Minimum of 250 words with at least 2 peer review reference in 6th edition APA style.

 

1. Anemia of chronic disease is a common occurrence in elderly patients. What is the pathophysiological mechanism behind this disease process?
2. Virchow’s triad refers to states that can produce hypercoagulability. What are the three categories? Give an example for each and explain the pathophysiological changes seen.

 

Based on your readings, compare and contrast (view any similarities or differences between) the theories of Dr. Marth Rogers and Dr. Rosemarie Rizzo Parse’s theories. Which one would you prefer for your nursing practice and why?

APA FORMAR 250 WORDS , EXCEPT REFERENCE

Chapter 14:

Martha E. Roger’s Science of Unitary Human Beings 

Chapter 15:

Rosemarie Rizzo Parse’s Human becoming Paradigm.

Text Readings:

Smith, M. & Parker, M. (2014). Nursing Theories and Nursing Practice. (4th ed.). Philadelphia, PA: F. A. Davis Company.

Supplemental Text Readings:

Masters, K. (2015). Nursing Theories: A Framework for Professional Practice. (2nd ed.). Burlington, Massachusetts. Jones & Bartlett Learning.

Editorial: Theory guided practice in nursing, Saleh (2018).

https://www.pulsus.com/scholarly-articles/theory-guided-practice-in-nursing.pdf

Comment 1      (150 WORDS ) NO PLAGIO

The development marker assessment that I would use is the CDC’s Developmental Milestones chart found on the CDC website, as they are based on age in months and are found in print quite readily in clinics, in addition to a downloadable phone application (CDC, 2019). Considering that every child makes his or her milestones at slightly different times and this child is quite low on growth charts, this would be a rough gage for how this baby should present and I would begin testing the 6 month categories; can she makes vowel sounds, roll over, sit without contact guard, stand with assistance, etc (CDC, 2019). I would also test many of the 9 month milestones: does she make a lot of different sounds, point at things, mimic, use thumb and point finger to pincer food, get to a seated position alone, pull herself to standing position, and can she crawl (CDC, 2019).

The child would also need a physical assessment, which could reveal abuse, neglect, etc but given our scenario is vague, I would contend that these are absent. I would likely assess and question for feeding or GI issues like mouth sores/malformation, gastroesophageal reflux (GER), frequent vomiting after meals, copious diarrhea, etc. (Montrowl, 2014). Given the child is low on all of the scales, it doesn’t appear to be anything acute, like weight loss from acute respiratory illness. Montrowl indicated that GER could very much be the issue. I would recommend that the child does not feed in a laying position, no bottles in bed, and should sit up after meals; the mother could try other formulas, some formulations with rice are gentler on the child’s belly (2014). I would also recommend an early intervention program, such as Birth to Three so there can be more monitoring of the child with possibility for more services provided at the county level (CDC, 2019). If the child is malnourished, for instance, if the mother is of lower socioeconomic status, recommending and assisting her in applying for food assistance programs could also benefit the child and the mother.

 

Centers for Disease Control and Prevention. [CDC]. (2019). CDC’s developmental milestones. Retrieved from https:// www.cdc.gov/ncbddd/actearly/milestones/index.html

Montrowl, S. (2014). Gastrointestinal system. In Kenner, C. & Lott, J. (Eds), Comprehensive neonatal nursing care. Retrieved from https://ebookcentral-proquest-com.lopes.idm.oclc.org/lib/gcu/reader.action?docID=1353392

COMENTS 2.  (150 WORDS) NO PLAGIO

Since the infant is 9 months of age, the WHO growth chart should be used to assess the female child. The CDC recommends use of the WHO charts for infants under 2 years of age as they are recognized as a better indicator of growth in early development, showing infant to toddler growth in optimal conditions and assuming breastfeeding for at least 4 months without introduction of other food sources and still breastfeeding with other nutrition sources at 12 months of age. I compared the CDC percentiles posed in the DQ question to the WHO charts and the results were comparable.

I would note the stature and build of the parents of the child as well, as this is important to consider when assessing an infant (and child) for growth.

The first thing to assess upon entering the infant’s space is how she reacts to you, the nurse who is most likely a stranger. Does the child hide her face and cling to the parent? Is the child consolable and does she rely on a comfort item from home? Does the child calm once she sees the parent comfortably interact with the nurse as the nurse interviews the parent and notes any concerns they have at this interaction. Also make note of how the parent reacts to healthcare providers; notice any signs of neglect, abuse, signs on the child that do not have explanation or do not seem right.

During my physical assessment of the child, I would make note of her developmental milestones listed by the CDC for 9 month old infants. I could show the child my stethoscope and see if she points at it with a finger and does she reach for it and grab with a thumb and finger? I could hand the baby a tongue depressor and watch to see how she learns about it. Does she put it in her mouth? I could drop a small toy on the exam table to watch the child look for it as it falls and then cover it with a drape to see if she looks for it. Does she delight in finding it in a makeshift game of peek-a-boo?

I would talk to the parent about the infant’s feedings. Have solid foods other than breastmilk or formula been introduced? If dry cereal or other finger food has been introduced, can the child use the pincher grasp to pick up a piece, transfer one hand to the other, and put a piece in her mouth (however successful attempts may be!)?

Finally I would assess muscle development and gross motor skills, including the parent’s replies in the assessment as well, as it not always possible to ask a 9 month old girl to pull up to standing on demand. Does the child sit up unassisted, can she stand supporting her own weight, does she crawl?

