Focused Nose Exam

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CASE STUDY

Richard is a 50-year-old male with nasal congestion, sneezing, rhinorrhea, and postnasal drainage. Richard has struggled with an itchy nose, eyes, palate, and ears for 5 days. As you check his ears and throat for redness and inflammation, you notice him touch his fingers to the bridge of his nose to press and rub there. He says he’s taken Mucinex OTC the past 2 nights to help him breathe while he sleeps. When you ask if the Mucinex has helped at all, he sneers slightly and gestures that the improvement is only minimal. Richard is alert and oriented. He has pale, boggy nasal mucosa with clear thin secretions and enlarged nasal turbinates, which obstruct airway flow but his lungs are clear. His tonsils are not enlarged but his throat is mildly erythematous.

Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis and justify why you selected each.

:Explain data collection standards used in the healthcare industry and health care data collection forms.Write a 700- 750-word memo e that evaluates database management in health care. Include the following:

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:Explain data collection standards used in the healthcare industry and health care data collection forms.Write a 700- 750-word memo e that evaluates database management in health care. Include the following:

Explain data collection standards used in the healthcare industry.
Explain health care data collection forms.
Explain health care database designs.
Analyze the application of a database in the desktop environment used in the health care industry.
Explain the design and implementation of a risk management plan.
Consider contingency, data recovery, and down time procedures.

Tay-Sachs Disease: Causes- Pathology and Treatment

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Abstract

Tay-Sachs disease is a neurodegenerative disorder that occurs when an individual has a mutation within the HEXA gene, hindering the central nervous system’s ability to break down toxins (Vu et al., 2018). These toxins build up within the body and destroy neurons located in the brain and spinal cord. Due to neuronal death within the central nervous system, individual experience a wide range of symptoms including seizures, ataxia and the decay of vision, hearing, speech, and motor skills (DynaMed, 2017). This can occur in infants, children, and adults; the most common form of Tay-Sachs disease is infantile-onset. There are no current treatments available for Tay-Sachs disease, only treatment management. Genetic counseling and prescreening methods for prospective parents is recommended if they are suspected to be a carrier of the disease.


Introduction

Tay-Sachs disease is a rare neurodegenerative, genetic disorder where toxic waste accumulates within the body and destroys neurons within the central nervous system (Tay Sachs Disease, 2019; DynaMed, 2017).  Tay-Sachs disease occurs on average one in one hundred thousand births (Solovyeva et al., 2018).  Hexosaminidase A (HexA) gene is responsible for creating an enzyme that removes toxins from the body, but individuals with Tay-Sachs disease have a mutation that hinders HexA’s functioning (Vu et al., 2018).  Tay-Sachs disease has over 130 different mutations identified that negatively affects affects the amount of work HexA performs (Tay-Sachs Disease, 2019; Solovyeva et al., 2018).  If symptoms of Tay-Sachs disease appear during infancy or early childhood, the dysfunction is severe (DynaMed, 2017; Solovyeva et al., 2018).  This time period in development signals critical dendritic growth and synaptic communication within the brain as the child begins to interact with the world around them.  The individual will continue to develop normally until the HexA’s dysfunction causes neuronal death.  The death of neurons within the central nervous system causes a variety of symptoms, but most notably, muscle weakness, seizures, vision difficulties, and ataxia (DynaMed, 2017; Solovyeva et al., 2018).  This disorder is fatal in infants and young children, whereas, adults can live longer with symptom management since their HexA’s dysfunction is not as severe (Tay-Sachs Disease, 2019).


Physiological Causes

Tay-Sachs disease starts when an individual’s DNA sequence mutates in the 15th chromosome, which affects the HexA gene that is responsible for helping create an enzyme that breaks down toxins (Tay-Sachs Disease, 2019; Vu et al., 2018).  The toxins that beta-hexosaminidase targets are referred to as GM2 gangliosides (Cachon-Gonzalez, Zaccariotto, & Cox, 2018; Solovyeva et al., 2018). HexA in conjunction with HexB form the enzyme beta-hexosaminidase, designed to break down GM2 gangliosides within the body (Solovyeva et al., 2018).  Beta-hexosaminidase is one of over 50 different enzymes stored within the lysosomes of a cell that removes toxic waste from the body (Cooper, 2000).  If an individual has a mutation within HexA, their ability to produce beta-hexosaminidase for the lysosomes is impaired .  Without the help of  beta-hexosaminidase, the body’s number of GM2 gangliosides will gradually accumulate depending upon the severity of genetic mutation (Solovyeva et al., 2018).  A small number of rare diseases affect the functioning of beta-hexosaminidase enzyme, including Tay-Sachs disease, AB variant, and Sandoff disease.  This group of disorders are referred to in the medical community as GM2-gangliosidosis because they all fail to remove these toxins within the body (Cachon-Gonzalez et al., 2018; Solovyeva, 2018).  Tay-Sachs disease mutates HexA functioning, whereas Sandoff disease has a mutation in both HexA and HexB. AB variant cannot synthesize HexA and HexB into beta-hexosaminidase due to a GM2 activator protein deficiency (Solovyeva, 2018). All of the GM2-gangliosidosis disorders result in a build up of toxins within the brain and the spinal cord and have identical symptomatology (Cachon-Gonzalez et al., 2018). The age of diagnosis informs clinicians on the prognosis; infants and children that develop Tay-Sachs disease have a severe mutation within HexA where the gene only functions 0-5% of the time, whereas adults with the HexA mutation have around 15% functionality (DynaMed, 2017).  The early neuronal development within the brain of infants is crucial for their survival, which makes Tay-Sachs disease for infants and children is fatal. Adults with Tay-Sachs disease have a good prognosis due to a slower accumulation of toxic waste which decreases the chance for neuronal death (Tay-Sachs Disease, 2019).


Disease Pathology

The most common form of Tay-Sachs disease occurs during infancy (Solovyeva et al., 2018).  At birth, an infant with Tay-Sachs disease will start to develop normally.  The accumulation of GM2 gangliosides within the central nervous system has started, but has not reached significant levels to see neuronal death.  Around age three to six months old, the infant’s neurons begin to degrade and communication across the central nervous system is impacted.  This degradation of neurons causes muscle weakness, an increased startle response, and leads to the loss of motor skills.  If the infant is crawling at this time, they will lose the ability to do so (DynaMed, 2017).   As time progresses, the symptoms become more obstructive until death.  Around six to ten months old, the infant will lose their sight and react to less stimuli.  A common marker of disorders within the GM2-gangliosidosis family is the cherry red spot within the macula of the eye (Tripathy & Patel, 2019).  The cherry red spot forms during this stage of disease development .  Eventually, the entire central nervous system begins to shut down.  Seizures start and become progressively worse (DynaMed, 2017). The child gradually becomes comatose before their body succumbs to Tay-Sachs disease.  Death almost always occurs prior to the age of 4 (Nestrasil et al., 2018).

Juvenile-onset of Tay-Sachs disease appears typically from the ages of three to ten years of age (Solovyeva et al., 2018).  The individuals affected at this age range have some similar symptoms to infantile-onset including weakened muscles, motor skill deficits, seizures, and vision loss (DynaMed, 2017).  However, given the advance in development when compared to infancy, juvenile Tay-Sachs disease has some unique symptoms.  Patients may experience slurred speech and difficulty swallowing due to motor difficulties present in pathology.  Abnormal patterns of walking can be a sign of Tay-Sachs considering the common symptoms of muscle weakness and issues with motor control.  Eventually, similar to infantile-onset, the individual’s body will enter a comatose state and death will typically occur prior to the age of 15 (DynaMed, 2017; Solovyeva et al., 2018).

Adult-onset Tay-Sachs disease is the most rare form of the disorder with the best prognosis.  In most cases, HexA’s dysfunction becomes apparent long before adulthood due to the high levels of GM2-gangliosides causing neuronal death.  However, when Tay-Sachs is diagnosed in adults, clinicians find the individual’s HexA typically has 5 to 20% of it’s normal functionality (Solovyeva et al., 2018).  With this level of function, adults with Tay-Sachs disease can survive and live their life managing the symptoms. Because of the rarity and wide range of mutations in HexA, adults with Tay-Sachs disease can have a variety of symptoms .  Some patients will present with memory loss and dementia like symptoms due to the disruption of synaptic transmission by accumulations of GM2-gangliosides (CITE).  Ataxia is common, around 88% of individuals present with atypical gait which (Solovyeva et al., 2018).  Cerebral atrophy is a revealing marker for Tay-Sachs disease as well.  However, due to the extreme rarity of this disease, other symptoms an adult patient presents with can vary and are considered ‘abnormal’ for the tract of the disorder (CITE). This can make late-onset diagnosis of Tay-Sachs disease difficult for health care professionals.


