Discussions

Screening for Intimate Partner Violence

Intimate partner violence program includes patterns of assaultive and coercive behaviors that inflict physical injury, sexual assault, psychological abuse among others to the victims. The actions are perpetrated by individuals who are or wishes to be involved in an intimate relationship with the victim and are aimed at taking control over the other partner. Issues related to intimate partner violence cohabitating, married or dating couples have sparked a lot of interest from scholars, the public, as well as social activists. Healthcare providers dedicated to the advancement of women’s health are also joining the fight against domestic violence. The United States Preventive Services Task Force recommends that clinicians screen all women of reproductive age for intimate partner violence (Moyer, 2013). According to the National Intimate Partner and Sexual Violence Survey, more than one in three women have experienced domestic violence in the hands of their intimate partner. The prevalence is even higher for women who are exposed to domestic violence risk factors such as marital conflicts, tension, and instability or low-income earners.

Screening of women at the clinic aims at unraveling abusive and controlling behaviors ranging from sexual assault, forced sex to other forms of victimization that interfere with a woman’s choice of sexual activities, safer sex practices, and unplanned pregnancy. In a systematic review, some clinical signs that may be observed in a woman experiencing intimate partner violence include inconsistent condom use, unplanned pregnancies, sexual dysfunction, recurring STIs, and sometimes induced abortions. According to the American College of Obstetrics and Gynecology (2013), women who experience IPV are more likely to report a lack of birth control use because their partner is not willing to use. Moreover, there is a higher probability for abused women not to use birth control due to their economic status and thus cannot afford it. 

References

American College of Obstetrics and Gynecology. (2013). Reproductive and Sexual Coercion. Retrieved from: https://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Reproductive-and-Sexual-Coercion

Moyer, V. A. (2013). Screening for Intimate Partner Violence and Abuse of Elderly and Vulnerable Adults: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine, 158(6), pp. 478 – 486. 

Discussion #2

Postpartum Depression

Postpartum depression (PPD) is a highly prevalent medical condition occurring in 10 to 15 percent of new mothers. Unfortunately, despite its high prevalence, most of the times, PPD goes unrecognized because its clinical indicators are often attributed to the postpartum changes of a mother. In addition to the inability of clinicians being unable to detect the condition, some women are reluctant to report unusual changes in their moods. Therefore, it is important for clinicians to screen women to screen patients for the medical condition before it escalates to unmanageable levels. In light of this, the United States Preventive Services Task Force (USPSTF) recommends screening for all adult population, including pregnant and postpartum females. According to Siu & USPSTF (2016), screening for depression should be implemented with adequate procedures in place for correct diagnosis, to be able to offer the most efficient treatment and easy follow-up.

Clinical Indicators for PPD

Most of the times, postpartum depression is mistaken for baby blues, but the clinical signs are more intense and last longer. Some of these clinical indicators include depressed or severe mood swings, loss of appetite or overeating, insomnia or sleeping too much, overwhelming fatigue (Zauderer, 2009). Other times, the mother may display signs of anxiety and panic attacks, and recurrent thoughts of suicide. Usually, patients get referrals to a specialist in case the clinical indicators of postpartum depression fail to fade away after two weeks. Another reason that may warrant a referral is if the patient seems to be getting worse making it hard for them to care for the baby or complete everyday tasks. Suicide thoughts are also some of the reasons that may prompt a doctor to recommend a referral. 

References

Liu, A. L., & US Preventive Services Task Force. (2016). Screening for Depression in Adults US Preventive Services Task Force Recommendation Statement. JAMA, 314(4), pp.380-387.

Zauderer, C. (2009). Postpartum Depression: How Childbirth Educators Can Help Break the Silence. Journal of Perinatal Education, 18(2), pp. 23-31.

