NURS 6512 Advanced Health Assessment and Diagnostic Reasoning Assignments

NURS 6512 Advanced Health Assessment and Diagnostic Reasoning Assignments

WEEK 1 :Nursing Management System Approach

Health care organization are social systems and is classified into interrelated subsystems such as inputs, throughput’s, outputs, systems as cycles of events, and negative feedback (Meyer & O’Brien-Pallas, 2010). Gillies stated that “a systems Theory refers to a theory of science that concentrates on the wholeness of the situation”. System theory has been unitized in nursing research. It has been beneficial in differentiating the input and output process for most organization. Over the years nursing theorist have unitized the system theory in nursing organizational patters and nursing research, (Gillies, 2010). Hospital settings sometimes are divided into various units which provide many different levels of care to patients, which include emergency department (ED), medical-surgical, intermediate care, and intensive care units, etc. Each of these units has specific inputs, throughput, outputs, cycles of events and negative feedback. This paper is to identifying a problem in a department and addresses it using a system theory approach. Inputs, throughput’s, outputs, a cycle of events and the negative feedback related to the problem being discussed in this paper. NURS 6512 Advanced Health Assessment and Diagnostic Reasoning Assignments

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Subsystems of the ED inputs include the staffing, supplies and financial resources needed to operate the ED, (Katz& Kahn, 1978). This would be the standard materials and concepts used by the organization. The input component from the model refers to the demand for emergency services, and it is influenced by timely access to primary and community services, and by the prevalence of conditions such as acute illnesses, chronic diseases, trauma, and mental illnesses. The proportion of people that are vulnerable based on socioeconomic factors also influences the input component.  In the emergency room, the input is as follows: 6 beds per two registered nurses, a charge nurse, and an LVN. It is managed together with another floor by a Director and Manager. There are a hospitality staff and nurse practitioner as well as resident doctors for the teaching group who admit their patients here, which make up the medical support team. Additional team members my also include the following; respiratory therapist, social worker, and case manager. The duty of the nurse is to provide quick, efficient care while managing admission and discharge process for the patients. This unit is to decrease the throughput for the emergency room and facilitate its accommodation as the turnover ratio of patients. Throughput’s are created when the unit utilizes all of their inputs to generate a product (Katz & Kahn, 1978).  In the example of the ED, the throughput would include all of the nursing services that the staff can provide to patients that seek their services.

Throughput

It consists of several factors and deals with the effectiveness of nursing care to patients in coordination with other healthcare professionals in the input unit. Nursing work entails providing the best possible care to patients that get into the emergency unit. The task the nurse is assigned to the patient and how he or she takes care of the patient is the throughput process, and this includes physical assessments and giving the patients medications prescribed by the physician.

Output

 The result at the end of effective throughput is the output as it depends on the quality of nursing care given to the patients by the nurses and healthcare professionals. Improved patient health and satisfaction with the level of care accorded in the unit will be examples of output. The cycle of events, another part of systems theory, revolves around the repeated sequence of events that takes place when the system is in progress. Upon arrival at the emergency unit, the patient’s vital signs are taken with admission history before the doctor puts for planned care. An individual treatment plan is drawn up according to the condition of the patient and the necessary blood work performed. In every setting, adjustments need to be made to improve the outcome based on results achieved; this is referred to as negative feedback. A hospital survey is sent out to patients to rate different aspects of the unit with regards to their previous stay. This provides valuable feedback that the staff and management can use to improve the quality of care and treatment, equipment inclusive, in anticipation of the next patient visit.

 Identifying the problem

 With the rush of patients in and out of the emergency unit, the number of patients frequently outnumbers the staff. With adequate staffing being a problem, the desired outcome cannot be acquired by the unit. When there is a shortage or inadequate staffing in a working, this most time lead to poor quality of care to patient, hence putting the patient health are risk and poor patient outcome.

. Other factors influencing nurse staffing requirements include time needed for patient documentation, patient/family education, and care coordination; supervision and delegation activities based on effectiveness and efficiency of support personnel; and ethical decision-making. During busy days there is a possibility of patients not getting adequate care and no chance to get floating nurses to the unit. This problem starts at the level of the input and affects all through to throughput and output. With the variety of work responsibilities for a nurse, staff shortage creates a burden of extra work that leads to less than ideal care for patients in the unit. Nurses may be placed in situations with unsafe nurse-to-patient ratios, patients could experience reduced quality of care, and the organization could suffer due to poor service outputs (Wise, Fry, Duffield, Roche, & Buchanan, 2015).  NURS 6512 Advanced Health Assessment and Diagnostic Reasoning Assignments

 Addressing the problem

 Emergency nurses are vital for the delivery of quality emergency care. A giant step in addressing the staffing issue will be the improvement of patient safety and satisfaction. A problem like this can be resolved using equifinal which means using more than one way to accomplish the same result. The desired outcome, in this case, would be to be able to provide proper and adequate health care to patients and also do it efficiently and beneficially to the patient. Calculating the number of beds to nurses will help know the number of care needed. A precise calculation will suggest two registered nurses and an LVN work on the vital signs and other ancillary duties. Another means will be to hire more nurses and give them the adequate training to prepare them for emergency response. This might seem slow and expensive at the beginning, but it is cost effective and better for the management in the future. Also recruiting new staff will avoid excessive overtime for the other nurses and reduce work. Hiring a unit secretary is also a more explainable solution as the secretary will do the other ancillary duties giving the nurses more time to focus on patients. It is almost impossible to control the number of patients admitted to the emergency room, but a triage system can be put into place where patients with the most severe cases are put priority. Applying some of these interventions will help the staff to stay with their current job and not leave the unit in search of other employment opportunities because the stress level will be decreased. Appreciation will contribute in retaining employees.

