Discussion post

Discussion post

  1. Compare and contrast current disease-modifying treatments with symptomatic treatments of Alzheimer’s disease. For this discussion, be sure to specify what the treatments are, their targets, and at what stage of the disease process they are used (if applicable).

  1. Discuss the three stages of Alzheimer’s disease; make sure to include neurodegeneration in your discussion.

  1. Discuss the sleep wake cycle and histamines role in it.

week 7 assignment

week 7 assignment

For this assignment, you will develop and deliver a 10–15 minute powerpoint  seminar/workshop aimed at the teen or young adult audience on a specific  health risk associated with the population. 

* If you  predominantly work with a specific population and would like to present  a relevant health risk seminar to that population, you must seek  instructor approval in advance. Email your instructor through the  Virtual Office.

  1. Choose a health risk associated with adolescence. Some categories to consider may include:
    • Suicide
    • Pregnancy
    • Substance use and abuse
    • Motor vehicle crashes
    • Tobacco use
    • Sexually transmitted disease
    • Domestic violence
    • Mental health issues
    • Eating disorders
    • Nutrition and fitness
  2. As  the health care advocate, you will present the following to the target  audience (adolescents or young adults)in 10-15 slides or screens:
    • An overview of the risk factor
    • Contributing factors
    • Prevalence of the health risk (meaningful data)
    • Explain your role with the issue as a health care practitioner/advocate
    • Ways to identify a problem and address the issue
    • Present an activity or project or exercise for the audience to engage in related to the topic
    • Help and support resources
  3. In your research materials, incorporate 3–4 current sources with one containing the most current statistics.
  4. Use age-appropriate creativity to ensure the message gets across to the selected audience. As you plan your seminar, consider:
    • How will you initiate a conversation (rather than give a lecture)?
    • How will you keep the attention and respect of this audience?
  5. Use APA for citing and referencing your sources.
  6. Keep  your design and audio appropriate to the audience, yet professional.  Your presentation must include both audio and visual components and be  professional in nature.

What is a seminar? (Links to an external site.) (Links to an external site.)

DQ response 2 16/1

DQ response 2 16/1

Rommel Lantajo

Posted Date

Jun 23, 2022, 12:24 AM

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Virag et al. (2021) explains that it is essential to optimize and stabilize hemodynamics in patients with sepsis and septic shock. The impact of hypoperfusion caused by delay and inadequate treatment is enormous and clinically can affect the patient’s outcome (Virag et al., 2021). Therefore, the early optimization and stabilization of the patient hemodynamics is a vital component in the patient’s meaningful recovery (Virag et al., 2021). In the patient group cohort that is being admitted for cardiogenic shock, the need for early stabilization and intervention is likewise important to avoid hypoperfusion (Brener et al., 2020). The assumption for the medical and surgical unit can monitor the non-invasive blood pressure and portable pulse oximetry are the most common hemodynamic values available for the bedside staff.  

The hemodynamic discussion should be designed for entry level nurses working at the medical-surgical floor units. The lecture should be written in the following outline: 

Method of dissemination: Formal classroom presentation using PowerPoint 

Lecture objectives: 

Be able to demonstrate understanding on the importance and need for early hemodynamic stabilization. 

Rationale: The content of this discussion will explain and emphasize the need and clinical impact of early intervention and stabilization of hemodynamics to patient outcomes.  

Be able to demonstrate understanding the basic parameters of hemodynamics that are likely available at the medical-surgical units  

Rationale: The content of this discussion will discuss the practical and available hemodynamic values available at the medical surgical floor units. In most cases, non-invasive blood pressure, pulse, and pulse oximetry are the only available parameters for critical care unit areas. These hemodynamic values are an integral part in the delivery of standard care practices in many healthcare practices (Bodys-Pelka et al., 2021).  

Be able to demonstrate understanding the basic principles and basic principles of hemodynamics such Starling law, Fick Principles 

Rationale: The content of this discussion will provide the bedside nurse with a better understanding of the pathophysiological underpinnings and able to correlate the likely clinical condition of the patient. According to Sequeira & van der Velden (2017) the Starling Law influences myocardial muscles to create cardiac output and as expressed as NIBP and Fick Principle influence on the circulating blood (Gafton et al., 2020).  