Discussion #3

Health Disparities

Health disparities are serious health concerns that have several social, economic, and health implications on the mother and child. Health disparities are influenced by various factors such as socio-economic status, environmental, genetic characteristics, and ethnic backgrounds among others. Low-income earners are especially at a higher risk of certain health disparities related to pregnancy. For instance, preterm births and intrauterine growth restrictions are some of the risks consistently linked to lower socioeconomic status women. Explanations for these disparities are often associated with higher rates of poor nutrition and increased rates of genitourinary tract infections among low-income pregnant women. Premature birth and genitourinary tract infections are usually explained by greater exposure to chronic stressors, including overcrowded home areas, unemployment, lack of social support and financial problems. Another health disparity risk associated with infant mortality is infant mortality rates. According to Larson (2007), research shows that child mortality rates are considerably higher in low-income neighborhoods. Disparities in postnatal mortality in low-income earners are also greater than middle and high-income neighborhoods. In fact, living in low-income neighborhoods was associated with a high risk of neonatal and postneonatal deaths. In addition to the above, poverty has been related to increased maternal mortality and maternal depression. According to a report by ASTHO (2012), most women die during pregnancy or within 42 days after pregnancy termination. Maternal depression among this group is also relatively high. Similarly, poverty has been found to be a strong determinant of slow cognitive growth in children. Although the hypothesis is still unclear, maternal poverty has been cited as one of the determinants of cognitive growth in children. 

References

ASTHO. (2012). Disparities and Inequities in Maternal and Infant Health Outcomes. Retrieved from: http://www.astho.org/Programs/Health-Equity/Maternal-and-Infant-Disparities-Issue-Brief/

Larson, C. P. (2007). Poverty during pregnancy: Its effects on child health outcomes. Pediatrics and Child Health, 12(8), pp. 673-680.

Discussion #4

Effects of Inadequate Sleep during the Menopausal and Perimenopausal Period

Sleep disturbances are a major concern in women during the peri-menopausal and menopausal period. During this period, women complain of difficulties maintaining or initiating sleep, alongside nocturnal awakenings. As it is, low levels of estrogen and progesterone have been associated with increased risk of insomnia and unstable mood swings in menopausal women. Several factors may play a role in this type of insomnia. However, the most worrying is the health concerns related to inadequate sleep. According to Jehan, Masters-Isarilov, & Salifu (2015), depression and anxiety disorders have been associated with lack of enough sleep in postmenopausal women. Problems initiating sleep strongly correlates with stress, with non-restorative sleep having a strong relationship with depression. Similarly, inadequate sleep leading to anxiety, irritability, and non-restorative sleep usually breeds into depressive conditions. By far, insomnia has been highly linked as a major causative factor for depression. Another health concern associated with inadequate sleep is the development of cardiovascular disease and hypertension, with several potential mechanisms explaining the link between sleep loss and the two diseases (Colten, Altevogt & Institute of Medicine (U.S.), 2006). In light of the effects of inadequate sleep in menopausal women, treatment of sleep disturbances is critical regardless of age or menopause status.

Studies show that treating menopausal symptoms immediately the period begins with estrogen alongside estrogen-progesterone therapy has effects that are more active especially with the risks of breast cancer that increases after the menopausal period making it hard to administer these interventions. Another intervention of menopausal insomnia is the use of melatonin to induce drowsiness and sleep. It can also be used to improve sleep disturbances, especially nocturnal awakenings.

References

Colten, H. R., Altevogt, B. M., & Institute of Medicine (U.S.). (2006). Sleep disorders and sleep deprivation: An unmet public health problem. Washington, DC: Institute of Medicine.

Jehan, S., Masters-Isarilov, A., Salifu, I., Zizi, F., Jean-Louis, G., Pandi-Perumal, S. R., Gupta, R., … McFarlane, S. I. (2015). Sleep Disorders in Postmenopausal Women. Journal of Sleep Disorders & Therapy, 4(5), pp. 1-18.

Discussion #5

 Clinical Assessment

Essentially, no individual displays the same symptoms for various illnesses. The patients admit that she does not experience shortness of breath, chest pain, or dyspnea. In this case, additional questions asked to look for symptoms that are more common include. Does the patient experience sweating on the hands, neck swelling, body aches or pains, or sometimes go into a state of confusion?

Physical Examination

Most of the times, it is hard to diagnose a condition based on the symptoms alone. The physical examination will be performed to check for evidence of dry skin, slow reflexes, reduced heart rate, and edema on legs and around the eyes.

Differential Diagnoses

At this time, the differential diagnoses projects to a case of hypothyroidism. 

Tests to Include

The most appropriate test, in this case, is the thyroid-stimulating hormone, which is a blood test used to measure the amount of T4 (thyroxine) the thyroid is signaled to produce (LeMone, Burke, & Levett-Jones (2013). In case high levels of TSH are detected, then it means the patient has hypothyroidism. Another test than being used is the radioactive iodine uptake to test how much thyroid is consumed by the thyroid gland in a specific period.

