ANP 652 DQ4 2025

You are a new AGACNP at an urban, tertiary referral center working in the emergency department (ED). You are presented with the following case: Patient is a 45-year-old, Caucasian male, acute care nurse practitioner (ACNP) who comes in with the chief complaint of back pain, acute on chronic. He describes severely compromising, debilitating lumbar spine pain due to a fall from a 20-foot scaffolding several years ago. There is MRI evidence of multilevel degenerative spine disease and bulging discs, with a dx of “failed back surgery.” In addition to the above, he is nauseated with emesis episodes that are too numerous to count this morning. He also has intractable diffuse abdominal pain, intermittent piloerection, and diaphoresis. He tells you he is prescribed the following by a local pain clinic: OxyContin 20 mg BID, with oxycodone 5 mg q. 3 hours breakthrough pain, Lyrica 100 mg at HS, Lexapro 10 mg daily, and Xanax 0.5 mg BID prn anxiety. He reports that he received #60 OxyContin 20 mg and #60 oxycodone 5 mg 2 weeks ago but is saying that he has been out of medication x 2 days. When you inquired about how quickly he has used his pills, he admits to using more pills than prescribed due to increased pain following a recent fall at home. He wants help, admits to opioid addiction, and is accepting of inpatient admission. He is also requesting methadone to assist with addiction/pain management. He is receiving outpatient physical therapy as well as intermittent epidural blocks (last one was 2 weeks ago). Answer all the following questions, in detail. Support your answer with two or three peer-reviewed resources. What are your initial orders to help control his acute pain? What is your diagnosis for his GI symptoms? What is your response to his request for methadone? Can you prescribe methadone for acute/chronic pain or addiction as an AGACNP? Ethically and professionally, what are your concerns for this patient and his own ACNP practice? What resources are available to you as a prescriber to track this patient’s opioid use/abuse? What referrals do you anticipate making for him while he is in the ED? What populations of people are at risk for addition, pain medication diversion, and psychological conditions that may cause hyperalgesia or adverse reactions to pain regimens? What resources are available to a provider of medical care who suffers from addiction?

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Reply 1 And 2 ,150 Words Each One By 11/19/2021 At 6:00 Pm ,please Add References And Citations 2025

