Peritonitis Essay Paper Assignment Available

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Assignment Instructions
• You will each choose 3 different journal published research study articles that explain the patient’s behavioral and/or psychological responses to having the illness. Do not include articles discussing the physiology or pharmacology of the illness, treatment of the illness or behavioral/psychological responses, or the risk factors for first developing the illness.
• Locate relevant journal published research study articles (these articles need to have been written after 1997 and you must NOT use general literature review articles.
• Choose the 3 articles that best relate to your case study patient.
• Briefly summaries the main topic and focus of each study and include a very summary of the study’s methodology, results, and discussion (i.e. where the authors explain the reasons for their findings and research conclusions) for the articles;
• discuss how each article explicitly and specifically explains the behavioral and psychological responses that the patient in your case study is experiencing in response to their illness.
• Make sure you are using article databases such as PsycINFO, MEDLINE, and CINAHL to run your searches. PsycINFO is likely to find you the most relevant articles for this assignment and all assignments within the behavioral stream. Just using Google or Google Scholar will NOT find you the articles you need. Also, make sure that the search terms you are using will give the databases the best chance of returning the articles you want. If you get no results with one search term, then try another or try and think laterally (e.g. what might be another word for “aggression” that you might find in the literature… hint: what about “irritability”? Or another word for “anxiety” might be “fear” etc.).
• The articles you include must have been published in a journal. Do not include theses, magazines, books or book chapters, letter to the editor or news articles. Academic journals publish all sorts of articles including research studies, book reviews, general literature reviews, editorials/commentaries, letters) but for the articles you include in your Annotated Bibliography you need to use only research study articles. A research study article will describe in detail a qualitative or quantitative research study (e.g., an experiment) including information about the study’s methodology, results, discussion and conclusions. For example, the Module 1 reading Zeilani and Seymour (2012) qualifies as a research study article because the authors describe how they collected and analyzed their data. A Module 3 reading, Lusk and Lash (2005) is a general literature review and does not qualify as a research study as the author does not specify how they went about sourcing information for their article. Lusk and Lash’s article is still a credible and valid source of reference information but it is not a research study and so cannot be used in the Annotated Bibliography assignment.

SAMPLE ANSWER

Peritonitis is a health condition that involves the inflammation of peritoneum (thin protective tissue layer that underlie the abdomen). This health condition is caused by infection which spreads around the body. It requires immediate treatment to prevent fatal complications from arising. In patients who have undergone surgical treatment, autonomic responses, mood swings and psychological coping responses are common. This paper explores 3 different journal study articles that explain patient’s behavioral and psychological responses to this illness. This study focuses on behavioral and psychosocial responses following surgical responses.

Boer, K. R., Mahler, C. W., Unlu, C., Lamme, B., Vroom, M. B., Sprangers, M. A., … Boermeester, M. A. (2007). Long-term prevalence of post-traumatic stress disorder symptoms in patients after secondary peritonitis. Critical Care, 11(1), R30.

Introduction/Literature review: This study investigates the behavioral response following secondary peritonitis. This is because numerous hospital admissions and intensive care unit (ICU) can be physically, emotionally and financially exhaustive. Patients who survive critical illness report critical poor quality of live and symptomology (PTSD) such as numbing, anxiety, loss of avoidant and intrusive recollections. The study suggests that the behavioral interventions are vital in patients with secondary peritonitis.

Methodology: This is a retrospective cohort in patients diagnosed with secondary peritonitis. The study comprises of 278 patients who had undergone surgery for secondary peritonitis, where 131 of them were long term survivors. The patients were interviewed Post-traumatic Stress Syndrome 10-question inventory (PTSS-10).

Study/ Results: The study indicates that in a cohort of 100 patients diagnosed with secondary peritonitis, 86% of them presented with post traumatic stress disorder. PTSD related symptoms were also present in 4.3 times higher in older male patients.

Discussion/explanation: The study indicates that 25% patients who have received surgical treatment for peritonitis are likely to be emotionally and physically upset due to surgical-related trauma, which could exacerbate illness behavior. The study suggests that patterns of behavior are seen as a product of socio-cultural conditioning and coping strategies. The study suggests that healthcare providers should recognize patient’s responses to various health procedures associated with pain and anxiety. Other symptoms such as impaired appetite, lack of energy and disturbed sleep can occur due to illness. In addition, some treatments can affect patient’s mood. These conditions can also be aggravated by other environmental factors such as financial strain of lack of physical and emotional support.

Application to the case study: The study findings contribute to the body of research that demonstrates that psychosocial responses in patients are associated with the socio-cultural factors. The suggests that the healthcare providers should incorporate psychosocial interventions in routine care so as to help patients such as Mr. Jacobs to manage stress associated with their new lifestyles of dependency, helplessness and pain. It is important for the healthcare providers to identify and be aware of this hidden morbidity among the patients diagnosed with secondary peritonitis.

Jennifer Finnegan-John and Veronica J. Thomas, “The Psychosocial Experience of Patients with End-Stage Renal Disease and Its Impact on Quality of Life: Findings from a Needs Assessment to Shape a Service,” ISRN Nephrology, vol. 2013, Article ID 308986, 8 pages, 2013. doi:10.5402/2013/308986

Introduction/Literature review: This study investigates the psychosocial experiences in patients with end stage renal disease. The study conducts needs assessment on renal patients to explore their psychological, spiritual and social needs. The study objective was to investigate behavioral responses and to conduct needs assessment so as to develop a comprehensive health psychology that can run concurrently with renal counseling.

Methodology: The study design is prospective qualitative. The study population consisted of 50 patients with end stage renal disease. The mean age of the participants was 55 years and 40% of them were from black and minority ethnic group. The study utilized series of semi- structured face to face interviews in renal patients and their carers in order to explore their behavioral and psychological responses and how the disease impacted their quality of life.

Study/ Results: The study findings indicated that depressive symptoms and disruptive behaviors are common in renal patients. This is associated with the psychological burden associated with the disease. Most of the patients in the study had feelings associated with depression and anxiety.

Discussion/explanation: This retrospective study indicates that depression and anxiety is a common behavioral response in patient diagnosed with renal disease. The study suggests that about 25% of patients who are diagnosed with the disease suffer from psychological burden. This behavioral response is associated with emotional numbness, avoidance of social activities and events. It is also associated difficulty in sleeping, disruptive and reckless behavior and is easily irritated. The study states that these are body responses to stress or perceived threat.

Application to the case study: The study indicates that depression and anxiety is a behavioral response that goes beyond the mental health. Based on this study, Mr. Jacob’s behavioral responses (irritability, social isolation and binge drinking) could be associated with the emotional burden of the disease. This research is interesting because it suggests that healthcare providers should engage with psychiatrists to help them better manage their improved outcome health.

Mckercher, C.M., Venn, A.J., Blizzard, L., Nelson, M., Palmer, A., Sshby, M., Scott, J., and Jose. M.D. (2012). Psychosocial factors in adults with chronic kidney disease: characteristics of pilot participants in the Tasmanian Chronic Kidney Disease study. BMC Nephrology, 14:83DOI: 10.1186/1471-2369-14-83

Introduction/Literature review: This study investigates behavioral and psychosocial responses in patient diagnosed with chronic illness. The literature links health outcomes with depression, anxiety and dispositional tendency described by aggression, cynicism attitudes and anger/irritability. The study also indicates that hostility, anger and depression are related with renal failure experiences. According to this study, these psychosocial responses are controlled by biomedical risk factors, and are associated with most aspects of immune function.

Methodology: This study design is quantitative. The study consisted of 105 patients above 18 years diagnosed with stage 4 CKD and was not under dialysis. The measures used in this study include depression (9- item patient Health questionnaire) and Beck Anxiety Inventory to investigate behavioral responses with disease progression and patient’s quality of life.

Study/ Results: The study findings indicated that hostility and patient’s behavioral responses to chronic disease are correlated with their plasma levels of CRP. The study findings indicated that the cycle of inflammation levels influence depressive behavior, indicating that depression is problematic indicator of patients under chronic pain.

Discussion/explanation: The longitudinal study findings indicated that there is a relationship between the CRP levels and psychosocial factors. The study also states that hormonal changes also induce inflammatory processes which in turn influence psychosocial responses. For instance, pain initiates systemic stress which activates neuro-endocrinological pathways (hypothalamic-pituitary-adrenal axis) leading to the secretion of stress hormone. Accumulation of stress hormone is associated with hostility and depressive symptoms. The study also suggests that genetic predispositions play a major role in both inflammation and hostility.

