The etiology associated with incontinence in the aging adult

/0 Comments/in /by
A nurse practitioner (NP) is talking with a 70-year-old patient who asks if she could discuss a problem that she is embarrassed to talk about with her physician. She states she has been having increasing problems with incontinence. Every time she coughs or sneezes, she notices a loss of urine. She has not had any fever or chills or pain with urination. She asks the NP if this is just a sign of getting older. Discuss the etiology associated with incontinence in the aging adult.

Use of healthcare technologies

/0 Comments/in /by
Instructions
To Prepare:
Reflect on the Resources related to digital information tools and technologies.
Consider your healthcare organization’s use of healthcare technologies to manage and distribute information.
Reflect on current and potential future trends, such as the use of social media and mobile applications/telehealth, Internet of Things (IoT)-enabled asset tracking, or expert systems/artificial intelligence, and how they may impact nursing practice and healthcare delivery.
By Day 3 of Week 6
Post a brief description of general healthcare technology trends, particularly related to data/information you have observed in use in your healthcare organization or nursing practice. Describe any potential challenges or risks that may be inherent in the technologies associated with these trends you described. Then, describe at least one potential benefit and one potential risk associated with data safety, legislation, and patient care for the technologies you described. Next, explain which healthcare technology trends you believe are most promising for impacting healthcare technology in nursing practice and explain why. Describe whether this promise will contribute to improvements in patient care outcomes, efficiencies, or data management. Be specific and provide examples.
By Day 6 of Week 6
Respond to at least two of your colleagues* on two different days, offering additional/alternative ideas regarding opportunities and risks related to the observations shared.
*Note: Throughout this program, your fellow students are referred to as colleagues.

National Patient Safety Goals website concerning Hospital Chapter

/0 Comments/in /by

Review the Millie Larsen case update within this assignment, read the questions, and consult your resources–particularly the texts and National Patient Safety Goals website concerning Hospital Chapter, Goal 7, NPSG.07.01.01 and NSPG.07.03.01. Brainstorm ideas and formulate your responses. Use the Braden Scale form to score her skin risk; access the Braden Scale form through the link below.

 

Several weeks have passed since the clinic visit, and Millie is now re-admitted to the hospital with a diagnosis of urinary tract infection and dehydration. Her presentation is atypical, and she is confused. Upon the admission assessment, the nurse notices that Millie has a wound on her sacrum and asks her if it is painful. Millie states that “it does hurt, so I have just been lying down more.” The nurse places a gauze dressing over the wound and continues with the assessment.

She is now being cared for on a medical-surgical unit and because she is confused, she has a bed alarm for her safety. Millie needs much encouragement to get out of bed and walk to the bathroom so has become more incontinent and requires frequent bed changes. She is receiving intravenous fluids and medications for the urinary tract infection. Millie appears weak and underweight as she is only eating about one-quarter of her meals. She refuses to drink the supplements that she is offered and sometimes refuses to take her medications.

A few days later, it is noted that the wound has worsened and now has purulent drainage with a foul odor which will require referral to a wound nurse for additional care. Wound cultures are positive for methicillin-resistant staphylococcus aureus (MRSA).

Before responding to the questions, review the following videos:

  1. Obtaining a Wound Culture by Swab (Links to an external site.)
  2. Removing and Applying Wet to Damp Dressings (Links to an external site.)
  3. Open-Pore Reticulated Polyurethane Foam Therapy (i.e., Vacuum-Assisted Closure [V.A.C.]) (Links to an external site.)

Respond to the Following Questions

 

 Oval wound on person with deep wound bed. Overall skin color is lightly pigmented.  Yellow fatty tissue noted in part of wound bed. Remainder of wound bed is red.

