APA format MSN 2 pages 3 references 2 from walden university library

 

Multiple Sclerosis 

Multiple sclerosis (MS) is thought to affect more than 2.3 million people worldwide. While the disease is not contagious or directly inherited, epidemiologists have identified factors in the distribution of MS around the world that may eventually help determine what causes the disease (nationalmssociety.org, 2018). It is a chronic, progressive, degenerative neurological disease, associated with immune system deregulation, culminating in demyelination and axonal damage within the central nervous system and is one of the most common neurological diseases in young adults and the leading cause of non‐traumatic disability in young and middle‐aged adults (Gold & Wolinsky, 2010).

Pathophysiology of Multiple Sclerosis

MS is a chronic, heterogeneous and complex disease. Autoreactive T‐cells in the periphery are activated by unidentified mechanism, possibly involving molecular mimicry or bystander activation. Activation of these T cells gives them the potential to migrate across the blood–brain barrier (BBB) via an interaction of integrins on the T‐cell surface with adhesion molecules on the endothelium of the BBB, followed by the degradation of the BBB via the secretion of matrix metalloproteases. Once in the central nervous system (CNS), T cells are reactivated on encountering local CNS antigens via an interaction with antigen‐presenting cells such as macrophages or microglia, or B cells. T cells secrete proinflammatory cytokines, and plasma cells secrete antibodies against myelin, leading to the destruction of the myelin sheath. Ongoing inflammation in the CNS promotes the recruitment of additional inflammatory cells. Activated microglia release free radicals, nitric oxide and proteases, which further contribute to tissue damage and axonal loss (Gold & Wolinsky, 2010).

Prescribed Medications to Modify Progression

Beta interferons: these medications are among the most commonly prescribed medications to treat MS. They are injected under the skin or into muscle and can reduce the frequency and severity of relapses.

Ocrelizumab (Ocrevus): humanized immunoglobulin antibody medication which is the only DMT approved by the FDA to treat both the relapse-remitting and primary progressive forms of MS. Clinical trials showed it reduced relapse rate in relapsing disease and slowed worsening of disability in both forms of the disease.

Glatiramer acetate (Copaxone): helps block the immune system’s attack on myelin and must be injected beneath the skin. 

Dimethyl fumarate (Tecfidera): reduces relapses. Side effects may include flushing, diarrhea, nausea and lowered white blood cell count.

Fingolimod (Gilenya):  reduces relapses. 

Teriflunomide (Aubagio):reduces relapses.

Natalizumab (Tysabri): designed to block the movement of potentially damaging immune cells from your bloodstream to your brain and spinal cord. It may be considered a first line treatment for some people with severe MS or as a second line treatment in others. 

Alemtuzumab (Lemtrada):reduce relapses of MS by targeting a protein on the surface of immune cells and depleting white blood cells. This effect can limit potential nerve damage caused by the white blood cells, but it also increases the risk of infections and autoimmune disorders.

Mitoxantrone: immunosuppressant drug can be harmful to the heart and is associated with development of blood cancers. As a result, its use in treating MS is extremely limited, therefore, is usually used only to treat severe, advanced MS.

Treatments for MS Attacks

Corticosteroids (oral prednisone and intravenous methylprednisolone: reduce nerve inflammation. Side effects may include insomnia, increased blood pressure, mood swings and fluid retention.

Plasma exchange (plasmapheresis). The liquid portion of part of your blood (plasma) is removed and separated from your blood cells. The blood cells are then mixed with a protein solution (albumin) and put back into your body. Plasma exchange may be used if your symptoms are new, severe and haven’t responded to steroids.

Controlling Negative Side Effects of Corticosteroids

Insomnia: evaluate if total dose can be taken in the morning. Establish a regular hour for getting into bed and small rituals that help you prepare for sleep. Make sure the bedroom is cool and dark and free of noise. 

Mood Changes: with doses over 30 milligrams per day, steroids can affect your moods. Some people can feel depressed, some extremely “up” and others go up and down for no apparent reason.  Medications can be taken to help with these mood changes.

Fluid Retention and Elevated Blood Pressure: because cortisone is involved in regulating the body’s balance of water, sodium, and other electrolytes, using these drugs can promote fluid retention and sometimes cause or worsen high blood pressure. It is important to maintain a low sodium diet to reduce fluid accumulation in turn controlling blood pressure. If hypertension persists, diuretics may be prescribed (Fields, 2017). 