Diagnosis

Tay-Sachs disease is very rare within the medical community and can be difficult to diagnose due to the large variety of mutations that can occur surrounding HexA (Akerman et al., 1997 ;ACOG, 2017).  Often, individuals present first with mobility issues and muscle weakness which can look similar to amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease), spinal muscular atrophy, and other neuromuscular diseases (Peters et al., 2008).  Additionally, Tay-Sachs disease outside of infancy is exceptionally uncommon.  Peters et al. (2018) discussed conceptualizing a unique case study of a 23-year-old man who had Tay-Sachs disease.  Prior to diagnosis, the patient reported experiencing symptoms of muscle loss, most notably in the upper legs, beginning at age 18.  He reported no genetic history for neuromuscular disorders. The clinicians initially diagnosed the patient with ALS, but with additional testing, the health care team noticed inconsistencies with the typical pathology.  To investigate this further and rule out ALS, the clinicians ordered a biopsy and MRI.  The biopsy of the patient’s thigh muscle showed significant atrophy, but was missing some physiological traits of  neuromuscular disorders.  The MRI displayed normal functioning except for cerebellar degeneration.  When the patient’s white blood cells were tested, the results showed significantly low levels of the beta-hexosaminidase enzyme and confirmed a diagnosis of Tay-Sachs disease (Peters et al., 2008).  This description of late-onset of Tay-Sachs pathology for a young adult adds to small variety of literature on abnormal manifestations of this disease.

While anyone could have a gene mutation, certain populations are at higher risk for the specific mutation that develops Tay-Sachs disease.  These populations include select French-Canadian villages in Quebec, the Amish community in Pennsylvania, Ashkenazi Jewish individuals hailing from central Europe, and the Cajun population in Louisiana (DynaMed, 2017; Tay Sachs Disease, 2019;).  Specifically, the Ashkenazi Jewish and French-Canadian population are the most at risk for developing Tay-Sachs disease with one in thirty people being a carrier (Hussein, Weng, Kai, Kleijnen, & Quresh, 2018).  Tight-knit communities such as the ones mentioned have less genetic variability and are known to be carriers for the HexA mutation.  A carrier would have the recessive gene for Tay-Sachs disease, but has a dominant gene that suppresses the recessive gene’s expression. If two carriers have children, the chance of their offspring receiving both recessive genes for the mutation is one in four. However, it’s more likely that the child will become a carrier like their parents with a one half chance (American College of Obstetricians and Gynecologists, 2017; Hussein et al., 2018).  Even a handful of individuals ascribing to a certain community carrying this recessive trait would greatly increase the population’s genetic odds of contracting the disease.


Prevention and Treatment Options

Currently, there are no treatment options for Tay-Sachs disease, only symptom management.  The medical community has made attempts to create pharmaceutical options for the disorders in the GM2-gangliosidosis family but with no avail.  Additionally, gene therapy for Tay-Sachs disease would be successful but the blood brain barrier has blocked the therapeutic genes that researchers have tried to deliver to increase HexA functionality (Kyrkanides et al., 2005; Solovyeva et al., 2018).  While testing mice, the researchers discovered they could inject the beneficial genes right into the brain and surpass the blood brain barrier, but this comes with complications for humans.  In order for the genes to be effective, the individual would need a large sum of injections throughout the central nervous system and according to scientists, this option is not realistic or viable (Solovyeva et al., 2018).  Science is making progress on targeting treatments for lysosomal storage disorders (which would include Tay-Sachs disease due to the lack of beta-hexosaminidase) but have not found the appropriate drug to increase HexA functioning (Thomas & Kermode, 2019.; Solovyeva et al., 2018) . One drug called Migulstat, a substrate reduction therapy, was tested in clinical trials on 20 adults with Tay-Sachs disease but there was no clinically significant findings (Solovyeva et al., 2018).

While treatment options for infancy-onset Tay-Sachs disease are extremely limited, prospective parents can take strides to prevent passing unfavorable genetic disorders to their offspring.  The American College of Obstetrics and Gynaecology has specifically stated genetic screening should occur for the Ashkenazi Jewish, French-Canadian, and Cajun population prior to pregnancy to assess for carrier status.  If there is a genetic history of Tay-Sachs disease in the family, clinicians may not see a positive result when testing possible carriers because the screening does not include all of the variety of genetic mutations (ACOG, 2017).  Akerman et al., (1997) pioneered the effort to identify new mutations of HexA outside of the Ashkenazi Jewish population, but additional work needs to be done to explore every possible mutation (Akerman et al., 1997). These screening panels identify 98% of carriers, but rare HexA mutations outside of the identified at-risk populations may not be identified (ACOG, 2017).  If parents are identified to both be carriers of Tay-Sachs disease, options are available to prevent passing the disease onto offspring.  Women can utilize amniocentesis, a test that samples from the amniotic fluid in the womb, to test for possible conditions.  Amniocentesis can give prospective parents an idea of the fetus’s health early in the pregnancy so that they can make educated decisions about their futures.  A test similar to amniocentesis, chorionic villus sampling, can also assess the fetus’s health through the mother’s placenta tissue (Alfirevic, Navaratnam, Mujezinovic, 2017).  Additionally, couples can consider in vitro fertilization to pick viable gametes and avoid passing on genetic conditions like Tay-Sachs disease to offspring (Hussein, 2018).  However, in vitro fertilization is not an option for everyone due to the high cost of the procedure.  Therefore, some couples may abstain from having biological children and adopt.  Prevention of genetic disorders like Tay-Sachs is pivotal due to the fatal nature of the disease.  Due to a lack of treatment options, precautions should be taken by individuals in high-risk communities to receive genetic counseling, assessment, and prenatal testing to avoid the development of Tay-Sachs disease.


Conclusion

Tay-Sachs disease is caused by a mutation in the HexA gene which partially forms the beta-hexosaminidase enzyme which fails to clear out GM2-gangliosides from the central nervous system (Peters et al., 2008, Vu et al., 2018). There are three main forms of Tay-Sachs disease which are infantile, juvenile, and adult-onset of the disorder.  The adult-onset of Tay-Sachs disease is the most rare, however, it has the best prognosis with a slow neural decay.  In cases of infantile and juvenile Tay-Sachs disease, the condition is fatal (Solovyeva et al., 2018).  There are no clinically significant drugs approved for Tay-Sachs disease to alter the amount of HexA functioning, therefore expectant parents should consider genetic counseling prior to conceiving especially if they hail from Ashkenazi Jewish, Cajun, or French-Canadian population (ACOG, 2017; DynaMed, 2017; Solovyeva et al., 2018,).


References

: As the session comes to a close, assess the overall financial health of your organization. What are good and bad signs, if any, in your assessment? Now, make a forecast for the future! How do you see Ford in ten years?

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: As the session comes to a close, assess the overall financial health of your organization. What are good and bad signs, if any, in your assessment? Now, make a forecast for the future! How do you see Ford in ten years?

Perform an analysis of the social / demographic, technological, economic, environmental / geographic, and political/legal / governmental segments to understand the general environment facing Union Pacific.

• Describe how Union Pacific will be a

1. Suppose the government imposes tax cuts for 95% of all households. How does this affect Ford Motor Company?

2. To what extent is Ford’s financial health affected by fiscal and monetary policy? Please give at least one specific example.

3. As the session comes to a close, assess the overall financial health of your organization. What are good and bad signs, if any, in your assessment? Now, make a forecast for the future! How do you see Ford in ten years?

Recovery-Oriented Practice in Mental Health

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Recovery-Oriented Practice in Mental Health

What is the difference between ‘clinical recovery’ and ‘personal recovery’ for people with lived experience of mental illness?

In a simple word” Recovery is pretty much getting back to normal “Clinical recovery is an idea which involves mental health medical team such as mental health nurses, doctors, psychologist and social worker who works together in team to treat a person with mental illness with or without involvement of medication( “What is recovery”, 2019).  Australian Health Ministers Advisory Council (2013) has described clinical recovery as a patient attend regular appointments and following the plan made by a medical team in the partnership with a patient and followed up regularly by medial staff. The department said clinical recovery not is only to treat the symptoms of the illness, but also help to take a control of the life. It is designed how they can improve and keep tracks of the changes and identify and manage in the future (Australian Health Ministers Advisory Council, 2013).  On the other hands, Personal recovery can be different from person to person. A personal recovery is a unique and personal experience which is a challenging journey of one who’s is battling own’s mental illness, however, still try to focus to gain and retaining the hope of positive changes on self, understanding own’s capability to make it happen and create a positive environment, engaging in an active life and participating in social function and programs and any other various ways that could help to build a positive future for a healthy lifestyle, leaving a unhealthy past behind (“Recovery”, 2017). Slade (2009) introduced personal recovery framework which focus on promoting well-being rather that treating illness that involves 4 recovery task which are developing a positive identity besides its illness. Secondly, Framing the mental illness involves frame and understand the illness as it is a part of the person. Thirdly, Self-managing the mental illness that comes after framing the illness which gives the ability to self-manage by taking personal responsibility of own well-being, seeking help and support from others however, it doesn’t mean doing everything on own. The final recovery task is developing valuable social roles and relationship which has no linked with mental illness. This may form new, previous or modified valued social roles and its important during the breakdown point of the life, when friends and family can provide comfort and effort to support the person for recovery (Slade,2009).

What is recovery-oriented language in mental health?

According to the mental health coordinating council (MHCC), Recovery oriented language is the concept where language or communication are most priorities and value that fetch hope and support to bring positivity and promote a culture, providing support for the people with mental illness or disability. MHCC has some general principles based on language we use which should represent the good meaning and should not impact or offence any other people. Similarly, our language needs to be respectful, non-judgmental, understandable and should be aware of its positive and negative contribution in someone’s life who may in their journey of recovery.

