You are admitting a 19-year old female college student to the hospital for fevers.  Using the patient information provided, choose a culture unfamiliar to you and describe what would be important to remember while you interview this patient. Discuss the health care support systems available in your community(maryland) for someone of this culture. If no support systems are available in your community, identify a national resource.

Abdominal bloating can be the result of many different ailments. Several questions can help the provider find the cause of the symptoms. The first question you can ask is when did she notice the bloating? This will help give some direction of how long the complaint has been going on and what may have caused it. If there is any associated pain and if so when was the onset, duration, frequency and relationship can help eliminate causes and questions such as: Does it get better or worse when you eat certain foods? Does movement or rest alleviate symptoms? Where is the bloating feeling exactly? Location can provide clue regarding the mechanism of the bloating. Has she has had any nausea or vomiting? Although the patient has passed gas, this writer would ask when was the last bowel movement because the patient could also be constipated. 

The physical examinations should include vitals and assessment of the abdomen (inspection, auscultation, percussion, and palpation). Included in the physical exam of this visit will be an oral exam making sure to thoroughly exam the teeth and the mucosa for sores, noting the teeth and mucosal colors. A musculoskeletal exam would also be performed noting any muscle weakness, fatigue, joint pain, numbness or tingling. Generalized skin exam noting skin color, lesions, or rashes. Neurological examination for headaches, migraines, or confusion. Psychosocial for any anxiety or depression. Social habits for any drug or alcohol abuse. There are tons of differential diagnoses that comes along with abdominal pain since this area can reciprocate pain from other areas in the body. Differential diagnosis can include constipation, bowel obstruction, Chrons, food allergies, enteritis, irritable bowel syndrome or celiac disease.

Test should be ordered and performed along the history and physical to help assist diagnosing. A complete blood count, serum chemistries, liver function tests, urinalysis, pregnancy test, and abdominal films will help determine the acuity of the problem (Dunphy, Winland-Brown, Porter, & Thomas, 2015). Antibody levels that are elevated indicate an immune reaction to gluten. Genetic testing could also be an option, and might include antigens that are used to rule out celiac (Bascunan, Vespa & Araya, 2017). A kidney, utter, and bladder (KUB) x-ray may also be ordered to asses organs, structures, causes of the bloating. Further testing may include endoscopes and possible biopsy to rule out other gastrointestinal (GI) conditions. 

The main thing about managing any disease is diet, education, and pharmacological and nonpharmacological interventions. This is most true for IBS. If gluten is the issue, the patient must have a strict diet that includes avoiding wheat, barley, rye, malt, and more. Education is key. In doing so, this promotes decreased inflammation and intestinal healing (Mayo Clinic, 2018). Crohn’s disease can also be treated with latter. It is mostly treated with immunosuppressant drugs. Medical follow-up is also necessary to ensure a healthy body response to the new changes. If unresponsive to this surgical interventions are required. 

References

Bascuñán, K., Vespa, M. & Araya, M. (2017). Celiac disease: Understanding the gluten-free diet. European 

Journal of Nutrition, 56(2), 449–459. doi: https://doi-org.wgu.idm.oclc.org/10.1007/s00394-016-1238-5.

Dunphy, L., Brown, J., Porter, B., Thomas, D. (2015). Primary Care: The Art and Science of Advanced 

Practice Nursing. Philadelphia: F.A. Davis Company.

Mayo Clinic (2018). Celiac Disease. Retrieved from https://www.mayoclinic.org/diseases-conditions/celiac- (Links to an external site.)Links to an external site.

disease/diagnosis-treatment/drc-20352225 (Links to an external site.)Links to an external site..

     

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Some believe that MCOs are best at managing a patient’s wellness and supporting preventive and early detection services.

Explain the benefit to a third-party payer of this approach over a program such as major medical that only gets involved when the patient has a major illness (hospitalization).

Be specific. 

Discussion board 

250 word count minimum, 

please use APA format, in text citations, include references

Please include two additional post 50 words minimum.

 

A nursing conceptual model is used to set a guideline and is based on a concept.  Nursing theory

describes the knowledge used to support nursing practice and is based on evidence.

