DQ Reply 16 634
Assignments
1- Answer to Discussion question two.
2- DQ replies to 3 DQs.
Instructions for Answer to Question
1- After Each DQ (question), write down references
2- 300 minimum words for every DQ, you can go up to 700 words but answer should be complete.
3- 2-3 references for each question
4- References should be within 5 years
5- I am in acute care nurse practitioner program.
6- The response to the DQ is expected to be a minimum of 300 words. A minimum of two resources are expected. These need to be appropriate for a clinical professional to guide decisions about patient care. If a textbook is used for one of these responses, the other needs to be journal or professional-level website. The references need to be correctly formatted, as do the citations for those references. Question words dont count towards 300 minimum count
Instructions for DQ Replies to 3 DQS
DO NOT JUST REPEAT SAME INFORMATION, DO NOT JUST SAY I AGREE OR THINGS LIKE THAT. YOU NEED TO ADD NEW INFORMATION TO DISCUSSION.
1- Each reply should be at least 200 words.
2- Minimum One scholarly reference ( NO MAYO CLINIC/ AHA)
3- APA 6th edition style needs to be followed.
4- Each response should have reference at the end of each reply
5- Reference should be within last 5 years
Assignments
1- Answer to Discussion question two.
2- DQ replies to 3 DQs.
Instructions for Answer to Question
1- After Each DQ (question), write down references
2- 300 minimum words for every DQ, you can go up to 700 words but answer should be complete.
3- 2-3 references for each question
4- References should be within 5 years
5- I am in acute care nurse practitioner program.
6- The response to the DQ is expected to be a minimum of 300 words. A minimum of two resources are expected. These need to be appropriate for a clinical professional to guide decisions about patient care. If a textbook is used for one of these responses, the other needs to be journal or professional-level website. The references need to be correctly formatted, as do the citations for those references. Question words dont count towards 300 minimum count
Instructions for DQ Replies to 3 DQS
DO NOT JUST REPEAT SAME INFORMATION, DO NOT JUST SAY I AGREE OR THINGS LIKE THAT. YOU NEED TO ADD NEW INFORMATION TO DISCUSSION.
1- Each reply should be at least 200 words.
2- Minimum One scholarly reference ( NO MAYO CLINIC/ AHA)
3- APA 6th edition style needs to be followed.
4- Each response should have reference at the end of each reply
5- Reference should be within last 5 years Question 1
Acute angle-closure glaucoma Summarize and discuss the clinical characteristics and identify the appropriate laboratory, imaging, and other diagnostic and screening tools that apply to this condition or disorder.
Explain why you selected these tests or tools as being appropriate for recognizing and diagnosing this condition. Recommend a plan of action for treating a patient with this condition. Support your summary and recommended plan with a minimum of two peer-reviewed references in addition to the course materials.
Question 2
Imagine a patient comes into your office with your selected condition or disorder. What elements in the patient history and physical exam would indicate the patient has the selected condition or disorder? Select two differential diagnoses that could be applied to this patient. How did you arrive at the two differential diagnoses? Include history and physical examination findings that would support each of the two alternative diagnoses.
DQ-1
Acute coronary syndrome (ACS) occurs when there is a sudden blockage of one or more coronary arteries for an extended period of time causing myocyte necrosis. The most common cause of myocardial ischemia is coronary artery disease (CAD) which is the narrowing or blockage of the coronary arteries due to atherosclerosis limiting blood supply. There are two types of MI. Subendocardial MI occurs if the thrombus dislodges and affects only the myocardium that is directly underneath the endocardium, whereas, transmural MI occurs if the thrombus remains in the vessel and affects the myocardium from the endocardium to the epicardium (Jain et al., 2019). Clinical characteristics may include n/v, diaphoresis, fatigue, weakness, syncope, palpitations, feeling of impending doom, hypertension/hypotension, dyspnea, and jugular vein distention. The patient would report chest pain that is a squeezing or a burning sensation and pain that radiates to the neck, shoulder, jaw, back, upper abdomen, or either arm. Women may have silent symptoms compared to men and delay seeking treatment (Jain et al., 2019).