 Conclusion

 Finally, it is necessary for the unit and facility to make add-ons to the policies and procedures that support the overall goal of the organization. These interventions will result in better quality care for the patients, improved patient safety and satisfaction, provide a sense of appreciation to the staff and promote exceptional care to patients making them feel important to the organization. Employees will stay long term, and the economy of the organization will be boosted up.

WEEK  3 : Health Issues and Risks of Children’s Weight

Doctors and scientists are concerned about the rise of obesity in children and teens because obesity may lead to the following health problems:

• Heart disease
• Type 2 diabetes
• Asthma
• Sleep apnea
• Social discrimination

Obese children may experience immediate health consequences which can lead to weight-related health problems in adulthood. Obese children and teens have been found to have risk factors for cardiovascular disease (CVD), including high cholesterol levels, high blood pressure, and abnormal glucose tolerance. In a sample of 5-to 17-year-olds, almost 60% of overweight children had at least one CVD risk factor and 25% of overweight children had two or more CVD risk factors. In addition, studies have shown that obese children and teens are more likely to become obese as adults.

Stigma and Self-Esteem

In addition to suffering from poor physical health, overweight and obese children can often be targets of early social discrimination. The psychological stress of social stigmatization can cause low self-esteem which, in turn, can hinder academic and social functioning, and persist into adulthood. While research is still being conducted, there have been some studies showing that obese children are not learning as well as those who are not obese. Further, physical fitness has been shown to be associated with higher achievement.

Severe obesity afflicts between 4% and 6% of all youth in the United States, and the prevalence is increasing. Despite the serious immediate and long-term cardiovascular, metabolic, and other health consequences of severe pediatric obesity, current treatments are limited in effectiveness and lack widespread availability. Lifestyle modification/behavior-based treatment interventions in youth with severe obesity have demonstrated modest improvement in body mass index status, but participants have generally remained severely obese and often regained weight after the conclusion of the treatment programs. The role of medical management is minimal, because only 1 medication is currently approved for the treatment of obesity in adolescents. Bariatric surgery has generally been effective in reducing body mass index and improving cardiovascular and metabolic risk factors; however, reports of long-term outcomes are few, many youth with severe obesity do not qualify for surgery, and access is limited by lack of insurance coverage. To begin to address these challenges, the purposes of this scientific statement are to (1) provide justification for and recommend a standardized definition of severe obesity in children and adolescents; (2) raise awareness of this serious and growing problem by summarizing the current literature in this area in terms of the epidemiology and trends, associated health risks (immediate and long-term), and challenges and shortcomings of currently available treatment options; and (3) highlight areas in need of future research. Innovative behavior-based treatment, minimally invasive procedures, and medications currently under development all need to be evaluated for their efficacy and safety in this group of patients with high medical and psycho social risks. NURS 6512 Advanced Health Assessment and Diagnostic Reasoning Assignments

WEEK 4 : Skin Abnormality

People who are fair or have a weak eyesight are more likely to develop skin cancer. People may develop skin cancer in certain weather conditions or areas. For example, people living in a warm climate have a higher chance of developing skin cancer because the sun releases higher levels of radiation. Skin cancer does not occur only by exposure to ultraviolet radiation for a long time. Your family’s medical history may make you more susceptible to cancer. What are the symptoms of skin cancer?

Skin cells that lose growth and division are called skin cancers. Another name for skin cancer is neoplasia. Skin cancer occurs from the outer layer of the skin called the epidermis and is the most common form of human cancer. Every skin cancer is important, but the most common are basal cell carcinoma, squamous cell carcinoma, melanoma. These skin cancers occur when the skin begins to grow abnormal skin cells and forms a mass called a skin tumor. – Cancer is one of the most important diseases categories in the world. Even in society like American medicine and technology development, we are still affected by cancer. According to experts from the American Cancer Society, cancer incidence rates in the American Cancer Therapy Center and the National Cancer Institute are decreasing.

Skin cancer – skin cancer occurs from epidermal cells of the skin. It is common for those who are overly exposed to the sun. According to the Skin Cancer Foundation, more than 3.3 million people in the United States receive treatment for non melanoma skin cancer every year. One in five Americans will develop skin cancer in their lifetime. The most common skin cancers are basal cell carcinoma and squamous cell carcinoma, and the most lethal skin cancer is malignant melanoma. Wart – harmless skin growth, most common hands, feet, face. Warts are caused by viruses and vary with the situation. They can be smooth, flat, rough, convex, black, small, and / or large. Remove the wart by medication at the storefront, surgery, laser, freezing or burning

I have researched many different Web-cites and articles to try and determine what role genetics plays in skin cancer.Yes there are certain genetic mutations that are inherited, or passed through the germ-line, but the main cause of skin cancer is UV radiation which is an environmental genetic defect.Many cancers begin when one or more genes in a cell are mutated, creating an abnormal protein or no protein at all.

WEEK 5 : Acute Sinusitis

The sinuses are tiny bags of air positioned at the back of a person’s forehead, eyes, cheekbones, and nose. Sinus infections are relatively harmless if detected and treated in time. This paper is a patient education material on sinus infections, their symptoms and treatment as well as the risk posed by not treating sinus infections in time.

Forms of Sinus Infections

Acute sinusitis is the form of sinus infection caused by a virus and lasts approximately one or two weeks (Brook, 2007). A sub-acute sinusitis is caused by bacteria or seasonal allergies and can persist for around three months. Chronic sinusitis persists for over three months and is often caused by incessant allergies or problems with the structure of the nose.