Application to the case study: The study findings contribute to the body of research that demonstrates that psychosocial responses in patients are associated with systemic inflammation. This indicates that the Mr. Jacob’s depressive behavior (irritability, social isolation and binge drinking) is associated with elevated levels of the systemic inflammation. This research is interesting because it suggests that healthcare providers should reduce systemic inflammation so as to improve patient’s ability to improve pain, and to help them cope with the illness-induced stress in their lives.

References

Jennifer Finnegan-John and Veronica J. Thomas, “The Psychosocial Experience of Patients with End-Stage Renal Disease and Its Impact on Quality of Life: Findings from a Needs Assessment to Shape a Service,” ISRN Nephrology, vol. 2013, Article ID 308986, 8 pages, 2013. doi:10.5402/2013/308986

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Benchmark Electronic Medical Records Essay

Benchmark Electronic Medical Records Essay Order Instructions:

Although technology advances in the health care industry have been widespread, organizations continue to grapple with implementation challenges. It is important to understand how organizations identify needs and address obstacles. You can view this process through the lens of electronic medical records (EMR) implementation and the perspective of a health care leader.

Interview an upper-level manager (e.g., CEO, CFO, CIO, IT manager) in a hospital or other health care facility that has instituted electronic medical records. Your interview should last about 30 minutes in length and may be completed face-to-face or over the phone. The interview should focus on the implementation of the EMR system, including:
1.Factors that influenced the organization to institute the EMR system.
2.Resistance to the decision-making process.
3. Obstacles experienced during the initial EMR rollout.
4.The overall impact on quality in health care since instituting the EMR system.

Write an 825-1,250 word paper summarizing the interview and the interviewee’s perspectives on the four points above. Your paper should also include a brief history of electronic medical records in the health care industry. How does the information gained in the interview match up with your readings/research on the subject?

Cite at least three references, including your textbook.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

1
Unsatisfactory
0.00%

2
Less than Satisfactory
65.00%

3
Satisfactory
75.00%

4
Good
85.00%

5
Excellent
100.00%

70.0 %Content

55.0 % Essay Report on Interview With a Health Care Manager to Determine Facts Related to the Institution of Electronic Medical Recordkeeping (EMR) as an Industry-wide Practice

An essay does not demonstrate an understanding of the business concepts involved regarding the institution of EMR, including the implications. The essay does not address the history of EMR in health care, resistance, and impacts on quality as specified in the assignment. The essay does not demonstrate critical thinking and analysis of the situation, including relating findings to module coursework and does not develop effective answers to the questions, with rationale.

The essay demonstrates an only minimal understanding of the business concepts involved regarding the institution of EMR, including the implications. Essay minimally addresses the history of EMR in health care, resistance, and impacts on quality as specified in the assignment. D Essay demonstrates minimal abilities for critical thinking and analysis, including relating findings to module coursework, and develops weak answers to the questions with minimal rationale.

The essay demonstrates knowledge of the business concepts regarding the institution of EMR but has some slight misunderstanding of the implications. Essay satisfactorily addresses the history of EMR in health care, resistance, and impacts on quality as specified in the assignment. The essay provides a basic idea of critical thinking and analysis, including relating findings to module coursework, and rationale. The essay does not include examples or descriptions.

The essay demonstrates an acceptable knowledge of the business concepts regarding the institution of EMR, including the implications. Essay satisfactorily develops the history of EMR in health care, resistance, and impacts on quality as specified in the assignment. Essay develops an acceptable response and rationale for it, including relating findings to module coursework. Essay utilizes some examples.

The essay demonstrates a thorough knowledge of the business concepts regarding the institution of EMR, including the implications. Essay thoroughly develops the history of EMR in health care, resistance, and impacts on quality as specified in the assignment. Essay clearly answers the questions and develops a very strong rationale, including relating findings to module coursework. Essay introduces appropriate examples.

15.0 % Integration of Information From Outside Resources Into the Body of Paper

The assignment does not use references, examples, or explanations.

The assignment provides some supporting examples, but minimal explanations and no published references.

Assignment supports main points with examples and explanations.

Assignment supports main points with explanations and examples. Application and description are direct, competent, and appropriate of the criteria.

Assignment supports main points with references, examples, and full explanations of how they apply.

20.0 %Organization and Effectiveness

7.0 % Thesis Development and Purpose

Paper lacks any discernible overall purpose or organizing claim.

Thesis and/or main claim are insufficiently developed and/or vague; the purpose is not clear.

Thesis and/or main claim are apparent and appropriate to the purpose.

Thesis and/or main claim are clear and forecast the development of the paper. It is descriptive and reflective of the arguments and appropriate to the purpose.

Thesis and/or main claim are comprehensive; contained within the thesis is the essence of the paper. Thesis statement makes the purpose of the paper clear.

8.0 % Argument Logic and Construction

Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. The argument is incoherent and uses noncredible sources.

Sufficient justification of claims is lacking. The argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.

The argument is orderly but may have a few inconsistencies. The argument presents a minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.

The argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from the introduction to the conclusion. Most sources are authoritative.

Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

5.0 % Mechanics of Writing (includes spelling, punctuation, grammar, language use)

Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice and/or sentence construction are used.

Some mechanical errors or typos are present but are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.

The prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.

A writer is clearly in command of standard, written, academic English.

10.0 %Format

5.0 % Paper Format (use of appropriate style for the major and assignment)

The template is not used appropriately, or documentation format is rarely followed correctly.

Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent.

Appropriate template is used. Formatting is correct, although some minor errors may be present.

Appropriate template is fully used. There are virtually no errors in formatting style.

All format elements are correct.

5.0 % Research Citations (in-text citations for paraphrasing and direct quotes, and reference page listing and formatting, as appropriate to assignment and style)

No reference page is included. No citations are used.

The reference page is present. Citations are inconsistently used.

The reference page is included and lists sources used in the paper. Sources are appropriately documented, although some errors may be present.

The reference page is present and fully inclusive of all cited sources. Documentation is appropriate and citation style is usually correct.

In-text citations and a reference page are complete and correct. The documentation of cited sources is free of error.

100 % Total Weightage

Benchmark Electronic Medical Records Essay Sample Answer

Benchmark-Electronic Medical Records Essay

Benchmark Electronic Medical Records Essay Introduction

EMR, Electronic Medical Records, traces back to the late 191960s Before this, doctor‘s relied only on recording patient’s diagnoses and treatment (“A History of Electronic Medical Records [Infographic] – Net Health,” 2016). During 19the ’60s, the idea of the Problem Oriented Medical Record was brought up by Larry Weed and it got incorporated into the practice of medicine. The use of EMR brought more than recording diagnosis to tracking patient health records. According to the Chief Executive Officer, that I interacted with, the factors influencing the implementation of EMR range from managerial factors of hospitals to environmental factors. The question behind some hospitals adopting the use of EMR while others do not poses the need to look at the possible factors that create a challenge to such institutions and how it can be properly done for the benefit of quality health care.

Factors that created the need for the EMR system

Need to Improve Care Coordination

The CEO admitted that the reason why they wanted an EMR was to improve coordination between their health system and their local network. Health information exchange is the only way to ensure patients being moved from one hospital to another get proper care and treatment alongside the right diagnosis. The platform was necessary for the statewide information exchange (Smith, 2016).

Cost Savings and Efficiencies

Another factor that led to the need for an EMR system was a cost reduction strategy and improved efficiency. Reviews from health websites of companies that had adopted the use of the EMR system made this organization opt for the option of implementing the system.

Improved Patient Care

The need for an improved patient care also served as a drive towards the necessity of an EMR system. The institution was after offering quality care, and this could not be made possible through an old and outdated manual system of doing work but through an EMR system (“The Benefits of Electronic Health Records (EHRs) | Providers & practitioners | HealthIT.gov,” 2016).

Environmental Features

Demand for EMR system heavily relied on the existence of other hospitals which use the system. The information opened the reality that competition influenced the need and fast adoption of the use of the EMR system. The institutions made all efforts to stay in business and therefore adoption of the EMR system helped them to be at par with their competitors.

Resistance to the decision-making process.

The adoption of the system was not readily welcomed by the committee as alleged by the CEO. He admitted that the process took quite some time before approval. There were some factors which formed an impediment towards the acquisition of the EMR system (Smith, 2016).

Funding

The primary factor behind refraining from the system was the inability of the hospital to purchase the system in the first place. Alongside the initial cost, the hospital was also forced to incur the cost of training their staff on the use of the EMR, and this would be expensive too. Therefore, an alternative viable funding solution had to be found, or the project would not be as feasible as it had been planned.

Lack of IT department

The health institution committee believed that the institution had a lot to do with the initial roll out of the system. An IT department had to be set up and running before the system is brought. The process of acquiring new staff and putting on the payroll was considered costly and the time limit for the system roll out was inadequate.

