Discussion: Factors That Influence Disease

In clinical settings, some of the most common questions that patients ask are Why do I have this? What caused this disorder? Will it ever go away? These emotional questions can be difficult to ask and to answer. However, for patients to come to terms with their diagnoses and adhere to treatment plans, they must have an understanding of factors that might have caused, or continue to impact, their disorders. As an advanced practice nurse, it is important that you are able to explain disorders, associated alterations and symptoms, and changes that might occur within your patients’ bodies.

To Prepare

· Review this week’s media presentation with Dr. Terry Buttaro. Reflect on the importance of developing an in-depth understanding of pathophysiology.

· Select a disorder from the following list:

o Adrenal insufficiency (Addison’s disease)

o Atherosclerosis

o Cholelithiasis (gallstones)

o Colon cancer

o Cystic fibrosis

o Hemophilia

o Nephrolithiasis (kidney stones)

o Osteoporosis

o Parkinson’s disease

o Tuberculosis

· Select one of the following patient factors: genetics, gender, ethnicity, age, or behavior. Reflect on how that factor might impact your selected disorder, as well as potential associated alterations and symptoms.

· Identify the pathophysiology of the associated alterations, including the normal and altered cellular function. Consider both intra- and extra-cellular changes that occur.

ASSIGNMENT: 

Post a brief description of a patient scenario involving the disorder and the factor you selected. Explain how the factor might impact your selected disorder, as well as potential associated alterations and symptoms. Finally, explain the pathophysiology of the associated alterations, including changes in cellular function.

Required Readings

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

• Chapter 1, “Cellular Biology”

This chapter reviews cellular biology to establish a foundation for exploring the pathophysiology of disease. It also covers the structure and function of cellular components, cell-to-cell adhesions, cellular communication, cellular metabolism, membrane transport, the cell cycle, and tissues.

• Chapter 2, “Genes and Genetic Diseases”

This chapter explores genetic disorders and factors that impact genetic disorders. It also examines how mutations and chromosomal abnormalities lead to transmission of genetic disorders.

• Chapter 4, “Altered Cellular and Tissue Biology”

This chapter examines disorders related to cell adaptation, injury, and death. It also explores disorders associated with altered cellular and tissue function as a result of aging.

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

• Chapter 2, “Genetic Disease”

This chapter reviews the clinical manifestations, pathophysiology, and genetic principles of genetic diseases. It also explores different types of genetic diseases and the mechanisms involved.

• Chapter 5, “Neoplasia”

This chapter explores various disorders associated with neoplasia. It also covers causes and effects of common cancers and tumors resulting from neoplasia.

Required Media

Review the animations, case studies, and review questions on the evolve textbook support link.http://evolve.elsevier.com/huether

Laureate Education, Inc. (Executive Producer). (2012d). Introduction to advanced pathophysiology. Baltimore, MD: Author.

Note: The approximate length of this media piece is 10 minutes.

In this media presentation, Dr. Terry Buttaro, associate professor of practice at Simmons School of Nursing and Health Sciences, discusses the importance of pathophysiology for the advanced practice nurse.

Accessible player  –Downloads– Download Video w/CC Download Audio Download Transcript 

Review the animations, case studies, and review questions on the evolve textbook support link. http://evolve.elsevier.com/huether

Rizek, P., Kumar, N., & Jog, M. S. (2016). An update on the diagnosis and treatment of Parkinson disease. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 188(16), 1157–1165. doi:10.1503/cmaj.151179

Parkinson’s Disease: A Concise Overview of Etiology, Epidemiology, Diagnosis, Comorbidity and Management

Getinet Ayano*

Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia

  

Client Profile

Ms. Champlin is a 52 – year old woman who was cooking New England clam cakes in a skillet filled with hot oil. While she was dropping the dough in the skillet, oil splattered onto the gas stove, catching on fire and filling the skillet with flames. In a panic, Ms. Champlin grabbed the handle of the burning skillet to remove it from the stove, spilling the hot oil all over her right arm and hand. The oil also splashed onto the right side of her face and neck and across her chest, burning her skin through her T-shirt. She is transported to the emergency department by emergency medical technician(EMTs).

