Discuss how nursing services can contribute to the Healthcare Transformation Program, including the New Model of Care and Business Model.

Description of relevant health systems/public health systems for Ghana (West Africa) that are responding to the challenges of Chronic Kidney Disease (CKD) including how these challenges are targeted, to which population, who implements the action, and published evidence for efficacy or support a lack of evidence.

** Description of at least one example of a public health policy or program that is not currently enacted in Ghana (West Africa) that its believe if enacted, would positively impact the health of population in Ghana including relevant cultural values and practices, and why this policy or program would have a positive impact on the health of this population.

** Description of potential challenges and barriers to implementing

Examine the relationship between Schistosomiasis in Benin and Indonesia

and economic level in two countries from different geographic areas. Examine the level of poverty—GDP (gross domestic product) and GNI (gross national income)— per capita for these two countries. Compare and contrast the incidence and trend of the disease in each of these countries in relation to the observed economic level. The following countries:

 

1- Review WHO (n.d.). Schistosomiasis. Retrieved from https://www.who.int/gho/neglected_diseases/schistosomiasis/en/ to identify the global distribution of Schistosomiasis  and WHO (2020). Schistosomiasis. Retrieved from https://www.who.int/en/news-room/fact-sheets/detail/schistosomiasis

 

2- Then review WHO (n.d.). Preventive chemotherapy (PC) data portal. Retrieved from https://apps.who.int/gho/cabinet/pc.jsp

Go to Schistosomiasis:

Population requiring PC (Estimated number of individuals in the country requiring preventive chemotherapy for schistosomiasia annually:2018)

Population received PC (Number of individuals receiving preventive chemotherapy for schistosomiasis:2018)

There are some other indicators here that might be of interest.

 

3- Go to The Poverty and Equity Data Portal in the World Bank Group POVHP1 (n.d.). http://databank.worldbank.org/data/POVHP1/id/d5ca92c0 and select dataset of poverty and explore the GINI index and different indicators of poverty from series by country for these two countries for the same years of 2008 and 2018. For each indicator, you will hover by your mouse on the line of the map to get the rate of this indicator in the selected country. For better viewing, select one indicator at a time.

 

4- Go to WHO (n.d.). WHO’s work on schistosomiasis. Retrieved from https://www.who.int/schistosomiasis/en/

 

• Compare and contrast the most appropriate relevant and current data on prevalence and trend of the tropical disease (Schistosomiasis)in the provided countries (Benin and Indonesia).
• Describe the poverty level in these countries (Benin and Indonesia) as they relate to this scenario, giving examples from the data sources.
• Explain how the incidence of the tropical disease (Schistosomiasis) for each country (Benin and Indonesia) might be related to the different poverty indicators level observed. Be sure to support your answer and cite your sources
• Identify interventions or efforts that could be in place in these countries (Benin and Indonesia) (governmental or non-governmental) that are aiming to achieve SDG 1 and SDG 3.3
• Summarize your findings with a take-home message on positive social change, evaluating this developmental goal and the impact on public health and health equity as it relates to the provided scenario
• Cite the sources and include an APA formatted reference list.

What would it be like to be a young single teenage mother in the SAN FERNANDO (California) community?

What resources are available for them?

Create a concept map or decision flow chart of a differential diagnosis showing signs and symptoms in assessing and diagnosing a patient with different types of osteoporosis. The kindly read case study below for the signs and symptoms.

 

Reference: https://www.scribd.com/document/514553698/Bruyere-Case79-001-010

 

Case Study:

PATIENT CASE

Patient’s chief complains

“I’ve had back pain now for more than 5 weeks and I can’t stand it anymore. I’ve tried extra- strength ibuprofen, naproxen, and acetaminophen, and I’ve visited a chiropractor, but I don’t get any long-term relief.”

History of Present Illness

Mrs. I.A. is a very pleasant 63-year-old white woman of slight stature who has been referred to an orthopedic specialist by her PCP. She has been experiencing insidious back pain for 5-6 weeks. OTC analgesics provide temporary relief, but the pain is otherwise constant and aggravated by activity. She denies any obvious acute injury to her back, although she reports that she had a case of the flu with a prolonged and severe cough approximately one month ago. She also reports a vertebral fracture approximately five years ago.

The patient has been an avid gardener for many years. Following the death of her husband 18 months ago, she has continued to live in her house and do all the household chores. Since her back pain began, she has been limited in her ability to do her household chores and gardening.

Past Medical History

The patient entered natural menopause at 52 years and has never used hormone replacement therapy. Currently, she has mild hot flashes and vaginal dryness. At age 58, she suffered a vertebral fracture at T10 by simply carrying a shopping bag. DEXA scans conducted at that time revealed the onset of osteoporosis. Her bone mass density T-scores at that time were: -3.33 lumbar spine, -2.24 right femoral neck, and -2.44 right radius. These scans represented a 6.1%, 6.9%, and 6.2% decrease in bone mass density in the previous 19 months in the lumbar spine, right femoral neck, and right radius, respectively. Her serum calcium concentration was low-normal at 8.5 mg/dL and serum alkaline phosphatase level was moderately increased at 290 IU/L. She was prescribed alendronate and a calcium supplement daily.