Cardiac biomarkers and accurate electrocardiogram findings play an important role in the early diagnosis and detection of an MI. Lab values will present elevated troponins, creatine phosphokinase-myocardial bound (CPK-MB), myoglobin, and C-reactive protein (CRP). The most specific indicator for cardiac tissue and the gold standard for the diagnosis of an acute MI are troponin levels (Nowak et al., 2018). The CPK-MB helps detect reinfarction while myoglobin indicates if the heart or muscle is injured. CRP is an inflammatory marker secreted by hepatocytes during an inflammatory stimulus and is a new test for heart disease risk, specifically, in patients with unstable angina (Nowak et al., 2018). Additionally, a CBC should be obtained as myocardial oxygen deprivation is accompanied by electrolyte disturbances, specifically loss of potassium, calcium, and magnesium. A 12 lead EKG is a critical tool for diagnosing MI as it can help localize the affected area through the identification of changes in ST segments and T waves (Mythili & Malathi, 2015). An ST-segment elevation (STEMI) indicates transmural ischemia and can give some indication of which coronary artery is involved.
Diagnostic imaging results can also identify and help with the diagnosis, extent of complications, and what areas of the coronary arteries are affected. A chest x-ray can identify cardiomegaly, CHG, and pulmonary diseases. A transthoracic echocardiogram (TTE) helps evaluate wall motion, heart function, and the potential of mechanical complications (Mythili & Malathi, 2015). Additionally, a TTE provides a new loss of viable myocardium or new regional wall motion abnormality and determines the ejection fraction of the heart (Mythili & Malathi, 2015). A coronary angiogram helps determine the anatomic extent of coronary artery disease by identifying any narrowing of the coronary arteries and is primarily used to evaluate for possible percutaneous coronary intervention or a CABG surgery (Mythili & Malathi, 2015).
References
Jain, V., Ghosh, R. K., Bandyopadhyay, D., Kondapaneni, M., Mondal, S., Hajra, A., Lavie, C. J. (2019). Serum bilirubin and coronary artery disease: Intricate relationship, pathophysiology, and recent evidence. Current Problems in Cardiology, 100431. doi:10.1016/j.cpcardiol.2019.06.00
Mythili, S., & Malathi, N. (2015). Diagnostic markers of acute myocardial infarction. Biomedical Reports, 3(6), 743748. doi:10.3892/br.2015.500
Nowak, R. M., Gandolfo, C. M., Jacobsen, G., Christenson, R. H., Moyer, M., Hudson, M., & McCord, J. (2018). Ultra-rapid rule-out for acute myocardial infarction using the generation 5 cardiac troponin T Assay: Results From the REACTION-US study. Annals of Emergency Medicine, 72(6), 654664. doi:10.1016/j.annemergmed.2018.06.021
DQ-2
Colon cancer is the third most common diagnosis and second deadliest malignancy for both males and females combined and being attributed to both environmental and genetic risk factors (Recio-Boiles & Cagir, 2020). The most important factor contributing to survival rates is the stage at which the cancer is discovered(Recio-Boiles & Cagir, 2020). Colon cancer prests as sporadic, familial clustering, and inherited syndromes(Recio-Boiles & Cagir, 2020). Each of these types has strong indications of origins from environmental and lifestyle associations for colon cancer(Recio-Boiles & Cagir, 2020).
Most colon cancers present to the physician with suspicious signs and symptoms such as abdominal pain, constipation, bloody stools, or irregular bowel movement shape (Lee et al., 2019). Less than 10% are found due to spontaneous severe acute abdominal pain (Lee et al., 2019).
Initial evaluations include the history and physical to obtain information about the patient’s dietary and bowel elimination habits(Recio-Boiles & Cagir, 2020). Next, a barium enema or ct colonography could be ordered as a “first look” test to see where any lesions may be and the extent of the lesions(Recio-Boiles & Cagir, 2020). However, the gold standard is tissue biopsy, and a complete diagnostic colonoscopy is the best way to achieve that(Recio-Boiles & Cagir, 2020).
Once confirmation of colon cancer is received, the patient should undergo additional studies to rule out malignancy(Recio-Boiles & Cagir, 2020). A baseline CT of the chest, abdomen, and pelvis with IV and oral contrast is recommended as the preferred cost-effective staging imaging study before treatment begins(Recio-Boiles & Cagir, 2020).