 

  1. View the picture to help you assess the wound. What are the “clinical findings” and how would you stage Millie’s wound?
  2. What would be included in the plan of care for treatment of Millie’s wound? Please include all aspects of a team-based approach that will be utilized in a successful treatment plan.
  3. What are three (3) nursing interventions that the nurse would incorporate into the plan of care? Give a rationale for each intervention.
  4. If the wound nurse orders a dressing change for this wound, what technique would be appropriate? (Medical asepsis, clean technique? Or surgical asepsis, sterile technique)? Describe the procedure and give a rationale for your choice.
  5. What are some of the risks that Millie demonstrates for forming a pressure injury? Using the Braden Scale  Download Braden Scale, how would you score Millie at this time?

 

 

Pathophysiology of acute renal failure

/0 Comments/in /by

Pathophysiology of acute renal failure in rhabdomyolysis; A 28-year-old male presents to the primary care office for evaluation of left calf pain, swelling, and redness. He reports that this started one day ago and worsened today. He ran a 27-mile marathon 2 days ago and traveled for 3 hours in a car today.

He reports slight pain on walking and a swollen red calf. He took Ibuprofen 600 mg twice today without relief. Patient reports being an experienced runner, running 3-5 miles daily. He trained for the marathon for 4 months. The patient also reports a history of exercise-induced asthma and uses albuterol sulfate HFA as needed.

On physical exam, the patient appears in good health T 99 P 68 R 18 BP 118/78 wt. 175 lb, height 72 in. BMI 23.1. Heart rate is regular without murmurs, rubs, or gallops. Lungs clear bilaterally. HEENT WNL. Strength lower extremities 5 and DTRs 2. Left calf erythematous, edematous, warm, and tender on palpation. Pulses 3

  • Two possible diagnoses were considered: deep vein thrombosis (DVT) and rhabdomyolysis.
  • ordered Stat ultrasound of left leg to rule out DVT  and read as normal
  • CBC WNL
  • Creatine Kinase (CK) 23,000 U/L (normal 24-170 U/L)
  • BUN and Creatinine WNL
  • A diagnosis of rhabdomyolysis was made.Discuss the pathophysiology of acute renal failure in rhabdomyolysis.

Gastrointestinal and Hepatobiliary Disorders

/0 Comments/in /by

Quiz – Module 3 Knowledge Check
Knowledge Check: Gastrointestinal and Hepatobiliary Disorders

• In this exercise, you will complete five essay-type questions in the Knowledge Check to gauge your understanding of this module’s content.
• Each question will hold one to two parts asked to be addressed and each part will need at least one citation, at least two citations if asked two parts to the question from the textbook and/or current peer-reviewed journals.
• Each question is worth 4 points. I would expect substantive paragraphs per answer (a paragraph would include 6-10 sentences).

KC each essay needs a citation(s) and reference(s), if using textbook apply correct page(s)
Basic book citation format
The APA in-text citation for a book includes the author’s last name, the year, and (if relevant) a page number.
In the reference list, start with the author’s last name and initials, followed by the year. The book title is written in sentence case (only capitalize the first word and any proper nouns). Include any other contributors (e.g. editors and translators) and the edition if specified (e.g. “2nd ed.”).
Format Last name, Initials. (Year). Book title (Editor/translator initials, Last name, Ed. or Trans.) (Edition). Publisher.
Reference entry Anderson, B. (1983). Imagined communities: Reflections on the origins and spread of nationalism. Verso.
In-text citation (Anderson, 1983, p. 23)

Possible topics covered in this Knowledge Check include:
• Ulcers
• Hepatitis markers
• After HP shots
• Gastroesophageal Reflux Disease
• Pancreatitis
• Liver failure—acute and chronic
• Gall bladder disease
• Inflammatory bowel disease
• Diverticulitis
• Jaundice
• Bilirubin
• Gastrointestinal bleed – upper and lower
• Hepatic encephalopathy
• Intra-abdominal infections (e.g., appendicitis)
• Renal blood flow
• Glomerular filtration rate
• Kidney stones
• Infections – urinary tract infections, pyelonephritis
• Acute kidney injury
• Renal failure – acute and chronic

