come in clusters and when she has these “spells”, she also experiences, tremor, nausea, weakness, anxiety, and a sense of doom and dread, epigastric pain, and flank pain. She had one of these spells when she was at the pharmacy and the pharmacist took her blood pressure which was recorded as 200/118. The pharmacist recommended that she immediately be evaluated for these symptoms. Past medical history significant for a family history of neurofibromatosis type 1 (NF1). Based on the presenting symptoms and family history of NF1, the APRN suspects the patient has a pheochromocytoma. Laboratory data and computerized tomography of the abdomen confirms the diagnosis. 
Question 2 of 2:
What are the treatment goals for managing pheochromocytoma? 
 
 

discussion

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Discussion Assignment: 

View the video below – If We Could See Inside Other People.  After viewing the video , respond to the following questions:

1. How will this video influence your nursing care?

2. Describe three things will you implement in your nursing practice and why?

https://youtu.be/IQtOgE2s2xI