Case Study 3 & 4: Case Study 3 & 4 S Inflammatory Bowel Disease and Urinary Obstruction. 

Students much review the case study and answer all questions with a scholarly response using APA and include 2 scholarly references. Answer both case studies on the same document and upload 1 document to Moodle. Case Studies will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program). Turn it in Score must be less than 50% or will not be accepted for credit, must be your own work and in your own words. 

The answers must be in your own words with reference to journal or book where you found the evidence to your answer. Do not copy paste or use a past students work as all files submited in this course are registered and saved in turn it in program.

All answers to case studies must have reference cited in text for each answer and minimum of 2 Scholarly References (Journals, books) (No websites)  per case Study

Inflammatory Bowel Disease Case Study 

The patient is an 11-year-old girl who has been complaining of intermittent right lower quadrant pain and diarrhea for the past year. She is small for her age. Her physical examination indicates some mild right lower quadrant tenderness and fullness. 

Studies Results Hemoglobin (Hgb), 8.6 g/dL (normal: >12 g/dL) Hematocrit (Hct), 28% (normal: 31%-43%) Vitamin B12 level, 68 pg/mL (normal: 100-700 pg/mL) Meckel scan, No evidence of Meckel diverticulum D-Xylose absorption, 60 min: 8 mg/dL (normal: >15-20 mg/dL) 

120 min: 6 mg/dL (normal: >20 mg/dL) 

Lactose tolerance, No change in glucose level (normal: >20 mg/dL rise in glucose) Small bowel series, Constriction of multiple segments of the small intestine 

Diagnostic Analysis 

The child’s small bowel series is compatible with Crohn disease of the small intestine. Intestinal absorption is diminished, as indicated by the abnormal D-xylose and lactose tolerance tests. Absorption is so bad that she cannot absorb vitamin B12. As a result, she has vitamin B12 deficiency anemia. She was placed on an aggressive immunosuppressive regimen, and her condition improved significantly. Unfortunately, 2 years later she experienced unremitting obstructive symptoms and required surgery. One year after surgery, her gastrointestinal function was normal, and her anemia had resolved. Her growth status matched her age group. Her absorption tests were normal, as were her B12 levels. Her immunosuppressive drugs were discontinued, and she is doing well. 

Critical Thinking Questions 

1. Why was this patient placed on immunosuppressive therapy? 

2. Why was the Meckel scan ordered for this patient? 

3. What are the clinical differences and treatment options for Ulcerative Colitis and Crohn’s Disease? (always on boards) 

4. What is prognosis for patients with IBD and what are the follow up recommendations for managing disease?

Urinary Obstruction case study

The 57-year-old patient noted urinary hesitancy and a decrease in the force of his urinary stream for several months. Both had progressively become worse. His physical examination was essentially negative except for an enlarged prostate, which was bulky and soft. 

Studies Results Routine laboratory studies Within normal limits (WNL) Intravenous pyelogram (IVP) Mild indentation of the interior aspect of the bladder, indicating an enlarged prostate Uroflowmetry with total voided flow of 225 mL 8 mL/sec (normal: >12 mL/sec) Cystometry Resting bladder pressure: 35 cm H2O (normal: <40 cm H2O) Peak bladder pressure: 50 cm H2O (normal: 40-90 cm H2O) Electromyography of the pelvic sphincter muscle Normal resting bladder with a positive tonus limb Cystoscopy Benign prostatic hypertrophy (BPH) Prostatic acid phosphatase (PAP) 0.5 units/L (normal: 0.11-0.60 units/L) Prostate specific antigen (PSA) 1.0 ng/mL (normal: <4 ng/mL) Prostate ultrasound Diffusely enlarged prostate; no localized tumor 

Diagnostic Analysis 

Because of the patient’s symptoms, bladder outlet obstruction was highly suspected. Physical examination indicated an enlarged prostate. IVP studies corroborated that finding. The reduced urine flow rate indicated an obstruction distal to the urinary bladder. Because the patient was found to have a normal total voided volume, one could not say that the reduced flow rate was the result of an inadequately distended bladder. Rather, the bladder was appropriately distended, yet the flow rate was decreased. This indicated outlet obstruction. The cystogram indicated that the bladder was capable of mounting an effective pressure and was not an atonic bladder compatible with neurologic disease. The tonus limb again indicated the bladder was able to contract. The peak bladder pressure of 50 cm H2O was normal, again indicating appropriate muscular function of the bladder. Based on these studies, the patient was diagnosed with a urinary outlet obstruction. The PAP and PSA indicated benign prostatic hypertrophy (BPH). The ultrasound supported that diagnosis. Cystoscopy documented that finding, and the patient was appropriately treated by transurethral resection of the prostate (TURP). This patient did well postoperatively and had no major problems. 