Does the child understand and react to “no” and does she babble at any point during the interaction?

I would talk to the parent about what to watch for next at the 12 month stage and could point them to a paper copy, online reference or phone app to read about 12 month milestones.

Lastly, I would check what vaccines are recommended, and let parents know a flu shot can be given over 6 months of age. I would ask about eruption of teeth, discuss comfort measures and dental checkups. I would inquire about the child’s sleep environment and habits, and remind parent that the crib mattress should be at the lowest position to prevent falls. I would inquire about car seat and remind parent that AAP advises rear-facing until age 2. I would ask about safety in the home and ask if the parents have inspected for electrical risks, cord dangers, security of windows and doors with a crawling climbing infant in the home. I would ask about the possibility of lead paint in the home especially with a teething infant who is becoming increasingly mobile.

Recommendations are based on evidence-based practice because this will help ensure the child develops, meeting milestones and not falling behind. Evidence shows infant safety and security can be protected by following safe sleep practices and AAP guidelines. Milestones from the CDC help assess every child using a uniform set of criteria that most children of certain ages will have met. Identifying possible delays helps enhance developmental support and further investigate and address any other risk factors early.

References

Centers for Disease Control and Prevention. (2019, January 11). Growth charts – WHO child growth standards. Retrieved from https://www.cdc.gov/growthcharts/who_charts.htm

Centers for Disease Control and Prevention. (2019, October 24). Important milestones: Your baby by nine months. Retrieved from https://www.cdc.gov/ncbddd/actearly/milestones/milestones-9mo.html

  

Leininger’s theory or the Culture Care theory, involves knowing and understanding cultural differences in the area of Nursing care practice. Her theory emphasizes that different cultures requires different but effective care. This knowledge provides culturally specific meanings and expression in relation to care and health. Without this theory an array of ineffective care can easily be presented. 

For example; A patient’s diet can be of great significance in their care. Not having thoroughly thought out culturally appropriate meals prepared for the sick can ultimately change the trajectory of how effective an outcome will be. Culturally competent nursing care helps ensure patient satisfaction an positive outcomes. 

  

Every race or culture may perceive or demonstrate the effect of pain differently. She developed a theory and research method designed to guide nurses to (a) understand cultural similarities and differences in how people care for themselves and others during health, illness, disability, dying, and death, and (b) provide culturally congruent, competent, and sensitive care. Wehbe-Alamah, Hilba B) Leininger’s Culture Care Diversity and Universality Theory: Classic and New Contributions. As written in The Parents’ Cultural Care Towards Promoting Child Development; A quantitative approach that was carried out with parents of children below five years old, who were registered in a healthcare service from Picos city, Piaui State, Brazil. 

Nurses are expected to explore even more the probable performance according to each child’s age and considering the child development stage, moreover, respecting the cultural care provided by their parents.  

  

The conception model was designed to guide Nursing practice therefore, Without understanding one’s culture, the risks of inadequate care arises. Conceptual modes are important in guiding the development of the discipline of nursing. Studies continue to show that patient satisfaction scores especially in the Hospital environment grossly increases when close attention and consideration is give to the Patient’s culture an their ways of life.

Leiniger’s model provides three action modes nurses can use to help bridge care and provide care to someone with respect to their individual beliefs, cultural background, and values. 

These modes are all used today in a variety of clinical settings.

 

“Vertigo is defined as a hallucination of motion of the body or the environment and may be rotatory or linear… it is a cardinal symptom of vestibular system disease” (Smouha, 2013, pp. 456). The most common causes of vertigo include benign paroxysmal positional vertigo (BPPV), Meniere’s disease, inner ear infections and/or vestibular neuritis. When treating vertigo, the provider will focus on the cause rather than the symptoms. For example, if a patient has Meniere’s disease, then the provider may prescribe them a diuretic or recommend a low sodium diet to help reduce the amount of fluid pressure on the inner ear. If the patient is experiencing BPPV, then they are usually treated with exercises, physical therapy and slow-positioning maneuvers.

Lightheadedness

“Lightheadedness (syncope or near-syncope) is cardiovascular or cerebrovascular in origin, or occasionally metabolic (e.g., hypoglycemia), but almost never vestibular” (Smouha, 2013, pp. 456). The most common causes of lightheadedness include orthostatic hypotension (sudden drop in blood pressure when a patient stands up), illnesses (cold, flu, allergies, etc.), certain medications, arrhythmia, anxiety stroke, anemia and/or neurological conditions. Treating lightheadedness is like treating vertigo even though it is not the same causes – you would treat a patient that is lightheaded with potential medications, head position maneuvers, balance therapy or psychotherapy for something caused by an anxiety disorder.

Referral

With treating an individual with either vertigo or lightheadedness, a referral to Ear, Nose and Throat (ENT) should be recommended when the patient is experiencing reoccurring episodes – regardless of the cause because there may be an underlying condition that should be further evaluated by a specialist.

Reference

Smouha, E. (2013). Inner ear disorders. NeuroRehabilitation, 32(3), 455–462.

https://doi.org/10.3233/NRE-130868 (Links to an external site.)Links to an external site.

• Levo, H., Kentala, E., Rasku, J., Pyykko, I. (2013). Fatigue in Meniere’s Disease. Hearing, Balance,
  and Communication, 11, 191-197. DOI: 10.3109/21695717.2013.835090
   
• Amanda DavisAmanda Davis
  10:28am