The scope of practicedescribes the procedures, actions, and processes that a health care practitioner is permitted to undertake in keeping with the terms of their professional license.

(Scope of practice – Wikipedia https://en.wikipedia.org/wiki/Scope of_practice)

Recommended readings:

1. Scope of practice of nurse practitioners: professional role. https://www.aanp.org/advocacy/advocacy-resource/position-statements/scope-of-practice-for-nurse-practitioners

2. State practice environment (AANP). https://www.aanp.org/advocacy/state/state-practice-environment

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3. I want to take an opportunity to discuss our new granted privilege to prescribe controlled substance. There are five classes of substance considered under the Comprehensive Drug Abuse Prevention and Control Act of 1970 (Comprehensive Drug Abuse Prevention and Control Act of 1970, 2019).This privilege was legally approved in Florida, the last state to grant such a privilege for midlevel practitioners, in 2017( Kellangs & Maye, 2017).  Once licensed as Florida Nurse Practitioner (NP) license, you will need 2 hours of controlled substance prescription CEUs and to apply for the DEA license.  The application cost $ 731 and it’s valid for three years. NPs are required to have a controlled substance agreement with the supervising physician.

 DEA website https://apps.deadiversion.usdoj.gov/webforms/jsp/regapps/common/newAppLogin.jsp

References

Comprehensive Drug Abuse Prevention and Control Act of 1970. Retrieved on March 10, 2019 fromhttps://en.wikipedia.org/wiki/

Comprehensive_Drug_Abuse_ Prevention_and_Control_Act_of_1970

Kellams, J. R., & Maye, J. P. (2017). The last state to grant nurse practitioners DEA licensure: An education improvement initiative on the Florida prescription drug monitoring program. Journal of addictions nursing, 28(3), 135-142. doi: 10.1097/JAN.0000000000000177

U.S Department of Justice and Drug Enforcement Administration. Diversion control division. Application for Registration Under Controlled Substances Act of 1970 (NewApplicants Only). Retrieved from https://apps.deadiversion.usdoj.gov/webforms/jsp/regapps/common/newAppLogin.jsp

The Discussion Section question is:  

Add a comment pertaining to the effect of workload on coronary blood flow. Please detail our potential to image the ratio of decrease blood flow for  diagnostic value. Add to to the DICUSSION PANNEL for this unit. 

Here some example for you :

1- The effect of workload on coronary blood flow and our potential to image the ratio of decrease blood flow for diagnostic value:

According to The Journal of the American Association, coronary blood flow is determined by the rate at which blood flows out of the coronary arteries to other parts of the body. For example, during rest, the amount of blood flows through the coronary arteries is 225 ml per minute which is 4-5% of total cardiac output. During stress, the blood flow is faster and the heart muscle contracts during systole. As a result, during diastole, the cardiac muscle relaxes to allow the flow of blood through the body without any resistance. One significant effect on coronary blood flow is the workload the heart is subjected to during stress. With an increase in stress rate, the heart reacts to pump blood in a faster rate to ensure oxygen is supplied to the rest of the body. When imaging, the vasodilator stress agents are helpful in decreasing the blood flow and relaxing the heart muscle. These pharmacological agents help when measuring the supply to the heart and viewing the heart’s workload.

2- The following is regarding the effect of workload on coronary blood flow and our potential to image the ratio of decrease blood flow for diagnostic value:

The heart is a very smart organ with very smart systems. An auto-regulatory mechanism known as coronary autoregulation is constantly maintaining the interaction of pressure and resistance of coronary blood flow. Decreases in pressure are compensated for by decreases in resistance and conversely, increases in pressure by increases in resistance so that flow remains constant for a give cardiac workload. This regulatory mechanism operates within the range of physiologic arterial pressures but fails during hypotension when flows become strongly dependent on the driving pressure.

For imaging purposes, pharmacological vasodilator stress agents seek to maximally lower the vascular resistance through relaxation of the vascular smooth muscle cell at the level of the microcirculation, thereby uncoupling coronary flow (supply) and myocardial work (demand). With the help of such pharmacological agents, imaging can take place in order for diagnostic purposes.