Obstacles experienced during the initial EMR rollout.

Users of EMR

At the initial roll out, not everyone was on board with the concept of using EMR. Some patients and health care providers had difficulty using the EMR. Initial technical malfunctions of the system made them give up on the utilization of the EMR. Patients and staff formed a barrier as users of the system (“6 common challenges in EHR implementation – Office Practicum®”, 2016).

Break up of workflow

The main benefit of using the EMR involves the creation of workflow. However, the system took much time than expected to ensure steady workflow as a result of improper customization into the purpose of the company. However, the vendor helped out to minimize the problem and later all when smoothly.

Training of Users

Unfortunately, effort, time and resources required for the process are costly. The process of convincing the staff and other co-workers in using the EMR system is tiresome and lengthy. However, the training process forms an integral part of the EMR implementation. Therefore, every institution should take into consideration the cost of training before implementing EMR.

Privacy Concerns

Patient confidentially agreement are a vital part of medical practice, and all patient files must be kept properly. The use of EMR posed the question of patient data being accessed by any individual, and this presented a challenge. The other main concerns about the use of the EMR system included the loss of patient data as a result of cyber-attacks and even the occurrence of natural disasters. Therefore, the consent of patients had to be obtained through persuasion that their data is safe and far from unauthorized access.

Outcome on quality of health care

The assessed implications of the EMR system included improved coordination of attention, more patients adopted the use of EMR system, improved availability of patient information and this resulted in improved medical care and accurate diagnosis of patients.

Benchmark Electronic Medical Records Essay References

6 common challenges in EHR implementation – Office Practicum®. (2016). Office Practicum®. Retrieved 23 November 2016, from http://officepracticum.com/industry-news/electronic-health-records/6-common-challenges-in-ehr-implementation/

A History of Electronic Medical Records [Infographic] – Net Health. (2016). Net Health. Retrieved 23 November 2016, from http://www.nethealth.com/a-history-of-electronic-medical-records-infographic/

Smith, P. (2016). Implementing an EMR System: One Clinic’s Experience – Family Practice Management. Aafp.org. Retrieved 23 November 2016, from http://www.aafp.org/fpm/2003/0500/p37.html

The Benefits of Electronic Health Records (EHRs) | Providers & Professionals | HealthIT.gov. (2016). Healthit.gov. Retrieved 23 November 2016, from https://www.healthit.gov/providers-professionals/benefits-electronic-health-records-ehrs

Liver disease Research Paper Available Here

Liver disease

Order Instructions:

select only one (1) of the case studies provided :

• Remember this is an essay and should be structured as such with an introduction body and conclusion. Do not simply answer the questions provided, these are given as a guide. You will be expected to use research or evidence-based journal articles, textbooks and appropriate authoritative web sites (not Better Health Channel, Virtual Hospital, etc.).
• All referencing is to be formatted using the APA referencing style. Please ensure carefully to follow the marking criteria

SAMPLE ANSWER

Liver disease

Introduction

Alcohol is a hepatotoxic compound that is commonly consumed across the globe. It is linked to a broad range of liver associated injury, ranging from simple steatosis, fibrosis to cirrhosis (Torruellas, French, & Medici, 2014). Alcohol liver disease refers to a spectrum of alcohol-related injuries that are potentially reversible especially when the progression of the disease is detected early enough. Therefore, regular screening and early diagnosis are essential. Excessive alcohol consumption adversely affects the health of an individual and is one of the primary causes of death in the world. Harmful or excessive use of alcohol results in a mortality rate of up to 2.5 million and an approximate disability of adjusted life years of up to o 69.4 million (Shield, Parry, & Rehm, 2013). As a result, it has been ranked as one of the leading risk factors for death and disability worldwide. The toxicity of alcohol components including ethanol largely contribute to increased chances of developing liver disease. The liver controls most of the body support systems, therefore, a disease of the liver is fatal as it will lead to malfunction of all the major body systems

Causes of confusion and other symptoms.

Various factors contribute to the occurrence of liver disease. Of these, duration and amount of alcohol consumed are most significant. Host factors such as IPNPLA3 gene polymorphisms and obesity and environmental factors also contribute to an increased risk of developing liver disease (Singal, Chaha, Rasheed, & Anand, 2013). Disease of the liver leads to reduced functionality of the liver which consequently cause accumulation of toxic substances in the bloodstream. These instances lead to alterations in the level of consciousness of an individual, confusion, and other cases coma. In Mr. McGrath’s case, hepatic encephalopathy may be the cause of disorientation.

Abdominal swelling by the patient indicates extensive complications. Life-threatening complications associated with portal hypertension including ascites may be present in the patient. Increased pressure on the portal vein leads to ascites characterized by fluid build-up in the abdominal cavity. Yellowish skin, delirium, and confusion are also observed in this condition (A.D.A.M, 2013). Varices are likely to develop in instances of portal hypertension, as a means of providing alternative pathways for diverted blood.

Oesophageal varices pathophysiology and management strategies.

Almost half of the patients suffering from cirrhosis during diagnosis have been found to have gastroesophageal varices (Pericleous et al., 2016). The varices arise due to portal hypertension resulting from an increase in portal blood flow resistance in cirrhosis and also due to the rise in blood inflow into the portal vein. An increase in resistance is said to be structural, due to a destruction of the vascular architecture of the liver by regenerative nodules and fibrosis as a result of an increase in the tone of the hepatic vasculature primarily due to the dysfunction of the endothelium and a decrease in the bioavailability of nitric oxide.

Three principal events cause portal hypertension. First, it can be due to a physical obstruction arising from a fibrosis or at other instances from regenerative nodules resulting in an increase in the resistance to blood flow. An imbalance between vasoconstrictors and vasodilators in the liver also develops. Such imbalance results in a reduction of the activity of eNOS in the liver. The event is, however, rectifiable using medications such as nitrates and beta-blockers. A combination of these events leads to the occurrence of porto-systemic collateral circulation of aiming to decompress the portal circulation (Frazier, Stocker, Kershner, Marasano, & McClain, 2014). Splanchnic vasodilation occurs due to a relative extra-hepatic and ischaemic liver increase in Nitrite Oxide, with the signalling of the sGC-PKG and smooth muscle cell relaxation. This leads to increased blood flow volume into the portal which maintains hypertension. This results in a hyper-dynamic circulation that is linked to these hemodynamic variations in portal hypertension and cirrhosis. This is manifested as high cardiac output with little arterial hypotension and systematic vascular resistance (Pericleous, et al., 2016).

Hepatic pressure can be applied to obtain hepatic venous pressure gradient (HVPG) that ranges normally from 1 to 5mmHg. This procedure is performed by inserting a catheter into a hepatic vein to get the hepatic vein pressure. HVPG is equal to WHVP minus free (HVP) where HVPG is used to represent the gradient between caval pressure and the portal (Molina et al., 2016). FHVP acts as an internal zero by cancelling out variations in abdominal pressure. Sinusoidal hypertension differs from pre-sinusoidal portal hypertension which associated with an increase in HVPG as flow resistance builds up in the portal vein. Varices therefore develop in the event that HVPG is greater than ten mmHg.

Antibiotics have been introduced in variceal hemorrhage management, a factor which has significantly improved clinical outcomes. Bacterial infections, both primary and secondary, are common in cirrhotic patients as bacteria actively translocate from the impaired mucosal surface into the portal system and the patient’s impaired immune function (Molina, Gardner, Souza-Smith, & Whitaker, 2014). In these patients, antibiotics decrease the bacterial load, reducing infections, recurrent bleeding, and reduce morbidity and mortality in patients with gastroesophageal varices. Broad spectrum antibiotics prophylaxis is thus recommended in individuals with suspected and confirmed variceal hemorrhage (Shah, 2016).

Nonselective beta blockers can be used in patients having a low-risk small varices, as they can delay variceal growth preventing variceal bleeding (Runyon, 2015, September 23). The treatment is applied in absence of severe liver disease, and where the varices are without red wale marks. In persons with varices containing red wale marks and others associated with a high risk of haemorrhage, non-selective beta-blockers are used.

For patients that have medium and large varices, endoscopic variceal ligation or beta-blockers can be used. Non-selective beta-blockers are advantageous as they are cheap and use requires no expertise. These medications also prevent against other medical conditions like spontaneous bacterial peritonitis and bleeding from ascites and portal hypersensitive gastropathy (Garcia-Tsao & Bosch, 2011).

The role of abdominal paracentesis and possible complications.