Symptoms of Sinusitis

The indications of a sinus infection look like the symptoms of common colds (Thaler & Kennedy, 2009). These signs include nasal discharge, headache, fever, persistent cough, congestion of the nasal cavity, fatigue, foul breath, and facial pain. Frontal sinusitis produces pain in the forehead can result in osteomyelitis if left untreated. The pain in the cheekbone and upper teeth is due to maximal sinusitis. NURS 6512 Advanced Health Assessment and Diagnostic Reasoning Assignments

Treatment for Sinus Infections

The headache and pain on the forehead and upper teeth can be remedied by taking pain relieving drugs such as ibuprofen. If the symptoms persist for more than one week, a healthcare provider can prescribe antibiotics since the infection probably is bacterial. A patient with facial pain probably has bacterial sinusitis and should take antibiotics as prescribed by the doctor. The patient must finish the dosage to prevent re-infection and is advised to visit the doctor for an extra check-up.

The Danger of Untreated Sinusitis

If undiagnosed or untreated for a protracted period, sinusitis can cause other serious problems such as abscesses (puss) in the nasal cavity and meningitis (Josephson, 2006). It can also result in orbital cellulitis, an illness of the aural that causes intense discomfort in the ear and can lead to swelling of the brain. This condition can also damage one’s auditory ability.

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Conclusion

The symptoms of sinusitis are often confused with the common cold and may not be diagnosed easily. If left untreated, sinusitis can lead to life-threatening complications, some of which may require surgery.

WEEK 6 : Abdominal Assessment

The diagnosis of gastroenteritis cannot be supported by current information.  The advanced practice nurse needs additional subjective and objective information to complete a proper assessment.  Also, diagnostic testing needs to be ordered to rule out any other possible diagnoses. 

Additional Subjective Information Needed

            The patient is very vague about his abdominal pain.  In his description, he failed to mention the exact location of his abdominal pain.  While rating his pain on a scale of 0 to 10, he failed to describe the pain he is feeling.  Is the pain sharp, cramping, aching, shooting, stabbing or throbbing?  What was the patient doing when the pain started?  Are there any foods that aggravate the pain or cause it to flare up?  How long does the pain last when it starts?  Are there any alleviating factors such as belching or defecating?  Does the patient have any problems urinating?  Not only does the provider need more information from the patient about the chief complaint, he/she also needs the subjective review of systems (ROS) to complete a proper examination.  The subjective ROS would be as follows:

Additional Objective Information Needed

            In order to complete a thorough assessment regarding an abdominal complaint, the advanced practice nurse must examine a number of different systems in addition to what has already been assessed.  The provider must examine the patient’s groin area to exclude an incarcerated hernia or testicular torsion (Dains, et al, 2016).  The provider should also percuss for tenderness in the flanks. Flank pain can indicate a kidney stone.  Genital and prostate examinations should be performed in men to rule out sexually transmitted infections (STIs) and prostatitis. The advanced practice nurse must also look for frank blood or fecal occult blood.  The presence of blood can indicate an acute process or carcinoma.  Because abdominal pain can be referred from other areas, the provider should also examine the lungs, heart, head and neck, and musculoskeletal system (Dains, et al, 2016).  NURS 6512 Advanced Health Assessment and Diagnostic Reasoning Assignments 

 

Is the Current Diagnosis Acceptable?

 

            The current diagnosis is unacceptable without further assessment and testing.  While gastroenteritis can be diagnosed via subjective and objective assessment data only (Dains, Bauman, Scheibel, 2015), the advanced practice nurse must rule out any other possible diagnosis.  Usually patients with gastroenteritis have a diffuse, cramps, abdominal pain accompanied by nausea, vomiting, diarrhea, and fever.  The patient is afebrile with nausea and diarrhea, but has not informed the provider of any vomiting.  According to Dains, et al, the patient with gastroenteritis will have hyperactive bowel sounds, which our patient does have.  Gastroenteritis usually resolves without any treatment and requires no diagnostic testing.

 

Conditions That May Be Considered as a Differential Diagnosis

 

            The patient could be experiencing a number of abdominal issues. The patient has complained of diffuse abdominal pain with nausea and has hyperactive bowel sounds.  These vague symptoms can also point to ureterolithiasis, bowel obstruction, or irritable bowel syndrome (IBS).  Each condition requires specific diagnostic testing in order to form an accurate diagnosis.

1)      Ureterolithiasis occurs when kidney stones form in the ureters.  The patient reports the sudden onset of excruciating intermittent colicky pain that can progress to a constant pain (Dains, et al, 2016).  The pain is in the lower abdomen and flank and radiates to the groin.  The patient with ureterolithiasis may also have nausea, vomiting, abdominal distention, chills, and fever (Dains, et al, 2016).  Hematuria and urinary frequency can also be present.  A urinalysis can be done to determine urine pH and the presence of crystals can help identify stone composition.  A definitive diagnosis is made via noncontrast-enhanced helical computed tomography (CT) scan. 

2)      Bowel obstruction occurs in newborns, the elderly, and those with recent GI surgery (Dains, et al, 2016).   According to Mayo Clinic (2018), causes of intestinal obstruction may include adhesions in the abdomen that form after surgery, an inflamed intestine (Crohn’s disease), diverticulitis, hernias, and colon cancer. The patient usually presents with sudden onset of cramp pain.  Vomiting usually occurs early with small intestinal obstruction and late with large bowel obstruction.  Obstipation occurs with a complete obstruction, but diarrhea can be present with a partial obstruction (Dains, et al, 2016).  Hyperactive, high-pitched bowel sounds can be present with a small bowel obstruction.  A mass may be palpable in a lower obstruction.  Abdominal distention can be present.  Definitive diagnosis is made with abdominal x-rays, CT scan, or MRI. 