Be able to demonstrate understanding the clinical significance of the hemodynamic values available at the medical-surgical floor units such as non – invasive blood pressure, mean arterial pressures, pulse oximetry. 

Rationale: The content of this discussion will provide the medical-surgical nurse the knowledge on the clinical significance of the hemodynamic values available to them in practice. Understanding the hemodynamic values and their significance is important information to help the medical-surgical nurse with the information or intervene appropriately (Gusmao-Flores et al., 2020).  

References  

Bodys-Pełka, A., Kusztal, M., Boszko, M., Główczyńska, R., & Grabowski, M. (2021). Non-Invasive Continuous Measurement of Haemodynamic Parameters-Clinical Utility. Journal of clinical medicine, 10(21), 4929. https://doi.org/10.3390/jcm10214929 

Brener, M. I., Rosenblum, H. R., & Burkhoff, D. (2020). Pathophysiology and Advanced Hemodynamic Assessment of Cardiogenic Shock. Methodist DeBakey cardiovascular journal, 16(1), 7–15. https://doi.org/10.14797/mdcj-16-1-7 

Grafton, G., Cascino, T. M., Perry, D., Ashur, C., & Koelling, T. M. (2020). Resting Oxygen Consumption and Heart Failure: Importance of Measurement for Determination of Cardiac Output With the Use of the Fick Principle. Journal of cardiac failure, 26(8), 664–672. https://doi.org/10.1016/j.cardfail.2019.02.004 

Gusmao-Flores, D., Luz, M., & Barreto, B. B. (2020). Understanding hemodynamics with seven variables. Annals of translational medicine, 8(20), 1332. https://doi.org/10.21037/atm-20-5493 

Sequeira, V., & van der Velden, J. (2017). The Frank-Starling Law: a jigsaw of titin proportions. Biophysical reviews, 9(3), 259–267. https://doi.org/10.1007/s12551-017-0272-8 

Virág, M., Leiner, T., Rottler, M., Ocskay, K., & Molnar, Z. (2021). Individualized Hemodynamic Management in Sepsis. Journal of personalized medicine, 11(2), 157. https://doi.org/10.3390/jpm11020157 

DQ 16/1 response

DQ 16/1 response

Amelia Mangune

Posted Date

Jun 23, 2022, 12:05 AM

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Asthma 

Asthma is a chronic respiratory disease associated with reversible airflow obstruction, bronchial hyperresponsiveness (BHR), and airway inflammation triggered by various stimuli, including viral upper respiratory infection, environmental allergens, and occupational exposures. It can lead to recurrent episodes of wheezing, cough, and dyspnea (Holguin, 2017). 

Presentation (Holguin, 2017) 

  • H&P reveals recurrent respiratory symptoms characterized by wheezing, cough, and chest tightness. 
  • Trigger exposures may exacerbate respiratory symptoms and include exposure to airway irritants (smoke, strong fumes, air pollution, etc.), aeroallergens, respiratory infections, and cold air. 
  • Psychological stress and physical exercise may also trigger respiratory symptoms without any other concomitant exposures.
  • Respiratory symptoms may have a nocturnal predominance and are frequently more severe in the morning after waking up when airflows are usually lower. 
  • Other presentation includes tachypnea, tachycardia, non-productive cough, prolonged expiration, use of accessory muscles in severe attack, and decreased exercise tolerance (Bray, 2018).

Categories of Asthma Severity (Fanta & Barrett, 2022)

Intermittent:

  • Daytime asthma symptoms happen 2 or fewer days per week.
  • Two or fewer nocturnal awakenings per month.
  • Use short-acting beta-agonists (SABAs) to relieve symptoms two or fewer days per week.
  • No interference with normal activities between exacerbations.
  • FEV1 measurements between exacerbations are consistently within the normal range (i.e., ≥80% of predicted).
  • FEV1/FVC ratio between exacerbations is normal.
  • One or no exacerbations require oral glucocorticoids per year.