Critical Thinking Questions 

1. Does BPH predispose this patient to cancer? 

2. Why are patients with BPH at increased risk for urinary tract infections? 

3. What would you expect the patient’s PSA level to be after surgery? 

4. What is the recommended screening guidelines and treatment for BPH? 

5. What are some alternative treatments / natural homeopathic options for treatment? 

Purpose

This week’s graded topics relate to the following Course Outcomes (COs).

• CO 2: Apply research principles to the interpretation of the content of published research studies. (PO 4 & 8)
• CO 4: Evaluate published nursing research for credibility and significance related to evidence-based practice. (PO 4 & 8)
• CO 5: Recognize the role of research findings in evidence-based practice. (PO 7 & 8)

Discussion

Access the following information. You may read the PDF online or download it.

American Nurses Association. (2014). Fast facts: The nursing workforce 2014: Growth, salaries, education, demographics & trends. ANA. Retrieved from https://www.nursingworld.org/globalassets/practiceandpolicy/workforce/fastfacts_nsgjobgrowth-salaries_updated8-25-15.pdf  (Links to an external site.)

• Review the data presented in the ANA Fast Facts and describe some of the key attributes/characteristics of this sample of the nursing workforce.
• Discuss some of the data that you found interesting; include what you believe the purpose (intent) of ANA sharing these results.
• The instruments and tools that we use to collect data need to be reliable and valid. Define these terms and explain the importance of each. Share one way that can be used to collect data that you were not aware of or familiar with.

Professor’s comment: Class,
This week we are continuing our discussion on methods as well as data collection. How does a researcher ensure that reliability and validity are maintained in instruments and between raters?

You are also asked to read the above fast facts from the ANA. What was your impression of this data collected? What do you believe the intent was of the researcher who designed the survey?  Furthermore, discuss instruments, tools, reliability and validity.

We will continue our discussion in this thread talking about various instruments and how the strength of an instrument is an important part of the research process. Often times if the data collection instrument is poor, then the results will be, too.

We will be working toward the following Course Outcomes in this thread:

• Apply research principles to the interpretation of the content of published research studies.
• Evaluate published nursing research for credibility and lab significance related to evidence-based practice.
• Recognize the role of research findings in EBP.

I look forward to seeing you advance your research knowledge! Paula

 

• Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.
• Develop a PICO(T) question to address the clinical issue of interest for the Assignment.
• Use the key words from the PICO(T) question you developed and  search at least four different databases in the Walden Library to  identify at least four relevant peer-reviewed articles at the  systematic-reviews level related to your research question.
• Reflect on the process of creating a PICO(T) question and searching for peer-reviewed research.

The Assignment (Evidence-Based Project)

Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews

Create a 6- to 7-slide PowerPoint presentation in which you do the following:

• Identify and briefly describe your chosen clinical issue of interest.
• Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest.
• Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.
• Provide APA citations of the four peer-reviewed articles you selected.
• Describe the levels of evidence in each of the four  peer-reviewed articles you selected, including an explanation of the  strengths of using systematic reviews for clinical research. Be specific  and provide examples.

This is my picot question

 In patients diagnosed with a mental illness,what effect does a fall risk  assessment specific for psychiatric patients have on a fall rates as  compared to universal fall assessments?  

Demonstration of Proficiency

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

• Competency 3: Transform processes to improve quality, enhance patient safety, and reduce the cost of care. 
  • Propose a plan, referencing relevant existing and newly created processes, to implement an intervention to improve quality and safety, and reduce costs within the context of a chosen health problem.
• Competency 4: Apply health information and patient care technology to improve patient and systems outcomes. 
  • Analyze technology within a chosen health care practice context to support a proposed plan.
• Competency 5: Analyze the impact of health policy on quality and cost of care. 
  • Explain the ways in which governmental or organizational policies could impact the proposed plan.
• Competency 6: Collaborate interprofessionally to improve patient and population outcomes. 
  • Explain strategies for communicating and collaborating with patients and interprofessional teams to improve health outcomes.
• Competency 8: Integrate professional standards and values into practice. 
  • Communicate professionally in clear, logically organized writing, using correct grammar, spelling, and APA style.

Important: You must complete all of the assessments in order for this course.

Professional Context

As a professional nurse, you perform a critical role in solving a host of health care problems. In this assessment, you will use the literature to plan best-practice strategies to foster positive health outcomes for your chosen patient or population.

