For this Assignment, you will work with a patient with a gastrointestinal condition that you examined during the last three weeks. You will complete your second Episodic/Focused Note Template Form for this course where you will gather patient information, relevant diagnostic and treatment information, and reflect on health promotion and disease prevention in light of patient factors, such as age, ethnic group, PMH, socioeconomic, cultural background, etc. In this week’s Learning Resources, please review the Focused Note resources for guidance on writing Focused Notes.

Note: All Focused Notes must be signed, and each page must be initialed by your preceptor. When you submit your Focused Notes, you should include the complete Focused Note as a Word document and pdf/images of each page that is initialed and signed by your preceptor. You must submit your Focused Notes using SAFE ASSIGN.

Note: Electronic signatures are not accepted. If both files are not received by the due date, faculty will deduct points per the Walden Late Policies.

To prepare:

• Use the Episodic/Focused Note Template found in the Learning Resources for this week to complete this Assignment.
• Select a patient that you examined during the last three weeks based on any gastrointestinal conditions. With this patient in mind, address the following in a Focused Note:

Assignment:

• Subjective: What details did the patient provide regarding her personal and medical history?
• Objective: What observations did you make during the physical assessment?
• Assessment: What were your differential diagnoses? Provide a minimum of three possible diagnoses. List them from highest priority to lowest priority. What was your primary diagnosis and why?
• Plan: What was your plan for diagnostics and primary diagnosis? What was your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters as well as a rationale for this treatment and management plan.
• Reflection notes: What would you do differently in a similar patient evaluation?

Note: Your Focused Note Assignment must be signed by Day 7 of Week 6.

Discuss the historical application of statistics in the field of health care. Describe an example, other than Florence Nightingale’s contributions, where statistical application has greatly influenced or changed health care operations or practice. 

Discuss why it is important for a person working in health care to understand statistical concepts. Provide an example of how statistical data is used in your organization or specialty area today and what you are expected to do with this information as a practitioner.   

DUE IN 24 HOURS

DF Instructions: Community Discussion Forum-Epidemiology & Disease prevention and outcomes

Select A or B  for your primary discussion posting. 

A-        How can data collection for notifiable diseases be improved?
            Why is tracking vital statistics so important?
            How does calculating Years of Potential Life Lost change the way we think about community health efforts?

  or

B-      Which components of the Multicausation Disease Model can communities most effectively impact?
         Which level of prevention is most important for better community health outcomes and why?
         Who plays a more significant role in preventing diseases, individuals or communities?

Directions for the primary posting

1) Limit your initial post to 250-300 words.

2) Use at least 2 literature resources to support your work in APA 7th format. Your textbook can be one of the resources.

3) Address all three assigned items above that included in section A or B.

Hi

I already completed my research paper for my advanced pathophisiology with the question below:

” What is the pathophysiologic difference between stable angina and unstable angina? “

Please make correction with grammar and sentences structure.  Thank you very much for your help!

Angina is a coronary artery disease that occurs when there is an imbalance between oxygen supply and demand in the myocardium (McCance & Huether, 2019). When supply is impaired and doesn’t meet demand, myocardial ischemia happens (McCance & Huether, 2019). There are two important concepts of accumulation of fatty streaks and endothelial dysfunction that explain the process of coronary artery disease (McCance & Huether, 2019). The coronary artery is made up of vascular smooth muscle and lined with vascular endothelium (McCance & Huether, 2019). 

With normal function, low-density lipoproteins (LDL) circulate throughout the arteries and deliver triacylglycerol fuel to tissues (McCance & Huether, 2019). However, when under abnormal circumstances, a certain percentage of LDLs are mutated by oxidative damage (McCance & Huether, 2019). Normally, macrophages ingest the oxidized LDL, and the body wants to get rid of waste. However, macrophages become engorged and become foam cells (McCance & Huether, 2019).  The foam cells become very big and accumulate and lodge in the layer of the vascular smooth muscle (McCance & Huether, 2019). When the foam cells accumulate, it displays the fatty steaks in the artery (McCance & Huether, 2019). The foam cells and lipid deposits will burst through the endothelial lining of the artery and cause a break in the artery. Besides the accumulation of fatty streaks, the dysfunctional endothelial cells have been damaged for many years and are result in the development of atherosclerosis (McCance & Huether, 2019). They cannot produce nitric oxide and cause the reduction of vasodilatation (McCance & Huether, 2019). As a result, the blood blow through the artery becomes restricted, oxygen supply to the distal tissues is diminished, and causing angina and heart attack.

Angina is a type of chest pain caused by reduced blood flow to the heart with a condition called myocardial ischemia and is a symptom of coronary artery disease (Mayo Clinic, 2020). Stable angina is not a heart attack and association with transient ischemia and no permanent damage and no infarction (American Heart Association, 2020). Patients usually feel uncomfortable pressure, fullness, squeezing, and pain at the center of the chest (American Heart Association, 2020). Stable angina is caused by fixed obstruction with a high cholesterol level (Huff, Boyd, & Jialal, 2020). Stable angina can be predictable, and patients are familiar with pain patterns, prompted by physical exertion such as exercise, emotional stress, cold temperatures, and having heavy meals (American Heart Association, 2020). Stable angina is not happened at rest, subsides with rest, and responds well to medications (American Heart Association, 2020).

On the other hand, unstable angina is unpredictable, even at rest, with unexpected chest pain (American Heart Association, 2020). It changes pain patterns, more severe, lasts longer and doesn’t respond well to medications (American Heart Association, 2020). As the coronary arteries are narrowed by fatty buildups, they can rupture, causing blood clots and blockage the flow of the heart muscle (American Heart Association, 2020). When having plaque ruptured, patients could have a heart attack and should be treated as a medical emergency (American Heart Association, 2020). 

Patients with angina is usually having ST-segment depression during attacks that display on the electrocardiograms (Ginghina, Ungureanu, Vladaia, Popescu, & Jurcut, (2009).). Providers can refer patients to have a stress test to perform during exercise (Mayo Clinic, 2020). Using an angiogram can also help detect obstruction and show the abnormal coronary (Mayo Clinic, 2020). The treatment of angina by relieving symptoms reduces the frequency of future anginas and reduces the risks of heart attacks. Patients can take nitroglycerin, long-lasting nitrates, antiplatelet drugs such as aspirin to relieve and prevent the symptoms (Mayo Clinic, 2020). They should also have lifestyle changes that include stop smoking, limit alcohol, keep a healthy weight, healthy diet, and regular exercise, but avoid exertion, avoid stress, and avoid large meals (Mayo Clinic, 2020). There are surgical procedures to restore normal blood flow, including a balloon or stent, coronary bypass, to wider the effective artery (Mayo Clinic, 2020).