In Florence Nightingales Environmental Theory, she states that the nurse can utilize the patient’s

environment to help optimize their healing. This can be done by making sure certain environmental factors

are present such as:

– clean water

-fresh air,

-sunlight

-cleanliness of the environment

-and appropriate drainage

This practice is still used today to aid is patients healing. Although we no longer need to worry about

things such as appropriate drainage, we still maintain a cleanly environment, make sure the patient has fresh

clean water to drink if allowed. In the hospital setting we turn on lights and open blinds during the day and

turn off lights and close the blinds at night.  We fill out the “white boards” to help the patient stay oriented to

date and day as well as who their providers are and the goal for the day. In the hospital where I work, we

have what is called “Quiet Time” It is a 2-hour block during the day from 1430-1630 where the hallway lights

are turned down, the staff is expected to be quieter in their work and no over head paging is allowed. This is

used to decrease stimulation and promote healing in the hospital patients. Signs are posted all around the

hospital notifying staff and visitors of quiet time hours.

Opioid use during pregnancy comes with many risks to the mother and fetus. In utero, there is a risk of preeclampsia, premature labor and rupture of membranes, placental insufficiency, abruptio placentae, intrauterine growth retardation, and intrauterine death (Ross, Graham, Money, & Stanwood, 2014). While in utero, opioids can also cross the placenta and lead to abnormal growth and development, birth defects, and opioid uptake (Yazdy, Desai, & Brogly, 2015). Neonatal abstinence syndrome (NAS) is a condition in which opioid exposed infants experience drug withdrawal symptoms shortly after birth (Krans & Patrick, 2016).

NAS is characterized by central nervous system hyperirritability, autonomic nervous system dysfunction, and gastrointestinal disturbances (Stover & Davis, 2015). Observed symptoms may include: irritability, excessive crying, poor sleep, increased muscle tone, tremors, hyperthermia, loose stools, excessive movements, yawning, sweating, sneezing, and nasal stuffiness (Stover & Davis, 2015). Some infants may also experience seizures (Stover & Davis, 2015). Neonates with NAS typically require prolonged hospitalization and pharmacotherapy with morphine or methadone (Yazdy et al., 2015).

In this scenario, it is also going to be important for the mother to get clean. Opioid withdrawal is not recommended during pregnancy, however, medication assisted treatment can be started while pregnant (Krans & Patrick, 2016). Mental health assessments and counseling will also be important for this mother. For women that are undergoing medication assisted treatment with methadone or buprenorphine, the AAP and ACOG both encourage breastfeeding (Stover & Davis, 2015). In these cases, breastfeeding is associated with a decrease in the incidence and severity of NAS (Stover & Davis, 2015).  

The long-term consequences of opioid exposure in utero and NAS have been difficult to determine (Stover & Davis, 2015). This is due to small study sizes and issues differentiating the effects of in utero exposures versus postnatal treatments versus environmental influences (Stover & Davis, 2015). Although, studies have found that in general, children with opioid exposures are more likely to have psychiatric issues, attention deficit disorders, and disruptive behaviors (Stover & Davis, 2015). Other effects may also include smaller brains, a thinner cortex, and reduced cognitive abilities (Stover & Davis, 2015).

References

Krans, E. E., & Patrick, S. W. (2016). Opioid use disorder in pregnancy: Health policy and practice in the midst of an epidemic. Obstetrics and Gynecology, 128(1), 4-10. https://dx.doi.org/10.1097%2FAOG.0000000000001446

Ross, E. J., Graham, D. L., Money, K. M., & Stanwood, G. D. (2014). Developmental consequences of fetal exposure to drugs: What we know and what we still must learn. Official Publication of the American College of Neuropsychopharmacology, 40(1), 61-87. https://dx.doi.org/10.1038%2Fnpp.2014.147

Stover, M. W., & Davis, J. M. (2015). Opioids in pregnancy and neonatal abstinence syndrome. Seminars in Perinatology, 39(7), 561-565. https://dx.doi.org/10.1053%2Fj.semperi.2015.08.013

Yazdy, M. M., Desai, R. J., & Brogly, S. B. (2015). Prescription opioids in pregnancy and birth outcomes: A review of the literature. Journal of Pediatric Genetics, 4(2), 56-70. https://dx.doi.org/10.1055%2Fs-0035-1556740