3)      Irritable bowel syndrome (IBS)– is a common disorder that is characterized by abdominal cramping, abdominal pain or discomfort, bloating, and altered bowel habits, consisting of diarrhea or constipation or alternating between diarrhea and constipation (Hurd, et al., 2013). The patient with IBS will have a normal bowel examination and the stool will be negative for blood.  If the onset of IBS is at middle age or older, if the stool is positive for blood, if there is a family history of colorectal cancer or polyps, or if the patient fails to show improvement of symptoms after 6 to 8 weeks of therapy a proctosigmoidoscopy or barium enema (BE) should be considered (Dains, et al).

WEEK 7 : Heart Failure

Congestive Heart Failure is a condition in which the heart cannot pump enough blood to meet the needs of the rest of the body (Department of Health & Human Services, 2012). The failure can occur in on either side of the heart.

In left-side heart failure, fluid backs up into the lungs, causing shortness of breath, due to the fact that the blood entering the left side of the heart comes from the pulmonary artery, and when the left ventricle cannot pump fluid out of the heart or when the left atrium cannot empty completely into the ventricle it backs up into the lungs.

In right-side heart failure, fluid can back up into the abdomen, legs, and feet, causing swelling. The blood being pumped into the right ventricle comes from systemic veins, and when the right atrium or ventricle can’t sufficiently empty, the fluid tends to back up into the body. There are many ways to treat this condition.

ACE inhibitors may be prescribed. These drugs are vasodilators, and help to widen blood vessels to reduce the workload on the heart, decrease blood pressure and increase blood flow (Mayo Clinic Staff, 2013). Many people with this disease are also prescribed diuretics, to increase fluid loss from the body and reduce fluid buildup and swelling. However, patients often need mineral supplements in addition to taking these drugs. When drugs are not sufficient enough, surgery may also be required. NURS 6512 Advanced Health Assessment and Diagnostic Reasoning Assignments

A coronary bypass is a sort of transplant, where veins from an arm or leg are used to bypass a blocked coronary artery, allowing blood to flow freely through the heart. Beta blockers are drugs that block Beta 1 and 2 receptors on the heart, which constrict blood vessels. By doing this and keeping blood vessels dilated, these drugs reduce blood pressure and heart rate. However, Carvedilol is the only agent labeled by the FDA for use in patients with heart failure (Chavey, 2000).

The many symptoms of this condition can occur suddenly (during activity) or develop slowly over time. Common symptoms include: cough, fatigue, loss of appetite, increased need to urinate, swollen feet and/or ankles, swelling of the abdomen due to excess fluid, weight gain, shortness of breath, heart palpitations and/or irregular pulse (American Heart Association, 2011).

This condition is best diagnosed after an examination for symptoms. A doctor could do several tests such as an electrocardiogram or an echocardiogram, as well as tests such as an MRI or blood tests to aid.

Some patients will be recommended for surgery such as an angioplasty, a pacemaker or even a complete heart transplant. While this condition is a chronic illness, the prognosis can be good if the symptoms are treated successfully. There are four main stages to this disease:

Stage 1: high risk for developing disease
Stage 2: patients have an enlarged/dysfunctional left ventricle but have no symptoms Stage 3: patients develop symptoms, get diagnosed
Stage 4: patient experiences symptoms even after treatment
(Heart Failure Society of America, 2002)

Depending on the specific cause of CHF, a patient could initially begin treatment at home with medications such as a diuretic and lifestyle changes (like no more drinking/smoking). Sometimes surgery to fix blockage of the coronary arteries or a congenital heart defect will be recommended. This would be done in a hospital and recovery at a rehabilitation clinic or at home. A benefit of an assisted living facility would be having preplanned meals and activities.

The CHF patient may not seek additional care until Stage 3 or 4 (Heart Failure Society of America, 2002). Also, if a patient’s symptoms are uncontrollable, hospitalization could be necessary. A downside of an assisted living facility is the spread of infection. CHF patients routinely struggle with breathing issues so a respiratory infection could be life threatening. Another example of risk in an assisted living facility is endocarditis, an infection of the inner lining of the heart chambers.

It can be caused by bacterial infections in the bloodstream, and patients with heart failure are at a much higher risk for succumbing to this infection (US Department of Health & Human Services, 2010). Contracting an infection like this can quickly kill someone already living with heart failure. It is important that a patient with CHF be monitored for signs of distress.

Vital signs like high blood pressure, rapid pulse, irregular respirations and fluid intake/output should be monitored. All of these vitals will already have expected irregularities, which lead to initial diagnosis. After care is started, the vitals should be monitored for additional changes. In the event of an emergency such as inability to breathe, a nursing assistant should call an ambulance right away and begin life-supporting measures such as CPR (Carter, 2012).

Legal and ethical issues associated with caring for someone with congestive heart failure vary widely. For example, a doctor has many ethical guidelines he or she must follow with those patients in need of a heart transplant.

Depending on factors such as the patient’s age, severity of the condition and their personal wishes and beliefs, the patient may want to have a power of attorney, a will and possibly a DNR on file (Carter, 2012). Patients with congestive heart failure must be careful of the amount of physical activity they participate in.

Short spurts of low-level exercise are often safe to perform, but it is important not to make the heart work too hard for its reduced capacity. Heart failure in its early stages may not greatly reduce mobility, but as it progresses, it can eventually make a patient completely immobile.