Reply 1 The physiology of blood pressure control results from several factors. Firstly, “regulation comes from cardiac output per minute from the left ventricle along with systemic vascular resistance and stretching of blood vessel walls” (Parker & Atkins, 2018). These sensory receptors are known as the baroceptor reflex. According to Shahoud et al. (2021), baroceptors are a form of mechanoreceptor that become activated by the stretching of the vessel. This sensory information is conveyed to the central nervous system and used to influence peripheral vascular resistance and cardiac output. The autonomic nervous system regulates short term blood pressure while long term arterial pressure depends on the relationship between arterial pressure and the output of water and salt in one’s urine. Furthermore, the hormone aldosterone regulates salt and water in the body thereby having an effect on blood pressure. Next, antidiuretic hormone made in the hypothalamus, also known as vasopressin, constantly balances and regulates the water amount in the blood. “ADH mainly functions to increase free water reabsorption in the collecting duct of the nephrons in the kidney, causing an increase on plasma volume and arterial pressure” (Shahoud et al., 2021). Finally, the renin-angiotensin aldosterone system is essential in regulating and relies on several hormones to increase peripheral resistance and blood volume. This system begins with the release of renin from the juxtaglomerular cell in the kidney. According to Shahoud et al. (2021), they respond to decreased blood pressure, sympathetic nervous system activity, and reduced sodium levels within the distal convoluted tubes of the nephrons. Renin then enters the blood and combines with angiotensin and is converted into angiotensin I. Then, angiotensin I travels to the pulmonary vessels where it encounters the angiotensin-converting enzyme created in the endothelium and converts angiotensin I to angiotensin II. This angiotensin II uses vasoconstriction of arterioles throughout the body to increase arterial pressure. One cause of primary hypertension is the overactivity of the renin-angiotensin-aldosterone system. This system is comprised of the related hormones, renin, angiotensin and aldosterone, that work in conjunction to regulate blood pressure and control inflammation. “These three act to elevate arterial pressure in response to decreased renal blood pressure, decreased salt delivery to the distal convoluted tubule, and/or beta-agonism” (Fountain & Lappin, 2021). However, overactivity of this system can lead to primary hypertension. According to Fountain and Lappin (2021), though the RAAS serves a critical function, it can be activated inappropriately in several conditions that may lead to the development of hypertension. One such condition is renal artery stenosis that results in a decreased amount of blood volume reaching one or both kidneys. “As a result, the juxtaglomerular cells will sense a decrease in blood volume, activating the RAAS. This can lead to an inappropriate elevation of circulating blood volume and arteriolar tone due to poor renal perfusion” (Fountain & Lappin, 2021). Another cause of primary hypertension is overactivity of the sympathetic nervous system. According to Wyss and Carlson, the primary final common pathway for the nervous system’s contribution to hypertension is the sympathetic nervous system. The overactivity of this system can be the result of several factors occurring in the body. “Sympathetic nervous system overactivity may result from either inappropriately elevated sympathetic drive from brain centers, an increase in synaptically released neurotransmitters in the periphery, or amplification of the neurotransmitter signal at the target tissue” (Wyss & Carlson, 2001). Finally, inflammation can also lead to hypertension. Inflammation is the result of an injury or infection as a protective response from various cells. The inflammatory cascade response results in oxidative stress and endothelial dysfunction. Therefore, excessive inflammation can produce extremely harmful effects on the body leading to chronic diseases like hypertension. According to Savoia and Schiffrin. (2006), inflammatory processes are important participants in the pathophysiology of hypertension and cardiovascular diseases. In primary hypertension, blood flow is restricted due to increased peripheral vascular resistance. “Inflammatory markers, such as C-reactive protein, are associated with vascular lesions in humans, and are predictive of cardiovascular outcome” (Savoia & Schiffrin, 2006). References Fountain, J. H., & Lappin, S.L. (2021). Physiology, Renin angiotensin system . StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470410/ Parker, D. E., & Atkins, W. A. (2018). Blood pressure . Gale Encyclopedia of Nursing and Allied Health. (4th ed.), Gale. https://su.idm.oclc.org/login?url=https://search.credoreference.com/content/entry/galegnaah/blood_pressure/0?institutionId=6543 Savoia, C., & Schiffrin, E. (2006). Inflammation in hypertension. Current Opinion in Nephrology and Hypertension 15 , 152-158. https://doi.org/10.1097/01.mnh.0000203189.57513.76 Shahoud, J. S., Sanvictores, T., & Aeddula, N. R. (2021). Arterial pressure regulation . StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK538509/ Wyss, J. M., & Carlson, S. H. (2001). The role of the nervous system in hypertension. Curr Hypertens Rep 3 (3), 255-262. https:// www.doi.org./10.1007/s11906_001-0048-0PMID:11353577 less Reply 2 Blood pressure supplies blood to all parts of the body as it is pumped through the heart. The systolic and desolate pressure helps to facilitate this movement resulting from the ventricular relaxation and contraction. However, the primary reason hypertension sometimes may characterize the functioning of the heart. Primary hypertension can be detrimental because it results from an overactive SNS, overactive RAAS, and hormonal changes among obese individuals. These occur when there is increased diastolic pressure. An individual with an overreactive SNS experienced a high possibility of developing paroxysmal sympathetic hyperreactivity. This is a condition associated with an increased risk of hypertension, especially because of our increasing activity with the sympathetic nervous system. This condition increases respiration rates and hatcheries that arise as primary symptoms of high blood pressure. The management of this condition requires incorporating diverse missions to increase the level of physical activities and healthy dietary practices (Sexana et al., 2018). An overactive renin-angiotensin-aldosterone system (RAAS) is also a major factor in high blood pressure. RAAS helps with the regulation of cardiovascular and renal functions. However, with primary high blood pressure, an increase in arterial pressure arises when the body fails to regulate extracellular fluid. When managing this condition, focused on incorporating both pharmacological and nonpharmacological measures focused on improving renal function. For obesity-related hormonal changes, they affect the body’s general functioning because of the accumulation of fat in specific regions, which increases the risk of primary hypertension. This one of the changes is often defined by reducing parasympathetic tone and increased sympathetic activity. The negative effects are associated with numerous changes in outdoor genomic activity, contributing to a decline in heart rate variability. The best techniques of managing this condition will entail incorporating approaches aimed at reducing baroreflex sensitivity and individuals (Hall et al., 2015). References Hall, J. E., do Carmo, J. M., da Silva, A. A., Wang, Z., & Hall, M. E. (2015). Obesity-induced hypertension: interaction of neurohumoral and renal mechanisms. Circulation Research , 116 (6), 991-1006. Saxena, T., Ali, A. O., & Saxena, M. (2018). Pathophysiology of essential hypertension: an update. Expert Review of Cardiovascular Therapy , 16 (12), 879-887. less 0 Unread0Unread0 Replies0Replies0 Views0Views