The presence of excess fluid in a patient’s abdominal cavity cause significant discomfort to the patient and shortness of breath. Abdominal paracentesis is a simple procedure that involves insertion of a needle into the peritoneal cavity of the patient to remove the ascetic acid. Removal of a small amount of the fluid for testing is referred to as diagnostic paracentesis, while therapeutic paracentesis is considered the removal of up to five litres of the excess fluid so as to decrease the resultant intra-abdominal pressure helping in relieving related abdominal pain, dyspnea and early satiety (Runyon, 2015).

Paracentesis should be performed by a properly trained physician. Performing this procedure at the time the patient is admitted to a hospital, to patients suspected or suffering from cirrhosis and ascites decrease the mortality rates in a health care setting. In instances where paracentesis was conducted on admission, a lower in-hospital mortality rate was recorded compared to those who did not perform the procedure (Cavazzo, Bugiantella, Graziosi, Franceschini, & Donini, 2013).

Paracentesis also helps clarify the primary cause of ascites when testing for infection. Unexpected diagnoses including chylous, eosinophilic or hemorrhagic ascites can also be indicated by this procedure (Pericleous et al., 2016). Analysis of the fluid shed light on the cause of the ascites and if present, the bacterial infection. Upon culturing antibiotic susceptibility of the bacteria can be identified therefore easier treatment.

Despite the benefits of paracentesis, various complications occur. The ascitic fluid leak is the most common complication associated with the procedure. Failure to peform a Z-track properly can lead to a leakage of the ascetic fluid leak. In this case, a large-bore needle may be used, or when the skin incision created is overly large. If the leak on the surface is prolonged, cellulitis may develop (Wedro, 2015).

Bleeding from a blood vessel may arise if a vein or artery is torn by the needle. Bleeding can be extremely severe and potentially fatal especially if an artery is affected. A further disastrous situation may arise in the presence of renal failure. In patients with primary fibrinolysis, three-dimensional hematomas may develop requiring anti-fibrinolytic treatment (Molina et al., 2014). Bowel infection may occur in instances where the bowel has been injured by the paracentesis needle. Fortunately, this does not usually result to clinical peritoritis, and thus treatment is not necessitated, not unless patients indicate signs of infections. Death may also occur due to paracentesis.

Mr. McGrath educational requirements.

Mr. McGrath should be advice on the importance of total abstinence from alcohol to prevent further complications. He should also be educated to take a diet low on ammonia to reduce the amount of toxic products that will be produced by the body. High cholesterol containing foods should also be avoided to reduce the arterial pressure and therefore amount of fluid in the stomach. The prescribed medicine should be strictly adhered to prevent further complications. Garcia-Tsao & Bosch, (2011) enlighten that support groups and peer help especially from other patients and medical practitioners can be employed to provide additional moral support to patients. Sharing of past experiences by the patients will boost the recovery of Mr. McGrath. Mr.Grath should be advised on the importance of abstinence from cigarettes as they significantly increase the level of toxic compounds in his blood system.

Analysis of Mr. McGrath current prescription.

Propranolol or otherwise known as Inderal is prescribed to the patient for pharmacologic crophylaxis of variceal bleeding. Varices may probably have been identified in the patient. Propranolol reduces the portal pressure through reduction in the cardiac output, and reducing portal blood inflow via splanchnic vasoconstriction (Runyon, 2015, September 23). Spironolactone is an aldosterone antagonist which act on the distal tubules to conserve potassium and increase natriuresis. The drug is mainly used as a diuretic. Furosemide is prescribed to Mr. McGrath to treat the fluid build-up in the body. The drug is an anthranilic acid derivative and a diuretic. It inhibits absorption of sodium and chloride in the proximal, the loop of Henle and distal tubes.

Conclusion

Alcohol liver disease is one of the primary causes of liver-related mortality in the United States. Clinicians, therefore, should be well versed in diagnosis and treatment procedure for the condition. Education to the population may play a significant role in reducing severe forms of the conditions by advocating for early testing and treatment. In Mr McGrath case, follow-up after treatment should be conducted to facilitate a full recovery. In cases of total failure of the liver a transplant should be considered in order to maintain the acceptable toxicity levels of blood ammonia.

References

A.D.A.M (Ed.). (2013, December 23). Cirrhosis. Retrieved September 4, 2016, from The New York Times: http://www.nytimes.com/health/guides/disease/cirrhosis/possible-complications.html

Cavazzo, E., Bugiantella, W., Graziosi, L. A., Franceschini, M. S., & Donini, A. (2013, February). Malignant ascites: pathophysiology and treatment. International Journal of Clinical Oncology, 18(1), 1-9. doi:10.1007/s10147-012-0396-6

Frazier, T. H., Stocker, A. M., Kershner, N. A., Marasano, L. S., & McClain, C. J. (2014, May 1). Critical pathophysiological process and contribution to disease burden. Physiology, 203-215. Retrieved September 04, 2016

Garcia-Tsao, G., & Bosch, J. (2011, March 4). Management of varices and variceal hemorrhage in cirrhosis. The New England Journal of Medicine, 362, 823-832. doi:10.1056/NEJMra0901512

Molina, P. E., Gardner, J. D., Souza-Smith, F. M., & Whitaker, A. M. (2014). Alcohol abuse: Critical pathophysiological processes and contribution to disease burden. Physiology, 29, 203-215. doi:10.1152/physiol.00055.2013

Pericleous, Marinos, Sarowski, Alexander, Moore, Alice, . . . Murtaza. (2016, March). The clinical management of abdominal ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome: a review of current guidelines and recommendations. European Journal of Gastroenterology & Hepatology, 28(3), e10-e19. Retrieved September 04, 2016, from http://www.ingentaconnect.com/content/wk/ejghe/2016/00000028/00000003/art00001?crawler=true

Runyon, B. A. (2015, September 23). Diagnostic and therapeutic abdominal paracentesis. Retrieved September 04, 2016, from UpToDate: http://www.uptodate.com/contents/diagnostic-and-therapeutic-abdominal-paracentesis

Shah, R. (2016, August 24). (P. K. Roy, Editor) Retrieved September 04, 2016, from http://emedicine.medscape.com/article/170907-treatment

Shield, K. D., Parry, C., & Rehm, J. (2013). Focus on: Chronic diseases and conditions related to alcohol use. The Journal of National Institute on Alcohol Abuse and Alcoholism, 35(2). Retrieved September 4, 2016, from http://pubs.niaaa.nih.gov/publications/arcr352/155-173.htm

Singal, A. K., Chaha, K. S., Rasheed, K., & Anand, B. S. (2013, September 28). Liver transplantation in alcoholic liver diseases current status and controversies. World Journal of Gastroenterology, 19(36), 5953-5963. doi:10.3748/wjg.v19.i36.5953

Torruellas, C., French, S. W., & Medici, V. (2014, September 7). Diagnosis of alcoholic liver disease. World Journal of Gastroenterology, 20(33), 11684-11699. doi:10.3748/wjg.v20.i33.11684

Wedro, B. (2015, July 28). Medical treatment. (M. C. Stoppler, Editor) Retrieved September 04, 2016, from E medicine health: http://www.emedicinehealth.com/ascites/page7_em.htm

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Orthodontists Charge Nonrefundable Fee

Orthodontists Charge Nonrefundable Fee Order Instructions: Orthodontists at an annual state meeting agreed to charge the parents of each child patient a nonrefundable fee of $200 before beginning any treatment. They also agreed that the charge for an orthodontia procedure would not be less than $2,000.

Analyze the legality of these agreements, citing the applicable law(s) and the appropriate legal analysis under the applicable law(s) as developed by the courts. What are the possible sanctions if there are legal violations? (25 points) (A 1- to 2-page response is required.)

Orthodontists Charge Nonrefundable Fee Sample Answer

Business Law

The Waiver and arbitration agreement of Orthodontist is that patients are supposed to sign a contract before the beginning of any treatment. These contracts specify the rights the patients have to recover in case of any damages caused during the process of treatment. However, these contracts at times limit the way that a patient can file a reasonable personal injury lawsuit. Besides recovery for damages, the contracts also include the terms of payments. Most Orthodontist will charge a non-refundable fee once records have been done (POULTON, et al., 2005). They also require payment in full before commencing treatment. Other times, the treatment fee may fluctuate and this causes the payment of the patient to go high as well.

Cases of unfair billing practices have been reported. Where an Orthodontist deliberately overcharges a patient or claims money from the insurance company and the individual. That also beside the treatment malpractices can be included in them and it automatically entitles a victim to damages (POULTON, et al., 2005).