QUESTION 1
1. Scenario 1: Peptic Ulcer
A 65-year-old female comes to the clinic with a complaint of abdominal pain in the epigastric area. The pain has been persistent for two weeks. The pain described as burning, non-radiating and worse after meals. Denies N&V, weight loss or obvious bleeding. She admits to frequent belching with bloating.
PMH: seasonal allergies with Chronic Sinusitis, positive for osteoarthritis,
Meds: Claritin 10 mg po daily, ibuprofen 400-600 mg po prn pain
Family Hx-non contributary
Social history: Separated recently pending divorce; stressful situation with trying to manage two homes. Works as a Legal Assistant at a local law firm. She has 35 PPY of smoking, drinks 1-2 glasses of wine a day, and 6-7 cups of coffee per day. She denies illicit drug use, vaping or unprotected sexual encounters.
Breath test in the office revealed urease.
The healthcare provider suspects the client has peptic ulcer disease.
Questions:
1. Explain what contributed to the development from this patient’s history of PUD?

QUESTION 2
1. Scenario 1: Peptic Ulcer
A 65-year-old female comes to the clinic with a complaint of abdominal pain in the epigastric area. The pain has been persistent for two weeks. The pain described as burning, non-radiating and worse after meals. Denies N&V, weight loss or obvious bleeding. She admits to frequent belching with bloating.
PMH: seasonal allergies with Chronic Sinusitis, positive for osteoarthritis,
Meds: Claritin 10 mg po daily, ibuprofen 400-600 mg po prn pain
Family Hx-non contributary
Social history: Separated recently pending divorce; stressful situation with trying to manage two homes. Works as a Legal Assistant at a local law firm. She has 35 PPY of smoking, drinks 1-2 glasses of wine a day, and 6-7 cups of coffee per day. She denies illicit drug use, vaping or unprotected sexual encounters.
Breath test in the office revealed urease.
The healthcare provider suspects the client has peptic ulcer disease.
Question:
1. What is the pathophysiology of PUD/ formation of peptic ulcers?

QUESTION 3
1. Scenario 2: Gastroesophageal Reflux Disease (GERD)
A 44-year-old morbidly obese female comes to the clinic complaining of “burning in my chest and a funny taste in my mouth”. The symptoms have been present for years but patient states she had been treating the symptoms with antacid tablets which helped until the last 4 or 5 weeks. She never saw a healthcare provider for that. She says the symptoms get worse at night when she is lying down and has had to sleep with 2 pillows. She says she has started coughing at night which has been interfering with her sleep. She denies palpitations, shortness of breath, or nausea.
PMH-HTN, venous stasis ulcers, irritable bowel syndrome, osteoarthritis of knees, morbid obesity (BMI 48 kg/m2)
FH:non contributary
Medications: Lisinopril 10 mg po qd, Bentyl 10 mg po, ibuprofen 800 mg po q 6 hr prn
SH: 20 PPY of smoking, ETOH rarely, denies vaping
Diagnoses: Gastroesophageal reflux disease (GERD).

Question:
1. If the client asks what causes GERD how would you explain this as a provider?

QUESTION 4
1. Scenario 3: Upper GI Bleed
A 64-year-old male presents the clinic with complaints of passing dark, tarry, stools. He stated the first episode occurred last week, but it was only a small amount after he had eaten a dinner of beets and beef. The episode today was accompanied by nausea, sweating, and weakness. He states he has had some mid epigastric pain for several weeks and has been taking OTC antacids. The most likely diagnosis is upper GI bleed which won’t be confirmed until further endoscopic procedures are performed.
Question:
1. What are the variables here that contribute to an upper GI bleed?

QUESTION 5
1. Scenario 4: Diverticulitis
A 54-year-old schoolteacher is seeing your today for complaints of passing bright red blood when she had a bowel movement this morning. She stated the first episode occurred last week. The episode today was accompanied by nausea, sweating, and weakness. She states she has had some LLQ pain for several weeks but described it as “coming and going”. She says she has had a fever and abdominal cramps that have worsened this morning.
Diagnosis is lower GI bleed secondary to diverticulitis.
Question:
1. What can cause diverticulitis in the lower GI tract?