Case Study

Upon arrival at the hospital, she is alert and oriented, without signs or symptoms of respiratory distress. She is screaming in pain. MS. Champlin’s vital signs are BP 130/60, Pulse 94, Respiratory rate 22, and Temperature 97°F (36.1°C). Her oxygen saturation is 99% on 2 Liters of oxygen. She has suffered superficial and superficial partial-thickness burns on her face, neck, and chest, and deep partial-thickness burns over her right arm and hand. The right side of her face and neck and her chest are red with several blisters noted. Her right arm and hand are swollen and have sloughing skin with a mottled appearance of cherry red, tan, and pale areas. The health care provider (HCP) does not observe any discoloration of soot around Ms. Champlin’s nose or mouth, singed nasal hair, or burned eyebrows. Acute care in the emergency department include oxygen, intravenous (IV) fluids, the insertion of an indwelling urinary catheter, nasogastric tube attached to low wall suction and the administration of IV morphine sulfate and tetanus toxoid. Ms. Champlin is transferred to a burn unit for continued care.

Questions

1.  Describe each of the five types of burn injury and provide examples of each. Which type of burn has Ms. Champlin sustained?

2. Describe the appropriate first aid intervention the EMTs will initiate while en route to the hospital.

3. Using the “Rule of Nines” estimate the extent of the client’s burn injury.

4. Why did the HCP assess Ms. Champlin for discoloration around her nose and mouth singed nasal hair, and burned eyebrows? What other related manifestations should be assessed to determine if there is a need for concern?

5. In the emergency department, treatment of the client included the insertion of an indwelling urinary catheter, insertion of nasogastric (NG) tube, and administration of tetanus toxoid. Provide a brief rationale for each of these interventions.

6. Briefly describe the skin depth and manifestation that define each degree of burn injury (first-, second-, third-, and fourth-degree). What degree(s) of burn injury does Ms. Champlin have?

7. Ms. Champlin cries to the nurse, “It seems as if my arm is getting bigger by the minute! Can’t you do something?” Help the nurse explain to the client what is causing the edema and the expected progression and resolution of the swelling.

8. Ms. Champlin weighs 180 lbs. Using the Parkland Formula below, estimate the IV fluid replacement needs of this client in the first 24 hours following her injury.

Parkland Formula: 2 to 4 ml of solution 

x body weight (in kg) 

x percent burn

9.  Help the nurse identify five priority nursing diagnosis for Ms. Champlin’s plan of care during the acute phase of her treatment.

10. The HCP is concerned that Ms. Champlin may develop a contracture of her right arm because of the burn injury over her right elbow. Discuss what a contracture is and why this client is at increas4d risk of developing one.

11. The HCP carting for Ms. Champlin tells her that I may become necessary to apply a skin graft to the deep partial-thickness area over her elbow to speed healing and minimize the risk for contracture. Skin grafts are obtained from various sources. Briefly explain these four types of grafts: autograft, allograft, heterograft, synthetic skin substitute graft. Is there any benefit(s) to selectin one type of graft over another? If so, explain.

12. Briefly discuss why environmental temperature control is an important intervention while caring for the client with a burn injury. At what temperature should the nurse maintain the client’s room?

13. Ms. Champlin has asked the nurses that no visitors be allowed in to see her. Briefly discuss Ms. Champlin’s psychological reaction to her burn. How should the nurse respond?

14. Ms. Champlin is being discharged. She will wear a custom molded hand and arm splint at home. Briefly describe the teaching points the nurse should address regarding limb assessment and proper use of the splint.

15. Ms. Champlin asks the nurse, “I have heard there is a cream you can apply to decrease scarring.” What types of cream might Ms. Champlin be referencing?