Dental fraud is an intentional act of deception and misinterpreting the facts about treatment so as to gain unauthorized advantages. The billing for services not provided for is unlawful and some dentists have become victims of copayments and waiving of coinsurance. This makes insurance companies incur expenses they would not have (POULTON, et al., 2005). The premium costs for the policyholders also shoot up. Most insurance companies and the government healthcare do not allow providers to waive patient’s deductibles.

The sanctions that the law gives in case of the violation of the normal methods of treatment are exclusion from the places of work and even in the health-care programs and enormous fines. Since these are not criminal violations, a jail term is not among the possible sanctions. That the plaintiff obtains a standing to sue since they are entitled to damages (POULTON, et al., 2005).

Orthodontists Charge Nonrefundable Fee References

POULTON, D., VLASKALIC, V. & BAUMRIND, S., 2005. Treatment outcomes in 4 modes of orthodontic practice. Journal of Am. J. Orthod. Dentofacial Orthop., 127(3), pp. 351-354.

Medical Condition in Treatment and Drug Administer

Medical Condition in Treatment and Drug Administer Order Instructions: Adam has been in hospital for five days following his accident. He has had surgery to remove a subdural haematoma and to repair his right fractured tibia and fibula.

This requires a daily dressing to his leg and head, and it is causing him considerable pain. He is on demand only PCA with fentanyl at 40mcg/ml, oxygen 2L/min. During a set of observation being taken, the nurse notices that Adam is a bit drowsy when being spoken to, and difficult to rouse at some point. The nurse checks the medication chart and sees that there is a doctor’s order for Adam to be administered Naloxone if he gets too difficult to rouse. The reaction is instantaneous and Adam is wide awake and orientated.
For this assignment we are to link pathophysiology and pharmacology and explain the reason why Adam might have become drowsy and difficult to rouse ( i.e maybe because of too much pain relief/fentanyl dose) and also about Naloxone effect on Adam, and what the nurse should recommend be done for Adam not to be drowsy and difficult to rouse again (e.g lower the fentanyl dose etc).

Medical Condition in Treatment and Drug Administer Sample Answer

Medical conditions contribute primarily to the body state of rest. The treatments and drugs administered to the patients may cause drowsiness. The drug Fentanyl may have been the primary cause of drowsiness. Fentanyl is an opioid analgesic drug that is metabolized in humans via the cytochrome p450 3A4 enzyme. The drug predominantly interacts with the mu-receptors in the human system which is found in the brain and spinal cord. Its absorbance in the body system has various alterations with drowsiness the most common. In achieving this function, Fentanyl depresses the body respiratory centers and the constriction of pupils. The drug effects may have led to the drowsiness symptoms observed in the patient (RxList, 2016).

Sleepiness may also arise due to the patient’s mental states and lifestyle choices. In this case, the patient’s mental state may have contributed to the drowsiness. Depression due to the disease state’s high level of anxiety and stress could have increased the drowsiness in the patient (Harvard.edu, 2010).

The patient could be suffering from sleeping disorders. The condition is primarily brought about by less sleeping time. Due to the pain felt by the patient, he could be having sleepless nights resulting to drowsiness during the day. Delayed sleep phase disorder could be triggered by the medications given to the patient.

Naloxone is a known opioid antagonist. Its use on the patient is used as a reversal of suspected opioid overdose. However, opioid withdrawal symptoms including drowsiness occur to the patient upon administration of Naloxone. This could have also contributed to the drowsiness of the patient.

To prevent drowsiness, the caregivers should ensure the patient gets enough rest. To treat drowsiness associated with the drug Fentanyl, drugs metabolized by the human cytochrome p450 3A4, e.g. acetaminophen and midazolam, should be given to the patient, to compete for the active sites of metabolism. This will reduce the rate of metabolism, reducing the active compounds of the drug in the blood system (Micromedex, 2016).

Medical Condition in Treatment and Drug Administer References

Harvard.edu, 2010. Medications that can affect sleep. [Online]
Available at: http://www.health.harvard.edu/newsletters/Harvars_Womens_Health_Watch/2101/July/medications-that-can-affect-sleep
[Accessed 11 August 2016].

Micromedex, 2016. Fentanyl (Transdermal Route). [Online]
Available at: http://www.mayoclinic.org/drugs-supplements/fentanyl-transdermal-route/precautions/drg-20068152
[Accessed 11 August 2016].

RxList, 2016. Treatment of kidney failure. [Online]
Available at: http://www.rxlist.com/duragesic-drug/clinical-pharmacology.htm
[Accessed 11 August 2016].

Athophysiology of an Allergic Reaction

Athophysiology of an Allergic Reaction Order Instructions: Briefly discuss the pathophysiology of an allergic reaction brought upon by administering antibiotics to a patient.

Athophysiology of an Allergic Reaction Sample Answer

DYNAMIC OF PRACTICE

An antibiotic reaction occurs soon after one takes the medicine or days after the patient had stopped taking the medicine. This arises because the patient immune system gets sensitive to the medication one takes it, making the patient develop antibiotic reaction the next time they take it. The antibiotics chemical compound combines with the serum proteins forming antigens; the next time one takes the antibiotics, it gives rise to antibodies. This creates immunological conditions. The antigens produce antigen-antibody reaction, releasing histamine and histamine-like substances in the blood stream; which in turn precipitate an alarming shock-like syndrome (McKean, 2012).

Interleukin (IL) 4 and IL 3 play an integral role in initial generation of inflammatory cell responses and the antibiotics. It has also been argued that other chemical substances such as cholinergic substances such as neutral protease, chymase, tryptase, and cytokines mediators activates the complement cascade, the kallikrein-kinin system as well as the coagulation pathways. Eosinophils, prostaglandin, leukotriene B4, cysteinyl leukotrienes and platelet activating factor contributes further to proinflammatory cascade observed in allergic reactions. The severity of the anaphylaxis depends on responsiveness of the targeted cells (Gopalakrishnan, Shukla, & MD, 2010).

This is followed by physiologic responses such as smooth muscle spasm in the gastrointestinal system, vasodilation, sensory endings stimulation and increased vascular permeability. In some cases, there is increased mucous secretion, airway edema and smooth muscle tone causes the observed changes in the respiratory system. The cardiovascular effects are due to capillary leakage, hypotension, syncope, cardiac arrthymias and shock. These physiological events lead to the classic anaphylaxis symptoms including bronchosapsm, angiodema, pruritus, laryngeal edema, abdominal cramping, vomiting, nausea and diarrhea. The concomitant symptoms include dysphonia, rhinorrhea, uterine cramps, headache and light headedness (Castells, 2011).

Athophysiology of an Allergic Reaction References

Castells, M. (2011). Anaphylaxis and hypersensitivity reactions. New York: Humana Press.

Gopalakrishnan, P., Shukla, S., & MD, T. (2010). Antibiotic Prophylaxis and Anaphylaxis. Clinical Medicine & Research, 8(2), 80-81. http://dx.doi.org/10.3121/cmr.2010.929

McKean, S. (2012). Principles and practice of hospital medicine. New York: McGraw-Hill Medical.

National Patient safety Research Paper Out

National Patient safety

Order Instructions:

Rubric Criteria for Mini Research Paper
4 pages total including title page, and reference page.
Concise and to the point (less is more, quality instead of quantity)
Must be in APA format Word document or PDF

Title page in APA format,
4 key points that best exemplifies my National Patient Safety Goal. ( my 4 point are: 1.risk assessment and preventive interventions in the hospital for risk of suicide of Veterans. 2. risk assessment in the hospital for risk of suicide for cancer patient, 3.assessing the risk for suicide in adolescents , 4. risks associated with home oxygen therapy, such as home fires for smocking patients.

Introduction:
State the National Patient Safety goal you have researched, the background on this problem and why it is important for patients and nurses to follow this goal

Body of Paper:
Review of four (4) nursing journal articles on your assigned National Patient Safety goal!!!! (Goal 15: Risk assessment for patient population: 1)Identify patients at risk for suicide, applies to:Behavioral Health Care, Hospital, 2)Identify risks associated with home oxygen therapy, such as home fires, applies to: Home Care

4 articles must be no more than 5 years old, 2011-2016.

Give a brief synopsis of each article and state the main points.
Conclusion
Wrap up what you read and why this is so important to healthcare/nursing
Reference page
Separate page for references, total of four (4) in APA format.
SAMPLE ANSWER

National Patient safety

Introduction

Patient safety is critical in ensuring the best possible outcomes for healthcare institutions. However, some conditions and treatments pose higher risks for patients due to their nature such as high and lethal dosage of cancer drugs, home oxygen, and suicidal thoughts for veterans and adolescents who might be suffering from psychological conditions. It is important for nurses and other healthcare personnel to assess the risks that are posed in each patient cases, and come up with ways of reducing the risk levels, or having them eliminated at once. It is critical to be aware of the risks that different patients are exposed to, and the means through which the safety of patients can be improved.