The patient was diagnosed with a seizure disorder at age 22 years and is currently well controlled with phenytoin. She has had asthma since childhood. Her current asthma medications include a bronchodilator that she uses when needed, a daily steroid inhaler, and an oral corticosteroid that she uses about four times per year for 3-6 weeks when symptoms worsen. She also takes a daily multivitamin tablet and has 1-2 dairy servings every day. She has noticed a slight reduction in height in recent years, but denies any significant changes in weight. She had an appendectomy at 11 years of age.

 

 

Family History

The patient has a positive family history of osteoporosis. Her older sister has experienced a hip fracture and her paternal aunt was diagnosed with an osteoporosis-related wrist fracture following a fall.

Her mother was diagnosed with breast cancer at age 56, but died from lung cancer at age 69. She also suffered from high blood pressure and “high blood sugar.” Her father died at age 54 from AMI. Her brother (age 65) has HTN and high cholesterol, and her younger sister (age 57) has no known medical problems.

Social History

The patient smokes four cigarettes a day (down from 11⁄2 ppd eight years ago) and drinks one glass of wine daily. Her main sources of dietary calcium are milk with her breakfast cereal and “some” cheese about three times a week. The patient is widowed and was married for 39 years until the death of her husband 11⁄2 years ago. She has one son who is healthy. She had a miscarriage at age 19. She does most of her cooking and “watches what she eats.” She denies non-compliance with her medications. She gets very little weight-bearing exercise. She uses SPF 30 sunscreen to protect herself from sunburn and skin cancer every time that she spends more than 15 minutes in the sun.

Review of Systems

The patient denies any unusual bleeding, weakness, back spasms, shortness of breath, chest pain, fever, chills, heat or cold intolerance, and changes in her hair, skin, and nails. She reports vaginal dryness, occasional hot flashes and night sweats “maybe once every 6 months.”

 

Medications

• Alendronate 10 mg po QD

• Calcium carbonate 1.25 g (500 mg calcium) po BID

• Multivitamin tablet po QD

• Phenytoin 100 mg po TID

•  Albuterol MDI 2 puffs BID PRN

• Triamcinolone MDI 2 puffs QID

• Prednisolone 5 mg po BID PRN

 

Allergies

• Codeine intolerance (nausea, vomiting)

• Sulfa drugs (rash)

• Aspirin (hives, wheezing)

• Cats (wheezing)

 

Physical Examination and Laboratory Test

General

The patient is an alert and oriented, cooperative 63-year-old white female of slight stature who walks with a normal gait and is in no apparent distress. She appears somewhat anxious.

VS

• BP-129/83 sitting, left arm
• RR-20 and unlabored
• HT-5 31⁄2″
• PR-88 and regular
• T-98.6°F oral
• WT-106 lbs

Skin	Fair complexion Color and turgor good No lesions
Head	Normocephalic No areas of tenderness Slight hair thinning
Eyes	Conjunctiva clear PERRLA EOMI Funduscopic exam unremarkable
Ears	TMS pearl without bulging and retraction
Throat	Mucous membranes moist Clear without drainage or erythema
Neck and Lymph Nodes	No obvious nodes Thyroid non-tender without thyromegaly and no masses palpable (-) JVD No bony tenderness Full ROM without pain elicited
Chest	Normal chest excursion Clear to A & P
Breast	WNL Mammography normal (3 months ago)
Cardiac	RRR (-) murmurs Normal S1 and S2  No S3 or S4
Abdomen	Soft, NT/ND (+) BS (-) organomegaly or masses
Genitalia	Deferred
Musculoskeletal/Extremities	Good peripheral pulses bilaterally Point tenderness with palpation of bony prominence at L2 Limited flexion and extension of the back Significant lumbar lordosis Lateral bending unlimited and non-painful (-) kyphosis (-) deformity or swelling of joints
Neurologic	A & O X 3 Recent and remote memory intact Cranial nerves intact No focal motor deficits No gross sensory deficits DTRs 1+ and symmetric throughout Toes downgoing

 

 

Laboratory Blood Test Results

 

Laboratory Blood Test Results
Na	139	meq/L	Glu, fasting	91 mg/dL	25,OH vitamin D        3 ng/mL
K	4.4	meq/L	TSH	1.42 µU/mL	Hb                      12.6 g/dL
Cl	103	meq/L	Ca	8.6 mg/dL	Hct                         39.5%
HCO3	23	meq/L	PO4	4.6 mg/dL	WBC           8.8 X 103/mm3
BUN	15	mg/dL	Mg	1.8 mg/dL	Plt               339 X 103/mm3
Cr	1.0	mg/dL	Alk phos	283 IU/L	PTH                    33 pg/mL

 

 

 

 

DEXA Scan Results

DEXA Scan Results
Site	T Score
Lumbar spine L2-4	-3.79
Right femoral neck	-3.19
Right radius	-2.97

 

 

Spinal Radiographs

• Significant radiographic lucency suggestive of poor bone density

• Recent compression fracture at L2

• Healed compression fracture at T10

• Thoracic vertebrae are wedge shaped, consistent with progressive osteoporosis

• Lumbar vertebrae are biconcave, consistent with progressive ost