 

This assignment provides the opportunity for the student to continue development of a MSN EBP scholarly project that started with the identification of a nursing concern and PICOT/PICo question from Week 2. The focus of this assignment is to discuss the research-based literature support for the selected concern, identify an appropriate research design, explain the sampling method, and discuss implementation through the use of a change model.

Course Outcome:

This assignment enables the student to meet the following course outcome:

CO 1. Integrate evidence-based practice and research to support advancement of holistic nursing care in diverse healthcare settings. (PO 1)

CO 2. Integrate knowledge related to evidence-based practice and person-centered care to improve healthcare. (PO 2, 5)

CO #4. Develop knowledge related to research and evidence-based practice as a basis for designing and critiquing research studies. (PO 1, 2, 3, 5)

CO #5. Analyze research findings and evidence-based practice to advance holistic nursing care initiatives that promote positive healthcare outcomes. (PO 1, 2, 5)

Due Date Sunday 11:59 PM MT at the end of Week Five

Students are given the opportunity to request an extension on assignments for emergent situations. Supporting documentation must be submitted to the assigned faculty. If the student’s request is not approved, the assignment is graded and a late penalty is applied as follows:

• Monday = 10% of total possible point reduction
• Tuesday = 20% of total possible point reduction
• Wednesday = 30% of total possible point reduction

If the student’s request is approved, the student will be informed of the revised due date. Should the student fail to meet the revised due date, the assignment is graded and a late penalty is applied as follows:

• Monday = 10% of total possible point reduction
• Tuesday = 20% of total possible point reduction
• Wednesday = 30% of total possible point reduction

Total Points Possible: 250 points

Requirements

Description of the Assignment: This continues the development of a MSN EBP scholarly project by requiring the student to identify the additional elements of the process. The required elements are noted to be:

• Research Literature Support (NOTE: Ten research-based references related to PICOT/PICo question are required)
• Research Approach and Design
• Sampling
• Intervention

Criteria for Content

1. Research Literature Support: In this section, comprehensive research literature support for the identified nursing concern and PCIOT/PICo question is to be provided. A minimum of ten (10) research-based references are required. The use of a systematic research review article as a reference is NOT allowed. All research studies are to be consistent with the selected concern and PICOT/PICo question. The PICOT/PICOT question is restated before presenting the research literature support. For each research-based reference the following information is to be discussed:

• -Purpose of the research study
• -Research approach that was used
• -Data collection methods used
• -Results of the research study
• -One strength of the research study
• -One limitation of the research study.
• 2. Research Approach and Design: In this section, the student will identify the research approach that he/she plans on using for the EBP project as being either quantitative or qualitative. In addition, if the selected approach is quantitative, the student needs to identify if the design is experimental, quasi-experimental, or descriptive. If the selected approach is qualitative, the student needs to identify if the design is phenomenological, ethnography, grounded theory, or historical. A description of the selected design is to be provided as well as rationale for its selection. In addition one advantage and one disadvantage to the selected design is to be identified and discussed. Required content includes:
• -Identification of the research approach that the student plans on using as either quantitative or qualitative
• -Identification of selected quantitative research design by indicating if the design is experimental, quasi-experimental, or   descriptive
• -Identification of the selected qualitative design by indicating if the design is phenomenological, ethnography, grounded theory,  or historical
• -Description of the selected design
• -Rationale for the selected design
• -Identification of one advantage of the selected design
• -Identification of one disadvantage of the selected design
• -Provide scholarly reference(s) to support information about the selected research approach/design
• 3. Sampling: In this section, the student will identify the sampling method to be used in order to obtain the necessary participants for the proposed EBP project. Discussion of participants’ rights as research subjects is also included. Required content includes:
• -Describe the target population
• -Identify the sampling method as being either probability or nonprobability
• -Provide a complete description of the sampling procedure including:
  • Sample size
  • Inclusion criteria
  • Exclusion criteria
• -Identify one advantage to the selected sampling procedure
• -Identify one disadvantage to the selected sampling procedure
• -Explain how participants’ rights will be protected including confidentiality, anonymity, protection from harm, and informed consent
• -Provide scholarly reference(s) to support information about the selected sampling method
• 4. Proposed Implementation with a change model: In this section, the student will apply the PDSA Change Model as the method to implement the proposed EBP practice solution/change. The required content includes:
• -Describe the PDSA Change Model
• -Explain why this change model is best suited for implementation of your evidence-based nursing practice solution/change
• -Apply each step of the PDSA Change Model to implementing the proposed practice solution/change
• -Explain how to overcome one barrier to the use of the EBP results from this project
• -Explain how an environment that supports EBP can be fostered in your future practice setting
• -Include a scholarly reference(s) for the PDSA Change Model