Mild persistent:

  • Symptoms > 2Xweekly (although < daily).
  • About 3-4 nocturnal awakenings per month due to asthma (but fewer than every week).
  • Use SABAs to relieve symptoms > 2 days/week (but not daily).
  • Minor interference with normal activities
  • FEV1 measurements within normal range (≥80% of predicted).

Moderate persistent:

  • Everyday manifestations of asthma.
  • Nocturnal awakenings as often as once per week.
  • Daily requirement for SABAs for symptom relief.
  • Some limitations in normal activity.
  • FEV1 ≥60 and <80% of predicted and FEV1/FVC below normal.

Severe persistent:

  • Presence of asthma symptoms throughout the day. 
  • Nocturnal awakening due to asthma every night. 
  • Reliever prescription needed for symptoms several times/day. 
  • Severe activity limitation due to asthma. 

Pathophysiology

The early phase of asthma (1st hour) is triggered by IgE antibodies that are sensitized and released by plasma cells (Sinyor & Perez, 2022). Based on Sinyor & Perez (2022), these antibodies respond to environmental triggers. IgE antibodies then bind to high-affinity mast cells and basophils. When a pollutant or risk factor gets inhaled, the mast cells release cytokines and eventually de-granulate. Released from mast cells are histamine, prostaglandins, and leukotrienes. These cells, in turn, contract the smooth muscle and cause airway tightening. In the late phase (4-6 hrs), eosinophils, basophils, neutrophils, and helper and memory T-cells all localize to the lungs, which causes bronchoconstriction and inflammation. As a result of inflammation and bronchoconstriction, there is an intermittent airflow obstruction, resulting in increased work of breathing.

Labs/Diagnostics (Holguin, 2017) 

Pulmonary Function Test

  • Reveals evidence of airway obstruction with a bronchodilator response > or = 12% (or 200 mL) improvement of FEV1 after short-acting bronchodilators.
  • Bronchodilation should only be evaluated after withholding asthma medications for at least 4 hrs for short-acting β2-receptor agonists (SABA) and 24 hrs for long-acting β2-receptor agonists (LABA).

Methacholine (a cholinergic agent utilized to stimulate bronchial constriction excludes asthma). 

  • A positive test occurs when a reduction in FEV1 > or = 20% from the baseline postmethacholine level. The methacholine test is very sensitive but lacks specificity so that a positive test can be seen in other airway diseases or allergies. 
  • Diligent assessment for the existence or lack of asthma through testing and evaluation of treatment response will help eliminate the roughly 30% of patients who are mistakenly diagnosed with this condition clinically (false positive) and are unnecessarily treated with corticosteroids.

Other studies (Bray, 2018)

  • Spirometry
  • Allergy testing (consider)
  • Peak flow monitoring

Differential Diagnosis (Holguin, 2017): 

Congestive heart failure 

  • Wheezing and coughing can happen, which may be linked with airway vascular congestion and peribronchial cuffing due to pulmonary edema, bibasilar inspiratory crackles on auscultation, and an elevated serum BNP. 

Airway obstruction 

  • Foreign body aspiration, tumor, laryngeal edema, anaphylaxis, and laryngospasm could lead to stridor, which can be mistaken for wheezing.

Other differential diagnoses (Bray, 2018)

  • Respiratory infection
  • GERD
  • Habitual non-asthma-related cough
  • Tuberculosis

Treatment (Holguin, 2017) 

  • Supplemental O2
  • Inhaled SABA 
  • Anticholinergic agents
  • Nebulizers
  • Oral systemic corticosteroids

Patient Education and Prevention (Bray, 2018):

  • Identify and minimize known asthma triggers by avoiding allergens and irritants.
  • Take prescribed asthma medications daily.
  • Learn how to identify early signs/symptoms of asthma exacerbation (frequency of dyspnea, cough, chest tightness, and the need for quick-relief medication).
  • Have an “asthma action plan,” a preplanned medication plan for an exacerbation.
  • Influenza and Pneumococcal Pneumonia vaccinations.
  • Monitor peak flow values.
  • Learn the correct use of inhalers, spacers, and other medications (about half of patients misuse inhalers, causing medications ineffective).
  • Routine follow-up visit ( 1 to 6 mons depending on the severity of asthma).

