Assignment 1: Gastrointestinal Tract: Disorders of Motility

Jamie is a 3-month-old female who presents with her mother for evaluation of “throwing up.” Mom reports that Jamie has been throwing up pretty much all the time since she was born. Jamie does not seem to be sick. In fact, she drinks her formula vigorously and often acts hungry. Jamie has normal soft brown bowel movements every day and, overall, seems like a happy and contented baby. She smiles readily and does not cry often. Other than the fact that she often throws up after drinking a bottle, she seems to be a very healthy, happy infant. A more precise history suggests that Jamie does not exactly throw up—she does not heave or act unwell—but rather it just seems that almost every time she drinks a bottle she regurgitates a milky substance. Mom thought that she might be allergic to her formula and switched her to a hypoallergenic formula. It didn’t appear to help at all, and now Mom is very concerned.

Cases like these are not uncommon. The mother was concerned and thinking her daughter may have an allergy; she changed to a different formula. However, sometimes babies have immature GI tracts that can lead to physiology reflux as they adapt to normal life outside the uterus. Parents often do not consider this possibility, prompting them to change formulas rather than seeking medical care. As in the case study above, GI alterations can often be difficult to identify because many cause similar symptoms. This same issue also arises with adults—adults may present with symptoms that have various potential causes. When evaluating patients, it is important for the advanced practice nurse to know the types of questions he or she needs to ask to obtain the appropriate information for diagnosis. For this reason, you must have an understanding of common GI disorders such as gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), and gastritis.

To Prepare

· Review this week’s media presentation on the gastrointestinal system.

· Review Chapter 35 in the Huether and McCance text. Identify the normal pathophysiology of gastric acid stimulation and production.

· Review Chapter 37 in the Huether and McCance text. Consider the pathophysiology of gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), and gastritis. Think about how these disorders are similar and different.

· Select a patient factor different from the one you selected in this week’s Discussion: genetics, gender, ethnicity, age, or behavior. Consider how the factor you selected might impact the pathophysiology of GERD, PUD, and gastritis. Reflect on how you would diagnose and prescribe treatment of these disorders for a patient based on this factor.

· Review the “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in the Week 2 Learning Resources. Use the examples in the media as a guide to construct a mind map for gastritis. Consider the epidemiology and clinical presentation of gastritis.

To Complete

Write a 2- to 3-page paper that addresses the following:

· Describe the normal pathophysiology of gastric acid stimulation and production. Explain the changes that occur to gastric acid stimulation and production with GERD, PUD, and gastritis disorders.

· Explain how the factor you selected might impact the pathophysiology of GERD, PUD, and gastritis. Describe how you would diagnose and prescribe treatment of these disorders for a patient based on the factor you selected.

· Construct a mind map for gastritis. Include the epidemiology, pathophysiology, and clinical presentation, as well as the diagnosis and treatment you explained in your paper.

Assignment 2: The Pathophysiology of Disorders

During the last 5 weeks, you have explored various body systems: neurological, cardiovascular, respiratory, and hematological. These four systems work together along with other body systems to complete a myriad of functions. For this reason, when disorders occur within one body system, it can create potentially devastating effects throughout the entire body. For instance, Parkinson’s disease is a disorder of the central nervous system, yet its alterations actually affect multiple body systems from the cardiovascular system to the gastrointestinal system. In this Assignment, you examine alterations associated with disorders, as well as the impact of the alterations on multiple body systems.

To Prepare

· From the list below, select a disorder of interest to you:

o Alzheimer’s disease

o Asthma in children

o Chronic obstructive pulmonary disease (COPD)

o Congestive heart failure

o Hepatic disease (liver disease)

o Hypertension

o Hyperthyroidism and hypothyroidism

o Seizures

o Sepsis

· Identify alterations associated with your selected disorder. Consider the pathophysiology of the alterations. Think about how these alterations produce pathophysiological changes in at least two body systems.

· Reflect on how patient factors such as genetics, gender, ethnicity, age, and behavior might impact the pathophysiology of the alterations you identified, as well as the diagnosis and treatment of your selected disorder. 

· Review the “Mind maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in the Week 2 Learning Resources. Use the examples in the media as a guide to construct a mind map for the disorder you selected. Consider the epidemiology and clinical presentation of your selected disorder.

To Complete

Develop a 5- to 10-slide PowerPoint presentation that addresses the following:

· Describe your selected disorder, as well as associated alterations. Explain the pathophysiology of the alterations, including changes that occur in at least two body systems.

· Explain how genetics, gender, ethnicity, age, and behavior might impact the pathophysiology of the alterations you identified, as well as diagnosis and treatment of your selected disorder.

· Construct a mind map for the disorder you selected. Include the epidemiology, pathophysiology of alterations, risk factors, and clinical presentation, as well as the diagnosis and treatment of the disorder.

Use resources below

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

• Chapter 35, “Structure and      Function of the Digestive System”

This chapter provides information relating to the structure and function of the digestive system. It covers the gastrointestinal tract and accessory organs of digestion.