Improving patient safety through reduction of risks

This part of the health safety paper will cover four journals on different risks that different patients might suffer from. The sections will also cover the actions that can be implemented by health professionals to ensure reduction of risks to patients and their loved ones.

Identify risks associated with home oxygen therapy, such as home fires, applies to: Home Care

According to Cooper (2015), 14-51% of cigarette smokers continue with their habit; which endangers those that use oxygen in their homes. The presence of oxygen in the homes contributes to an improvement of the health of those that are ailing. However, it also contributes to an increase in the risk of flammability in the home. Unfortunately, most cigarette smokers in places with home oxygen fail to report the exact danger that their habits might cause the individuals probably feel some guilt because of the increased risks and dangers that they pose to their loved ones and homes. In 2010, about 4.3% of the United States population as estimated to have experienced home fires based on data from an extrapolation in Maine. Tobacco smoking, cooking, flammable materials, and outdoor fire related activities were blamed as some of the greatest contributors to home fires in the country and globe. Countries such as Finland and Romania had the highest rates of fires while Switzerland and Italy had the lowest level of oxygen related home fires that resulted in deaths in Europe, between 2008 and 2010. The level of home oxygen fires is greater among elderly patients which could be attributed to the poor physical agility in comparison to that of younger individuals. Healthcare professionals have an ethical duty to ensure that they contribute to the reduction of fires especially for elderly patients and their relatives and neighbors. Most tobacco smokers allege that they have an addiction, and might therefore experience difficulty in trying to quit their habit. The home oxygen containers are fitted with safety fittings or tubing to minimize the flow of oxygen in case of fires especially in elderly home cares where patient mobility is likely to be low.

Predictive modeling and concentration of the risk of suicide: implications for preventive interventions in veterans

According to McCarthy et al (2015), there has been a high rate of suicides among veterans in the country (US). The health system concerned with the well-being of veterans (Veterans Health Administration) initiated a program to ensure a steady reduction or maintenance of a low number of suicides among veterans. The VHA program did not contribute to a dramatic reduction in the number of suicides among the intended population, but resulted in a stable rate of suicide control in comparison to the rate of suicide among other populations. According to McCarthy et al. (2015), a predictive modeling can be utilized in finding out the at risk individuals among the population, and therefore reduce the number of individuals that commit suicide. Based on the results of the modeling, action steps would be implemented to ensure the reduction of the number of those at risk, and offering of treatment services. Those that portray risks of suicide should be involved in community or clinical based support groups based on the level of indications that they exhibit. The health department has also proposed the ease of access and counseling for pain management related patients; as a means of reducing the rates of suicides among veterans and general population. According to McCarthy et al (2015), homeless unmarried males were more likely to contemplate and execute suicidal thoughts in comparison to those individuals that had support from their family members.

Assessing the risk for suicide in patients with cancer

All chronically ill patients might suffer psychological stress in addition to their physical symptoms. Some cancer patients might feel that suicide would be a means of dying with dignity since their health keeps on deteriorating. Some healthcare professionals such as nurses might share these views, and therefore increase the risk of successful suicides for the patients. Therefore, there is a need for a high level of assessment and knowledge regarding patient safety for cancer related patients; in reducing suicide levels. According to Aiello-Laws (2010), the cancer patient might be contemplating suicide due to untreated depression or anxiety. The nurses and other healthcare patients that are around the cancer patients should ensure that there are no lethal substances or objects that are left around the patients. The cancer patients might inject themselves with lethal doses of drugs or cut themselves with sharp objects. For patients that are residing outside hospital confines, the nurses should involve the family or loved ones of the patient in ensuring the reduction of risks to increase safety. Social workers or religious leaders could be involved in the offering of visits to cancer patients that live alone so that they get encouragement and guidance that would encourage them.

A process model for assessing adolescent risk for suicide

The level of suicides among adolescents has increased over the last two decades; at an alarming rate. Most of the adolescents suffer from depressive or bi-polar conditions which contribute to an increase in their suicidal tendencies and thoughts. Adolescents who had attempted to commit suicide in the past were 18 more times likely to attempt suicide a second time. The social conditions around the adolescents such as bullying or subjection to abuse are also likely to contribute to an increased likelihood of abuse among adolescents. If adolescents are bullied, they are likely to contemplate committing suicide especially if they come from unstable homes. The adolescents would feel unappreciated and likely succumb to peer pressure or the negativity around them. The young individuals are also likely to have higher levels of suicidal thoughts if they are engaged in substance abuse. According to Stoelb & Chiriboga (1998), counseling and involvement in physical activities such as sports offers some of the best ways of ensuing patient safety among adolescents that contemplate suicide.

Conclusion

Patient safety is one of the most critical goals for the healthcare industry Nurses and other healthcare professionals have the duty of ensuring that patients do not suffer any danger or avoidable death as a result of their environment or untreated psychological state. Depressed individuals that contemplate suicide should be kept away from harmful agents and objects that would increase their likelihood of committing suicide.

Patients that smoke or have increased risks that could contribute to fires for home oxygen users should be briefed on possible accidents that could occur. Where necessary, the fire department should be involved in the assessment and briefing of the possible risks of fires for home oxygen users.

References

Aiello-Laws, L.B. (2010). Assessing the risk for Suicide in patients with cancer. Clinical Journal of Oncology. 14 (6): 685- 691.

Cooper, B. G. (2015). Home Oxygen and Domestic Fires. Lung Function and Sleep. 11 (1): 1-11.

McCarthy, J., Bossarte, R., Katz, R.I., Thompson, C., Kemp, J., Hannemann, C., Nelson, C. & Schoenbaum, M. (2015). Predictive Modeling and Concentration of the Risk of Suicide: Implications for Prevention Interventions in the US Department of Veteran Affairs. American Journal of Public Health. 105 (9):

Stoelb, M. & Chiriboga, J. (1998). A Process for Assessing Adolescent risk for suicide. Journal of Adolescence. 21 359-370.

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Pathophysiological Presentation of DVT and CVI

Pathophysiological Presentation of DVT and CVI Order Instructions: Advanced practice nurses often treat patients with vein and artery disorders such as chronic venous insufficiency (CVI) and deep venous thrombosis (DVT).

While the symptoms of both disorders are noticeable, these symptoms are sometimes mistaken for signs of other conditions, making the disorders difficult to diagnose. Nurses must examine all symptoms and rule out other potential disorders before diagnosing and prescribing treatment for patients. In this Assignment, you explore the epidemiology, pathophysiology, and clinical presentation of CVI and DVT.
To prepare:
Review the section “Diseases of the Veins” (pp. 585–587) in Chapter 23 of the Huether and McCance text. Identify the pathophysiology of chronic venous insufficiency and deep venous thrombosis. Consider the similarities and differences between these disorders.
Select a patient factor different from the one you selected in this week’s Discussion: genetics, gender, ethnicity, age, or behavior. Think about how the factor you selected might impact the pathophysiology of CVI and DVT. Reflect on how you would diagnose and prescribe treatment of these disorders for a patient based on the factor you selected.
Review the “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in the Week 2 Learning Resources. Use the examples in the media as a guide to constructing two mind maps—one for chronic venous insufficiency and one for venous thrombosis. Consider the epidemiology and clinical presentation of both chronic venous insufficiency and deep venous thrombosis.
To complete:
Write a 2- to 3-page paper that addresses the following:
Compare the pathophysiology of chronic venous insufficiency and deep venous thrombosis. Describe how venous thrombosis is different from arterial thrombosis.
Explain how the patient factor you selected might impact the pathophysiology of CVI and DVT. Describe how you would diagnose and prescribe treatment of these disorders for a patient based on the factor you selected.
Construct two mind maps—one for chronic venous insufficiency and one for deep venous thrombosis. Include the epidemiology, pathophysiology, and clinical presentation, as well as the diagnosis and treatment you explained in your paper.
This Assignment is due by Day 7.
Note: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.

VERY IMPORTANT SEE BELOW FOR THE GUIDE FOR THE MIND MAP

Media
Zimbron, J. (2008). Mind maps—Dementia, endocarditis, and gastro-oesophageal reflux disease (GERD) [PDF]. Retrieved from http://www.medmaps.co.uk/beta/
Gastro-oesophageal reflux disease. [Image]. Used with permission of MedMaps.

This media provides examples of mind maps for dementia, endocarditis, and gastro-oesophageal reflux disease (GERD).