Managing the Condition

The condition can be managed through thyroid hormone drugs. The most efficient and reliable intervention is the use of synthetic hormone replacement. Synthetic thyroid contains thyroxine and the required triiodothyronine by the body are extracted here (Jonklaas, Bianco & Bauer, 2014). Regular visits should also be scheduled with the patient to assess if they are taking the right dose.

References

Jonklaas, J., Bianco, A. C., Bauer, A. J., Burman, K. D., Cappola, A. R., Celi, F. S., Cooper, D. S., … American Thyroid Association Task Force on Thyroid Hormone Replacement. (2014). Guidelines for the treatment of hypothyroidism: prepared by the American Thyroid association task force on thyroid hormone replacement. Thyroid: Official Journal of the American Thyroid Association, 24(12), pp. 1670-1751.

LeMone, P., Burke, K. M., & Levett-Jones, T. (2013). Medical-Surgical Nursing VS. Sydney: Pearson Education Australia.

Discussion #6

Rheumatoid Arthritis

Rheumatoid Arthritis is a disease coupled with several ups and downs. Some days, the patient may be feeling good and next day they are can barely get out of bet because of swelling and pain. These episodes as Markusse, Dirven & Gerards, (2015) elaborate are called flares. Unfortunately, it is not yet clear what triggers flare ups.  When faced with such, the best way to navigate with the treatment plan is to start by investigating the history of the patient over the past couple of days and review systems to understand what triggered the reaction. Sometimes, flare-ups are a sign of another illness, although it is obvious to have no obvious trigger.

Diagnostic testing

Rheumatoid arthritis is an autoimmune disease, and certain blood tests such as rheumatoid factor test, anti-CPP test, and antinuclear antibody test among others can help detect immune system changes or antibodies attacking the joints and other organs. Other diagnostic tests include X-rays to scan for damages in the cartilage, tendons, or bones. Other times, MRI-scan can also be used to take pictures of soft tissues to check for synovium inflammation. 

Managing exacerbated Rheumatoid Arthritis

Exacerbated rheumatoid arthritis can be managed through symptomatic treatments designed to relieve acute pain and accelerate inflammation (“Medication for the treatment of rheumatoid arthritis,” 2016). The drugs include steroids, nonsteroidal anti-inflammatory medicines, and acetaminophen. Disease-modifying and biologics drugs act as immunosuppressants and can be used to prevent chronic inflammation.

Patient Education

Physical therapy, fish oil supplements, and herbal medications provide relief from pain and inflammation. Doctors have a responsibility to educate patient on various home care options that can relieve the pain and rheumatoid arthritis flare-ups. 

References

“Medication for the treatment of rheumatoid arthritis.” (2016). National Center for Biotechnology Information. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0089163/

Markusse, I. M., Dirven, L., Gerards, A. H., van, G. J. H., Ronday, H. K., Kerstens, P. J., Lems, W. F., … Allaart, C. F. (2015). Disease flares in rheumatoid arthritis are associated with joint damage progression and disability: 10-year results from the BeSt study. Arthritis Research & Therapy, 17(232), pp. 1-9. 

Discussion #7

Clinical Assessment

The clinical assessment for Mildred includes complaints about fatigue and unstable sleeping patterns. Mildred also suffers from constant worry because of her husband recent layoff from work. She experiences depressed moods that usually switch from sad to anxious and vice versa. She also displays signs of hopelessness, has difficulties eating, and is sometimes forgetful. Recently, she experienced an episode of fast heart rate, difficulty in breathing, and felt as if a heart attack was imminent but managed to calm down with the help of her husband.

Initial Differential Diagnoses

Drawing on the clinical assessment, the initial differential diagnoses projects to a case of depression or anxiety disorder.

Major Psychological Questions

Various psychological questions may involve a feeling of nervousness, irritability, sleeping patterns, and concentration ability. 

Recommended Tests to Rule out any Medical Problems

Mildred experienced an episode of increased heart rate, difficulties in breathing, and experienced a moment of an impending heart attack; the most recommended test is electrocardiogram, chest X-ray, and blood gas analysis. The electrocardiogram test checks for problems with electrical activities of the heart (Bhattacharyya, 2015). The chest X-ray test will be used to check for the cause of shortness of breath, while the blood gas analysis will be used to asses cause for shortness of breath and difficulty in breathing (Berliner, Schneider & Welte, 2016).