References

Schelbert H. R. (2010). Anatomy and physiology of coronary blood flow. Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology, 17(4), 545–554. doi:10.1007/s12350-010-9255-x

3- The effect of workload on coronary blood flow and our potential to image the ratio of decrease blood flow for diagnostic value: 

Blood flow to the heart mainly occurs during diastole, the great majority of blood flow to the left ventricle occurs during diastole. The diastolic pressure from the aorta propels blood through the coronary circulation. The more coronary blood flow to the left ventricle means the longer time that diastole will last. The right ventricle receives blood equally during both systole and diastole. Diastole lasts for about two thirds of the cardiac cycle. The coronary arties through the myocardium are compressed during ventricular contraction when fibers are thickening and are unable to fill.  The pressure within the left ventricle offers resistance to this flow. Blockage of coronary arteries can reduce coronary blood flow at rest, resulting in a buildup of a clot, and also anything that causes arteries to constrict and not allow the vasodilatation to even improve coronary blood flow.

For imaging potential of decreased blood flow, pharmacological vasodilator stress agents can be utilized to cause a lower vascular resistance through relaxation of the smooth muscles of the heart during a nuclear stress test. This can lead to measuring the supply and demand of the heart, it is which these pharmacological stress agents that when can possibly use to help increase the potential to image the ratio of decreased blood flow for diagnostic reasons and value.

  

Case Study, Chapter 8, Overview of Genetics and Genomics in Nursing

1. A patient who is 38 years of age is diagnosed with autosomal dominant polycystic kidney disease, a hereditary disease that results in fluid-filled cysts occupying space in the kidneys. The cysts can interfere with the function of the kidney and may burst and cause bleeding inside the kidney. The patient with polycystic kidney disease may or may not have a berry aneurysm of a blood vessel in the brain that could lead to bleeding and death, cysts on the ovaries, and a mitral valve prolapse (in females) that can lead to dysrhythmias (irregular heart rhythms), or diverticula (outpouching of the bowel) that are susceptible to infection and inflammation and may lead to gastrointestinal bleeding. The patient is susceptible to retaining fluid in the abdomen so the abdomen is large to constipation, and to hypertension. There is no cure for the disease. The patient receives supportive care for the various symptoms or complications the patient may have. 

1. When explaining to the patient and family about polycystic kidney disease, the nurse should explain what characteristics about an autosomal dominant genetic disease?
2. How does variable expression of genetic characteristics play a role in the course of polycystic kidney disease and how can the nurse further predict the level of the disease?
3. Identify the roles of the nurse in integrating genetics in the nursing care provided for the patient.

2. Mr. Wayne is a 38-year-old man with a significant family history of elevated cholesterol levels. His father died at age 42 from a massive heart attack secondary to elevated cholesterol and triglycerides, and two of his older siblings are currently taking medications to lower their cholesterol levels. Mr. Wayne makes an appointment to discuss his risk for hypercholesterolemia. The nurse recognizes that Mr. Wayne is at risk for familial hypercholesterolemia because this is an autosomal dominant inherited condition.

1. Describe the pattern of autosomal dominant inheritance.
2. Mr. Wayne asks what chance his children have of developing familial hypercholesterolemia. How should the nurse respond?
3. Explain the phenomenon of penetrance observed in autosomal dominant inheritance.

 

Thinking points :

1.Look for the connections between prejudice/discrimination on the spread of diseases. 

2. Think about why the fight against diseases cannot be purely medical. Discuss why psychology and sociology are important as well. 

3. How does this change the way you look at diseases or public healthcare trends in the world. 

4. How does this awareness help you become a better citizen of the world and a better healthcare worker.

5. Use personal experiences, recent global events, and/or local happenings in your discussion. 

Consider the following scenario.

As a school nurse, you conduct an assessment of the elementary school. Among your list of problems are inactivity, obesity, and lack of knowledge of healthy food choices. Develop a plan of action to help the school improve the health of its students. Evaluate which methods of assessment (quantitative and qualitative), intervention, and evaluation will be most appropriate to help change this specific environment.