MS and Genetics

Genetic factors are thought to play a significant role in determining who develops MS.For first-degree relatives of a person with MS, such as children, siblings or non-identical twins, the risk rises to approximately 2.5-5% — with the risk being potentially higher in families that have several family members with the disease.The identical twin of someone with MS (who shares all the same genes) has a 25% chance of developing the disease. If genes were solely responsible for determining who gets MS, an identical twin of someone with MS would have a 100% chance of developing the disease; the fact that the risk is only one in four demonstrates that other factors, including geography, ethnicity and the elusive infectious trigger, are likely involved as well.Research has demonstrated that MS occurs in most ethnic groups, including African-Americans, Asians and Hispanics/Latinos, but is most common amongst Caucasians of northern European ancestry. Susceptibility rates vary among these groups, with recent findings suggesting that African-American women have a higher than previously reported risk of developing MS (nationalmssociety.org, 2018).

References

Who Gets MS? 2018. Retrieved from https://www.nationalmssociety.org/What-is-MS/Who-Gets-MSGold, R., Wolinsky, J.S. 2010.

Pathophysiology of multiple sclerosis and the place of teriflunomide. Acta Neurologica Scandinavica. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1111/j.1600-0404.2010.01444.x

Fields, T. 2017. Steroid Side Effects: How to Reduce Corticosteroid Side Effects. Retrieved from https://www.hss.edu/conditions_steroid-side-effects-how-to-reduce-corticosteroid-side-effects.asp

  

Answer critical Thinking question #2 for chapter 6 on page 180. Answers should be submitted in word document with any associated references used

1 E.Coli was incubated with aeration in a nutrient medium containing two carbon sources, and the following growth curve was made from this culture

A) Explain what happened at the time marked x

B) Which substrate provided “better” growth condition for the bacteria? How can you tell?

2  Assume that after washing your hands you leave ten bacterial cells on a new bar of soap. You then decided to do a plate count of a soap after it was left in soap dish for 24 hours. You dilute one gram of the soap 1:106 and plate it on heterotrophic plate count agar. After 24 hours of incubation, there are 168 colonies. How many bacterial were on the soap? How did they get there?

3) Heat lamps are commonly used to maintain food at about 50 degree C for as long as 12 hours in cafeteria serving lines . The following experiment was conducted to determine whether this practice poses a potential health hazard.

Beef cubes were surface-inoculated with 500,000 bacterial cells and incubated at 43-53degree C to establish temperature limits for bacterial growth. The following results were obtained from heterotrophic plate counts performed on beef cubes at 6 and 12 hours after incubation.

In a 4- to 5-page project proposal written to the leadership of your healthcare organization, propose a nursing informatics project for your organization that you advocate to improve patient outcomes or patient-care efficiency. Your project proposal should include the following:

• Describe the project you propose.
• Identify the stakeholders impacted by this project.
• Explain the patient outcome(s) or patient-care efficiencies this project is aimed at improving and explain how this improvement would occur. Be specific and provide examples.
• Identify the technologies required to implement this project and explain why.
• Identify the project team (by roles) and explain how you would incorporate the nurse informaticist in the project team.

Choose one legal issue and describe the basis for its existence. See below for directions. 

The student should address the following:

1. Define the scope of a legal issue.
2. Examine briefly the existing laws on this issue as it relates to nursing.
3. Highlight this legal issue in a clinical nursing example.
4. Explore the expert forecasts and any new needed laws regarding this legal issue as it relates to nursing practice.

 

Nursing Research and Evidence-Based Practice

 

In your practice as a nurse, you may use procedures and methods that did not necessarily originate in evidence, but instead were derived from informal and unwritten conventions, traditions, and observations. While these techniques may have merit, practices are constantly being updated and contradicted by information from scholarly research studies and professional guidelines. This new information serves as “evidence” for revising practices to improve outcomes across health care.

 

Based on this evidence, you can formulate a question. In this Discussion, you consider the use of evidence-based practice in your own organization and formulate a question that you will need to answer for your portfolio project. This is called a PICOT question. You will also investigate strategies for overcoming barriers to implementing evidence-based practice (EBP).