Pathophysiological Presentation of DVT and CVI Sample Answer

Chronic Venous Insufficiency (CVI) arises due to the incompetence of vascular walls as well as valves of the veins. This disorder leads to a reduction in blood flow to the heart resulting in pooling of blood or stasis in the extremities especially the lower limbs. Patients with CVI usually complain of pain and swelling in the limbs. Conversely, deep venous thrombosis (DVT) arises when clotting occurs in the deep veins in the lower limbs (Patel & Brenner, 2013). Patients suffering from DVT usually complain of pain as welling as swelling just as those with CVI. The presentation of these conditions is almost similar. It is for this reason that health care providers take extra caution when diagnosis CVI and DVT.

The Pathophysiological Presentation of DVT and CVI

The key pathophysiological difference between CVI and DVT is that DVT occurs in deep veins whereas CVI occurs majorly in superficial veins. CVI affects popliteal, femoral, and peroneal veins while DVT mail affects the soleal vein. Chronic Venous Insufficiency arises as a result of damage of the endothelial walls and valves in the veins (Eberhardt & Raffetto, 2014). Some of the common causes of CVI include pelvic tumors, DVI, and vascular malformations. The valves of patients suffering from CVI are incompetent in that they cannot hold blood back against the force of gravity. Consequently, blood pools in the lower extremities leading to swelling especially in the ankles and the legs. Moreover, individuals with CVI present with venous stasis ulcers, varicose veins, pain the feet, and itching and flaking of the skin. On the other hand, DVT develops due to clotting in the veins. Severe clinical complications occur when the formed clots lyse and get into the general circulation. Blood from deep veins usually flows into the lungs. Therefore, when this blood carries clots with it, it may lodge them in the lungs causing pulmonary embolism, one of the most severe result of DVT (Goldhaber & Bounameaux, 2012). Often CVI presents with dermatitis and ulceration due to the structural difference between the deep veins and superficial veins. That is, the superficial veins have an adipose layer and a connective tissue whereas the deep veins have a fascia and muscles. This gives deep veins more protection and structural support.

Venous and arterial thrombosis have a number of similarities although they differ in terms of their pathophysiology, clinical interventions, and epidemiology. Venous thrombosis occurs in undamaged parts of venous walls and in areas that have low sheer pressure. This disorder leads to the formation of red thrombi. Conversely, arterial thrombosis occurs in parts that have high sheer stress and are rich in plaques. Unlike, venous thrombosis, arterial thrombosis forms white thrombi.

Patient Behavior

The predisposition and pathophysiological advancement of DVT and CVI relies heavily on the lifestyle of an individual. The pathophysiology of DVT and CVI is enhanced when a person engages in activities that enhance the metabolic syndrome. Some of the most notable practices that have been cited to predispose individuals to CVI and DVT include lack of physical exercises, smoking, intake of meals rich in cholesterol, and psychosocial behavior (Csordas & Bernhard, 2013). Smoking affects the circulation of blood and enhances blood clotting. On the other hand, inactivity such as sitting for long periods causes calf muscles to contract hence inhibiting the proper circulation of blood. Lack of activity may also result in an increase of weight which then increases pressure in veins especially in the legs and the pelvis.

When diagnosing of CVI and DVT based on behavior, a physician should enquire the social history of the patient. For instance, s/he can ask the patient whether s/he smokes or has ever smoked. If the patient smokes, he should enquire when the patient started smoking and how many sticks he smokes in a day. Questions on whether the patient engages in physical exercises such as jogging or long distance travelling are also essential in finding a differential diagnosis.

Clinical interventions for these patients involves the use of pharmacological as well as non-pharmacological approaches. If the patient smokes, a physician should assess the willingness of the patient to quit smoking. If s/he is willing to make a quit attempt, a brief counselling session should be introduced, medications such as bupropion will be offered as well as self-help resources. Follow-up visits should also be scheduled. The patient should also be advised to engage in physical exercises such as jogging. The patient should also limit his/her intake of cholesterol, a leading factor in DVT development.

Mind Maps

Pathophysiology

Formation of blood clots in deep veins, which may then be transported by the blood to the lungs or the heart.

Clinical presentation

Pain and swelling in the lower extremities especially the ankles

Diagnosis

Patient History

Ultrasound

Venography

MRI and CT

DVT

Causes about 1 out of 1000 deaths annually with Europeans and North American populations being highly affect.

Treatment

Blood Thinners

Clotbustors

Compression Stockings

Recommendation of physical activity an proper diet

Pathophysiological Presentation of DVT and CVI References

Berkman, L. F., Kawachi, I., & Glymour, M. M. (Eds.). (2014). Social epidemiology. Oxford University Press.

Csordas, A., & Bernhard, D. (2013). The biology behind the atherothrombotic effects of cigarette smoke. Nature Reviews Cardiology, 10(4), 219-230.

Eberhardt, R. T., & Raffetto, J. D. (2014). Chronic venous insufficiency.Circulation, 130(4), 333-346.

Goldhaber, S. Z., & Bounameaux, H. (2012). Pulmonary embolism and deep vein thrombosis. The Lancet, 379(9828), 1835-1846.

Patel, K., & Brenner, B. (2013). Deep venous thrombosis. Medscape reference.

Side effects of Corticosteroid to treat Addisons Disease

Side effects of Corticosteroid to treat Addisons Disease Order Instructions: Initial Discussion Post:

Base your initial post on the scenario below, your readings and research on this topic.

Long-term use of corticosteroids can lead to physical and psychological side effects. Consider a 16-year-old female high-school student who is receiving treatment for Addison’s disease. The student confided in the school nurse (RN) that she is going to stop taking her prednisolone. She states she is depressed and embarrassed to be at school because of the side effects caused by the medication. After further review of the situation, the RN determines an interprofessional team should be convened to address the student’s needs.

After reflecting on the above scenario, discuss the following points (minimum of 250 words):

Describe three common side effects of corticosteroid treatment for Addison’s disease.
What factors make a diagnosis of Addison’s disease problematic for adolescents?
Discuss why an interprofessional team is appropriate for this situation, who should be included on the team and the role of the RN on the team.

Side effects of Corticosteroid to treat Addisons Disease Sample Answer

Side effects of using corticosteroid to treat Addison’s disease

Patients diagnosed with Addison’s disease need to take up their medication daily in order to replace the inadequate hormones. This normally helps the patients to live a normal life. Treatment mainly involves the use of corticosteroids (steroid therapy) to replace hormones lost and those not produced by the aldosterone. Although these medications are effective, corticosteroids are associated with the short term and long term side effects (Bentley, 2011)

The short-term side effects include stomach upset, increased irritability, weight gain due to water retention, increased fat on the face, unusual hair growth, high blood pressure, and risk of other infections. The long-term side effects include muscle weakness, brittle bones, and stunted growth among the children. To minimize such side effects, people taking the drugs should be watched carefully and if necessary, their doses reduced as low doses can be effective and have minimal side effects (In Arieti, 2014).

Factors that make it problematic for management Addison’s disease in adolescents

The process of diagnosing Adrenal insufficiency is usually a challenge. This is because most of the clinical manifestation are nonspecific, and tend to vary according to the underlying causative agent and extent of disease progression. It is important to make an early diagnosis as the disease can be life-threatening if not diagnosed early enough. The signs and symptoms and management of the diseases are the main challenges faced by the adolescents diagnosed with Addison’s disease. These include issues such as fatigue, malaise, and general muscle weakness. This negatively impacts on quality of life and their daily activities (Helms, 2015).

Importance of inter-professional team for treatment of Addison disease

Team-work in the management of Addison disease is important as it aids in improving patient quality of life, reduce mortality, improve communication, reduce errors, and increase patient satisfaction. In this case study, healthcare staff from the following disciplines should work together when delivering care to Addison’s patients. These include physicians, nurses, nutritionists, pharmacists, and physiotherapists. This will help in developing detailed case-related information, which facilitates the decision making processes (Bar, 2013).

Side effects of Corticosteroid to treat Addisons Disease References

Bar, R. S. (2013). Early diagnosis and treatment of endocrine disorders. Totowa, N.J: Humana Press.

Bentley, P. J. (2011). Endocrine pharmacology: Physiological basis and therapeutic applications. Cambridge [England: Cambridge University Press.

Helms, R. A. (2015). Textbook of Therapeutics: Drug and disease management. Philadelphia,

Pa: Lippincott Williams & Wilkins.

In Arieti, S. (2014). American handbook of psychiatry. New York: Basic Books.