Care Plan

When dealing with patients with anxiety disorder, the first thing is to maintain calmness when working with the client. Establish a trusting relationship by paying close attention to what they say, display warmth when answering questions and respect personal space. In the case of Mildred, self-help care can be combined with psychotherapy, which involves working with a therapist to minimize the anxiety symptoms. Cognitive behavioral therapy and medications are the mainstays of this condition and considered the most effective forms of treatment of anxiety disorder. 

Patient Education

Enroll in a relaxation training to help reduce tension. Maintain active communication with friends and family and express your worries and fears.  

References

Berliner, D., Schneider, N., Welte, T., & Bauersachs, J. (2016). The Differential Diagnosis of Dyspnea. Deutsches Arzteblatt International, 113(49), pp. 834-845.

Bhattacharyya, D. (2015). Vedic Machine. [Place of Publication not Identified]: DevB Inc.

Discussion #8

Resolution Guideline

The nurse practitioner has detected a contusion and recommended further investigation if Ms. Brown’s dizziness does not go away. However, she complains that it is not easy for her to travel back to the clinic as she is poor and relies on public transport. Besides, their belongings have been robbed, and her partner is not very concerned about her health. Unfortunately, while the nurse practitioner understands the current situation with Ms. Brown, she is not in a position to help with accommodation. Additional data may be in the form of checking any other person who may help Ms. Brown with transport or accommodation near the hospital so she can attend the follow-up plan. Nonetheless, Ms. Brown is the only person who should be making the decision regarding the whole issue. As it is, she has a right to say no or yes to any proposal from the nurse practitioner. 

For humanity’s sake, the nurse practitioners may help the patient with transport or consult with the nurse manager to help the patient. Community-based programs can be asked to offer any possible assistance to Ms. Brown and most probably by providing her with shelter. Such programs are available in the Center for Budget and Policy Priorities that advocates housing the vulnerable people (Dohler, Bailey, & Rice, 2016). Ray should also be involved in the decision-making process. 

In this case, the standards of care that should be incorporated include veracity or telling the truth. According to Dunphy, Winland-Brown &  Porter (2015), health care providers should not omit some information even if they feel the patient cannot handle it. Confidentiality should also be observed to respect privileged information. 

Since the patient is adamant about her ability to come back for a follow-up, the nurse practitioner should inform Ray and advise him on the information of having his partner attending the recommended follow-up.

References

Dohler, E Bailey, P, Rice, D, & Katch, H. 2016. Supportive Housing Helps Vulnerable People Live and Thrive in the Community. Center on Budget and Policy Priorities. Retrieved from: http://www.cbpp.org/research/housing/supportive-housing-helps-vulnerable-people-live-and-thrive-in-the-community

Dunphy, L. M. H., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2015). Primary care: The art and science of advanced practice nursing. Philadelphia: F.A. Davis Company.

Article Summary

Nurse practitioners can help alleviate the shortage of primary care facing the United States, but their scope of practice is limited by state regulations. The article by Emily, Miller & Tyler (2015), outlines the roles of nurse practitioners in various states and their scope of practice. In the United States, nurse practitioners play a prominent role in healthcare by providing primary care to patients. Primary care includes a variety of interventions such as initial diagnosis, evaluation, disease prevention, screening, and management of chronic diseases. By far, nurse practitioners play a primary role in ensuring access and quality in low-cost service delivery through preventive care and screening. Increased quality care is associated with low morbidity and mortality rates of reduced hospitalizations, costs, and customer satisfaction. In fact, research shows that the quality of care provided by NPs is often considered more satisfying as compared to the one administered by physicians. Unfortunately, although NPs are certified nationally, their respective States determines their scope-of-practice. These regulations typically focus on the level of education the nurse practitioner must attain to be allowed to practice. As it is, a majority of the states adopted more stringent education requirements, which have served as a barrier for aspiring Nurse Practitioners. Sadly, these measures are projected to cause a shortage of primary caregivers in the United States and increasing the workload. In the state of Alabama, the physician is expected to direct and supervise the work, records, and practice of the nurse practitioner. The nurse practitioner is also not allowed to prescribe controlled substances II. 

References

Gadbois, E. A., Miller, E. A., Tyler, D., & Intrator, O. (2015). Trends in State Regulation of Nurse Practitioners and Physician Assistants, 2001 to 2010. Medical Care Research and Review, 72(2), pp. 200-219.

