In a well-developed paragraph (300–350 words) to each peer integrating atleast 2 an evidence-based resource, APA format. Respectfully agree and disagree with the responses and explain your reasoning by including your rationales in your explanation.

Response 1

 The purpose of this post is to discuss diagnosis of RR case study. After reviewing the present complaint and past medical history of RR, this writer suspects that the patient has pneumonia. This writer suspects that either of the following S. pneumoniae, H. influenzae, S. aureus, or gram-negative bacteria was the cause of the infection (Woo, Terri Moser, Robinson & Marylou. 2020). This is because RR has symptoms of fever, chills, green sputum (Woo, Terri Moser, Robinson & Marylou. 2020). Additionally, RR has complaints of pain in the right mid-back with deep breathing and coughing (Woo, Terri Moser, Robinson & Marylou. 2020). Additionally, RR had rales during the auscultation of the lungs in the right lower-posterior lung field (Woo, Terri Moser, Robinson & Marylou. 2020). As a result, ordering a lung ultrasound is beneficial to solidify the diagnosis of pneumonia (Long et al., 2017).

Pneumonia is an infection of one or both lungs (Zambare & Thalkari. 2019). The cause of pneumonia is from either bacteria, viruses, or fungi (Zambare & Thalkari. 2019). As a healthcare provider assessing for the cause of pneumonia in patient RR is crucial because pneumonia can be life-threatening (Zambare & Thalkari. 2019). The goal of treatment is to return to the respiratory status before having pneumonia (Woo, Terri Moser, Robinson & Marylou. 2020). This writer would assess the last use of antibiotics to ensure no antibiotics in the past 3 months, and the patient was previously healthly with no cardiopulmonary disease (Woo, Terri Moser, Robinson & Marylou. 2020).The first choice antibiotic this writer would recommend to treat RR with is an advanced-generation macrolide, such as azithromycin or clarithromycin (Woo, Terri Moser, Robinson & Marylou. 2020). Erythromycin would mostly likely be used to treat RR pneumonia because it is the least expensive of the macrolides (Woo, Terri Moser, Robinson & Marylou. 2020). If RR is allergic to macrolide, then this writer would use doxycycline for treatment (Woo, Terri Moser, Robinson & Marylou. 2020). The patient should respond to treatment within 48 to 72 hours, unless the patient illness is not improving (Woo, Terri Moser, Robinson & Marylou. 2020). Due to RR not having any comorbidities fluoroquinolone ushc as moxifloxacin, gemifloxacin, or levofloxacin is not needed for treating pneumonia (Woo, Terri Moser, Robinson & Marylou. 2020).

Erythromycin is the medication used to treatment RR pneumonia. The mechanism of action for macrolide such as erythromycin is to suppresses protein synthesis at the level of the 50S bacterial ribosome (Vallerand & Sanoski. 2016). The therapeutic effect of erythromycin is bacteriostatic action against susceptible bacteria  (Vallerand & Sanoski. 2016). Educating and counseling the patient about the medication is essential for the patient to understand the treatment, expected adverse effects, drug interactions, and length of treatment (Woo, Terri Moser, Robinson & Marylou. 2020). Some of the adverse effects of erythromycin are nausea, vomiting, abdominal pain, and cramping  (Vallerand & Sanoski. 2016). Moreover, RR should be informed to take the medication as prescribed and until finished even if feeling better  (Vallerand & Sanoski. 2016). Patient will be educated that the response to treatment will assist in determining the pathogen (Woo, Terri Moser, Robinson & Marylou. 2020). This writer will discuss lifestyle modifications such as hydration, smoking cessation and rest (Woo, Terri Moser, Robinson & Marylou. 2020). A discussion of worsening symptoms of pneumonia with RR will occur (Woo, Terri Moser, Robinson & Marylou. 2020). Lastly, this writer will inform RR to contact this writer or seek urgent medical care for worsening symptoms (Woo, Terri Moser, Robinson & Marylou. 2020).