Case Study on Moral Status and Fetal Abnormality

Case Study on Moral Status and Fetal Abnormality Order Instructions: Case Study on Moral Status

View Rubric Details: Write a 250-500 word analysis of “Case Study: Fetal Abnormality.” Be sure to address the following questions:
1.Which theory or theories are being used by Jessica, Marco, Maria, and Dr. Wilson to determine the moral status of the fetus? Explain.
2.How does the theory determine or influence each of their recommendation for action?
3.What theory do you agree with? How would the theory determine or influence the recommendation for action?

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.
HLT310V.R.CaseStudyFetalAbnormality.docx
Case Study: Fetal Abnormality

Jessica is a 30-year-old immigrant from Mexico City. She and her husband Marco have been in the U.S. for the last 3 years and have finally earned enough money to move out of their Aunt Maria’s home and into an apartment of their own. They are both hard workers. Jessica works 50 hours a week at a local restaurant, and Marco has been contracting side jobs in construction. Six months before their move to an apartment, Jessica finds out she is pregnant.
Four months later, Jessica and Marco arrive at the county hospital, a large, public, nonteaching hospital. A preliminary ultrasound indicates a possible abnormality with the fetus. Further scans are conducted and it is determined that the fetus has a rare condition in which it has not developed any arms, and will not likely develop them. There is also a 25% chance that the fetus may have Down syndrome.
Dr. Wilson, the primary attending physician is seeing Jessica for the first time, since she and Marco did not receive earlier prenatal care over concerns about finances. Marco insists that Dr. Wilson refrain from telling Jessica the scan results, assuring him that he will tell his wife himself when she is emotionally ready for the news. While Marco and Dr. Wilson are talking in another room, Aunt Maria walks into the room with a distressed look on her face. She can tell that something is wrong and inquires of Dr. Wilson. After hearing of the diagnosis, she walks out of the room wailing loudly and praying out loud.
Marco and Dr. Wilson continue their discussion, and Dr. Wilson insists that he has an obligation to Jessica as his patient and that she has a right to know the diagnosis of the fetus. He furthermore is intent on discussing all relevant factors and options regarding the next step, including abortion. Marco insists on taking some time to think of how to break the news to Jessica, but Dr. Wilson, frustrated with the direction of the conversation, informs the husband that such a choice is not his to make. Dr. Wilson proceeds back across the hall, where he walks in on Aunt Maria awkwardly praying with Jessica and phoning the priest. At that point, Dr. Wilson gently but briefly informs Jessica of the diagnosis, and lays out the option for abortion as a responsible medical alternative, given the quality of life such a child would have. Jessica looks at him and struggles to hold back her tears.
Jessica is torn between her hopes of a better socioeconomic position and increased independence, along with her conviction that all life is sacred. Marco will support Jessica in whatever decision she makes, but is finding it difficult to not view the pregnancy and the prospects of a disabled child as a burden and a barrier to their economic security and plans. Dr. Wilson lays out all of the options but clearly makes his view known that abortion is “scientifically” and medically a wise choice in this situation. Aunt Maria pleads with Jessica to follow through with the pregnancy and allow what “God intends” to take place, and urges Jessica to think of her responsibility as a mother.

Case Study on Moral Status

1
Unsatisfactory
0.00%

2
Less than Satisfactory
65.00%

3
Satisfactory
75.00%

4
Good
85.00%

5
Excellent
100.00%

70.0 %Content

25.0 % Determination of Moral Status

Theory/Theories are not identified that determine the moral status of the fetus.

Theory/Theories are identified that determine the moral status of the fetus for at least a few of the people listed in the case study, but explanation is lacking.

Theory/Theories are identified that determine the moral status of the fetus for at least a few of the people listed in the case study. Some explanation is provided.

Theory/Theories are identified that determine the moral status of the fetus for all of the people listed in the case study, including an adequate explanation.

Theory/Theories are identified that determine the moral status of the fetus for at least all of the people listed in the case study, including detailed explanation.

25.0 % Recommendation for Action

Recommendation for action is not present.

Recommendation for action is present, but lacks explanation.

Recommendation for action is present, with some explanation.

Recommendation for action is present, with explanation.

Recommendation for action is present, with detailed explanation that shows a deep understanding of the subject.

20.0 % Personal Response to Case Study

Personal response to case study is not present.

Personal response to case study includes if you agree or disagree but does not detail how the theory determines or influences the recommendation for action.

Personal response to case study includes whether if you agree or disagree and an explanation on how the theory determines or influences the recommendation for action.

Personal response to case study includes if you agree or disagree and a detailed explanation on how the theory determines or influences the recommendation for action.

Personal response to case study includes if you agree or disagree and a detailed explanation that shows a deep understanding of the subject including how the theory determines or influences the recommendation for action.

20.0 %Organization and Effectiveness

7.0 % Thesis Development and Purpose

Paper lacks any discernible overall purpose or organizing claim.

Thesis and/or main claim are insufficiently developed and/or vague; purpose is not clear.

Thesis and/or main claim are apparent and appropriate to purpose.

Thesis and/or main claim are clear and forecast the development of the paper. It is descriptive and reflective of the arguments and appropriate to the purpose.

Thesis and/or main claim are comprehensive. The essence of the paper is contained within the thesis. Thesis statement makes the purpose of the paper clear.

8.0 % Argument Logic and Construction

Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.

Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.

Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.

Argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.

Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

5.0 % Mechanics of Writing (includes spelling, punctuation, grammar, language use)

Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice and/or sentence construction are used.

Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register) and/or word choice are present. Sentence structure is correct but not varied.

Some mechanical errors or typos are present, but are not overly distracting to the reader. Correct and varied sentence structure and audience-appropriate language are employed.

Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech.

Writer is clearly in command of standard, written, academic English.

10.0 %Format

5.0 % Paper Format (use of appropriate style for the major and assignment)

Template is not used appropriately, or documentation format is rarely followed correctly.

Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent.

Appropriate template is used. Formatting is correct, although some minor errors may be present.

Appropriate template is fully used. There are virtually no errors in formatting style.

All format elements are correct.

5.0 % Research Citations (in-text citations for paraphrasing and direct quotes, and reference page listing and formatting, as appropriate to assignment and style)

No reference page is included. No citations are used.

Reference page is present. Citations are inconsistently used.

Reference page is included and lists sources used in the paper. Sources are appropriately documented, although some errors may be present

Reference page is present and fully inclusive of all cited sources. Documentation is appropriate and citation style is usually correct.

In-text citations and a reference page are complete and correct. The documentation of cited sources is free of error.

100 % Total Weightage

Case Study on Moral Status and Fetal Abnormality Sample Answer

Case Study on Moral Status

The question on moral status of early fetuses and the issues about ethics of choice on decision to abort a pregnancy continue to elicit mixed reactions. Different views and theories have emerged that deliberate on this issue. The paper therefore, deliberates on a case study provided, focusing specifically on the issue of moral status.

In this case study, Marco, Maria, Jessica and Dr. Wilson applies different theories to determine moral status of the fetus. For instance, Marco who is also the husband of Jessica uses pragmatic theory in determining the moral status of the fetus. He has left the decision of making a choice to Jessica and this indicates clearly his in decisiveness. Jessica is also faced with conflicting view on whether to stay with the pregnancy or do away with it so that she may avoid the consequences of living with a disabled child, but seems to be guided by natural law of ethics (Stewart, 2009). Maria on the other hand, observes or is guided by Kant theory. She believes that every human has the virtues of the capacity for moral freedom (Harman, 1999). She believes that regardless of the situation, Jessica has the capacity to concept what is good and bad and to take the best choice that upholds to morality. She seems to believe that the fetus has moral status.

Dr. Wilson on other hand uses pragmatic ethics theory in determining the moral status of the fetus. He believes that abortion is medically and scientifically advised on such a fetus because of its health after birth and the implication it will have on the parents.

These theories have influenced these individuals on each of their recommendation for action. For instance, Dr. Wilson makes recommendation of aborting because of the implication the fetus in terms of financial upkeep. It will cause more challenges to the parents and to the child and therefore is advisable to do away with it. Maria believes in natural law as well as Jessica and this makes them to be adamant in making decisive decision. Similarly, Marco is torn-apart and wants Jessica to make decision solely.

I do agree with the pragmatic situation. This theory supports abortion on medical ground. The fetus has down syndrome and lacks limbs. The life of the fetus once born is posed to have challenges. The couple would therefore, be obliged to follow the doctor’s recommendation and abort the fetus to save the situation. This decision will also lead to ethical outcome since it is ethically supported.

Case Study on Moral Status and Fetal Abnormality References

Harman, E. (1999). Creation Ethics: The moral status of early fetuses and the ethics of abortion. Philosophy and public affairs, 28(4), 310-324.

Stewart, N. (2009). Ethics. New York: Polity