• Chapter 36, “Alterations of      Digestive Function”

This chapter presents information relating to disorders of the gastrointestinal tract and accessory organs of digestion. It also covers the pathogenesis, clinical manifestations, evaluation, and treatment of gastroesophageal reflux disease, gastritis, peptic ulcer disease, inflammatory bowel disease, and irritable bowel syndrome.

• Chapter 37, “Alterations of      Digestive Function in Children”

This chapter presents information relating to disorders of the gastrointestinal tract and liver that affect children. It focuses on congenital impairment, inflammatory disorders, metabolic disorders, as well as the impairment of digestion, absorption, and nutrition.

Hammer, G. D., & McPhee, S. J. (2019). Pathophysiology of disease: An introduction to clinical medicine (8th ed.). New York, NY: McGraw-Hill Education.

• Chapter 13,      “Gastrointestinal Disease”

This chapter provides a foundation for exploring gastrointestinal disorders by reviewing the structure and function of the GI tract. It also describes mechanisms of regulation of GI tract disorders such as acid-peptic disease, inflammatory bowel disease, and irritable bowel syndrome.

• Chapter 14, “Liver Disease”

This chapter reviews the structure and function of the liver. It then explores the clinical presentation, etiology, pathogenesis, pathology, and clinical manifestations of three liver disorders: acute hepatitis, chronic hepatitis, and cirrhosis.

• Chapter 15, “Disorders of      the Exocrine Pancreas”

This chapter begins by reviewing the anatomy, histology, and physiology of the exocrine pancreas. It then examines the clinical presentation, etiology, pathology, pathogenesis, and clinical manifestations of acute and chronic pancreatitis, pancreatic insufficiency, and pancreatic cancer.

• de Bortoli, N., Martinucci, I., Bellini, M.,      Savarino, E., Savarino, V., Blandizzi, C., & Marchi, S. (2013).      Overlap of functional heartburn and gastroesophageal reflux disease with      irritable bowel syndrome. World Journal of Gastroenterology,      19(35), 5787-5797. doi:10.3748/wjg.v19.i35.5787

  

It is one of the most cliché of clichés, but it nevertheless rings true: The only constant is change. As a nursing professional, you are no doubt aware that success in the healthcare field requires the ability to adapt to change, as the pace of change in healthcare may be without rival.

As a professional, you will be called upon to share expertise, inform, educate, and advocate. Your efforts in these areas can help lead others through change. In this Assignment, you will propose a change within your organization and present a comprehensive plan to implement the change you propose.

To Prepare:

· Review the Resources and identify one change that you believe is called for in your organization/workplace.

o This may be a change necessary to effectively address one or more of the issues you addressed in the Workplace Environment Assessment you submitted in Module 4. It may also be a change in response to something not addressed in your previous efforts. It may be beneficial to discuss your ideas with your organizational leadership and/or colleagues to help identify and vet these ideas.

· Reflect on how you might implement this change and how you might communicate this change to organizational leadership.

The Assignment (5-6-minute PowerPoint presentation):

Change Implementation and Management Plan

Create a narrated PowerPoint presentation of 5 or 6 slides with video that presents a comprehensive plan to implement the change you propose.

Your Change Implementation and Management Plan should include the following:

· An executive summary of the issues that are currently affecting your organization/workplace (This can include the work you completed in your Workplace Environment Assessment previously submitted, if relevant.)

· A description of the change being proposed

· Justifications for the change, including why addressing it will have a positive impact on your organization/workplace

· Details about the type and scope of the proposed change

· Identification of the stakeholders impacted by the change

· Identification of a change management team (by title/role)

· A plan for communicating the change you propose

· A description of risk mitigation plans you would recommend to address the risks anticipated by the change you propose

Required Readings

Marshall, E., & Broome, M. (2017). Transformational leadership in nursing: From expert clinician to influential leader (2nd ed.). New York, NY: Springer.

· Chapter 8, “Practice Model Design, Implementation, and Evaluation” (pp. 195–246)

Cullen, L., & Adams, S. L. (2012). Planning for implementation of evidence-based practice. Journal of Nursing Administration, 42(4), 222–230. Retrieved from https://medcom.uiowa.edu/annsblog/wp-content/uploads/2012/10/JONA-FINAL-Cullen-2012.pdf 

Kotter, J. (2007, January). Leading change: Why transformation efforts fail. Best of HBR. Harvard Business Review, 1–10. Retrieved from https://wdhb.org.nz/contented/clientfiles/whanganui-district-health-board/files/rttc_leading-change-by-j-kotter-harvard-business-review.pdf (Original work published 1995) 

Note: This article is considered seminal to the field.

Tistad, M., Palmcrantz, S., Wallin, L., Ehrenberg, A., Olsson, C. B., Tomson, G., …Eldh, A. C. (2016). Developing leadership in managers to facilitate the implementation of national guideline recommendations: A process evaluation of feasibility and usefulness. International Journal of Health Policy and Management, 5(8), 477–486. doi:10.15171/ijhpm.2016.35. Retrieved from http://www.ijhpm.com/article_3183_5015382bcf9183a74ef7e79b0a941f65.pdf 

Required Media

TEDx. (2013, January). Six keys to leading positive change: Rosabeth Moss Kanter at TEDxBeaconStreet [Video file]. Retrieved from https://www.youtube.com/watch?v=owU5aTNPJbs