It is important as caregivers to know the limits of a patient’s mobility, and not to push them. In order to reduce risks, the extent of a patient’s mobility should be made clear, and guidelines should be followed. It is important to communicate with the facility, care team, family and patient to make sure everyone is aware of safety procedures to reduce the chance of heart attack or complete heart failure of these patients (American Heart Association, 2011).

The diet plan for a patient diagnosed with CHF would need to be “low sodium”. Foods that are naturally low in sodium like fresh fruit and veggies, and lean meats are the best choice for this diet. A doctor may also restrict a patient’s fluid intake.

A diet high in sodium and drinking and consuming too many fluids (water, soups, etc.) can cause additional water retention, thus making the heart work harder (Mayo Clinic Staff, 2013). Patients who have been put on diuretics may be instructed to eat more foods high in potassium, like bananas, dried fruits, avocados, nuts, and whole grains, because often potassium levels drop. (Department of Health & Human Services, 2012). They may also be instructed to eat extra fiber, which helps food move along the digestive tract, and may help control blood glucose levels, as well as possibly decreasing cholesterol levels.

As CHF progresses, personal care will become more difficult. Regular tasks will require a lot of energy. Medications the patient may be taking such as diuretics could cause more frequent urination, also resulting in more energy exertion. Other simple tasks for hygiene such as brushing teeth and hair will also require energy where there is not a lot to spare. If the patient is retaining a lot of fluid, it could be difficult to move around, and even breath fully.

Emotionally it will be tough for a patient to come to terms with not being physically able to do personal care and hygiene anymore, and needing someone to do it for them (US Department of Health & Human Services, 2010). Hopefully a CNA could soothe the patient and make personal care less stressful. Let the patient do as much as he/she can tolerate physically, and try to treat the patient with empathy and respect, not pity. NURS 6512 Advanced Health Assessment and Diagnostic Reasoning Assignments

The condition is progressive and unfortunately terminal. At some point, the patient may need hospice care. A CNA could try to listen to what the person has to say if they feel like saying anything at all. As a nursing assistant, it is important to stay positive, and to continue encouraging the patient to be as independent as possible (Carter, 2012).

The scariest part about a progressive disease is the anticipation of death. All people will deal with this differently, but it is important to stay open-minded and do what we can to help patients and families cope and remain positive about the situation. Listening is one of the most important parts of communication, and one of the most valuable skills to have as a nursing assistant.

Diseases of the heart are the leading cause of death in America.  “Nearly 5 million people in the United States have congestive heart failure. Each year, there are an estimated 400,000 new cases, and half of those diagnosed with the condition will be dead within five years”( “Two New Treatments for Congestive Heart Failure”).

            Generally congestive heart failure begins with a dysfunctional ventricle in the heart; however this event usually occurs before any symptoms of the disease become apparent (Cohn). Essentially, Congestive Heart Failure is due to the heart making valiant attempts to make up for its weakened pumping abilities that is caused by this dysfunctional ventricle. It does this by enlarging and pumping faster to make up for the loss of strength. Recent studies are finding that the most indicative per-existing risk factors for developing Congestive Heart Failure is hypertension, but there are many more risk factors to be considered as well (Levy, Larson, Vasan, Kannel, & Ho). If the patient has had any previous heart attacks or coronary artery disease, an irregular heartbeat or arrhythmia, any disease of the heart muscle itself or cardiomyopathy, a disease affecting the heart valves particularly that of the mitral and aortic valves, and any kind of congenital heart disease then they are at a considerably higher risk to develop Congestive Heart Failure as well. Alcohol and drug abuse have also been linked to the development of this disease (Cohn; Congestive Heart Failure).

            Symptoms of Congestive Heart Failure are often dependent upon which side of the heart has been afflicted. If the left side of the heart is the damaged side “blood and fluid back up into your lungs. You will feel short of breath, be very tired, and have a cough (especially at night). In some cases, patients may begin to cough up pinkish, blood-tinged sputum” (“Congestive Heart Failure”). If the dysfunction is in the right side of the heart then the fluid will build in the veins as opposed to the lungs. Edema of the legs, ankles, and feet will occur because of this collection of fluid. “Sometimes edema spreads to the lungs, liver, and stomach. Because of the fluid buildup, you may need to go to the bathroom more often, especially at night. Fluid buildup is also hard on your kidneys. It affects their ability to dispose of salt (sodium) and water, which can lead to kidney failure” (“Congestive Heart Failure”). In addition to these site-specific symptoms, the patient may find it difficult to breathe, feel weak or tired causing an inability to participate in physical activities, develop chest pain, loss of appetite, swollen veins in the neck, clammy skin, a fast or irregular pulse (“Two New Treatments”; “Congestive Heart Failure”). Additionally the patient may feel confused and restless, and suffer from memory lapses and difficulty in concentration.