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Ques/5 PR 2025

Instructions: Response must be at least 310 words written in current APA format with at least two academic references cited. References must be within the last five years. Response must extend, correct/refute, or add additional nuance. Gastrointestinal Function: Case Study Questions In your own words define constipation and name the risk factors that might lead to developing constipation. List recommendations you would give to a patient who is suffering from constipation. You might use a previous experience you might have. Constipation can be defined as the situation where an individual experiences less frequent bowel movements and difficulties in passing stools. Several factors have been associated with the cause of constipation ranging from exercises, diet, and use of medication. Some of the most common risk factors for constipation include lifestyle concerns that affect an individual’s bowel habits such as eating solid food with no fibers, inadequate water intake, travel, ignoring the urge to use the bathroom, and inadequate stress management (Benjamin, &Drobatz, 2020). Medications such as antacids containing aluminum or calcium, antidepressants, antispasmodics, diuretics, antihistamines, and narcotic pain medications have been associated with increased risks of constipation. Other risk factors include health conditions such as diabetes, structural conditions such as anal fissure, pelvic floor dysfunction, neurological disorders such as multiple sclerosis, cancer, advanced age, and family history among others. Several approaches are utilized in the management of patients suffering from constipation. For starters, I would recommend the removal of the impacted faeces with stool softeners such as Docusate, enemas, and short-acting laxatives. I would then initiate dietary changes to about 30g daily fiber intake in addition or taking lots of water (Benjamin, &Drobatz, 2020). Alternatively, the patient can take fiber supplements such as Metamucil, and engage in 30 minutes of daily exercise. If constipation is associated with an underlying condition, then it is necessary to treat the underlying disorder. The use of laxatives such as MiraLAX will be necessary for complete emptying. Based on the clinical manifestations of R.H.’s case study, name and explain signs and symptoms presented that are compatible with the constipation diagnosis. Complement your list with signs and symptoms not present in the case study. For the diagnosis of constipation, an individual must present with the following four symptoms, such as having fewer than three bowel movements in a week, straining to initiate or complete defecation, consistency of a hard stool, and the feeling of incomplete emptying (Thakare, 2020). The patient in the provided case study presented with symptoms of constipation and bloating for about a month. She presented with one bowel movement for an entire week, with straining feelingsthat lasted for up to 10 minutes before initiating or completing a bowel movement. She also confirmed that her stool was extremely hard. Consequently, the patient complained of incidences of heartburn about three to four times every week. Looking at the causative aspects that might have contributed to the patient’s constipation, to confirm the diagnosis, she has been involved in limited exercise and physical activity, in addition to taking naproxen with can also result in constipation (Thakare, 2020). Other signs and symptoms of constipation not presented by the patient include the feeling that one has not completely emptied his or her rectum, and the need for help such as using your hands to empty your rectum. Sometimes as an associate diagnosis and a complication, patients with constipation could have anemia. Would you consider that possibility based on the information provided in the case study? The human body normally requires vitamin B12 to synthesize red blood cells just like the way it needs iron. Consequently,the symptoms of all other types of anemia, most commonly vitamin B12 deficiency anemia can lead to symptoms of constipation or diarrhea. Consequently, the patient in the provided case study presented with worsening arthritis, whose most common complication is anemia (Auerbach, & Schrier, 2017). The patient’s advanced age also predisposes her to high risks of developing anemia. As such, the patient’s constipation symptoms may also be associated with anemia diagnosis. Endocrine Function: Case Study Questions In which race and ethnic groups is DM more prevalent? Based on C.B.’s clinical manifestations, please compile the signs and symptoms that she is exhibiting that are compatible with the Diabetes Mellitus Type 2 diagnosis. According to the Centre for Disease Control and Prevention (CDC), the prevalence of diabetes mellitus was highest among the American