Discussions

Student’s Name

Institutional Affiliation

Discussion #1

Screening for Intimate Partner Violence

Intimate partner violence program includes patterns of assaultive and coercive behaviors that inflict physical injury, sexual assault, psychological abuse among others to the victims. The actions are perpetrated by individuals who are or wishes to be involved in an intimate relationship with the victim and are aimed at taking control over the other partner. Issues related to intimate partner violence cohabitating, married or dating couples have sparked a lot of interest from scholars, the public, as well as social activists. Healthcare providers dedicated to the advancement of women’s health are also joining the fight against domestic violence. The United States Preventive Services Task Force recommends that clinicians screen all women of reproductive age for intimate partner violence (Moyer, 2013). According to the National Intimate Partner and Sexual Violence Survey, more than one in three women have experienced domestic violence in the hands of their intimate partner. The prevalence is even higher for women who are exposed to domestic violence risk factors such as marital conflicts, tension, and instability or low-income earners.

Screening of women at the clinic aims at unraveling abusive and controlling behaviors ranging from sexual assault, forced sex to other forms of victimization that interfere with a woman’s choice of sexual activities, safer sex practices, and unplanned pregnancy. In a systematic review, some clinical signs that may be observed in a woman experiencing intimate partner violence include inconsistent condom use, unplanned pregnancies, sexual dysfunction, recurring STIs, and sometimes induced abortions. According to the American College of Obstetrics and Gynecology (2013), women who experience IPV are more likely to report a lack of birth control use because their partner is not willing to use. Moreover, there is a higher probability for abused women not to use birth control due to their economic status and thus cannot afford it. 

References

American College of Obstetrics and Gynecology. (2013). Reproductive and Sexual Coercion. Retrieved from: https://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Reproductive-and-Sexual-Coercion

Moyer, V. A. (2013). Screening for Intimate Partner Violence and Abuse of Elderly and Vulnerable Adults: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine, 158(6), pp. 478 – 486. 

Discussion #2

Postpartum Depression

Postpartum depression (PPD) is a highly prevalent medical condition occurring in 10 to 15 percent of new mothers. Unfortunately, despite its high prevalence, most of the times, PPD goes unrecognized because its clinical indicators are often attributed to the postpartum changes of a mother. In addition to the inability of clinicians being unable to detect the condition, some women are reluctant to report unusual changes in their moods. Therefore, it is important for clinicians to screen women to screen patients for the medical condition before it escalates to unmanageable levels. In light of this, the United States Preventive Services Task Force (USPSTF) recommends screening for all adult population, including pregnant and postpartum females. According to Siu & USPSTF (2016), screening for depression should be implemented with adequate procedures in place for correct diagnosis, to be able to offer the most efficient treatment and easy follow-up.

Clinical Indicators for PPD

Most of the times, postpartum depression is mistaken for baby blues, but the clinical signs are more intense and last longer. Some of these clinical indicators include depressed or severe mood swings, loss of appetite or overeating, insomnia or sleeping too much, overwhelming fatigue (Zauderer, 2009). Other times, the mother may display signs of anxiety and panic attacks, and recurrent thoughts of suicide. Usually, patients get referrals to a specialist in case the clinical indicators of postpartum depression fail to fade away after two weeks. Another reason that may warrant a referral is if the patient seems to be getting worse making it hard for them to care for the baby or complete everyday tasks. Suicide thoughts are also some of the reasons that may prompt a doctor to recommend a referral. 

References

Liu, A. L., & US Preventive Services Task Force. (2016). Screening for Depression in Adults US Preventive Services Task Force Recommendation Statement. JAMA, 314(4), pp.380-387.

Zauderer, C. (2009). Postpartum Depression: How Childbirth Educators Can Help Break the Silence. Journal of Perinatal Education, 18(2), pp. 23-31.