Preparation

Your intervention and implementation plan should be carried out in an interprofessional context, aligned to your topic, and based on the work you did in the first assessment. You should find collaborators as soon as possible so you can solicit their feedback about intervention and implementation plans to inform your approach.

Instructions

Having identified a health problem relevant to your current or future nursing practice and reviewed the literature to support nursing standards, decision making, and improvement strategies, you should now plan an intervention to address the chosen health problem based on the research you conducted.

Construct a plausible plan that leverages the best practices and research collected to date as well as additional research into similar projects that you find in the literature. Be sure to frame your plan within the context of the health care setting in which you are completing your practicum hours. Incorporate relevant site-specific processes and policies into your implementation plan.

Use the Plan Proposal Template [DOC] to complete this assessment.

As you develop your plan, be sure to address the following:

• Collaboration and communication with patients and colleagues to improve health outcomes.
• Governmental or organizational policies that could affect the plan.
• Quality and safety improvement strategies.
• Technology at the site that could be leveraged.

Scoring Guide Criteria

• Propose a plan, referencing relevant existing and newly created processes, to implement an intervention to improve quality and safety, and reduce costs within the context of a chosen health problem.
• Analyze technology within a chosen health care practice context to support a proposed plan.
• Explain the ways in which existing governmental or organizational policies could impact the proposed plan.
• Explain strategies for communicating and collaborating with patients and interprofessional teams to improve health outcomes.
• Communicate professionally in writing that is clear, logically organized, and uses correct grammar, spelling, and APA style.

Additional Requirements

• Length of submission: Use the provided template. Most submissions will be 3 to 5 pages. You do not need to include a title page. Be sure to complete the reference page at the end of the template.
• Number of references: Cite a minimum of 5 sources of scholarly or professional evidence that support your central ideas. Resources should be no more than five years old.
• APA formatting: Make sure that in-text citations and reference list follow current APA style.

Portfolio Prompt: Remember to save the assessment to your ePortfolio. After you complete your program you may want to consider leveraging your Portfolio as part of a job search or other demonstration of your academic competencies.

  

Case study.

Patient HL comes into the clinic with the following symptoms: nausea, vomiting, and diarrhea. The patient has a history of drug abuse and possible Hepatitis C. HL is currently taking the following prescription drugs:

· Synthroid 100 mcg daily

· Nifedipine 30 mg daily

· Prednisone 10 mg daily

Assignment

Gastrointestinal (GI) and hepatobiliary disorders affect the structure and function of the GI tract. Many of these disorders often have similar symptoms, such as abdominal pain, cramping, constipation, nausea, bloating, and fatigue. Since multiple disorders can be tied to the same symptoms, it is important for advanced practice nurses to carefully evaluate patients and prescribe a treatment that targets the cause rather than the symptom.  

Once the underlying cause is identified, an appropriate drug therapy plan can be recommended based on medical history and individual patient factors. In this Assignment, you examine a case study of a patient who presents with symptoms of a possible GI/hepatobiliary disorder, and you design an appropriate drug therapy plan.

To Prepare

· Review the case study assigned above.

· Reflect on the patient’s symptoms, medical history, and drugs currently prescribed.

· Think about a possible diagnosis for the patient. Consider whether the patient has a disorder related to the gastrointestinal and hepatobiliary system or whether the symptoms are the result of a disorder from another system or other factors, such as pregnancy, drugs, or a psychological disorder.

· Consider an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.

Write a 1-page paper that addresses the following:

· Explain your diagnosis for the patient, including your rationale for the diagnosis.

· Describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.

· Justify why you would recommend this drug therapy plan for this patient. Be specific and provide examples.

Resource for reference——- Need 3+ references.

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

• Chapter 62, “Drugs for Peptic Ulcer Disease” (pp.      703–714)
• Chapter 63, “Laxatives” (pp. 715–722)
• Chapter 64, “Other Gastrointestinal Drugs” (pp.      723–735)
• Chapter      78, “Antiviral Agents I: Drugs for Non-HIV Viral Infections” (pp. 867–886)

Chalasani, N., Younossi, Z., Lavine, J. E., Charlton, M., Cusi, K., Rinella, M., . . . Sanya, A. J. (2018). The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology, 67(1), 328–357. Retrieved from https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/hep.29367

This article details the diagnosis and management of nonalcoholic fatty liver disease. Review this article to gain an understanding of the underlying pathophysiology as well as the suggested pharmacotherapeutics that might be recommended to treat this disorder.