Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who were assigned a different patient case study, and provide recommendations for alternative drug treatments to address the patient’s pathophysiology. Be specific and provide examples.

                                      Main Post

Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

Patients today are much sicker than they used to be. The advanced practice nurse needs to manage all comorbidities in the plan of care. In this post, I will discuss the patient’s health care needs and a recommended treatment plan, including pharmacotherapeutic choices. Also, I will present an education strategy to assist the patient in managing their disease conditions. The patient has a history of hypertension, myocardial infarction, hyperlipidemia angina, and diabetes type two. Her needs center around the management of these comorbidities. Also, I noticed that her serum creatinine is on the high end of the range if not outside of it. This fact is not surprising considering her diabetes. The case reports that she was doing well until about a month ago. It was tempting to consider adding another medication to the regimen. However, I believe that either the metoprolol is not high enough to manage her current disease state or she has been missing doses, and I am leaning toward the latter. If withdrawn suddenly, the drug can increase the incidence and intensity of anginal attacks. Metoprolol is the first-line drug for stable angina and should be working (Rosenthal & Burchum, 2018).  

A review of her current drug therapy appears appropriate. Aspirin, simvastatin, and metformin are competent choices, and the doses are adequate. My plan would include an assessment of how she takes medication at home and manages them before making any changes. If this were in order, I would increase the metoprolol to 75 mg twice a day and set a follow-up appointment in two weeks. I prefer to increase the dose of metoprolol first before adding any new drug because of polypharmacy considerations, and the drug does not require renal adjustment (Epocrates, 2019). This fact is beneficial to consider because she has diabetes. Assuming that the patient has missed doses over the last month, the priority is to determine why. Costa et al. (2015) recommend explaining how to take medication, discussing reluctance to take drugs, and a conversation about the patient’s beliefs and knowledge about their health and treatment. I believe that this is a great strategy to use with the patient. Medication adherence is troubling and particularly so with the elderly who have multiple medications and conditions. I think it is essential for the patient and provider to be partners in the plan of care. The patient must agree to it and fully understand their conditions and the purpose of each medication. 

 

                                          References

Costa, E., Giardini, A., Savin, M., Menditto, E., Lehane, E., Laosa, O., … Marengoni, A. (2015). Interventional tools to improve          medication adherence: review of literature. Patient Preference And Adherence, 9, 1303–1314. doi:10.2147/PPA.S87551Epocrates. (2019). Metoprolol Tartrate Adult Dosing. Retrieved from https://online.epocrates.com/drugs/25501/metoprolol-        tartrate/Adult-DosingRosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO:        Elsevier.

 Discuss how each of these factors (inflation, changing population demographics, intensity, and technology of services) influence health care costs. 

 

And I need two responses of my classmates about how I  might offer ways that individuals can mitigate a negative effect of these factors.

reference book:  Stanhope, M. & Lancaster, J. (2018). Foundations for Population Health in Community/Public Health Nursing (5 th ed.). Elsevier. (e-Book) 

200 words for each response.

1) 

Social Determinants and Disease Development

       Social determinants of health are conditions in which a person is born in to – social, economic and physical conditions to include resources and daily needs, biases, crime and violence statistics, community support, availability of sending and receiving communication, education quality and community, etc., each impacts an individuals daily activities, health, wellness and evidence of disease.  Individual behaviors will also support or not, the chain of events that lead to health or illness.  Although many circumstances may prevent wellness, it is up to the individual how these circumstances will impact their life.

Chain of Infection

       The chain of infection is comprised of six units; the infectious agent or the germ; the reservoir or where the pathogen lives; portal of exit, why and how the infectious agent exits it reservoir; mode of transmission, how it is passed on; portal of entry, how the infectious agent enters its new host; and the susceptible host which can be any person or animal.

How the Community Health Nurse Can Break the Chain of Infection

       Community nurses and education are at the center of breaking communicable disease processes from spreading, surveillance of and prevention.  In order to stop the infectious agent from spreading it is imperative to break the link of transmission.  Hand hygiene, vaccination, prevention of spreading an organism could include education on the importance of covering your cough or sneeze, isolate the person or persons infected, use of personal protective equipment when indicated, especially in healthcare settings, utilizing antibiotics wisely.  At home and beyond, maintain and clean your home especially the high use areas such as countertops, faucets, light switches, bathroom surfaces, keyboards or cell phones, doorknobs or the steering wheel of your car.  In grocery stores, utilize the antiseptic wipes to wipe down cart handles, etc.  If you find yourself or a loved one as a patient in a hospital or clinic setting, speak up, call out anyone who enters your room to utilize hand sanitizers prior to engaging in your care.  All are ways to break the link and to prevent spread of infectious agents.

       Improve community knowledge and information of possible outbreaks and the steps needed to contain the infectious agent.  Through collaboration with local healthcare professionals, social media or television, provide hyperlinks to public health forums or available telephone numbers for social support services.  Community health nurses need to be well informed and educated in surveillance statistics of their local area in order to break the chain of infection.

