Joe’s GFR

Course Objective:

“Describe how the glomerular filtration rate is measured.”

Mr. Joe Sixpack is a patient with kidney disease who presents to your clinic for monitoring. You notice on his chart that his GFR was estimated through inulin administration to be about 35 ml/min. What does this tell you about the health of his kidneys? Mr. Sixpack is taking a medication that is normally excreted from the body in the urine. You look at his blood work and find that the concentration of this medication in his plasma is much higher than normal.

The Question for you to answer and discuss is:

    How does his decreased GFR explain the elevated level of medication in his plasma? 

Reply the discussion of ROSE  Rose discussion starts : Mr Sixpack is taking a medication ………and bone disease .’ 

    Mr. Sixpack is taking a medication that is normally excreted from the body in the urine. His blood work is indicating that the concentration of this medication in his plasma is much higher than normal. This would cause concern that his kidney function has been reduced. The major function of the kidneys is to remove waste products and excess fluid from the body. These waste products and excess fluid are removed through the urine. The production of urine involves highly complex steps of excretion and re-absorption. This process is necessary to maintain a stable balance of body chemicals. {1}

    The critical regulation of the body’s salt, potassium, and acid content is performed by the kidneys. The kidneys also produce hormones that affect the function of other organs. For example, a hormone produced by the kidneys stimulates red blood cell production. Other hormones produced by the kidneys help regulate blood pressure and control calcium metabolism. {1}

    The kidneys are powerful chemical factories that perform the following functions: remove waste products from the body, remove drugs from the body, balance the body’s fluids, release hormones that regulate blood pressure, produce an active form of vitamin D that promotes strong, healthy bones and control the productions of red blood cells. {1}

    Mr. Sixpack has already been diagnosed with kidney disease. However, it seems evident by his decreased glomerular filtration rate and the unusually high level of medication in his plasma that his kidney function has been reduced.  

    The glomerular filtration rate (GFR) is a test used to check how well the kidneys are working. Specifically, it estimates how much blood passes through the glomeruli each minute. Glomeruli are the tiny filters in the kidneys that filter waste from the blood. {2} Mr. Sixpack’s GFR of 35 ml/min would suggest that he is in stage 3b of chronic kidney disease which is catagorized by a range of an estimated GFR between 30 and 44. Many people with stage 3 kidney disease do not have any symptoms. If there are symptoms, there may be: swelling in the hands and feet, back pain and urinating more or less than normal.  At this stage, one is more likely to have health complications as waste builds up in the body, and the kidneys are not working well, such as: high blood pressure, anemia, and bone disease. {3}

References:

{1}  How Your Kidneys Work, National Kidney Foundation, (Date of publication unknown), https://www.kidney.org/atoz/content/howkidneyswork#:~:text=Here’s%20how%20kidneys%20perform%20their,bloodstream%20by%20way%20of%20veins

{2} Glomerular Filtration Rate, MedlinePlus, U.S. National Library of Medicine, 31 July 2020, https://medlineplus.gov/lab-tests/glomerular-filtration-rate-gfr-test/

{3} Stages of Chronic Kidney Disease CKD), American Kidney Fund, 17 June 2020, https://www.kidneyfund.org/kidney-disease/chronic-kidney-disease-ckd/stages-

References:

{1}  How Your Kidneys Work, National Kidney Foundation, (Date of publication unknown), https://www.kidney.org/atoz/content/howkidneyswork#:~:text=Here’s%20how%20kidneys%20perform%20their,bloodstream%20by%20way%20of%20veins

{2} Glomerular Filtration Rate, MedlinePlus, U.S. National Library of Medicine, 31 July 2020, https://medlineplus.gov/lab-tests/glomerular-filtration-rate-gfr-test/

{3} Stages of Chronic Kidney Disease CKD), American Kidney Fund, 17 June 2020, https://www.kidneyfund.org/kidney-disease/chronic-kidney-disease-ckd/stages-

In this assignment, you are asked to prepare a final memory matrix. You will need to work a bit harder than in the previous assignments to mine the data from the textbook chapters. You are asked to choose one developed and one developing country and complete the matrix with information from Chapter 15. After you have all the information available (not all information is available for all countries) in the matrix, analyze the data and make some determinations about what the two countries could learn from each other. Remember, we cannot assume that the developed countries are always more advanced in the treatment of mental health or behavioral health issues.