Response 2

 The purpose of this discussion is to assess and treat patient RR from the case study provided. RR could have several causes of these symptoms. The test I would focus on due to her health history and symptoms would be for pneumonia, however I would like to rule out Tuberculosis (TB)as well. Mycobacteria is responsible for TB and is defined as an atypical bacterium and are more difficult to treat than other forms of bacteria (Woo & Robinson, 2020). The most common bacteria that causes bacterial pneumonia in America is called Streptococcus pneumoniae (CDC, 2020). Bacterial pneumonia presents with all the symptoms RR lists: fever, productive green sputum, cough that causes pain, difficulty breathing, and rales. Smoking will exacerbate these symptoms. The rule out on TB would be because of her living conditions, patients who are in homeless shelters are at higher risks for being susceptible to TB (Brown, 2019).
The antibiotic used for bacterial community acquired pneumonia is most commonly a combination of azithromycin and ceftriaxone (Woo & Robinson, 2020). Because this condition has not yet been treated starting with the most generally used antibiotics would be recommended. If these medications do not work and the bacteria appears to be resistant other antibiotics can be initiated.
Azithromycin is known as a bacteriostatic or bactericidal antibiotic when given in higher doses (Woo & Robinson, 2020). This is a broad spectrum antibiotic that gram-negative and gram-negative bacteria are susceptible to. Ceftriaxone is a third generation cephalosporin medication that is recommended for broader indications and is more effective against gram-negative bacteria (Woo & Robinson, 2020).
The mechanism of action for azithromycin is that it binds to 50S ribosomal subunit of the causative bacteria and intercepts the detachment of peptidyl tRNA from the ribosomes. The bacteria are dependent on the RNA for protein synthesis therefore, without it the bacteria cannot synthesize (Medscape, 2020). Ceftriaxone works less successfully against gram-positive microorganisms, however, is a better choice for a cephalosporin for resistant organisms. This antibiotic inhibits the production of peptidoglycan which is the bacteria’s enzyme that builds its cell wall. This creates the bacteria lyse (Medscape, 2020).
Studies have concluded that the use of these two medications in a combination therapy has resulted in quicker recovery, less residual symptoms, and a decrease in sepsis occurrence and should be given to high risk patients (Caballero et al., 2011). Given RR’s health history and current living conditions I would conclude that she falls into the high risk population for pneumonia complications. I would also recommend that RR gets plenty of rest and fluid, educate on the benefits of smoking cessation (and offer a nicotine gum prescription), to take the full course of medication even if symptoms resolve, and to come back if any symptoms persist or worsen.

RUBRIC

 Peer Response Post. Offers both supportive and alternative viewpoints to the discussion, using two or more scholarly references per peer post. Post provides additional value to the conversation.

All instruction requirements noted.

40 pointsEvidence of further synthesis of course content. Provides clarification and new information or insight related to the content of the peer’s post.

Response is supported by course content and a minimum of one scholarly reference per each peer post.

All instruction requirements noted.

35 pointsLacks clarification or new information. Scholarly reference supports the content in the peer post without adding new information or insight.

Missing reference from one peer post.

Partially followed instructions regarding number of reply posts.

Most instruction requirements are noted.

31 pointsPost is primarily a summation of peer’s post without further synthesis of course content.

Demonstrates incomplete understanding of content and/or inadequate preparation.

Did not follow instructions regarding number of reply posts.

Missing reference from peer posts.

Missing several instruction requirements.

Submits post late.

27 points40Frequency of DistributionInitial post and peer post(s) made on multiple separate days.

All instruction requirements noted.

10 pointsInitial post and peer post(s) made on multiple separate days.

8 pointsMinimum of two post options (initial and/or peer) made on separate days.

7 pointsAll posts made on same day.

Submission demonstrates inadequate preparation.

No post submitted.

6 points10OrganizationWell-organized content with a clear and complex purpose statement and content argument. Writing is concise with a logical flow of ideas.