Why is recovery-oriented language important for a person’s recovery?

Language has a power to shape and sense of the person’s reflection by describing self and others. It also helps to shape possibilities and promote positivity to others to break with the past, talk about their trauma, which may have resulted in a range of psychosocial difficulties. Similarly, language also create a good environment to ease or promote openness that could contribute in recovery. Language is very crucial as it provide an opportunity to build a rapport relationship with the partnership that eases therapeutic liaison. This recovery ensures that accurate language and ways to communicate to the client reflecting theirs’s voice and support the recovery journey, plus doesn’t exaggerated any opinion of professionals. The care plan is designed with client perspectives with client’s consent for the treatment, recommendations, discharge plans, housing referrals etc. which promotes client directed service planning.

  • https://www1.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-n-recovpol-toc~mental-pubs-n-recovpol-8
  • http://content.ementhe.eu/Recovery/Diagnosis-Labelling-stigma/Theuseof.pdf


NSW Mental Health Act (2007)

What is the purpose of the Mental Health Act?

Mental health ACT is the legislation established by government to provide care and treatment of people in Australia who experience mental disorder. This ACT can relate to voluntary patient who are admitted to a hospital with their consent, involuntarily patient who are admitted to or apprehended in a hospital setting against their consent and those who required to access the treatment in the community under Community treatment order (CTO). The main aim of this act section 3 is to protect the civil rights of every individuals to access the care and treatment; they are to provide care, treatment and promote recovery for mentally ill or disorder people. This ACT also facilitate who access the care and treatment from the community care facilities and facilitate the voluntary or involuntary patient in the hospital setting provisional treatment. This act provides care and comfort to the people with mental disorder and their carer by involving them in decision making and appropriate education about the treatment plan. As per Division 1 General, Section 68, the parliament has ensured that the principles are more practicable and people with mental illness receive the best possible care and treatment in any circumstances.

  • https://www.legislation.nsw.gov.au/#/view/act/2007/8/whole#%2Fchap1%2Fsec3

Who has rights under the Mental Health Act?

According to the Australian legislation, Mental Health Act 2007, no.8 Schedule 3, Section 74, Person with mental illness or disordered, mental health team, next of kin and designated care have right under mental health act. Person can get treatment on request or may also get refused if authorised medical officer and psychiatrist think that it won’t be beneficial for the patient or does not need one. On the other hand, person can also be retained as an involuntary patient against their ill for his own protection and prevent serious harm for self and others. Person can be detained no more than three times a month and no more than three months if admitted as involuntary patient. Patient or carer may appeal for the decision of medical team which would be reviewed by a medical health review tribunal under the mental health act. Discharge, referral can be made by a patient and carer if any alternative however, appropriate and reasonable care available which need medical superintendent or medical officer approval. A person can be given consideration for the least restrictive environment care and treatment if safe to do so. A patient has a right to check medical records, have primary carer, relatives, friends, even lawyer or interpreter and also can wear street clothes as they desire. A help can get easily via facility staff member, medical team or mental health advocacy service. A person may get the treatment in order to save life or prevent serious damage including electro convulsion therapy (ECT) against the will, if mental health review tribunal determines if its desirable or necessary.

What are the criteria for mental illness under the NSW Mental Health Act 2007?

There are different criteria that applied to a person for their admission in a mental facility. A person may give admitted on own request as a voluntary patient or get an admission as an involuntary patient on request from a carer, friends or colleagues if the person has any mental illness or disorder but will be assessed by a authorised team. An authorised Medical officer Must notify parent of the person on admission and begin the treatment as soon as possible in case of children under 16 years as a voluntary patient. For the age 14 or 15 years, a child may get discharge on the objection of parent unless the child elect self to continue the treatment as voluntary patient. Under CD 1990, section 9, Criteria for involuntary admission etc as mentally ill person if the person it’s suffering from mental illness and does or self harm or harm to others then he or she needs an admission. In same way, mentally disordered person would meet the criteria if patient is deteriorating, had some behavioural issues which can not be justify or any sign of doing harm.


Least Restrictive Practice

Why is the use of seclusion and restraint risky – for the consumer?

Number of incident occurred due to seclusion and restraint while a consumer is held in a physical/ manual restraint, but the mechanism of death is not clear however, possible reason may be positional as physic or cardiac arrest …. notepad reference…..  Some good example of restraint is apparent pressure on neck, thorax or abdomen and inappropriate application of the strain. Studies have revealed that a period of intense struggle, severe lactic acidosis excessive muscle activity and the position could be the reason of death. Another adverse event associated with the use of restraint and seclusion may include choking, loss of consciousness, pressure sore, muscle strains, skin and circulatory problems and in rare case death.  There’s intervention contribute to self-harm, self-directed aggression including self-multinational and cutting and suicidal attempts. There are policies and protocols in every Australian state and territory for the use of these interventions.


Why is the use of seclusion and restraint risky – for staff members?

All physical restraints are potential risk to the staff and consumer. It is stated on mental health act  under section 190 recognised the work, health and safety legislation for workplace safety which is why Recognised medical officer or staff should take an appropriate action in order to prevent serious incident during unfavourable situation in order to the safety of staff and other member. NCBI has mentioned in his articles that use of physical restraint has an adverse physical and psychological on staff as well, which could be clinical or non-clinical factors such as cultural biases, role perceptions and attitudes. Author has also provided a report of survey which has proven that mental health profession are at a considerably higher risk fro workplace violence, followed by nurses while physical restraint and seclusion was in use. There should be programme and training provided to the staff member to be familiar with the type of restraint and management of behaviour to minimise or eliminate the incidents related to restraint and seclusion.

What does ‘least restrictive care’ mean in the mental health context?

Least restrictive care can be defined as a treatment or care provided in a least restrictive environment. Community based treatment and institutional based treatment may also provide but a person needs to be eligible and meet some criteria. A report based on the reform for more recovery oriented and least restrictive approach surveyed in 2014 in Queensland’s acute mental health including locked wards has found that the least restrictive practice has better outcomes for patient, hospital and community. It has also outlined that all Australian state and territory has committed to implement the least restrictive practice in the legislation and works towards recovery oriented practice implementing supportive relationship, organisation culture and monitor and review of recovery-oriented practice.

Describe two (2) nursing interventions that could be used to promote a person’s personal recovery in the inpatient or community mental health setting.

Being the mental health nurse can be very challenging and emotionally draining however, it very rewarding as well. Mental health nurse treats and care the patient with type of mental illness or disorder such as depression, schizophrenia, bipolar disease or a psychosis including the patient locked in a special locked psychiatric unit. Nurses have a various role to play in the treatment of the patient.

  1. Building a therapeutic relationship with a client.

Nurses can be the best advocates for the patient. The nurse-patient relationship is build with mutual trust and respect, nurturing of faith and hope and providing the support and care through the skill and knowledge.  (pullen and omo). this can help to promote awareness, person growth and work in collaboration through the challenges . It is also important to the nurse to develop a trust and empathy to support the patient throughout the recovery journey.  Empathy and trust can be build by being an active listener, providing comfort, maintaing eye contact and some physical gesture with professional boundaries and using the appropriate and simple language.

2. Encouraging and participating the groups’ session.

Group session can be beneficial for the patient as it facilitates the confrontation or sharing the feelings, fears, concerns and experiences that they went through the treatment with others. Sharing the things provides an opportunity to ventilate and provide feedback to the person to person. Involvement of the nurse can be very supportive and also encourage their patient to participate. Stress management, psychosocial groups, substance related abuse group, physical health, peer support group and creational activity group are some good examples of group therapy where patient get to share and shows their gratitude or even talk about their grief, regret, mistakes and past life.  A recent survey from UK found sharing the feelings increase hospital discharge rate and have better health outcomes in patient’s health. During the group therapy, nurses and other group member can provide support by building new relationship and give a hope, which may led to a positive environment. This led to build a good therapeutic relationship between nurse and patient which can be contribute in the treatment and care plan.


References: –


International Organ Trafficking and Medical Ethics

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Abstract

Medical ethics is are an exceedingly complex topic and with today’s advancements in technology the debate only gets more intricate and weightier. This paper addresses the current problem of organ trafficking that the world faces today and has faced for several decades. Medical ethics are also discussed in this paper, in the light of changing values within our society and the medical fields.

Organ distribution is a practice that has become common in the medical field but finding enough organs to distribute can become a hitch in the process. Finding people who are willing or able to give up an organ is an extremely hard task. Organ trafficking clearly contradicts several medical ethics, such as autonomy, non-maleficence, justice, and informed consent. This why organ trafficking has become such a concerning problem, because doctors must try their best to help people who are in need of organ transplantation but doing so may be killing or worsening another patient’s life. Middle Eastern and Asian countries continue to traffick poor people or even prisoners for their organs, and this situation must be rectified. Organ trafficking oppresses certain demographics and only benefits the few that can afford it. There are countries trying to find solutions to this dilemma, but none have been set into motion.  The goal of this paper is to educate people about organ trafficking, and in raising awareness motivate today’s society to continue to work to find a solution to this ethical and medical problem.