The last step is to write 100-word essay to report your overall findings. This is your opportunity to expand upon what you wrote in each block of the matrix and explain anything that might be confusing to the reader.

  

I need the DNP Project 10 Strategic points attached to be changed from a Qualitative Research to a Quantitative one. All the sections must change to reflect Quantitative Research. Additionally, please update the reference page too

The sections are:      

Problem Statement

Clinical/PICO Questions

Sample

Define Variables 

Methodology and Design

Purpose Statement

Data Collection Approach

Data Analysis Approach

Discussion #2

Charlie Berger, a 58-year-old obese man, comes to a nurse practitioner because he has difficulty swallowing, heartburn, and occasional regurgitation. Answering his nurse practitioner’s questions, Mr. Berger says that his symptoms worsen when he drinks coffee or alcohol.

Endoscopy reveals inflammation in his lower esophagus and poor closure of the lower esophageal sphincter. There is no evidence of esophageal narrowing or movement of the proximal stomach into the thorax.

The nurse practitioner diagnoses gastroesophageal reflux disease (GERD) and tells Mr. Berger to do the following:

• Take proton-pump inhibitor drugs to reduce gastric acid.
• Elevate the head of his bed.
• Avoid eating large meals, especially near bedtime.
• Enter a weight-loss program.
• Reduce his use of caffeine and alcohol.

Answer the following questions about Mr. Berger and gastroesophageal reflux disease.

1. Why did his nurse practitioner tell Mr. Berger to elevate the head of his bed?

2. Why did his nurse practitioner suggest that Mr. Berger avoid eating large meals, especially near bedtime? 

3. Why did his nurse practitioner check to see if Mr. Berger had movement of the proximal stomach into the thorax?

4. Are Mr. Berger’s symptoms of dysphagia, heartburn, and regurgitation specific to GERD?

5. In addition to discomfort, what is a danger of untreated GERD?

6. What is the mechanism by which obesity contributes to GERD?

Use APA 6th Edition Format and support your work with at least 3 peer-reviewed references within 5 years of publication. All paragraphs need to be cited properly. All responses must be in a narrative (paragraph) format. Be sure to include references based on APA guidelines. 

For this discussion, you are not required to respond to your peers. Responses must be supported by peer-reviewed references, and in APA 6th ed format.

Reading Reflection Chapters 26 & 27

Reading and objective reflection, in one to two paragraphs, reflect on the objectives and what you have learned from your readings. How do you anticipate the use of research?

250 words , APA format . 

Chapter 26: Patient safety and quality research

What are the reasons for quality and research initiatives? As per Tappen (2015) states, there is not much imagination required to understand the reason for these research initiatives. Patient safety and improvement can lend itself to many concepts. Drug improvement, practice initiatives, mitigation of practice errors, and the list continues. Two immediate concepts that come to mind are safety as well as infection control. In conducting these studies, we must remember that we are responsible for safeguarding the well-being of our patients in the study.

The formulation of a design is not always easy, there are considerations that must be accounted for you. As per Tappen (2015), one issue is design formulation where one must look at defining the content, looking for an occurrence in existing records, the sequence of events, population comparison, baseline adherence rates, complex interventions, encompassing a complex system transformation, and complex data analysis. To add the list of requirements it is imperative to consider ethical considerations. Page 496 of your text highlights the guidelines for publishing safety and quality study results.

Article/Website Link:

Patient Safety and Quality Improvement

https://www.ahrq.gov/patient-safety/index.html

Medication Reconciliation

https://www.ncbi.nlm.nih.gov/books/NBK2648/

Chapter 27: Developing a program of research

Tappen (2015) states that this concept is a series of studies that are aimed at filling a knowledge gap in research. This is an area where there are insufficient studies to address an issue encountered. Additionally, this could also be viewed as purposeful construction of new knowledge to address a problem where scientific knowledge is lacking. One example is when a new disease surface. There is value in construction of new research, the methodology for its implementation involves a process, if you refer to page 501 of your course text and see how this development evolves or unfolds.

Article Link:

Basic Steps to Building a Research Program

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2805347/

Developing a Program of Research in Nursing

http://lghttp.48653.nexcesscdn.net/80223CF/springer-static/media/samplechapters/9780826123251/9780826123251_chapter.pdf