 

To prepare:

 

• Consider a recent clinical experience in which you were providing care for a patient.
• Determine the extent to which the care that you provided was based on evidence and research findings or supported only by your organization’s standard procedures. How do you know if the tasks were based on research?
• What questions have you thought about in a particular area of care such as a  procedure or policy? 
• Review Chapter 2, pages 36—39 on “Asking Well worded Clinical Questions” in Polit & Beck and consult the resource from the Walden Student Center for Success: Clinical Question Anatomy & examples of PICOT questions (found in this week’s Learning Resources). Formulate your background questions and PICOT question.
• Reflect on the barriers that might inhibit the implementation of evidence-based practice in your clinical environment.
• Review the article “Adopting Evidence-Based Practice in Clinical Decision Making” in this week’s Learning Resources. Select one of the barriers described that is evident in your organization and formulate a plan for overcoming this barrier.

 

Post on or before Day 3:

 

• (1)  an evaluation of the use, or lack thereof, of EBP in a recent clinical experience.
• (2) Identify which aspects of the care delivered, if any, were based on evidence and provide your rationale.
• (3) List your background questions and PICOT question about this nursing topic.
• (4) Critique how the policies, procedures, and culture in your organization may hinder or support the adoption of evidence-based practices.
• (5) Identify the barrier you selected from the article and explain how this barrier could be overcome within your organization

 

 REQUIRED RESOURCES

 

 

 

Readings

 

• Polit, D. F., & Beck, C. T. (2012).  Nursing research: Generating and assessing evidence for nursing practice (Laureate Education, Inc., custom ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
• Chapter 1, “Introduction to Nursing Research in an Evidence-Based Practice Environment”

  This chapter provides an introduction to nursing research, its history, and the evolution of evidence-based practice. It includes an overview of credible sources of evidences and a description of the different paradigms used in nursing research.

• Chapter 2, “Evidence-Based Nursing: Translating Research Evidence into Practice”

  The focus of this chapter includes an overview of the key aspects of evidence-based practice, a review of how to identify credible research and appraise its value, and, finally, a discussion on how to take the identified evidence and convert it into a practice.

• Chapter 3, “Key Concepts and Steps in Qualitative and Quantitative Research”

  In this chapter, quantitative and qualitative research models are compared and the major steps in each approach are described. Information is also presented on the different sections of a research journal article and how you can identify the research model that was utilized. 

• Adams, J. S. (2010). Utilizing evidence-based research and practice to support the infusion alliance. Journal of Infusion Nursing, 33(5), 273–277.
  Retrieved from the Walden Library databases.  

  This article examines how evidence-based research and practice supports infusion alliances. The text also specifies the increasing challenges that infusion nurses face.

• Mallory, G. A. (2010). Professional nursing societies and evidence-based practice: Strategies to cross the quality chasm. Nursing Outlook, 58(6), 279–286.
  Retrieved from the Walden Library databases.

  This article describes strategies for reducing the gap between research knowledge and practice. The article also details how nursing societies could use these strategies to improve the quality of care.

• Newhouse, R. P., & Spring, B. (2010). Interdisciplinary evidence-based practice: Moving from silos to synergy. Nursing Outlook, 58(6), 309–317.
  Retrieved from the Walden Library databases.

  In this article, the authors examine the state of interdisciplinary evidence-based practice (EBP). The authors detail efforts to promote interdisciplinary EBP, academic and clinical training regarding interdisciplinary EBP, and strategies that may facilitate EBP translation across disciplines.

• Shaheen, M., Foo, S., Luyt, B., Zhang, X., Theng, Y-L., Chang, Y-K., & Mokhtar, I. A. (2011). Adopting evidence-based practice in clinical decision making: Nurses’ perceptions, knowledge, and barriers. Journal of the Medical Library Association, 99(3), 229–236.
  Retrieved from the Walden Library databases.

  This article reviews a study that sought to determine nurses’ awareness of, knowledge of, and attitude toward EBP. The article also describes factors likely to promote barriers to EBP adoption.

• Shivnan, J. C. (2011). How do you support your staff? Promote EBP. Nursing Management, 42(2), 12–14.
  Retrieved from the Walden Library databases.

  This article explores the role of the nurse manager in supporting evidence-based practice. The article also explains barriers and strategies to promote EBP for a nurse manager.

• Walden Student Center for Success. (2012). Clinical Question Anatomy. Retrieved July 9, 2014, from http://academicguides.waldenu.edu/content.php?pid=183871&sid=2950360

 

Media

 

• Laureate Education, Inc. (Executive Producer). (2012).Timeline of nursing research. Baltimore, MD: Author.

  This multimedia piece features a timeline of major events in nursing research. The timeline highlights how historical events and seminal research have contributed to nursing practice.