Syndrome of Antidiuretic Hormone

/0 Comments/in /by

 Endocrine Disorders

• In this exercise, you will complete 5-essay type questions in the Knowledge Check to gauge your understanding of this module’s content.
• Each question will hold one to two parts asked to be addressed and each part will need at least one citation, at least two citations if asked two parts to the question from the textbook and/or current peer-reviewed journals.
• Each question is worth 4 points. I would expect substantive paragraphs per answer (a paragraph would include 6-10 sentences).

KC each essay needs a citation(s) and reference(s), if using textbook apply correct page(s)
Basic book citation format
The APA in-text citation for a book includes the author’s last name, the year, and (if relevant) a page number.
In the reference list, start with the author’s last name and initials, followed by the year. The book title is written in sentence case (only capitalize the first word and any proper nouns). Include any other contributors (e.g. editors and translators) and the edition if specified (e.g. “2nd ed.”).
Format Last name, Initials. (Year). Book title (Editor/translator initials, Last name, Ed. or Trans.) (Edition). Publisher.
Reference entry Anderson, B. (1983). Imagined communities: Reflections on the origins and spread of nationalism. Verso.
In-text citation (Anderson, 1983, p. 23)

•
QUESTION 1
1. Scenario 1: Syndrome of Antidiuretic Hormone (SIADH)
A 77-year-old female was brought to the clinic by her daughter who stated that her mother had become slightly confused over the past several days. She had been stumbling at home and had fallen twice but was able to walk with some difficulty. She had no other obvious problems and had been eating and drinking. The daughter became concerned when she forgot her daughter’s name, so she thought she better bring her to the clinic.
HPI: Type II diabetes mellitus (DM) with peripheral neuropathy x 30 years. Emphysema. Situational depression after death of spouse 6-months ago
SHFH: – non contributary except for 40 pack/year history tobacco use.
Meds: Metformin 1000 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-102 mg/dl, BUN 16 mg/dl, Creatinine 1.1 mg/dl, Na 116 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:
1. Define SIADH and identify any patient characteristics that may have contributed to the development of SIADH

QUESTION 2
1. Scenario 2: Type 1 Diabetes
A 14-year-old girl is brought to the pediatrician’s office by his parents who are concerned about their daughter’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with her school activities. She had been seemingly healthy until about 4 months ago when her parents started noticing these symptoms. She admits to sleeping more and gets tired very easily.
PMH: noncontributory.
Allergies-NKDA
FH:- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process
SH: denies alcohol, tobacco or illicit drug use. Not sexually active.
Labs: random glucose 244 mg/dl.
DIAGNOSIS: Diabetes Mellitus type 1 and refers to an endocrinologist for further work up and management plan.

Question
1. Explain the pathophysiology of the three P’s for (polyuria, polydipsia, polyphagia)” with the given diagnosis of Type I DM.

QUESTION 3
1. Scenario 2: Type 1 Diabetes
A 14-year-old girl is brought to the pediatrician’s office by his parents who are concerned about their daughter’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with her school activities. She had been seemingly healthy until about 4 months ago when her parents started noticing these symptoms. She admits to sleeping more and gets tired very easily.
PMH: noncontributory.
Allergies-NKDA
FH:- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process
SH: denies alcohol, tobacco or illicit drug use. Not sexually active.
Labs: random glucose 244 mg/dl.
DIAGNOSIS: Diabetes Mellitus type 1 and refers to an endocrinologist for further work up and management plan.

Question
1. Explain the genetics relationship and how this and the environment can contribute to Type I DM.