Referrals (Fanta & Barrett, 2022)

Pulmonologist 

  • If there is uncertainty about asthma diagnosis, poorly-controlled asthma, an episode of near-fatal asthma, treatment of comorbid conditions, or the need for bronchoscopy.

Allergist/Immunologist

  •  If considering the need for specialized diagnostic studies (e.g., allergy skin testing) or potential treatment with biologics.

References

Bray, S.L. (2018). Asthma. In Hollier, A. (Ed). Clinical Guidelines In Primary Care (2nd Ed, pp. 662-669). Advanced Practice Education Associates, Inc.

La Fayette, LA.

Fanta, C.H. & Barrett, N.A. (June 06, 2022). An overview of asthma management. UpToDate. https://www.uptodate.com/contents/an-overview-of-asthma-management?source=history_widget#H31

Holguin, F. (2017). Asthma. In McKean, S.C., Ross, J.J. Dressler, D.D. & Scheurer, D.B. (Eds.). Principles and Practice of Hospital Medicine (2nd ed., Chap. 231, pp. 4507-4509). McGraw-Hill Education. 

Sinyor, B. & Perez, L.C. (May 08, 2022) Pathophysiology of asthma. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK551579/

Reflective journal

Reflective journal

Assessment Description

Reflect on the course objectives, clinical practice guidelines, the three to five clinical objectives, and your plan to incorporate clinical practice guidelines for your clinical experience that you developed for Topic 1 DQ 1.

In 250-500 words, summarize the objectives you met during your clinical experience and discuss your incorporation of the course objectives and clinical practice guidelines. Provide specific examples to justify and illustrate your experiences.

APA format is not required, but solid academic writing is expected.

You are not required to submit this assignment to LopesWrite.

APA , Nursing

APA , Nursing

Note: Kindly respond to the discussion posts, 250words 

          APA format, 1-2 references.

          Thank you.

What factors do you see in practice that influence safe, quality, patient-centered care?

Multiple factors are driving or influencing safe, quality, and patient-centered care. They include communication, technology, shared decision-making, collaboration, and policies/regulations/laws (Mosadeghrad, 2014). For instance, technological changes are pushing the creation of new health IT systems like electronic medical records (EHRs) in clinical settings to improve the quality and safety of care. 

2. Have those factors shifted or changed as your role as an RN has progressed or changed?

I strongly believe that the five factors have significantly shifted with the advancement of my role as a registered nurse (RN). For example, technology, communication, collaboration, and shared decision-making have become key factors driving my work, especially as I transition from a mere bedside nurse to a clinical nurse coordinator. I rely on these factors to supervise patient care transitions, conduct informatics analysis and design, coach patients, and manage population health. The fifth factor (policy, laws, and regulations) has also shifted as I have developed policy advocacy skills. I now understand my role in policy, especially in changing practice and professional laws, policies, and regulations to improve quality, safety, and patient-centered care.

3.Do you think the factors will continue to change?

There is no doubt that most of these factors will continue changing from time to time. For example, new technology and innovation will continue being developed, and the role of RNs will change to match the new technological requirements. New policies, regulations, and laws will also continue to be passed or amended at the federal, state, and local levels. These new policies will stipulate the new roles of RNs in upholding the quality of care and patient safety. 

4.What factors do you see affecting safe, quality, patient-centered care in 10 years?

In ten years, the factors I believe can affect quality, safety, and patient-centered care are the transition of care to telehealth services, a shift in healthcare systems, the integration of IoT-enabled devices, and changes in law and policies (Zimlichman et al., 2021).

References 

Zimlichman, E., et al. (2021, Mar 3). Healthcare 2030: The coming transformation. NEJM Catalyst. https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0569

Mosadeghrad, A. M. (2014). Factors influencing healthcare service quality. International Journal of Health Policy and Management, 3(2), 77-89. doi: 10.15171/ijhpm.2014.65

DQ 16/2

DQ 16/2

Discuss the role of an AGACP as an educational change agent in health care. Then select one colleague’s proposed educational lesson from the first DQ in this topic. Do not select a lesson for which you have provided feedback. Analyze their method on disseminating evidence to other health care professionals. Provide constructive feedback to your colleague regarding the following.