References

Clark, M. J. (2015). Population and community health nursing (6th ed.).  Boston, MA: Pearson

     Chapter 3

Infection Prevention and You.  Break the Chain of Infection.  Retrieved from (professional.site.

     apic.org)

Prevention by Breaking the Chain of Infection.  Retrieved from (cdn.ps.emap.com)

Social Determinants of Health.  Retrieved from (healthypeople.org)

2) 

Social determinants of health can be connected with a person’s culture. The way that a person’s culture views healthy habits can impact their health. Social determinants of health can be defined as conditions that people are born and function in (Healthy People 2020, n.d.). Some examples of social determinants are the availability to meet daily needs (Healthy People 2020, n.d.). This means that a person access to healthy food, health care, safe housing, social support, etc. (Healthy People 2020, n.d.). I believe that social determinants of health can have a major development to disease. When someone has access to clean water, air, and food it can make a difference in the spread of disease. Florence Nightingale believed in this theory as well and made sure that soldiers had access to clean water, air, and food. Nightingale found that 10 times more soldiers died of “filth disease” than died of bullets (Markel, 2017). Nightingale believed that the reason so many soldiers died was because of the filthy conditions that they were living in. These soldiers did not have access to clean conditions during the war, if these soldiers were born in these conditions, I am sure that they would find that many of them would be sick throughout their life.

            The chain of infection is how infection is spread from person to person. The reservoir is where the infection normally lives and grows (Centers for Disease Control, n.d.). These reservoirs can be environmental, human, or animal. Next in the chain is the portal of exit. This is how the infection leaves a host. A mode of transmission is how a pathogen is spread from host to host (CDC, n.d.). A portal of entry is how the infectious agent enters a host (CDC, n.d.).  The final link is to have a susceptible host (CDC, n.d.). The Center for Disease Control (n.d.) suggests that preventing the spread of infection can be done by protecting the portal of entry, increasing a host’s defenses, and finally by eliminating at transmission. A community health nurse can help break this chain by studying the different parts of the chain of infection and how to adequately stop the spread of infection. If a nurse wants to break a link in the transmission, they can protect the way that the infection is spread. For instance, when at the hospital and a patient has an infection with a disease that can be spread by direct contact, we make sure to dress in gloves and a gown to make sure that we are protecting ourselves from the spread of disease. If someone in the community has an airborne disease like tuberculosis, the community health nurse can prevent the spread of infection by making sure the infected person does not leave their house.

Reference:

Centers for disease Control. (n.d.). Principles of epidemiology | Lesson 1 – Section 10. Retrieved

from https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section10.html.

Healthy People 2020. (n.d.). Social determinants of health. Retrieved from

https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health.

 

Analyze the key benefits and/or consequences of practicing in a multicultural city such as Miami, FL. Select one (1) scholarly practice-based article that addresses application of theTheory of Culture Care Diversity and Universality in advanced nursing clinical practice, and after reading the article, create a diagram to document the ways in which the article identifies all components of the theory and its application to clinical and/or advanced nursing practice. 

 
4 postsRe: Topic 5 DQ 2

Based on the script from Haiti hurricane 2010 my thoughts are:

       Phase 1, the pre-disaster phase, is characterized by fear and uncertainty. The specific reactions a community experiences depend on the type of disaster. Phase 2, the impact phase, is characterized by a range of intense emotional reactions. As with the pre-disaster phase, the specific reactions also depend on the type of disaster that is occurring. Phase 3, the heroic phase, is characterized by a high level of activity with a low level of productivity (Substance Abuse and Mental Health Services Administration (2018).

       Primary prevention would be having volunteers appropriately vaccinated before leaving. After landing in Haiti, have the Hatians vaccinated against airborne and vector-borne diseases such as malaria. Ensure safe and proper sanitation such as making sure hands are washed before and after personal hygiene and patient care. Have clutters cleaned and cleared and make tracks for stagnant water to flow to avoid breeding mosquitos and encourage infestation of bugs. Shelters should be adequate and not overcrowded. Educate about diarrhea, what symptoms to look for and how to handle it.

        Secondary prevention depends on how devastating things are. Triage casualties according to acute, urgent, emergent. Initiate search and rescue efforts in wreckages, but not until damaged structures are deemed safe to enter or dismantle. Have a plan to manage casualties so that there will be no chaos. This could be done by using tents and designated signs with volunteers directing traffic. Teach the Hatians how to cope by asking for help from friends and families not badly affected by the disaster. Set-up an area where they can get emotional support to deal with their loss and address future community educational needs, such as disaster preparedness.

        Teritary prevention entails looking at long-term needs after the resolution of the disaster. Things such as healing and how to cope. Stress related issues such as rebuilding, that could be dealt with by the government and outside organizations such as the Salvation Army and other charitable organizations.

        I would work with Adventist Disaster Relief Agency (ADRA) because they are a branch of my church, the Seventh Day Adventist Church.  They have been helping with the organization of outreach world wide.  They are always on the ground in every disaster alongside the Canadian Red Cross and the Salvation Army organizations. Here’s a link for ADRA if interested to know more: www.adra.ca/connections

        Prevention includes a wide range of activities — known as “interventions” — aimed at reducing risks or threats to health. For many health problems, a combination of primary, secondary and tertiary interventions are needed to achieve a meaningful degree of prevention and protection, (Institute for Work and Health 2015). 

        Based on the script, this nurse is at the preimpact stage which falls under primary prevention, as she is planning to reduce the impact of the hurricane on the population and what damage may have occurred.  This could only be assessed on her arrival.

References

GCU. (2010). “Diary of a medical mission trip.” Retrieved from Grand Canyon University: http://lc.gcumedia.com/nrs427v/diary-of-medical-mission-trip/v2.1/

Institute for Work and Health (2015). Primary, Secondary and Teritary Prevention. Retrieved from: https://www.iwh.on.ca

Substance Abuse and Mental Health Services Administration (2018). Phases of Disaster. Retrieved from https://www.samhsa.gov