QUESTION 4
1. Scenario 3: Type II DM
A 55-year-old male presents with complaints of polyuria, polydipsia, polyphagia, and weightloss. He also noted that his feet on the bottom are feeling “strange” “like ants crawling on them” and noted his vision is blurry sometimes. He has increased an increased appetite, but still losing weight. He also complains of “swelling” and enlargement of his abdomen.
PMH: HTN – well controlled with medications. He has mixed hyperlipidemia, and central abdominal obesity. Physical exam unremarkable except for decreased filament test both feet. Random glucose in office 333 mg/dl.
Diagnosis: Type II DM and prescribes oral medication to control the glucose level and also referred the patient to a dietician for dietary teaching.

Question:
1. How would you describe the pathophysiology of Type II DM?

QUESTION 5
1. Scenario 4: Hypothyroidism
A patient walked into your clinic today with the following complaints: Weight gain (15 pounds), however has a decreased appetite with extreme fatigue, cold intolerance, dry skin, hair loss, and falls asleep watching television. The patient also tearfulness with depression, and with an unknown cause and has noted she is more forgetful. She does have blurry vision.
PMH: Non-contributory.
Vitals: Temp 96.4˚F, pulse 58 and regular, BP 106/92, 12 respirations. Dull facial expression with coarse facial features. Periorbital puffiness noted.
Diagnosis: hypothyroidism.

Question:
What causes hypothyroidism?

Comparing Philosophical Approaches

/0 Comments/in /by
Comparing Philosophical Approaches: Plato and Aristotle

Can we trust what we see, hear, and feel? Do our senses tell us how the world “really” is? Or is there a different reality that our senses cannot fully help us comprehend? Both Plato and Aristotle grappled with these questions, and each philosopher settled on his own theory. In this assignment, you will explore Plato’s theory of rationalism as well as Aristotle’s theory of empiricism. You will then connect one of these two theories with your own experience.To prepare for this Discussion:

Complete Interactive Unit 2, Module 1, titled “The Meaning of Philosophy.” Pay particular attention to the pages in which Plato and Aristotle are discussed.
To complete this Discussion:

By Day 4
Post to the Discussion board the following:

A description of the philosophical approach of the Rationalists (represented by Plato) and the Empiricists (represented by Aristotle). As part of your descriptions, identify at least two ways in which these approaches differ from one another.
A paragraph in which you select either Rationalism or Empiricism as the approach that resonates most deeply with your personal experiences. Support your selection with an example from your own life.

UNIT 1, Module 1, “The Meaning of Philosophy.” Pay particular attention to the pages in which Plato ans Aristotle are discussed.

The Philosophical Perspective Introduction
Introduction

In this course, we will explore the discipline of Philosophy as the pursuit of wisdom. Throughout our lives, we all seek wisdom in different ways. In this course, we will focus on the quest for knowledge in our relationship with others, our contact with the objective world, and our relationship with ourselves.

These three fundamental ways of pursuing wisdom through relating to the world, to others, and to ourselves are known as the practice of “critique,” the practice of “dialogue,” and the practice of “self-examination,” respectively. Throughout the course, we will continually refer back to these fundamental practices to remind us of the meaning that philosophy has in all the various aspects of our lives.

The philosophical tradition that we will be studying began with the practice of dialogue in ancient Greece. The first texts we will encounter in this course are Plato’s dialogues — passages presented as a series of conversations between two partners who are seeking answers to tough questions of their day, such as the question, “What is justice?” Dialogue, however, as the ancient philosophers discovered, gives way to questions about the world around us.

All human beings, Aristotle says, seek knowledge. Since human beings are always seeking knowledge, we are also continually making claims about the world around us. The problem, however, is that everyone— by being human—has claimed about the world.

When engaging others in dialogue, we often run into the problem that others do not agree with our claims about the world. The task of philosophy beyond discussion, therefore, is to find out which claims about the world are true and which are false. This practice is known as critique—allowing examination of one’s claims and views about the world in light of the evidence, reason, and argument.