International Illegal Organ Trafficking

  1. Medical Ethics
  1. Personally, I believe medical ethics are the collection of moral beliefs and values that all medical practitioners try their best to follow, in respect to the patient and their work. Medical ethics shape the way doctors, nurses, and others involved in the medical field interact and take care of patients. Proverbs 31:8 says “Open your mouth, judge righteously, and defend the rights of the poor and needy,” and doctors must take that into consideration when they take care of their patients, who are, at their core, human beings

    .

    In the traditional Hippocratic Oath it states

    “

    I will use those … which will benefit my patients according to my greatest ability and judgement, and I will do no harm or injustice to them,” this line especially sums up my belief of medical ethics: that whatever a practitioner may face they must rely on these foundational statements of morality to shape everything they do.

II.      Medical ethics are moral criterion that are based upon four values:

autonomy, non-maleficence, beneficence, and justice. Autonomy is belief that every human has dignity and is respected (Varelius, 2006). Non-maleficence insinuates that the doctor must do as little harm as possible (do no harm) in the process of treatment. Beneficence is the value that all medical professionals uphold, that you are to do good to others and that treating a patient in their best interest is your goal (Beauchamp, 2007). Lastly, justice is universally known as jus treatment of others. In the medical field justice is the idea that the burdens and benefits of treatments must be distributed equally. Within the value of justice comes many debates but the main factors of judgement are fair distribution of scarce resources, competing needs, and rights (Johnson, n.d.).

III. Ethical Dilemmas

  1. Numerous ethical dilemmas are within the topic of organ trafficking. Namely, that it heavily rests upon the disadvantage of the weakest in society, preying upon their social and financial status to lure them into the trafficking (Harris, 2002). Organ trafficking insinuates the trade of human bodies, based on their worth. Ethically, this issue enforces oppression to lesser classes which exploits the value of justice (Danovitch, 2013).
  2. The medical ethical principles addressed in this paper and how they relate to the topic.

WORDS: Autonomy, non-maleficence, justice, informed consent.

The principle of autonomy is fundamentally rejected in the act of organ trafficking, because it strips any respect for an individual other than the worth of their organs. Non-maleficence is clearly disregarded particularly because the balance between the risks and benefits is very unreliable, specific to each case.  Justice is challenged since the poorer/weaker people are targeted by this market. They are manipulated into this market because of their circumstances and in most cases only the wealthy are recipients of organs. Informed consent is contradicted since the people who are coerced into selling their organs aren’t informed of the risks of the procedure.

  1. The Medical Dilemma
  1. Organ trafficking is an international problem and in the recent decades it has been uncovered in Israel, China, Kosovo, and even in the United States (Rogers, 2019).  Israel has long been a hotbed for trafficking, reaching its peak in the 90s and early 2000s. In 2007 there were several trafficking rings exposed, and in 2008 the Knesset law banned purchase and sale of human organs (Klein, 2018). In the past three years, reports from CNN, the WSJ, Forbes, Washington Post and more unveiled China’s practice of mass harvesting prisoners on death row. Kosovo’s Lutfi Dervishi and Sokol Hajdini were convicted again in 2016 (originally in 2013) for illegal transplanting organs in their unlicensed clinic. Dervishi was found to be part of an international criminal organization and using his position as a surgeon to remove patient’s organs (Morina, 2018).
  2. An ethically defensible market in organs (Defense vs. Prosecution)

    1. DEFENSE: American health officials believe that establishing a monopsony, where only one buyer exists for the products of multiple sellers, could reduce the unfair distribution of organs. That purchaser must take on responsibility for ensuring equitable distribution of all organs and tissues purchased. This marketing method would hopefully curb the rich from using their financial advantage to exploit the market at the expense of the poor (Harris, 2002).
    2. Prosecution: In the case of a monopsony, only one buyer (most likely being a national corporation) decides on the distribution and worth of the organs. This automatically raises the uncertainty that purchaser being fair and equitable distribution of all materials. Placing any monetary value on the body quickly negatehuman dignity by placing it at the same level as an economic market. The human body should never be degraded to only a product on the market for profit (Marino, 2002). It is wrong to prey upon people lesser than us for our own benefit (Proverbs 31:8-9, ESV).
  1. Personal and Biblical Application
  1. I believe that creating a monopsony is a risky way to take on organ distribution. In discordance to my personal definition of medical ethics, the monopsonic structure is something that can be easily corrupted and be used against patients. It is great that the proposed structure is able to free the poor from being the main oppressed demographic, but if the distributor (or people within that work force) become corrupt or manipulative (which is easy in our fallen nature). That is clearly against taking care of the patient and doing their best to help them.
  2. I don’t believe that any trafficking is good. In the case of organ trafficking, it places a worth simply on someone’s organs, but in 1 Corinthians 6:19-20 (ESV) it says, “Do you not know that your bodies are temples of the Holy Spirit, who is in you, whom you have received from God? … Therefore, honor God with your bodies.” In that verse we are clearly told that we were worth more than the price of any organ. Organ distribution is an, and it unfortunately is   what fuels the trafficking since people become desperate to acquire organs. Organ transplantation is something that has become a norm in our society and crucial to many, but we must work to find a steady income of them without relying on trafficking individuals for parts of their bodies.


References

Abbud-Filho, Mario & Al-Mousawi, Mustafa & Alobaidli, Ali & Alrukhaimi, (2008). Organ

trafficking and transplant tourism and commercialism: the Declaration of Istanbul. The

Lancet. 372. 5-6. doi:10.1016/S0140-6736(08)60967-8

Ambagtsheer, F., Zaitch, D., & Weimar, W. (2013). The battle for human organs: organ

trafficking and transplant tourism in a global context.

Global Crime

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14

(1), 1–26. doi:

10.1080/17440572.2012.753323

Beauchamp, T.L. (2007). The “four principles’ approach to heath care ethics. In R.E. Ashcroft,

  1. Dawson, H. Draper, and J.R. McMillan (Eds).

    Principle of health care ethics.

doi: 10.1002/9780470510544.ch1

Brody, H. (1989) Transparency: Informed consent in primary care.

Hasting Center Report,

19: 5-9. doi: 10.2307/3562634

Danovitch, G. M., Chapman, J., Capron, A. M., Levin, A., Abbud-Filho, M., Mousawi, M. A.,

Delmonico, F. L. (2013). Organ trafficking and transplant tourism.

Transplantation Journal

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95

(11), 1306–1312. doi: 10.1097/tp.0b013e318295ee7d

Greenberg, O. (2013). The global organ trade.

Cambridge Quarterly of Healthcare


Ethics

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22

(3), 238–245. doi: 10.1017/s0963180113000042

Harris, J. (2002). An ethically defensible market in organs.

Bmj

,

325

(7356), 114–115. doi:

10.1136/bmj.325.7356.114 (CHECK?)

Johnson, A. (n.d.). What are the basic principles of medical ethics? Retrieved from

https://web.stanford.edu/class/siw198q/websites/reprotech/New Ways of Making Babies/EthicVoc.htm

Marino, I. R. (2002, August 23). A response to an ethically defensible market in organs.

Retrieved October 2, 2019, from https://www.bmj.com/rapid-response/2011/10/29/mar

ket-organs-unethical-under-any-circumstances.

Morina, D., Iberdemaj, B., & Birn. (2018, November 2). Kosovo convicts two in organ-

trading trial. Retrieved October 2, 2019, from https://balkaninsight.com/2018/05/24/ko sovo-organ-trafficking-medicus-trial-verdict-05-24-2018/.

Rogers, B. (2019, February 5). Opinion | The nightmare of human organ harvesting in China.

Retrieved October 2, 2019, from https://www.wsj.com/articles/the-nightmare-of-human-

organ-harvesting-in-china-11549411056.

Trey, T., Caplan, A. L., & Lavee, J. (2013). Transplant ethics under scrutiny – responsibilities of

all medical professionals.

Croatian Medical Journal

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(1), 71–74. doi: 10.3325/cmj.20 13.54.71

Varelius J. (2006). The value of autonomy in medical ethics.

Medicine, health care, and


philosophy

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(3), 377–388. doi:10.1007/s11019-006-9000-z


Impact of Health Inequality in the UK

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According to the NHS (2013) the UK is perceived as healthier that it has ever been in its history. This is mainly due to the enhancement of life expectancy, the eradication of diseases, and the advantages brought by public health reforms and technology. However, the problem of health inequalities remains omnipresent. Even if the health of the population is improving, the health of the poor or those less well-off is either improving really slow or it gets worse. This is a main challenge for the policy makers, who see that even though their interventions work, they fail in some sections of the population.

Health inequalities in the UK

To understand the impact of health inequalities, we need to start from the beginning. Economic and social changes, the downfall of manual work, the development in women’s employment, as well as migration patterns and the change of the family structure have modified the population’s nature. Additionally, the NHS (2013) believes that these changes also affect the data about health. They also add that occupation-based classification attracts social inequality in Britain. Moreover, living standards improve the higher one moves on the social ladder, but so do a range of people’s wellbeing factors, such as education, employment opportunities and, last but not least, health.