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            Often a diagnosis of Congestive Heart Failure can be made by a physical examination of the patient based on the development and reporting of the symptoms above. The development of fluid in the lungs can be heard through a physical examination with a stethoscope, as can an indication of arrhythmia or a hastened heartbeat. A tapping on the chest can help the doctor determine whether there has been any build up of fluid in the chest. While these diagnostic efforts are generally quite accurate, verification of diagnosis of Congestive Heart Failure can be achieved through chest x-rays which will reveal the enlarged heart and the development of fluid in the lungs. An EKG can be used to verify the arrhythmia and any other abnormalities of rhythm or pace of the heart. A sonogram-type examination of the heart called electrocardiography can take a rather detailed look at the physical structure of the heart and can evaluate valve function, motion of the heart, and can again detect an enlarged heart size. Nuclear ventriculography, a technique where a radioactive material is injected into the veins and its path through the body can be traced through special cameras, as well as angiography, a method where a catheter is fed through the femoral artery in order to take site-specific internal x-rays (“Angiography Test”), are both used to provide sure verification of the diagnosis and to determine how far alone the disease has come (“Congestive”). NURS 6512 Advanced Health Assessment and Diagnostic Reasoning Assignments

            There are multiple ways in which Congestive Heart Failure can be treated, many that are used together to ensure effective management of the disease. Lifestyle Changes such as smoking cessation; management of risk factors such as hypertension, diabetes and high cholesterol; a restricted low-calorie, low-fat, low-salt diet; a sensible limit set on alcohol consumption; monitoring any weight gain that could be due to continued fluid buildup; and, of course, an approved aerobic exercise program are all in the first line of defense both against Congestive Heart Failure and in the treatment of the disease once it is diagnosed. Beyond these lifestyle changes, medications are also extremely helpful in both controlling symptoms and in prolonging the life of an individual diagnosed with the disease. Medicines called inotropics (which are usually delivered directly to the heart through a catheter) work to strengthen the heart’s pumping action, while vasodilators (such as nitroglycerin) help open up narrow blood vessels. Diuretics help reduce the buildup of fluid. ACE inhibitors keep vessels open and are used to keep blood pressure in check (Cohn; “Congestive”). These as well as other medications that a doctor may feel helpful in the treatment of the disease can all be used in orchestration to both alleviate symptoms and manage the disease itself.

            More intrusive therapies are often used in emergency and extreme situations. Angioplasty is a technique where the arteries are “puffed up” with a small balloon. This effectively pushes any fatty buildup of plaque in the heart up against the artery wall, thus opening it up again for more healthy heart functioning. Stents, mesh-like metal inserts, are often placed at the time of angioplasty to keep the artery from collapsing (“Congestive”).

Surgery is also an option, though this is usually reserved for the most extreme cases, or for those whose other treatments are no longer effective. Correction of any congenital heart defects should be tackled first to avoid any further development of the disease and to facilitate any other kind of surgical procedures. Hear valves can be repaired or completely replaced, as can the entire heart by transplantation. Bypass surgery has been quite successful as well. Insertion of mechanical devices to help sustain the heart’s functions, such as pacemakers, is also a viable option in these extreme cases (“Congestive”).

            With the help of good medical support and the various treatments available, those who suffer from Congestive Heart Failure can continue to live full, happy lives.

WEEK 8 : Assessment of the Musculoskeletal System

The human muscular system is made up of over 600 connecting muscles. All of the muscles work together in sync to make your body move in several different ways.

None of the body systems can work without muscles and your muscles can’t work without your other body systems so that means that all of your body systems need each other to work and make your body function correctly.

Your muscles need protein, nutrients, and oxygen to move and work. Then the circulatory system carries those essential particles to your muscles from the digestive and respiratory systems.

That is when your circulatory system carries the leftover waste back to the original systems to be discharged from your body. Your nervous system runs the whole show by telling your different systems to make this whole process happen

Muscles

Your muscles are made up of body tissue which consists of very very small fibers which make up your muscles and you also have ligaments which help your muscles move in the right way.

Each of your muscles are responsible for their own special job. All of your muscles contract to provide motion when the brain sends a signal through the nervous system which are stimulants. These stimulants tell your muscles to move your arms, legs and other muscles move your eyelids and they all work in sync to make you walk and talk. There are some muscles in which you have no control over like the muscles in your internal organs like your heart, stomach, and other organs in all of your body systems.

There are three different types of muscular tissues. There are the Smooth, the Skeletal, and the Cardiac muscular tissues. Smooth muscles are made of spindle-shaped cells. Smooth muscles are found in the skin, internal organs, reproductive system, major blood vessels, and excretory system. Skeletal muscles are composed of long fibers surrounded by a membranous sheath, the sarcolemma. Since the Skeletal muscles are under control by whom ever they belong to are called voluntary muscles. This muscle is attached to two or more bones which are then attached to the skeleton by tendons. For example, head and neck muscles; contraction of these muscles produces facial expressions and head movements. They are also responsible for speech and swallowing. Skeletal muscles are the main muscles which move your body.

Muscles nearly always work in coordinated groups; contraction of one muscle is accompanied by relaxation of another, while other muscles stabilize nearby joints. Then the last of the muscle types is the Cardiac Muscle or the involuntary muscles. Cardiac muscles are not under conscious control they do not react by a persons decision or movement. and are connected to the nervous system which are stimulated by autonomic impulses. Cardiac muscles are found in your internal organs like the heart or the intestine. For example; they include muscles that propel food through the intestine and those that control sweating and blood pressure.

Muscles that are properly exercised react to stimuli quickly and powerfully. As a result of excessive use muscles may have an abnormal increase of an organ or tissue in the muscle cells. That is why if you work out at the gym your muscles become larger, but if you overwork your muscles they decrease sometimes to a fraction of its original size and becomes substantially weak NURS 6512 Advanced Health Assessment and Diagnostic Reasoning Assignments

WEEK 9: ADHD and Treatment

Treatment for attention deficit hyperactivity disorder (ADHD) has two important components — psychotherapy interventions (for both the child and the parents; or the adult with ADHD) and medications. There is a significant amount of research demonstrating that medication alone won’t really help address so many of the core issues a child or adult with ADHD has. So while medication may help with some immediate relief from some of the symptoms, the person with attention deficit disorder still often needs to learn the skills needed to be successful while living with the disorder.

In the past, ADHD treatment has typically focused on medications. The specific class of medication most commonly prescribed for ADHD is stimulants.