Discussion #3

Health Disparities

Health disparities are serious health concerns that have several social, economic, and health implications on the mother and child. Health disparities are influenced by various factors such as socio-economic status, environmental, genetic characteristics, and ethnic backgrounds among others. Low-income earners are especially at a higher risk of certain health disparities related to pregnancy. For instance, preterm births and intrauterine growth restrictions are some of the risks consistently linked to lower socioeconomic status women. Explanations for these disparities are often associated with higher rates of poor nutrition and increased rates of genitourinary tract infections among low-income pregnant women. Premature birth and genitourinary tract infections are usually explained by greater exposure to chronic stressors, including overcrowded home areas, unemployment, lack of social support and financial problems. Another health disparity risk associated with infant mortality is infant mortality rates. According to Larson (2007), research shows that child mortality rates are considerably higher in low-income neighborhoods. Disparities in postnatal mortality in low-income earners are also greater than middle and high-income neighborhoods. In fact, living in low-income neighborhoods was associated with a high risk of neonatal and postneonatal deaths. In addition to the above, poverty has been related to increased maternal mortality and maternal depression. According to a report by ASTHO (2012), most women die during pregnancy or within 42 days after pregnancy termination. Maternal depression among this group is also relatively high. Similarly, poverty has been found to be a strong determinant of slow cognitive growth in children. Although the hypothesis is still unclear, maternal poverty has been cited as one of the determinants of cognitive growth in children. 

References

ASTHO. (2012). Disparities and Inequities in Maternal and Infant Health Outcomes. Retrieved from: http://www.astho.org/Programs/Health-Equity/Maternal-and-Infant-Disparities-Issue-Brief/

Larson, C. P. (2007). Poverty during pregnancy: Its effects on child health outcomes. Pediatrics and Child Health, 12(8), pp. 673-680.

Discussion #4

Effects of Inadequate Sleep during the Menopausal and Perimenopausal Period

Sleep disturbances are a major concern in women during the peri-menopausal and menopausal period. During this period, women complain of difficulties maintaining or initiating sleep, alongside nocturnal awakenings. As it is, low levels of estrogen and progesterone have been associated with increased risk of insomnia and unstable mood swings in menopausal women. Several factors may play a role in this type of insomnia. However, the most worrying is the health concerns related to inadequate sleep. According to Jehan, Masters-Isarilov, & Salifu (2015), depression and anxiety disorders have been associated with lack of enough sleep in postmenopausal women. Problems initiating sleep strongly correlates with stress, with non-restorative sleep having a strong relationship with depression. Similarly, inadequate sleep leading to anxiety, irritability, and non-restorative sleep usually breeds into depressive conditions. By far, insomnia has been highly linked as a major causative factor for depression. Another health concern associated with inadequate sleep is the development of cardiovascular disease and hypertension, with several potential mechanisms explaining the link between sleep loss and the two diseases (Colten, Altevogt & Institute of Medicine (U.S.), 2006). In light of the effects of inadequate sleep in menopausal women, treatment of sleep disturbances is critical regardless of age or menopause status.

Studies show that treating menopausal symptoms immediately the period begins with estrogen alongside estrogen-progesterone therapy has effects that are more active especially with the risks of breast cancer that increases after the menopausal period making it hard to administer these interventions. Another intervention of menopausal insomnia is the use of melatonin to induce drowsiness and sleep. It can also be used to improve sleep disturbances, especially nocturnal awakenings.

References

Colten, H. R., Altevogt, B. M., & Institute of Medicine (U.S.). (2006). Sleep disorders and sleep deprivation: An unmet public health problem. Washington, DC: Institute of Medicine.

Jehan, S., Masters-Isarilov, A., Salifu, I., Zizi, F., Jean-Louis, G., Pandi-Perumal, S. R., Gupta, R., … McFarlane, S. I. (2015). Sleep Disorders in Postmenopausal Women. Journal of Sleep Disorders & Therapy, 4(5), pp. 1-18.

Discussion #5

 Clinical Assessment

Essentially, no individual displays the same symptoms for various illnesses. The patients admit that she does not experience shortness of breath, chest pain, or dyspnea. In this case, additional questions asked to look for symptoms that are more common include. Does the patient experience sweating on the hands, neck swelling, body aches or pains, or sometimes go into a state of confusion?

Physical Examination

Most of the times, it is hard to diagnose a condition based on the symptoms alone. The physical examination will be performed to check for evidence of dry skin, slow reflexes, reduced heart rate, and edema on legs and around the eyes.

Differential Diagnoses

At this time, the differential diagnoses projects to a case of hypothyroidism. 

Tests to Include

The most appropriate test, in this case, is the thyroid-stimulating hormone, which is a blood test used to measure the amount of T4 (thyroxine) the thyroid is signaled to produce (LeMone, Burke, & Levett-Jones (2013). In case high levels of TSH are detected, then it means the patient has hypothyroidism. Another test than being used is the radioactive iodine uptake to test how much thyroid is consumed by the thyroid gland in a specific period.