Researchers believe that in an intricate society as Britain, there are “a number of axes of social differentiation” (Anthias (1990) as cited by the NHS (2013)). These refer to ethnicity, gender, sexuality, age, area, community and religion. Furthermore, it is believed that these classifications are linked but represent separate dimensions of inequality. Exposure to racism is a major factor why the wider population is disadvantaged, and this can take and additional effect on the health of black and Asian communities (Karlsen, 2002).

(NHS, 2013)

The table provided illustrates a pathway, in the same time giving examples of determinants or factors that operate at different stages along the way. It runs from

social structure

to

health and wellbeing

. As it can be seen, education impacts on a person’s health and wellbeing through

social position

and

intermediary factors

that are associated with it. Besides the environmental and behavioural factors (housing quality, exposure to smoking) the table also presents health and social services among the intermediary factors. These not only have a strong role in preventive care, but they also contribute so reducing the effects of illness and injury on health.

We need to keep in mind that the figure does not provide a complete picture. It shows examples from a key set of pathways. This can refer to poor health and disability which can affect an individual’s socioeconomic circumstances, which influences health and all the way to social position.

In addition, due to a person’s social standing, which can alter access to societal resources (education and job opportunities) and exposure to risks, this has a strong relation with health over time and across different diseases.

In order to make sure that health inequalities are eradicated, the NHS (2004) comes up with a series of changes that can be applied. Attention needs to be given to the baseline data collected and compare it within and across the New Deal for Communities. Moreover, the planning agenda needs to be more focused towards local health and make sure that goals are realistic and measurable. Last but not least, planned activities need to be specified, resourced and targeted towards change.

However, David Buck (2014) states that reducing health inequalities should not be left only to local authorities. Although they have an essential role to play when dealing with these issues, Buck proposes a joint commitment by the leaders of communities on how they approach and deal with this situation by using the “big levers: commissioning, incentives and accountability”.

Further, if health inequalities are not solved, it can have disadvantages not only on the population, but also on the economy. The Marmont Review (201) as cited by Jane Dreaper (2010) states that inequality in health accounts for £33bn of lost productivity every year. She also advises the NHS to start spending more on prevention than the 4% it currently does, so as to provide more help to those who need it.

Challenges

When identifying and analysing challenges I have decided to focus on diet and lifestyle factors.

Diet and nutrition

The Department of Health (England) states that food poverty is “the inability to afford, or to have access to, food and to make up a healthy diet”. The Faculty of Public Health (2009) also adds that the poorer an individual is, the worse their diet and the more diet-related diseases they suffer from. This represents a risk which can backfire to diseases such as cancer, coronary heart disease and diabetes. It has been found that poor diet accounts for 30% of life years lost to early death and disability (National Heart Forum, 2004).

Inequality in health has a strong correlation to food poverty. People with low incomes suffer from poor diets, due to low intakes of fruit and vegetables, and also dental caries among children, to name a few. Already the government is trying to solve the issue, but the actions needs to be more than health professionals giving advice to individuals. The “food environment” needs to change, referring to accessibility, affordability and culture. By strategically including public health professionals in key areas and developing programmes, the barriers to healthy eating can be broken down and nutrition improvement can be achieved (Faculty of Public Health, 2009).

Some barriers to healthy eating have been tackled and presented. One of the main factors is the low income and debt. This can restrict an individual’s access to fresh fruit and vegetables, which are normally more expensive. Additionally, this is influenced by the poor accessibility to affordable healthy foods. In disadvantages neighbourhoods, shops are starting to close down, and the construction of supermarkets out of town proves to be difficult due to transport links and impossibility to pay for the fair. Furthermore, foods which are high in fat, sugar and salts are cheaper and more available, making it one of the biggest factors of poor nutrition. The same findings have been stated by Hillary Shaw in her study conducted in Birmingham (Hillary Shaw 2012).

Exercise

The Health Survey of England conducted a survey in 2008 regarding participation in all types of physical activity at work, and during leisure time. The results showed that social class is a great factor in participation, but it differs regarding gender.

(Health Survey for England 2008)

This measurement includes physical activities carried out during work. However, when this is excluded, a connection between physical activity and income is observed among men, but not women. This can also be explained by active transport, such as walking or cycling, since people on lower income may walk or cycle more due to not owning a car or affording public transportation.

Furthermore, The Active People Survey conducted in 2011/12, with 500 participants, found a relation between socioeconomic factors and participation in sport. The figures in the table below use the notations of the National Statistics Socio-Economic Classifications (NS-SEC). From the findings, we can observe that 43% of the adults in groups 1 and 2 take part in sport for at least 30 minutes once a week or more, compared to 27% of adults in groups 5-8.

(Active People Survey 2011/12)

The National Institute for Health and Clinical Excellence (NICE) affirmed that the figures reported from the above surveys are influenced by the built and natural environments people live in. People from lower social standings tend to live in areas or neighbourhoods which have poor access to environments that support physical activities (parks, gardens or safe areas), and tend to live near busy roads. To add, people from lower socioeconomic groups tend to live in areas that do not present a framework for public transportation, therefore they rely on walking or cycling for transport and to access employment (The Marmont Review 2010). More, fear of traffic can be another factor in allowing children to play outside, walking or cycling. The Institute of Public Policy Research (2002) revealed that children in the 10% most deprived wards in the UK are more than three times as likely to be pedestrian casualties as children in the 10% least deprived wards.

Affordability may also be a barrier to taking part in sports and activities. This is due to gym membership costs that are out of the range for many people with low incomes. The Health Survey for England (2007) showed that 13% of men and 16% of women cite lack of money as a barrier to exercise. Even though, taking part in activities such as walking or hiking are less costly, 45% of men and 34% of women stated that work commitments represent another obstacle to being active. Therefore, people from a lower social standing may not have the money and the time to take part in physical activities.

One example for these findings is provided by Rowenna Davis (2011). She compared two neighbourhoods in Glasgow which are close to one another, but differ in every way: Jordanhill, a posh area, and Parkhead, a poor neighbourhood. The ladder area is known for having worse housing, not enough parks and poor transportation links. Moreover, researchers believe that children living in this area are more likely to start smoking, drinking and having a poor diet.

Smoking

People in poorer social classes are believed to die sooner due to a series of factors. The dominant factor among men is smoking, accounting for nearly half of the difference in risk of premature death between the social classes. Additionally, smoking is more concentrated in Britain’s poorest families, with low income lone parents having the highest rates of smoking. This is also influences the high rate in illnesses in this category, such as cancer and heart disease (NHS 1999)

Smoking during pregnancy also has its say in this issue. It not only hurts the mother, but also the unborn child. The highest rates have been recorded among expectant mothers under the age of 0 and women who have left school at the minimum leaving age and with no educational qualifications. These results show to be three times higher among women from a bad social standing than women in the rest of the categories (NHS 1999).

Leaders

There are many charities nowadays that are trying to solve the health inequality prove by helping those who need aid. One of the charities I have identified is the Gleaning Network UK. This initiative’s goal is to save thousands of tonnes of fresh fruit and vegetable which are wasted on UK farms. These crops cannot reach the market because they fail the cosmetic standards of due to overproduction. The Gleaning Network UK uses teams of volunteers, local farmers and redistribution charities in order to salvage this food and give it to those that need it. In 2013, they have saved 48 tonnes of produce which were made into 200,000 meals that helped communities around 6 major cities (Gleaning Network UK, 2014).

The British Heart Foundation is also fighting to stop health inequalities, by providing support to those who smoke and want to quit, with the help of “No Smoking Day”. This is one of the UK’s biggest annual health awareness campaigns which creates supportive environments for everyone and provides sources of help and advice. Already in 2013, 20% of the smokers aware of this campaign made an attempt to stop smoking, reaching an estimate of 1 million quitters (No Smoking Day website 2014).

Regarding exercise and physical activity, one of the most prolific charities I have found is the Right To Play. They believe that play and exercise if a tool for education and health, so volunteers teach children and youth that through sport one can be taught about values and goals. Their vision is “to create a healthy and safe world through the power of sport and play”. Even though the organisation works at a global level, it helped many communities in the UK to start taking up sports and leading a healthier life (Right to Play website 2014).

Recommendations

Improving people’s lifestyles and eradicating food poverty need to be top priorities for primary care organisations and local authorities. Moreover, collaboration of organisations, charities and councils need to focus on developing strategies which will reduce barriers to a healthy life.

One of the first recommendations drawn from the charity examples from before is to establish a local “food poverty partnership” with organisations including health services, local authorities and voluntary organisations to develop a local food poverty strategies. One successful example is the Cyrenians in Edinburgh, Scotland, a charity which started an initiative of “turning waste into opportunities”. Their aim is to get food waste down to zero, by working with local restaurants and shops and socially disadvantaged people from different communities. The food that the eateries and shops do not use anymore is donated to charities which will prepare meals for those who need it. Moreover, they provide jobs for those who also wish to work in the fields of collection and cooking (Cyrenians 2014).