These stimulant medications — like Ritalin (methylphenidate) or Adderall (an amphetamine) — are commonly prescribed, well-tolerated, act quickly (usually soon after a person takes them), and in most people, have few side effects. These medications also have a robust research base supporting their effectiveness in treatment of attention deficit disorder.

Children vary a great deal in their response to medication treatments. Finding the combination with the highest efficacy and fewest side-effects is a challenge in every case. A child’s prescribing physician will aim to discover the medication and dose that’s best for your child.

If one medication doesn’t appear to be working after a few weeks of treatment, a doctor will often try another medication. This is normal and most people will switch medications to find the one that works best for them at least once. The side effects of stimulants may include reduced appetite, headache, a “jittery” feeling, irritability, sleep difficulties, gastrointestinal upset, increased blood pressure, depression or anxiety, and/or psychosis or paranoia. If any of these symptoms are experienced, then the doctor who prescribed them should be contacted. Many parents may be concerned about having stimulant medications prescribed to their child.

This is a typical concern among st parents, but such medications are not addicting, nor do they produce a “high” in a person with ADHD who takes them. Researchers are still unclear as to why stimulant medications do not “over-stimulate” people who take them, but it is hypothesized that people with ADHD have a problem with certain neurotransmitters in their brain that the medication helps correct. It is unknown exactly why some drugs help some people, but not others, nor the exact mechanism that makes stimulants effective.

However, it is known that they work in most people who take them, effectively treating the symptoms of ADHD. Researchers are concerned how a medication such as Ritalin may interfere with normal brain development. However, stimulant medications such as Ritalin and Adderall have been linked to the sudden death of children and adults that had heart conditions. Because these stimulants increase heart rate and blood pressure it is now recommended that physicians have their patients go through a cardio evaluation prior to starting a stimulant to treat ADHD.

Medications Used to Treat ADHD

Stimulant medications commonly prescribed for attention deficit disorder include methylphenidate (Ritalin, Concerta, Metadate, Methylin) and certain amphetamines (Dexedrine, Dextrostat, Adderall). Methylphenidate is a short acting drug, and in older forms, had to be taken multiple times a day. Longer-acting versions of the drug are now available for once-daily use. Although taking stimulants for treatment may seem risky, there is significant research that demonstrates that when taken as directed, they are safe and effective in the treatment of adult ADHD. Stimulant drugs are often beneficial in curbing hyperactivity and impulsivity, and helping the individual to focus, work, and learn.

Sometimes the drugs will also help with coordination problems which may hinder sports and handwriting. Under medical supervision, these stimulant drugs are quite safe and do not make the child feel “high”, although they may feel slightly different. To date, there is no convincing evidence that children risk becoming addicted to these drugs, when used for ADHD. In fact, “a review of all long-term studies on stimulant medication and substance abuse, conducted by researchers at Massachusetts General Hospital and Harvard Medical School, found that teenagers with ADHD who remained on their medication during the teen years had a lower likelihood of substance abuse than did ADHD adolescents who were not taking medications.” (2013) NURS 6512 Advanced Health Assessment and Diagnostic Reasoning Assignments

Other, newer kinds of drugs, have also been approved for the treatment of ADHD. These non-stimulant medications include Strattera (atomoxetine, a selective norepinephrine reuptake inhibitor) and Vyvanse (lisdexamfetamine dimesylate). These drugs typically offer similar benefits to stimulants, but act in a different way on the brain. Some people may find they better tolerate these drugs.

Another useful category of drugs for adults with ADHD are the antidepressants, either alongside or instead of stimulants. Antidepressants which target the brain chemicals dopamine and norepinephrine are the most effective. These include the older form ofantidepressant known as the tricyclics, as well as new antidepressants, such as Venlafaxine (Effexor). The antidepressant Bupropion (Wellbutrin) has been found useful in trials of adult ADHD, and may also help reduce nicotine cravings.

ADHD Drug Side-effects

Some medications for ADHD can bring on symptoms of hostility, anxiety, depression and/or paranoia. People with a family history of suicide are at greater risk and should be closely monitored while taking stimulants to treat their ADHD. The majority of side-effects are minor and do not result in stopping the medication. They may be alleviated by lowering the dosage, but the prescribing physician should be contacted before making any changes to any. Another growing concern of taking stimulants, is the weight loss properties of the drug or the alertness it gives to someone who takes the medication, but doesn’t suffer from ADHD.

A study that was at Columbia University 2003, found that “ As many as 20 percent of college students have used Ritalin or Adderall to study, write papers and take exams, according to recent surveys focused on individual campuses.” (New York Times News) 2005. Parents should be aware of the amount of medication that their children have and talk to their children about the dangers of sharing or selling their medication.

This would make the medication an illicit drug and criminal charges will be laid if anything happens to someone who took the drug that it was not prescribed to. Some side effects in dealing with ADHD medication do go away after the first few weeks. People on ADHD medication my experience loss of appetite, insomnia, upset stomach, headaches, dizziness, and mood changes. If any of these side effects are bothersome, the patient should speak to their doctor about adjusting the dosage or trying an alternative drug. As well as medication, behavioral therapy, emotional counseling, and practical support will also help a person with ADHD cope with the disadvantages of the disorder.