Managing the Condition

The condition can be managed through thyroid hormone drugs. The most efficient and reliable intervention is the use of synthetic hormone replacement. Synthetic thyroid contains thyroxine and the required triiodothyronine by the body are extracted here (Jonklaas, Bianco & Bauer, 2014). Regular visits should also be scheduled with the patient to assess if they are taking the right dose.

References

Jonklaas, J., Bianco, A. C., Bauer, A. J., Burman, K. D., Cappola, A. R., Celi, F. S., Cooper, D. S., … American Thyroid Association Task Force on Thyroid Hormone Replacement. (2014). Guidelines for the treatment of hypothyroidism: prepared by the American Thyroid association task force on thyroid hormone replacement. Thyroid: Official Journal of the American Thyroid Association, 24(12), pp. 1670-1751.

LeMone, P., Burke, K. M., & Levett-Jones, T. (2013). Medical-Surgical Nursing VS. Sydney: Pearson Education Australia.

Discussion #6

Rheumatoid Arthritis

Rheumatoid Arthritis is a disease coupled with several ups and downs. Some days, the patient may be feeling good and next day they are can barely get out of bet because of swelling and pain. These episodes as Markusse, Dirven & Gerards, (2015) elaborate are called flares. Unfortunately, it is not yet clear what triggers flare ups.  When faced with such, the best way to navigate with the treatment plan is to start by investigating the history of the patient over the past couple of days and review systems to understand what triggered the reaction. Sometimes, flare-ups are a sign of another illness, although it is obvious to have no obvious trigger.

Diagnostic testing

Rheumatoid arthritis is an autoimmune disease, and certain blood tests such as rheumatoid factor test, anti-CPP test, and antinuclear antibody test among others can help detect immune system changes or antibodies attacking the joints and other organs. Other diagnostic tests include X-rays to scan for damages in the cartilage, tendons, or bones. Other times, MRI-scan can also be used to take pictures of soft tissues to check for synovium inflammation. 

Managing exacerbated Rheumatoid Arthritis

Exacerbated rheumatoid arthritis can be managed through symptomatic treatments designed to relieve acute pain and accelerate inflammation (“Medication for the treatment of rheumatoid arthritis,” 2016). The drugs include steroids, nonsteroidal anti-inflammatory medicines, and acetaminophen. Disease-modifying and biologics drugs act as immunosuppressants and can be used to prevent chronic inflammation.

Patient Education

Physical therapy, fish oil supplements, and herbal medications provide relief from pain and inflammation. Doctors have a responsibility to educate patient on various home care options that can relieve the pain and rheumatoid arthritis flare-ups. 

References

“Medication for the treatment of rheumatoid arthritis.” (2016). National Center for Biotechnology Information. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0089163/

Markusse, I. M., Dirven, L., Gerards, A. H., van, G. J. H., Ronday, H. K., Kerstens, P. J., Lems, W. F., … Allaart, C. F. (2015). Disease flares in rheumatoid arthritis are associated with joint damage progression and disability: 10-year results from the BeSt study. Arthritis Research & Therapy, 17(232), pp. 1-9. 

Discussion #7

Clinical Assessment

The clinical assessment for Mildred includes complaints about fatigue and unstable sleeping patterns. Mildred also suffers from constant worry because of her husband recent layoff from work. She experiences depressed moods that usually switch from sad to anxious and vice versa. She also displays signs of hopelessness, has difficulties eating, and is sometimes forgetful. Recently, she experienced an episode of fast heart rate, difficulty in breathing, and felt as if a heart attack was imminent but managed to calm down with the help of her husband.

Initial Differential Diagnoses

Drawing on the clinical assessment, the initial differential diagnoses projects to a case of depression or anxiety disorder.

Major Psychological Questions

Various psychological questions may involve a feeling of nervousness, irritability, sleeping patterns, and concentration ability. 

Recommended Tests to Rule out any Medical Problems

Mildred experienced an episode of increased heart rate, difficulties in breathing, and experienced a moment of an impending heart attack; the most recommended test is electrocardiogram, chest X-ray, and blood gas analysis. The electrocardiogram test checks for problems with electrical activities of the heart (Bhattacharyya, 2015). The chest X-ray test will be used to check for the cause of shortness of breath, while the blood gas analysis will be used to asses cause for shortness of breath and difficulty in breathing (Berliner, Schneider & Welte, 2016).