The next recommendation focuses on working with local communities and understanding their priorities, barriers and opportunities. With the help of community meetings and surveys, healthy living can be promoted. One of the best examples in this case is the Good Gym organisation. This charity encourages people to combine their exercise routine with volunteering, matching busy workers with elderly “coaches” who receive their paper or deliveries in exchange of an incentive for their weekly visitors to keep on running. The Good Gym works with the NHS, charities and local community centres, and talks to people from poor neighbourhoods trying to understand their situation and what can be done. As a result, the foundation organises monthly group runs in east London, performing useful activities along the way. Up till now, the members have distributed flyers for a local hospice, tidied up community gardens and hauled compost on to a school roof (Barkham 2012).

When tackling smoking, care providers, local councils and the organisations involved need to put together treatments that will prove to be effective. The GP should consider holding brief interventions to those trying to give up smoking, also providing advice, self-help materials and suggestions for more intensive support. Individual behavioural counselling will be essential when lending a help for those seeking motivation to quit. Additionally, mass-media campaigns need to become the main means of sending the message of “stop-smoking” across, by using radio commercials, internet and TV ads. The same strategies have been used by the NHS with their “No Smoking Day” campaign. This movement has recorded an increase of 10% over the last 4 years of those who want to smoke.

Assignment: PMHNPs Priority

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ORDER NOW FOR AN ORIGINAL PLAGIARISM-FREE PAPER:  Assignment: PMHNP’s Priority

Assignment: PMHNP’s Priority

Assignment: PMHNP’s Priority

Question 20

A patient recovering from shingles presents with tenderness and sensitivity to the upper back. He states it is bothersome to put a shirt on most days. This patient has end stage renal disease (ESRD) and is scheduled to have hemodialysis tomorrow but states that he does not know how he can lie in a recliner for 3 hours feeling this uncomfortable. What will be the PMHNP’s priority?

a) order herpes simplex virus (HSV) antibody testing

b) Order a blood urea nitrogen (BUN) and creatinine STAT

c) Prescribe lidocaine 5%

d) Prescribe hydromorphone (dilaudid) 2mg

Question 21

The PMHNP prescribed a patient lamotrigine (Lamictal), 25 mg by mouth daily, for nerve pain 6 months ago. The patient suddenly presents to the office with the complaint that the medication is no longer working and complains of increased pain. What action will the PMHNP most likely take?

a) Increase the dose of lamotrigine (Lamictal) to 25mg twice daily

b) Ask if the pt has been taking the medication as prescribed

c) Order gabapentin, 100mg TID because lamotrigine is no longer working for this patient

d) Order a CBC to assess for an infection

Question 22

An elderly woman with a hx of alzheimer’s disease, coronary artery disease, and myocardial infarction had a fall at home 3 months ago that resulted in her receiving an open reduction internal fixation. While assessing this patient, the pmhnp is made aware that the patient continues to experience mild to moderate pain. What is the pmhnp most likely to do?

a) order an X-ray because it is possible that she dislocated her hip

b) order ibuprofen because she mayneed long term treatment and chronic pain is not uncommon

c) Order naproxen because she may havarthritis and chronic pain is not uncommon

d) Order morphine and physical therapy

Question 23

The PMHNP is assessing a 49-year-old male with a history of depression, post-traumatic stress disorder (PTSD), alcoholism with malnutrition, diabetes mellitus type 2, and hypertension. His physical assessment is unremarkable with the exception of peripheral edema bilaterally to his lower extremities and a chief complaint of pain with numbness and tingling to each leg 5/10. The PMHNP starts this patient on a low dose of doxepin (Sinequan). What is the next action that must be taken by the PMHNP?

a) Orders liver function tests

b) Educate the patient on avoiding grapefruits when taking this medication

c) Encourage this patient to keep fluids to 1500ml/day until the swelling subside

d) Order BUN/Creatinine test

Question 24

The PMHNP is evaluating a 30-year-old female patient who states that she notices pain and a drastic change in mood before the start of her menstrual cycle. The patient states that she has tried diet and lifestyle changes but nothing has worked. What will the PMHNP most likely do?

a) Prescribe estrin FE 24 birth control

b) Prescribe Ibuprofen 800mg every 8 hours as needed for pain

c) Prescribe desvenlafaxine (Pristiq) 50mg daily

d) Prescribe Risperdal 2mg TID

Question 25

A patient with chronic back pain has been prescribed a serotonin-norepinephrine reuptake inhibitor (SNRI). How does the PMHNP describe the action of SNRIs on the inhibition of pain to the patient?

a) “the SNRI can increase noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn”

b) “the SNRI can decrease noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn”

c) “the SNRI can reduce brain atrophy by slowing the gray matter loss in the dorsolateral prefrontal cortex”

d) “the SNRI can increase neurotransmission to descending neurons”

Question 26

A patient with fibromyalgia and major depression needs to be treated for symptoms of pain. Which is the PMHNP most likely to prescribe for this patient?

a) Venlafaxine (Effexor)

b) Duloxetine (Cymbalta)

c) Clozapine (Clozaril)

d) Phenytoin (Dilantin)

Question 27

The PMHNP prescribes gabapentin (Neurontin) for a patient’s chronic pain. How does the PMHNP anticipate the drug to work?

a) It will bind to the alpha-2-delta ligand subunit of voltage-sensitive calcium channels

b) It will induce synaptic changes, including sprouting

c) It will act on the presynaptic neuron to trigger sodium influx

d) It will Inhibit activity of dorsal horn neurons to suppress body input from reaching the brain

Question 28

Mrs. Rosen is a 49-year-old patient who is experiencing fibro-fog. What does the PMHNP prescribe for Mrs. Rosen to improve this condition?

a) Venlafaxine (Effexor)

b) Armodafinil (Nuvigil)

c) Bupropion (Wellbutrin)

d) All of the above

Question 29

The PMHNP is caring for a patient with fibromyalgia. Which second-line treatment does the PMHNP select that may be effective for managing this patient’s pain?

a) Methylphenidate (Ritalin)

b) Viloxazine (Vivalan)

c) Imipramine (Tofranil)

d) Bupropion (Wellbutrin)

Question 30

The PMHNP is attempting to treat a patient’s chronic pain by having the agent bind the open channel conformation of VSCCs to block those channels with a “use-dependent” form of inhibition. Which agent will the PMHNP most likely select?

a) Pregabalin (Lyrica)

b) Duloxetine (Cymbalta)

c) Modafinil (Provigil)

d) Atomoxetine (Strattera)

Question 31

A patient with irritable bowel syndrome reports chronic stomach pain. The PMHNP wants to prescribe the patient an agent that will cause irrelevant nociceptive inputs from the pain to be ignored and no longer perceived as painful. Which drug will the PMHNP prescribe?

a) Pregabalin (Lyrica)

b) Gabapentin (Neurontin)

c) Duloxetine (Cymbalta)

d) B and C

Question 32

The PMHNP wants to use a symptom-based approach to treating a patient with fibromyalgia. How does the PMHNP go about treating this patient?

a) Prescribing the patient an agent that ignores the painful symptoms by initiating a reaction known as “fibro-fog”

b) Targeting the patient’s symptoms with anticonvulsants that inhibits gray matter loss in the dorsolateral prefrontal cortex

c) Mzatching the patient’s symptoms with the malfunctioning brain circuits and neurotransimitters that might mediate those symptoms

d) None of the above

Question 33

The PMHNP is working with the student to care for a patient with diabetic peripheral neuropathic pain. The student asks the PMHNP why SSRIs are not consistently useful in treating this particular patient’s pain. What is the best response by the PMHNP?

a) “SSRIs only increase norepinephrine levels”

b) “SSRIs only increase serotonin levels”

c) “SSRIs only increase serotonin and norepinephrine levels”

d) “SSRIs do not increase serotonin or norepinephrine levels”

Question 34

A patient with gambling disorder and no other psychiatric comorbidities is being treated with pharmacological agents. Which drug is the PMHNP most likely to prescribe?

a) Antipsychotics

b) Lithium

c) SSRI

d) Naltrexone

Question 35

Kevin is an adolescent who has been diagnosed with kleptomania. His parents are interested in seeking pharmacological treatment. What does the PMHNP tell the parents regarding his treatment options?

a) “Naltrexone may be an appropriate option to discuss”

b) “there are many medicine options that treat Kleptomania”

c) “Kevin may need to be prescribed antipsychotics to treat this illness”

d) “Lithium has proven effective for treating kleptomania”

Question 36

Which statement best describes a pharmacological approach to treating patients for impulsive aggression?

a) Anticonvulsant mood stabilizers can eradicate limbic irritability

b) Atypical antipsychotics can increase subcortical dopaminergic stimulation

c) Stimulants can be used to decrease frontal inhibition

d) Opioid antagonists can be used to reduce drive

Question 37

A patient with hypersexual disorder is being assessed for possible pharmacologic treatment. Why does the PMHNP prescribe an antiandrogen for this patient?

a) It will prevent feelings of euphoria

b) It will amplify impulse control

c) It will block testosterone

d) It will redirect the patient to think about other things

Question 38

Mrs. Kenner is concerned that her teenage daughter spends too much time on the Internet. She inquires about possible treatments for her daughter’s addiction. Which response by the PMHNP demonstrates understanding of pharmacologic approaches for compulsive disorders?