Indians/Alaska Natives (14.7%) between 2017 to 2018, followed by Hispanic origin (12.5%), and non-Hispanic blacks (11.7%) in the United States (Glovaci, Fan, & Wong, 2019). Non-Hispanic Asians and non-Hispanic whites recorded a percentage of 9.2% and 7.5% respectively. The diagnosis of Diabetes Mellitus Type 2 is normally based on the results of the glycated hemoglobin (A1C) test in addition to presenting symptoms provided in the patient history. Glycated hemoglobin (A1C) test results of less than 5.7% are normal, whereas between 5.7% and 6.4% represented prediabetes and 6.5% or higher represent diabetes diagnosis. A fasting blood glucose level of 126 mg/dL (7 mmol/L) or higher is also used to confirm a diabetes diagnosis(Glovaci, Fan, & Wong, 2019). The patient in the provided case study presented witha fasting blood sugar level of 141 mg/dL. His cholesterol levels were also 225mg/dL, higher than 40mg/dl, which also indicates complications of DM. Other diagnostic signs and symptoms displayed by the patient confirming a diabetes type 2 diagnosis include left foot weakness and numbness for about three weeks, in addition to reduced range of movement, increased thirst, increased urine frequency especially at night, and significant weight gain over the past few months. If C.B. develop bacterial pneumonia in her right lower lobe, how would you expect her Glycemia values to be? Explain and support your answer. Studies have confirmed the association between hyperglycemia among diabetic patients with community-acquired pneumonia. As such, when the patient in the provided case study develops bacteria pneumonia, then it means that his diabetes is not properly managed. Diabetes type 2 is associated with low immunity as it leads to a reduction in the response of T cells, disorders of humoral immunity, and decreased neutrophil function (Webber et al., 2020). As such, patients with worsening DM will exhibit increased susceptibility to infections such as bacterial pneumonia. Consequently, such infections in addition to repercussions associated with its infectivity can result in complications of DM such as ketoacidosis and hypoglycemia. The bacteria on her right lobe will consume glucose from the patient’s blood for their growth and sustaining their survival leading to decreased glycemia values. What would be the best initial therapy non-pharmacologic and pharmacologic to be recommended to C.B? C.B presents with symptoms confirming a diagnosis of Diabetes Mellitus Type 2. The management of DM involves the incorporation of both pharmacological and non-pharmacological interventions. The pharmacological intervention will involve the initiation of Metformin which is FDA approved as the first-line medication for the management of type 2 diabetes. The drug does not cause weight gain. The patient can also be initiated on HMG-CoA reductase inhibitors, or statins, such as atorvastatin to lower her high cholesterol levels (Serbis et al., 2021). Non-pharmacological interventions will involve nutritional therapy, physical activity programs like yoga or walking, psychological interventions to promote patients’ compliance, social network interventions to promote supportive care, and diabetes self-management education and support for the patient to be able to appropriately monitor her blood sugar levels regularly to enhance treatment outcome.

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Critical Thinking: Exercise 2025

Scenario: Exercise You are checking blood pressures at a senior citizen health fair. After you check the blood pressure of an older woman, she asks you about starting an exercise program. She has not been exercising, but some of her friends have told her that she should start to exercise regularly. Directions: • Must be at least 200 – 300 words in length • What recommendations do you give her? • What precautions do you include in your recommendations? * Reference APA format (7th edition)

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Critical Thinking: Safety 2025

Scenario: Safety A 77, year old woman is hospitalized for management of her diabetes. She has a history of functional urinary incontinence and poor vision from the diabetes. The nursing staff observes her climbing over the side rails on numerous occasions at night en route to the bathroom. She is quite agitated during this time. The nursing assistant requests that you obtain an order for a body restraint at night to prevent her from falling out of bed. Directions: • Must be at least 200 – 300 words in length • Should this patient be restrained to prevent injury? • Would you request the order for a body restraint? Why, or why not? • What other information is relevant to this case? • What nursing interventions could be tried before considering a restraint? * Reference in APA format (7th edition)

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