Preparing the Assignment

Criteria for Format and Special Instructions

1. The additional sections to the proposal are not to exceed 15 (fifteen) pages. Be sure that all literature review articles are on your reference page. Points will be lost for not meeting these length requirements.
2. Title page, running head, body of paper, headings, and reference page(s) must follow APA guidelines as found in the 6th edition of the manual.
3. Required textbook for this course, dictionary and Chamberlain College of Nursing lesson information may NOTbe used as scholarly references for this assignment. For additional assistance regarding scholarly nursing references, please see the Library Guide. Be aware that information from .com, .edu, and library websites may be incorrect and should be avoided. Please contact your faculty member for guidance concerning the acceptability of a website as a scholarly source. References are current – within a 5-year time frame unless a valid rationale is provided and the instructor has approved the use of the older reference.
4. This assignment is the required submission to Turn It In™ (TII) for NR 505. To prepare for the final submission, students are encouraged to submit their assignments early. A similarity score of 24% or less is required for the final submission. Any other level of similarity index requires the student to revise the assignment before the due date and time. To allow sufficient time for revision, early submission of the assignment to TurnItIn™ is highly encouraged. The final submission will be graded by faculty. If the final TurnItIn™ report indicates that plagiarism has occurred, the Academic Integrity policy will be followed. Similarity scores of 25% or higher result in the implementation of the Academic Integrity Policy located in the Chamberlain College of Nursing Student Handbook.

 

Describe the key concepts underlying community activism and give examples of how each of these concepts applies to a specific context. Examine how advanced practice nurses can engage in community activism to limit further negative health impacts from Big Tobacco in their respective health communities.

Attached below is an additional resource, an article, that details various ways by which nursing professionals can engage in community activism.

Patient Advocacy and in the Community and Legislative Arena: http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-17-2012/No1-Jan-2012/Advocacy-in-Community-and-Legislative-Arena.html?css=print

 

When you decide to purchase a new car, you first decide what is important to you. If mileage and dependability are the important factors, you will search for data focused more on these factors and less on color options and sound systems.

The same holds true when searching for research evidence to guide your clinical inquiry and professional decisions. Developing a formula for an answerable, researchable question that addresses your need will make the search process much more effective. One such formula is the PICO(T) format.

In this Discussion, you will transform a clinical inquiry into a searchable question in PICO(T) format, so you can search the electronic databases more effectively and efficiently. You will share this PICO(T) question and examine strategies you might use to increase the rigor and effectiveness of a database search on your PICO(T) question.

To Prepare:

• Review the materials offering guidance on using databases, performing keyword searches, and developing PICO(T) questions provided in the Resources.
• Review the Resources for guidance and develop a PICO(T) question of interest to you for further study.

By Day 3 of Week 4

Post your PICO(T) question, the search terms used, and the names of at least two databases used for your PICO(T) question. Then, describe your search results in terms of the number of articles returned on original research and how this changed as you added search terms using your Boolean operators. Finally, explain strategies you might make to increase the rigor and effectiveness of a database search on your PICO(T) question. Be specific and provide examples.