a) “Compulsive internet use can be treated similarly to how we treat people with substance use disorders”

b) “internet addiction is treated with drugs that help block the tension/arousal state your daughter experiences”

c) “When it comes to internet addiction, we prefer to treat patients with pharmaceuticals rather than psychosocial methods”

d) “there are no evidence-based treatments for internet addiction, but there are behavioral therapies your daughter can try”

Question 39

Mr. Peterson is meeting with the PMHNP to discuss healthier dietary habits. With a BMI of 33, Mr. Peterson is obese and needs to modify his food intake. “Sometimes I think I’m addicted to food the way some people are addicted to drugs”, he says. Which statement best describes the neurobiological parallels between food and drug addiction?

a) There is decreased activation of the prefrontal cortex

b) There is increased sensation of the reactive reward system

c) There is reduced activation of regions that process palatability

d) There are amplified reward circuits that activate upon consumption

Question 40

The PMHNP is caring for a patient who reports excessive arousal at nighttime. What could the PMHNP use for a time-limited duration to shift the patient’s brain from a hyperactive state to a sleep state?

a) Histamine 2 receptor antagonist

b) Benzodiazepines

c) Stimulants

d) Caffeine

Question 41

The PMHNP is caring for a patient who experiences too much overstimulation and anxiety during daytime hours. The patient agrees to a pharmacological treatment but states, “I don’t want to feel sedated or drowsy from the medicine.” Which decision made by the PMHNP demonstrates proper knowledge of this patient’s symptoms and appropriate treatment options?

a) Avoiding prescribing the patient a drug that blocks H1 receptors

b) Prescribing the patient a drug that acts on H2 receptors

c) Stopping the patient from taking medicine that unblocks H1 receptors

d) None of the above

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WHAT ARE THE CHALLENGES FACED BY PHS IN IMPLEMENTING AN ENTERPRISE-WIDE ELECTRONIC MEDICAL RECORDS SYSTEM?

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WHAT ARE THE CHALLENGES FACED BY PHS IN IMPLEMENTING AN ENTERPRISE-WIDE ELECTRONIC MEDICAL RECORDS SYSTEM?

 

Order Description
answer the question no more the 3 lines font size 6 and the summariztion no more 5 small lins with font 6.
_____________________________________

SMART COMMUNICATIONS CASE STUDY ( A & B)
1- SUMMARIZE BOTH CASES

2- ANSWER THE FOLLOWING QUESTIONS CONSIDERING INNOVATION, CREATIVITY AND CHANGE MANAGEMENT ISSUES
QUESTION 1
HOW LARGE IS THE GLOBAL OPPORTUNITY FRO SERVING CONSUMERS AT THE BOTTOME OF THE ECONOMIC PYRAMIS” WHAT ARE THE CHALLENGES IN SERVING THESE CUSTOMERS
QUESTION 2
WHY MIGHT PEOPLE LIVING INPOVERTY NEED MOBILE TELECOMMUNICATIONS?
QUESTION 3
SHOULD SMART PURSUE A MARKET PENETRATION STRATEGY FOR LOW INCOME CUSTOMERS IN THE D& E SEGMENTS, OR SHOULD THE COMPANY FOCUS ON A MARKET DEVELOPMENT STRATEGY FOR ITS EXISTING CUSTOMERS? WHY?
_________________________________________________________________
PARTHNERS IN HEALTHCARE CASE
1- SUMMARIZE THE CASE
2- ANSWER THE QUESTIONS
1-WHAT WAS THE CULTURE OF PHS CLINICAL DECISION MAKING BEFORE THE ADVENT OF LMR AND CPOE SYSTEMS?

2-HOW HAS THE ENTERPRESIE-WIDE ROLLOUT OF LMR AND CPOE CHANGED CORE HEALTH CARE DELIVERY BUISNESS PROCESSES?

3-WHAT CHALLENGES DID THE LEADERSHIP OF PHS NEED TO OVERCOME TO ACHIEVE THE SWEEEPING TRANSFORMATION OF CORE PROCESSES WROUGHT BY ACCESS TO APTIENT’S LONGITITUNAL MEDICAL RECORD AND TO CLINICAL DECISION SUPORT SYSTEMS?

4-WHAT CIRCUMSTANCES CONTRIBUTED TO THE SUSCCESSFUL ADOPTION OF PROCESS CHANGE AND NEW INFORMATION SYSTEM ACROSS PHS?

5-WHAT BARRIERS EXISTED AT THE TIME OF IMPLEMENTATION, AND WHICH BARRIERS REMAINING AFTER DEPLOYMENT OUGHT TO BE OF CONCERN TO PHS MANAGEMENT?

6-WHAT ARE THE IMPLICATIONS OF PHS TRANSFORMATION IN THE FOLLOWING AREAS:
1-THE SELECTION, TRAINING AND PERFORMANCE MANAGEMENT OF PHS PERSONNEL
2-COLLABORATION AMONG PHS PERSONNEL
3-COLLABORATION WITH NON-PHS HEALTH CARE SERVICE PROVIDERS AND GOVERNMENT REGULATORY AGENCIES
4-ONGOING QUALITY MANAGEMENTAND MEASUREMENT
5-THE ALLOCATION OF IT RESOURCES
7-WHAT ARE THE CHALLENGES FACED BY PHS IN IMPLEMENTING AN ENTERPRISE-WIDE ELECTRONIC MEDICAL RECORDS SYSTEM?
8-WHAT ARE THE CHALLENGES FACED IN ESTABLISHING A DECISION SUPPORT SYSTEM TO ASSIST HEALTH CARE PROVIDERS IN TREATING THEIR PATIENTS?
9- FROM PROJECT MANAGEMNT PERSPECTIVE, WHICH SYSTEM DEPLOYEMENT SUCCESS FACTORS ARE IN PLACE AND WHICH FACTORS APPEAR TO BE ABSENT?
10-DOES THE IS UNIT’S APPROACH TO THE ARCHITECTURAL DESIGN OF THE SOLUTION MITIGATE PROJECT RISK AND CONTRIBUTE TO A SUCCESSFUL OUTCOME? IF SO, EXPLAIN HOW. IF NOT, IDENTIFY WHAT IS NEEDED TO IMPROVE THE SITUATION.
11-IS THERE ANYTHING NOTEWORTHY IN THE IS UNIT’S USE OF RESEARCH AND DEVELOPMENT CENTERS? DO THESE CENTERS CONTRIBUTE TO THE INITIAL SUCCESS OR TO THE ONGOING VALUE OF THE LMR/CPOE INVESTMENT?
12-WHAT ARE THE OPERATIONAL IT AND MIS CHALLENGES POSED BY TH SYSTEM NOW IN PLACE FOR THE FOLLWOWING GROUPS:
13-PHS MANAGEMENT
14-PHS HEALTH CARE PRACTIONERS
15-HEALTHCARE PRACTIONERS AND ALLIED AGENCIES ( SUCH AS INSURANCE COMPANIES AND STATE AND FEDERAL AGENCIES) WHO MUST INTERACT WITH PHS
16-WHAT ARE THE TOTAL COST OF OWNERSHIP (TCO) IMPLICATIONS OF THE OVERALL LMR/CPOE INVESTMENT?

Treatments For HIV/AIDS

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Treatments For HIV/AIDS Among Different Types Of Population

HIV is the disease that had been link to human and it is also known as the disease of the century. According to avert.org, the first case of HIV in human was found in 1959 form a man in the Democratic Republic of Congo. Evidences shown that it was started in Africa. HIV is a dangerous virus that destroys human immune system which help to prevent illnesses. It is even more dangerous because there is no cure or vaccines available for this fatal disease. Once someone is infected by this disease, it is almost impossible to return to who they were before and they will get weaker and easy to catch sickness since their immune systems are weakened. People can die from HIV virus if left untreated but there are treatments out there that is proven effective in treating HIV and AIDS. There are many ways that the disease can be transmitted form one person to another. Unfortunately, the number of cases caught with HIV disease This paper explores the facts of this disease such as what are HIV and AIDS, origin, ways to expose, and treatments available for different types of population in society in North America.


What Is HIV? What is AIDS?

HIV is also known as Human Immunodeficiency Virus. It is a deadly virus because it attacks the immune system which help prevent illnesses and give the bodies the abilities to fight back against other diseases. There is misunderstanding that people tend to think HIV and AIDS are the same because they go together. But HIV and AIDS are actually different from each other. Based on the above definition, HIV is the virus. According to avert.org, AIDS in order words which is Acquired Immune Deficiency Syndrome and also known as the advanced HIV infection or late stage HIV. It is a set of symptoms caused by HIV virus. It is the last stage of HIV and when the infection is advanced, death can occur if left unthreatened.

According to HIV.gov, millions people are living with HIV in the Unites States, but 15% percent of the number which mean every 1 out of 7 people are unaware that they are infected with the virus. Based on the data recorded in 2016, an estimation of 38,700 Americans is become newly infected with HIV virus. This mean that the number of case that is infected with HIV increase everyday due to many activities and factor that can contribute to the infection. Based on CDC.gov, in 2017, roughly 21% of the new HIV diagnoses in the United States are youth from age 13 to 24. In the age group of 13 to 24, about 87% are young men and 13% are young women which mean the number of HIV infection is likely more in young male compare to young women. In 2016, an estimation of 17% of new diagnoses are people from age 50 and older. In the population of people 50 years and older, 42% are African American, 37% White American, 18% Hispanic/ Latinos and 4% for the other races.