Studies have shown that a decrease in time between diagnosis and treatment yields better survival rates for patients (Lee et al., 2019). So, it is imperative to order follow up screenings and referrals promptly upon receiving confirmation of positive tissue biopsy (Lee et al., 2019).
Surgical resection of the colon is the main treatment for localized non-metastatic colon cancer of any stage at any age and should be performed within a reasonable time frame of discovery(Recio-Boiles & Cagir, 2020). Colon cancer with metastasis still includes surgical resection as a treatment modality but in adjunct with chemotherapy beginning 4-6 weeks post-surgery (Recio-Boiles & Cagir, 2020).
References:
Lee, Y.-H., Kung, P.-T., Wang, Y.-H., Kuo, W.-Y., Kao, S.-L., & Tsai, W.-C. (2019). Effect of length of time from diagnosis to treatment on colorectal cancer survival: A population-based study. PLoS ONE, 14(1), 116. https://doi-org.lopes.idm.oclc.org/10.1371/journal.pone.0210465
Recio-Boiles, A., Cagir, B. (2020). Colon Cancer. Treasure Island (FL): StatPearls Publishing. Retrievedfrom: https://www.ncbi.nlm.nih.gov/books/NBK470380/
DQ-3
The worldwide Covid-19 pandemic is the biggest public health crisis in modern history. It emerged out of Wuhan, China in late 2019 and has been a global health issue since. Covid-19 is a coronavirus, a enveloped positive-strand RNA viruses that infects vertebrates including bats, snakes and birds (Abdulamir & Hafidh, 2020). Corona viruses are enveloped viruses with corona-like projections, or spikes that are attack host cells and infect them. After the cell is infected, the viral RNA will replicate using viral RNA-dependent-RNA polymerase and replicates in the cytoplasm of the cell (Abdulamir & Hafidh, 2020). Covid-19 has an incubation period of approximately 14 days, and symptoms include fever, cough, dyspnea, myalgias, diarrhea and taste/smell disorders. Most infections are asymptomatic to mild, but severe infections can lead to pneumonia, ARDS and death. Patients with active Covid-19 infections will have lymphopenia, elevated aminotransaminase levels, elevated lactate dehydrogenase levels, elevated inflammatory markers (ferritin, C-reactive protein, and erythrocyte sedimentation rate), and altered coagulation studies. Patients will also have ground glass opacities seen on chest X-ray or CT. Covid-19 is diagnosed by RT-PCR assay from a nasal-pharyngeal swab. Patients who test negative but are symptomatic or have high suspicion of exposure can undergo serologic testing to check for antibodies, this is done approximately 30 days after the onset of symptoms. Since there is currently no vaccine available and treatment is based on supportive care, containment measures have been taken to mitigate the spread of the infection. Prevention measures include early identification of the cases through testing and contact tracing, keeping a physical distance of 6 feet apart, improved hygiene and cleaning methods, wearing masks in public and practices like imposing restrictions in public places by closing bars, gyms, school and implementing a mandatory curfew and lockdowns (Davagli, Undi, Annadani & Nawaz, 2020). Many business have transitioned workers to work remotely to avoid the spread of Covid-19, and non-essential businesses have been open in a limited capacity to reduce the transmission.
Abdulamir, A. S., & Hafidh, R. R. (2020). The Possible Immunological Pathways for the Variable Immunopathogenesis of COVID–19 Infections among Healthy Adults, Elderly and Children. Electronic Journal of General Medicine, 17(4), 14. https://doi-org.lopes.idm.oclc.org/10.29333/ejgm/7850
Davalgi, S., Undi, M., Annadani, R., & Nawaz, A. S. (2020). Comparison of Measures adopted to combat COVID 19 Pandemic by different countries in WHO regions. Indian Journal of Community Health, 32, 288299.
1. What you have seen of the epidemic in your region in terms of # of cases, impact on your community, and impact on your hospitals.
2. Specific case presentations r/t patients you have cared for w/ COVID.
3. Treatment protocols in your hospitals/facilities r/t COVID patients.