  1. Additional information that should be included in the lesson plan.
  2. Structure and flow of the lesson.
  3. Other supportive ideas to assist your colleague in developing a comprehensive, effective, and relevant lesson on the chosen educational topic.

Use the course text and a minimum of three APRN approved scholarly resources in your response.

Week 4 Participants/PRAC 6675: PMHNP Care Across the Lifespan II Practicum/

Week 4 Participants/PRAC 6675: PMHNP Care Across the Lifespan II Practicum/

 

By multiple days between Days 4 and 7

Respond at least 2 times each to all colleagues who presented this week (should be 2-3 presenters each week). The goal is for the discussion forum to function as robust clinical conferences on the patients. Provide a response to 1 of the 3 discussion prompts that your colleagues provided in their video presentations. You may also provide additional information, alternative points of view, research to support treatment, or patient education strategies you might use with the relevant patient.

Grand Rounds Discussion: Complex Case Study Presentation

Grand Rounds Discussion: Complex Case Study Presentation

 In Weeks 4, 7, and 9 of the course, you will participate in clinical discussions called grand rounds. In one of these three weeks, you will be a presenter as well as help facilitate the online discussion; in the others you will be an active discussion participant. When it is your week to present, you will create a Focused SOAP note and a short didactic (teaching) video presenting a real (but de-identified) complex patient case from your practicum experience.
 

Student response 2

Student response 2

Insights

 According to Gandolfi and Stone (2021), leadership failures are well documented. The article points out the importance of good leadership by stating that in many cases leadership failures are the rule, not the exception. The article points out several examples of leadership failures. One example is the Olympic games in Brazil. Several example of lack of leadership at the Olympics were reselling tickets, high crime rates and lack of proper security at the games. The article goes on to explain how an effective leader needs to be able to inspire and prioritize needs. In doing this, follows can feel safe. I believe this is an important characteristic of a leader: the ability to help followers feel safe. Follows need to believe a leader has their best interest in mind and have a sense of calmness. This leads to a less toxic work environment.

Moreover, according to Sousa and Rocha (2019), leadership characteristics can be learned at a young age. The article examined what leadership skills were learned through game-based learning. For example, a child that learns through a game such as a computer application develops motivation, communication, and facilitation. A good leader needs to be self-driven.  A follower should feel like the leader has the skill set and motivation to get everyone’s job completed.

In Practice

The insights I gained from reviewing these articles was a leader needs to instill a sense of calmness within their followers and a leader needs to be self-driven. I have seen leaders use these skills. I work in critical care. My director of nurse teaches us through simulations. We can learn better as she keeps everyone call and provides a safe learning environment. This was not true about our previous leader. She does this through communicating effectively, ensuring we have a proper equipment and knowledge to do our jobs and praising us for a job well done.

My leader at the clinic I would parttime is very self-driven. One example, if she wants to run an additional lab, she does it herself. Instead of calling me back into the room to re-swab the patient she simply will do it herself and run the lab. She also took the time to learn how to run all our lab equipment. Not all the providers do this, so it makes a huge difference in the work environment. I have noticed all the nurses are very willing to go above and beyond for her as well.

Impact

 The examples I provided have an impact on the work environment. First, both leaders can have employees who do more consistently quality work. With both leaders I often hear others say things like “what else can I do for you today?” Employees are much more engaged in their duties. The skills are both very effective. Moreover, the skill of keeping a calm follower has led to more communication. Followers feel comfortable approaching the leader with ideas. Leadership calmness translated into better communication, a better work environment and a more ideal environment for learning (Muhammad, 2019).

References

Gandolfi, F., & Stone, S. (2021). The Effect of Servant and Transformational Leadership Styles on Employee Creative Behavior: The Moderating Role of Authentic Leadership. International Journal of Organizational Leadership. https://doi.org/10.33844/ijol.2021.60538

Muhammad, I. A. (2019). The Benefits of Superlative Calmness. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.3365133

Sousa, M. J., & Rocha, L. (2019). Leadership styles and skills developed through game-based learning. Journal of Business Research, 94, 360–366. https://doi.org/10.1016/j.jbusres.2018.01.057