5 pointsOrganized content with an informative purpose statement, supportive content, and summary statement. Argument content is developed with minimal issues in content flow.

4 pointsPoor organization and flow of ideas distract from content. Narrative is difficult to follow and frequently causes reader to reread work.

Purpose statement is noted.

3 pointsIllogical flow of ideas. Prose rambles. Purpose statement is unclear or missing.

Demonstrates incomplete understanding of content and/or inadequate preparation.

No purpose statement.

Submits assignment late.

2 points5APA, Grammar, and SpellingCorrect APA formatting with no errors.

The writer correctly identifies reading audience, as demonstrated by appropriate language (avoids jargon and simplifies complex concepts appropriately).

Writing is concise, in active voice, and avoids awkward transitions and overuse of conjunctions.

There are no spelling, punctuation, or word-usage errors.

5 pointsCorrect and consistent APA formatting of references and cites all references used. No more than two unique APA errors.

The writer demonstrates correct usage of formal English language in sentence construction. Variation in sentence structure and word usage promotes readability.

There are minimal to no grammar, punctuation, or word-usage errors.

4 pointsThree to four unique APA formatting errors.

The writer occasionally uses awkward sentence construction or overuses/inappropriately uses complex sentence structure. Problems with word usage (evidence of incorrect use of thesaurus) and punctuation persist, often causing some difficulties with grammar. Some words, transitional phrases, and conjunctions are overused.

Multiple grammar, punctuation, or word usage errors.

3 pointsFive or more unique formatting errors or no attempt to format in APA.

The writer demonstrates limited understanding of formal written language use; writing is colloquial (conforms to spoken language).

The writer struggles with limited vocabulary and has difficulty conveying meaning such that only the broadest, most general messages are presented.

Grammar and punctuation are consistently incorrect. Spelling errors are numerous.

 

Data-Based Changes

Write an word essay addressing each of the following points/questions. Be sure to completely answer all the questions for each number item. There should be three sections, one for each item number below, as well the introduction (heading is the title of the essay) and conclusion paragraphs. Separate each section in your paper with a clear heading that allows your professor to know which bullet you are addressing in that section of your paper. Support your ideas with at least three (3) scholarly citations using APA citations in your essay. Make sure to reference the citations using the APA writing style for the essay. The cover page and reference page do not count towards the minimum word amount. Review the rubric criteria for this assignment.

1. Identify one aspect of big data and data mining that is interesting to you. Explain the concept and how it might bring value to healthcare. 
2. Describe the concept of continuity planning. If you were the director or manager for your current workplace, describe the preparedness program you would recommend.
3. Locate an article discussing the use of informatics in healthcare education of the general public or of nursing students. Discuss the benefits and drawbacks to using technology in this situation and recommendations from the author. Do you feel this use of technology is a viable method of educating (the public or nursing students)? Why or why not?

Students will:

• Develop effective documentation skills for family therapy sessions *
• Develop diagnoses for clients receiving family psychotherapy *
• Evaluate the efficacy of solution-focused therapy and cognitive behavioral therapy for families *
• Analyze legal and ethical implications of counseling clients with psychiatric disorders *

Select two clients you observed or counseled this week during a family therapy session. Note: The two clients you select must have attended the same family session. Do not select the same family you selected for Week 2.

Then, address in your Practicum Journal the following:

• Using the Group Therapy Progress Note in this week’s Learning Resources, document the family session.
• Describe each client (without violating HIPAA regulations) and identify any pertinent history or medical information, including prescribed medications.
• Using the DSM-5, explain and justify your diagnosis for each client.
• Explain whether solution-focused or cognitive behavioral therapy would be more effective with this family. Include expected outcomes based on these therapeutic approaches.
• Explain any legal and/or ethical implications related to counseling each client.
• Support your approach with evidence-based literature.