Care Plan

When dealing with patients with anxiety disorder, the first thing is to maintain calmness when working with the client. Establish a trusting relationship by paying close attention to what they say, display warmth when answering questions and respect personal space. In the case of Mildred, self-help care can be combined with psychotherapy, which involves working with a therapist to minimize the anxiety symptoms. Cognitive behavioral therapy and medications are the mainstays of this condition and considered the most effective forms of treatment of anxiety disorder. 

Patient Education

Enroll in a relaxation training to help reduce tension. Maintain active communication with friends and family and express your worries and fears.  

References

Berliner, D., Schneider, N., Welte, T., & Bauersachs, J. (2016). The Differential Diagnosis of Dyspnea. Deutsches Arzteblatt International, 113(49), pp. 834-845.

Bhattacharyya, D. (2015). Vedic Machine. [Place of Publication not Identified]: DevB Inc.

Discussion #8

Resolution Guideline

The nurse practitioner has detected a contusion and recommended further investigation if Ms. Brown’s dizziness does not go away. However, she complains that it is not easy for her to travel back to the clinic as she is poor and relies on public transport. Besides, their belongings have been robbed, and her partner is not very concerned about her health. Unfortunately, while the nurse practitioner understands the current situation with Ms. Brown, she is not in a position to help with accommodation. Additional data may be in the form of checking any other person who may help Ms. Brown with transport or accommodation near the hospital so she can attend the follow-up plan. Nonetheless, Ms. Brown is the only person who should be making the decision regarding the whole issue. As it is, she has a right to say no or yes to any proposal from the nurse practitioner. 

For humanity’s sake, the nurse practitioners may help the patient with transport or consult with the nurse manager to help the patient. Community-based programs can be asked to offer any possible assistance to Ms. Brown and most probably by providing her with shelter. Such programs are available in the Center for Budget and Policy Priorities that advocates housing the vulnerable people (Dohler, Bailey, & Rice, 2016). Ray should also be involved in the decision-making process. 

In this case, the standards of care that should be incorporated include veracity or telling the truth. According to Dunphy, Winland-Brown &  Porter (2015), health care providers should not omit some information even if they feel the patient cannot handle it. Confidentiality should also be observed to respect privileged information. 

Since the patient is adamant about her ability to come back for a follow-up, the nurse practitioner should inform Ray and advise him on the information of having his partner attending the recommended follow-up.

References

Dohler, E Bailey, P, Rice, D, & Katch, H. 2016. Supportive Housing Helps Vulnerable People Live and Thrive in the Community. Center on Budget and Policy Priorities. Retrieved from: http://www.cbpp.org/research/housing/supportive-housing-helps-vulnerable-people-live-and-thrive-in-the-community

Dunphy, L. M. H., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2015). Primary care: The art and science of advanced practice nursing. Philadelphia: F.A. Davis Company.

Article Summary

Nurse practitioners can help alleviate the shortage of primary care facing the United States, but their scope of practice is limited by state regulations. The article by Emily, Miller & Tyler (2015), outlines the roles of nurse practitioners in various states and their scope of practice. In the United States, nurse practitioners play a prominent role in healthcare by providing primary care to patients. Primary care includes a variety of interventions such as initial diagnosis, evaluation, disease prevention, screening, and management of chronic diseases. By far, nurse practitioners play a primary role in ensuring access and quality in low-cost service delivery through preventive care and screening. Increased quality care is associated with low morbidity and mortality rates of reduced hospitalizations, costs, and customer satisfaction. In fact, research shows that the quality of care provided by NPs is often considered more satisfying as compared to the one administered by physicians. Unfortunately, although NPs are certified nationally, their respective States determines their scope-of-practice. These regulations typically focus on the level of education the nurse practitioner must attain to be allowed to practice. As it is, a majority of the states adopted more stringent education requirements, which have served as a barrier for aspiring Nurse Practitioners. Sadly, these measures are projected to cause a shortage of primary caregivers in the United States and increasing the workload. In the state of Alabama, the physician is expected to direct and supervise the work, records, and practice of the nurse practitioner. The nurse practitioner is also not allowed to prescribe controlled substances II. 

References

Gadbois, E. A., Miller, E. A., Tyler, D., & Intrator, O. (2015). Trends in State Regulation of Nurse Practitioners and Physician Assistants, 2001 to 2010. Medical Care Research and Review, 72(2), pp. 200-219.