How Do Someone Contract HIV Virus?

HIV is an unusual virus because it isn’t contagious in which it cannot be contract easily from one person to another. HIV is only contracted through specific activities and the most common that most cases that got transmitted are through sexual behaviors, syringe or needle sharing.  There are certain body fluids that contribute to the spread of HIV virus such as semen, blood, vaginal fluids, rectum fluids, breast milk, pre-cum, semen…These body fluids must come in contact with damage tissues such as a tear or mucous membrane to infect HIV viruses. It is usually injected through the bloodstream for the spread to happen. Mucous membranes are usually found in mouth, vagina, penis. HIV are mainly spread in the United States by having sexual intercourse (anal or vaginal sex) without using a condom or HIV prevention medications such as PrEP or TasP. When having sexual behaviors without using

protection, a person is at risk of infecting HIV virus. HIV can be transmitted through syringe or needle sharing because it comes to blood contact and that is when it is the easiest route

for HIV virus to travel into one’s bloodstream and start developing signs and symptoms of the immune system being impacted. HIV virus is not easy to be transmit but once it had developed then it became a dangerous disease with no medication that can get rid it. If left untreated it will soon lead to AIDS.


What are the symptoms?

Based on Mayo Clinic, in the first few week of the HIV virus infection, one may have some flu like symptoms such as cold, sore throat, fever, and fatigue may occur. The disease sometimes doesn’t show any signs until it progressed to the AIDS which is the last stage and a person may have signs of weight loss, fatigue, recurrent infections, night sweat, … During the HIV infection, the person may experience extreme fatigue, pain in abdomen, dry cough, and find it hard to swallow, diarrhea, vomiting, … The latter stage of the HIV infection usually has signs such as skin rashes, swollen glands, bleeding in anus, vagina…It is hard to know if one is infected with HIV virus because there are no definite specific signs or physical abnormal that confirm one’s infection status. The best way to fight against the virus is know the status by going through blood testing. HIV is commonly tested by using blood or saliva. HIV home kit testings are also available. One can use the kit by droping a drop of blood or saliva and if the test shows positive, one must immediately see a doctor to confirm the status of HIV. There are also testing centers for HIV. Some may have the result at the spot but some take time for the result to come back so make sure if one believes that they are exposed to HIV they must get tested right away to get the result quickly and more accurate. It is important to know the status of HIV to get the treatment as soon as possible. The early stage is usually having a higher risks of spreading. If one is negative to HIV, one can explore prevention ways to keep them protected. It is the most accurate way and help detect disease and prevent spreading because of lack of knowledge about the infection status.  HIV doesn’t kill someone immediately but it is a silent killer by taking time to kill them by attacking their immune system and let sickness happen to them. That is why everyone should take it seriously by understanding HIV and the risks of it.


Is There A Cure to HIV/ AIDS?

HIV is a silent but extremely dangerous virus that is a fear for mankind since the destructive is massive to a person health and life. Since more and more people are infected by HIV virus these days that is why finding a cure is very important but unfortunately there is no cure for HIV or AIDS because not every disease have a cure. HIV and AIDS seems scarier by the name of it since there is no “going back” to who they used to be. There is no procedure that ever been proven scientifically that can eliminate HIV virus or reverse the damage that the virus has cause for human immune system. In recent years, there are many new developments of medicine and health which contain advanced treatments and also therapies that help to improve the life of a HIV patient. When we think of HIV or AIDS, we may likely think of death, pain, horrible but more and more people are living with HIV and they may still have a normal life thanks to new and advanced medical treatments available today.


Treatments Available For HIV/ AIDS

Before jumping right into the treatments, a person must go over several tests and those include such as CD4 T Cell Count. According to Mayo Clinic, this test is use to determine the number of white blood cell being destroyed by HIV virus. AIDS which is the late stage of HIV will be transform when the white blood cell count is below 200. Other test such as viral load to determine the number of HIV virus in bloodstream and the higher the virus the more serious or progress of the disease. Some strain of HIV often resists to the medication so drug resistance test is to determine the specific virus. These tests are very important because its confirm the HIV status of a person from their treatments are being introduce with my option for patients. HIV can be a nightmare because there is no 100% cure to this disease, however, there are treatments out there that are available and somehow help fight the disease and reduce the risk of infecting so that person can live a normal and better life. Antiretroviral therapy or also ART is a type of medication which help block the spread of HIV virus in different ways. The medication is now widely used for HIV treatment and can be used for everyone even the one with high CD4 count. Mayo Clinic and webmd.com show the medications that are available for HIV patients:


Nucleoside Or Nucleotide Reverse Transcriptase Inhibitors (NRTIs)

Nucleotide reverse transcriptase inhibitors (NRTIs) is an anti-HIV classes that help block the reverse of HIV enzyme and stop the spreading of the disease. Examples such as abacavir (ABC/Ziagen), Didanosine (ddl/ Videx), Stavudine (


Non-nucleotide Reverse Transcriptase Inhibitors (NNRTI)

According to AIDSinfo.com, this treatment is similar to the above. It binds protein and block the reverse of HIV and prevent HIV to replicate.


Protease inhibitors (PIs)

This process inactive the protease which is a type of protein which contribute to the copies of HIV virus. Examples are: Lopinavir + ritonavir (LPV/r), Nelfinavir (NFV/ Viracept), …


Integrase inhibitors

A protein is called integrase, which the virus uses to insert its genetic material into CD4 T cell, will be disable in the treatment. Examples includes: Dolutegravir (DTG/ Tivicay), Raltegravir (RAL/ Isentress), …


Fusion Inhibitors

This treatment is different than other treatment since the others have effect on infected cell, this treatment cures the healthy cell first to prevent it from being destroy. Examples are: Enfuvirtide (ENF/ Fuezon), Maraviroc (Selzentry).

According to catie.ca, studies had shown that Antiretroviral therapy (ART) had tremendously successful in treating for HIV patients and relief. But it is the only treatment that is FDA approved and popular for the disease. The modern advance antiretroviral therapy also helps the HIV population expectancy to increase significantly. Based on the information betablog.org provided, from 1996 until 2010, the life expectancy for people living with HIV virus had increase to about 10 more years of life. It also added that for example of a 20-year-old who had been infected with the virus when apply the antiretroviral treatment, the life expectancy increase to 78 years of age which is almost the average lifetime of a normal people in today society. But it is not always the fact that the treatment will always bring

miracle to save the lives of the patients. There are a lot of people who died their first year of starting ART. A study had been conducted based on betablog.com, 2,106 people had died within the first year of treatment which took up 2% the total participants. Studies showed that the people who started treatments after 2008 will less likely die compare to the ones that started before 2008. It is because of the advance medication and effectiveness had been proven. Emily Land said: “Mortality in the first year of HIV treatment was “strongly influenced” by people starting treatment very late in their HIV infection (who are already severely immunocompromised).” The mortality rate for second and third year is more dramatic in declining. Emily Land also added that: “Improvements in survival during the second and third years of ART are probably caused by increased viral suppression, declining rates of viral failure, and increasing treatment options. People who inject drugs can have a higher mortality rate.”

Overall, everyone should get their treatment as soon as possible after being diagnosed. It is important because the earlier one start the therapy, the higher life expectancy. Antiretroviral therapy is for everyone, go see a medical provider and they will help that person to choose the medicine that is best for them and their budget.


Prevention

“Disease control priority in developing countries” is a book that mentioned the ways of preventing HIV:


Information, education, communication:

This way is to help educate public by includes facts and education for the uses of condoms through advertising, pamphlets. The more information going to people there will be a change in the number of HIV cases we faced. Educate also inform the public of the risks of HIV and lead humanity to a brighter future. School based sex education is being brought to schools and institutions to guide students from the risks. It is important to know what it is and how it work first in order to prevent it.


Condoms promotions and distribution:

This intervention indicate that the program will help lower the case of transmitted disease through sexual intercourse and proven their effectiveness. The information that proven to public their effectiveness is very little and social marketing given low cost condoms with high efficiency. Condoms should be more popular and proven for less infected disease such as STI, other cancer and unwanted pregnancies,…


References

  1. What are HIV and AIDS? (2019). Information on HIV. Retrieved from avert.org
  2. How is HIV transmitted? (2017). US Department of Health & Human Services. Retrieved from HIV.gov
  3. US Statistic. (2019). Center for Disease Control and Prevention. Retrieved from hiv.gov
  4. Mayo Clinic Staff. (2018). Diagnoses and treatments. Retrieved from mayoclinic.org
  5. Sean R Hosein. (2014). Longer life expectancy for HIV-positive people in North America. Retrieved from catie.ca
  6. ​D T Jamison​, and ​W H Mosley​. (2011). Disease Control Priorities in Developing Countries, Los Angeles; University of California.
  7. The Antiretroviral Therapy Cohort Collection.(2017)

    Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: a collaborative analysis of cohort studies

    . Retrieved from betablog.org