Regarding Alma I would first plan my approach to make her feel important in her care and respected. I would make eye contact, smile, introduce myself and clearly explain to the patient all my actions before doing them to attempt to build a rapport. I would assess the patient’s beliefs, daily activities, current behaviors, treatments and environment. All keeping in mind that this patient may take time to accept me as someone she wants to trust. Issues and experiences are going to be very important to analyze to get to underlying reasons the patient acted like this. I also would make sure to assess patient understanding of medical history, and current medicatons. I would speak clearly, slowly, and in normal tone repeating as necessary to the patient as needed. However, I would aim for patient centered care and involvement, since the reading says the patients that are complaint are just following instruction rather than making a choice I would much rather follow strategies that empower the patient to be active in health care. Collaboration is between the patient, physician, nurses, pharmacist, dietician and any other provider that is part of the care team. Effective communication and collaboration between health professional and patient, guided by factual information and experience of the health professional, allows patients to make informed choices about an agreed upon recommendation (Falvo, 2011). Outcomes are more favorable when patient centered care and collaboration are applied.

Research suggests strategies that can be rememebered by the pneumonic “SIMPLE”

S= Simplifying regimen characteristics such as adjusting medications (time, dosage, frequency), matching the patient with activities of daily living, using reminders of changes in routine (medication reminders, excercise ot routine reminders, medication boxes with daily routine planned out)

Imparting knowledge= distributing written pamphlets, or handouts. Discussing with care team (nurse, physician, pharmacist). Analyzing patient knowledge and

M= Modifying patient beliefs- Assessing perceived susceptibility, severity, benefit, and barriers. Rewarding, tailoring, and contingency contracting

P= Patient and family- providing patient with clear messages and active listening. Including the patient in decisions regarding care. Sending reminders or follow up via email, phone, call or mail.

L= Leave the bias- Tailoring the education to patients’ level of understanding

E-Evaluate adherence- Patient self reporting is most common. Pill counting or logging of activities.

“Clinicians can optimize behavior change by ensuring that the patients (1) perceive themselves to be at risk due to lack of adoption of healthy behavior (perceived susceptibility), (2) perceive their medical conditions to be serious (perceived severity), (3) believe in the positive effects of the suggested treatment (perceived benefits), (4) have channels to address their fears and concerns (perceived barriers), and (5) perceive themselves as having the requisite skills to perform the healthy behavior (Atrja, Bellam, &Levy, 2005).”

Reference:

Atreja, A., Bellam, N., & Levy, S. R. (2005). Strategies to enhance patient adherence: making it simple. MedGenMed : Medscape general medicine, 7(1), 4.

Falvo, D. (2011). Effective Patient Education: A Guide to Increased Adherence. Retrieved from https://www.gcumedia.com/digital-resources/jones-and-bartlett/2010/effective-patient-education_a-guide-to-increased-adherence_ebook_4e.php

REPLY2

There are many different efforts that could be taken in order to use collaboration to assist in compliance with a patient as difficult as Alma.The first effort could be integrating the family member, significant other or caretaker in with the patient education and treatment plan.This would give Alma someone that she trusts involvement in her care, which would be supplemental support in ensuring Alma remained compliant in her care, especially post-procedurally when Alma will need to follow after care instructions to avoid complications.Another source of collaboration is a multi-disciplinary approach.This type of care would require the collaboration and coordination among healthcare professionals involved in Alma’s care such as the general practitioner, pharmacists, health insurers and other practitioners involved in her care.Not only would all of her healthcare providers be aligned in her care, it alleviates some risk of polypharmacy and any conflict of interests between providers.Having a health insurer involved in the collaboration can reduce dispersion in care that could result in higher costs, which would ultimately decrease the cost strain on the patient.Finally, it would be of most importance to ensure Alma was part of the collaboration so that she felt empowered in her decision-making and was an active participant in her treatment plan.Combining all factors of this collaboration would help ensure that Alma was compliant in her procedure and post-procedural medications.

References:

Costa, E., Giardini, A., Savin, M., Menditto, E., Lehane, E., Laosa, O., . . . Marengoni, A. (2015, September 14). Interventional tools to improve medication adherence: Review of literature. Retrieved October 06, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4576894/