Psychotherapy for ADHD

We have decades’ worth of research demonstrating the effectiveness of a wide range of psychotherapies for the treatment of ADHD in both children and adults. Some people turn to psychotherapy instead of medication, as it is an approach that does not rely on taking stimulant medications. Others use psychotherapy as an adjunct to medication treatment. Both approaches are clinically accepted. In psychotherapy (commonly, cognitive-behavioral therapy for ADHD), the child can be helped to talk about upsetting thoughts and feelings, explore self-defeating patterns of behavior, learn alternative ways to handle emotions, feel better about him or herself despite the disorder, identify and build on their strengths, answer unhealthy or irrational thoughts, cope with daily problems, and control their attention and aggression.

Such therapy can also help the family to better handle the disruptive behaviors, promote change, develop techniques for coping with, and improving their child’s behavior. Behavioral therapy is a specific type of psychotherapy that focuses more on ways to deal with immediate issues. It tackles thinking and coping patterns directly, without trying to understand their origins. The aim is behavior change, such as organizing tasks or schoolwork in a better way, or dealing with emotionally charged events when they occur.

In behavior therapy, the child may be asked to monitor their actions and give themselves rewards for positive behavior such as stopping to think through the situation before reacting. Psychotherapy will also help a person with attention deficit disorder to boost their self-esteem through improved self-awareness and compassion. Psychotherapy also offers support during the changes brought about through medication and conscious efforts to alter behavior, and can help limit any destructive consequences of ADHD. NURS 6512 Advanced Health Assessment and Diagnostic Reasoning Assignments

Social Skills Training for ADHD

Social skills training teaches the behaviors necessary to develop and maintain good social relationships, such as waiting for a turn, sharing toys, asking for help, or certain ways of responding to teasing. These skills are usually not taught in the classroom or by parents — they are typically learned naturally by most children by watching and repeating other behaviors they see. But some children — especially those with ADHD — have a harder time learning these skills or using them appropriately. Social skills training, helps the child to learn and use these skills in a safe practice environment with the therapist (or parent).

Skills include learning how to have conversations with others, learning to see others’ perspective, listening, asking questions, the importance of eye contact, what body language and gestures are telling you. Social skills training is done in a therapy office, or parents can learn them and teach them in the home. The therapist teaches the behaviors that are appropriate in different situations and then those new behaviors are practiced with the therapist. Clues that can be taken from people’s facial expressions and tone of voice may be discussed.

Support Groups for ADHD

Mutual self-help support groups can be very beneficial for parents and individuals with ADHD themselves. A sense of regular connection to others in the same boat leads to openness, problem-sharing, and sharing of advice. Concerns, fears and irritations can be released in a compassionate environment where members can safely let off steam and know that they are not alone.

As well as this type of support, the groups can invite experts to give lectures and answer specific questions. They can also help members to get referrals to reliable specialists. For people who are either uncomfortable openly talking about their issues with ADHD or are simply not able to attend support groups, there are online support groups such as, Psych Central that hosts two support groups online for people with ADHD: Psych Central ADHD support group and NeuroTalk’s ADHD support group.

WEEK 11: Health Assessment

A comprehensive history and physical examination is essential for all well-child visits allowing for minor variations based on the patient’s age (Sullivan, 2012). Addressing any new issues if present would be the first step. The child has been coming to the office since birth, past medical, family, and social history would be updated. A review of systems and comprehensive physical exam will also be completed. NURS 6512 Advanced Health Assessment and Diagnostic Reasoning Assignments

The health assessment includes growth and developmental screenings to determine if the patient is following a healthy growth and developmental trajectory (Sullivan, 2012). Establishing if the patient has received any immunizations from birth until now should also be included particularly due to parental opposition to immunizations and the likelihood that the patient has not received any.  Assessment of attention span and ability to separate from parents is important for school readiness (Sullivan, 2012). Patient safety such as seat belts, booster seats, street safety should be determined while discussing anticipatory guidance. Laboratory data is not necessary at this age unless it is required for a new onset issue. Lastly, discussing other topics anticipatory for this age include knowing full name, address, and phone number; sexual curiosity; household chore participation; and no playing with match (Sullivan, 2016).

It is most important to address the parent’s opposition to immunizations. The first step as an advanced practice nurse is to establish why they are opposed to immunizations such as religious or cultural beliefs, lack of understanding for immunizations, fear of pain for their child, or misinformation about the risks of immunizations (Sullivan, 2016). According to Whyte, Whyte, Cormier, and Eccles (2011), perceived risk related to vaccine safety, such as immediate side effects and increased susceptibility to chronic conditions such as autism, is significantly substantial in influencing parents’ decision to immunize. Low immunization rates are also associated with lack of knowledge regarding communicable diseases and the importance of vaccination (Whyte et al., 2011).  As advanced practice nurses we should listen carefully and respectfully to the parent’s concerns and be honest about what is known and not known about the risk and benefits of each vaccine (Whyte et al., 2011). We should address any misconceptions or misinformation and attempt to correct it. Concerns regarding multiple vaccines in once visit can also be addressed and remedied by spreading out the vaccines. Lastly, concern about pain related to vaccination administration can also be addressed and prevented with the use of numbing cream or pain medication at least 20 minutes before administration of vaccines. 

As an advanced practice nurse it is important to explain the risks of not being vaccinated.  If an unvaccinated child is exposed to a disease germ, the child’s body may not be strong enough to fight the disease. Before vaccines, many children died from diseases that vaccines now prevent, such as whooping cough, measles, and polio. Those same germs exist today, but because babies are protected by vaccines, we don’t see these diseases nearly as often.  Immunizing individual children also helps to protect the health of our community, especially those people who cannot be immunized (children who are too young to be vaccinated, or those who can’t receive certain vaccines for medical reasons), and the small proportion of people who don’t respond to a particular vaccine (CDC, 2017). NURS 6512 Advanced Health Assessment and Diagnostic Reasoning Assignments