However, as both ancient and modern philosophers discovered, wonder about the world around us eventually come back to the inquiry of our role in the world—the question of ourselves. For, after all, if so many people disagree about the reality of the external world, how can I be sure that there exists an external world apart from my perception? Does the world live as I see it precisely, or is there something more to it? Is there an objective world apart from my limited understanding, or are my beliefs about the world all that matter? This problem is one that caused both Plato and Descartes to wonder. For both philosophers, this question led to the third sphere of philosophical practice: self-examination.

In this way, we will approach the study of philosophy in this course as a pursuit of wisdom in our encounters with others (dialogue), in our contacts with the external world (critique), and in our meeting with ourselves (self-examination).

At the end of this lesson, students will be able to:

Explain concepts central to philosophical inquiry.
Describe Western philosophical tradition and timelines.
Identify significant figures in the birth of philosophy in ancient Greece.
Describe critiques, opinions, arguments, and the Socratic Method.
Describe the building blocks of logic and the structure of an argument.
Explain how to classify and evaluate an argument.
Describe the traditional branches of philosophy.
Distinguish different forms of philosophical skepticism.
Describe the types of continental and analytic philosophy.

Diabetes Care through Government services

/0 Comments/in /by

Diabetes Care through Government services; At our hospital, the government health facility gives free service to diabetics who are under age 18 and over age 64.

However with diabetes being so prevalent and chronic leading to kidney failure and other illnesses I want to propose that my country’s government give diabetics of all ages access to free diabetes medication and free clinic follow up with 2 free HBA1c lab tests per year and free glucose test strips for the glucose monitors.

Also, I want to propose the government strengthen the school health program to include monitoring Diabetes children while at school.

Can you see if any of the country’s or country’s government health systems provides free care for diabetes patients?

Do a Literature review of how the government healthcare system of a Caribbean country and another country (you can choose which country) has stepped in to ensure diabetics receive diabetes medication and follow-up care. This is to put together a proposal for the government and health system in my country to make diabetes care and follow-up accessible to all citizens no matter the economic status.

Philosophies of Women and People of various Cultures

/0 Comments/in /by

Philosophies of Women and People of various Cultures. Many women have pushed back against these accusations and misogynistic views, sparking an intellectual revolution in the process. For a long time, philosophy was seen as a boy’s club, but with Simone de Beauvoir’s views, Harriet Taylor Mill, Hypatia of Alexandria, and others, that prejudice has been dispelled. A diverse perspective is sometimes required to make progress, and a fabulous idea can originate from anybody, anywhere.

Males have definitely controlled the philosophical discourse, Marjorie, especially in terms of whose voices were taken seriously. Men have long defined women as different and. often, less than. Are female philosophers caught within a “Catch 22”? Are they marginalized as long as their gender is highlighted, as long as they continue to be called “female philosophers” instead of just philosophers? Do we ever append male to the philosopher, or do we see that as the default?

Of course, this raises some very big issues about sex and gender, with sex being defined as biological differences between males and females and gender being described as the cultural constructs that the culture attachs to sex. And we often mistake one for the other, mistake cultural constructions for biological differences.

Ursula Le Guin’s classic, award-winning science fiction novel The Left Hand of Darkness imagines a world without gender. That world’s inhabitants are not just genderless, but sexless for most of the time (on a regular cycle they become one gender or the other, not always the same gender each cycle, during which they can have sex and even reproduce). What is particularly interesting is that the story is told from the perspective of a man from Earth. And he repeatedly misreads people on this planet (sometimes to his great detriment) because he cannot get past his own assumptions about gender.

This brings us back to the issue of universality here on Earth. Do we often mistake the male experience as the universal experience?

 Non-Opioid Pain Intervention for Veterans

/0 Comments/in /by

 Non-Opioid Pain Intervention for Veterans; PICO – In injured veterans experiencing chronic pain (P), does the use of non-opioid modalities (Pharmacological and Non-pharmacological) (I), compared to the administration of systemic opioids (C), lead to improved pain management and decreased incidence of opioid overdose (O)?