1.

Find a minimum of ten peer-reviewed journal articles in regards to the use of steroids injections for chronic or acute pain written in the last 5 years or less. Use the Appendix G Individual Evidence Summary Tool to synthesize and organize your findings (SEE APPENDIX G FORM ATTACHED BELOW). 

Submit the completed Appendix G table with the attached reference for all articles in APA format.

2.

When appraising the literature complete either Appendix E or F (SEE APPENDIX E and F FORM ATTACHED BELOW). Depending on whether your article is research or non-research. Do this for one of your final articles. 

Reference in APA format for the article 

 

This week students will complete an APA paper to address the following case study

Amish Case Study:

After an Ohio Medina County judge ruled that Andy and Anna Hershberger, the parents of a 10-year-old girl, had the right to choose what was medically best for her, an appeals court reversed the decision and sided with a hospital that is fighting to resume her chemotherapy after her parents terminated the treatment. The Hershbergers are a deeply religious Amish family, who chose to take a different route from modern medicine after Sarah became ill from chemotherapy in June. The girl reportedly begged her parents to stop her chemotherapy and testified in court against resuming the treatment. “Our belief is, to a certain extent, we can use modern medicine, but at some times we have to stop it and do something else,” her father told the AP. They plan on going to a wellness center and turning to natural medication such as herbs and vitamins in the hopes that they could help her without putting her in pain. Akron Children’s Hospital, where Sarah had begun her chemotherapy, strongly advocated for the girl to continue her chemo, stating that it was a matter of life or death.

Sarah has lymphoblastic lymphoma, a form of non-Hodgkin lymphoma that rarely affects adults but is most often found in people under 35. It is reported to have a five-year survival rate of 85 percent if the patient undergoes chemotherapy. Lymphoma is a blood cancer that occurs when white blood cells divide faster than regular cells, causing tumors of lymphoid cells to grow throughout the body, typically in lymph nodes. “Although there’s all these dire medical predictions they (Sarah’s parents) would refute that by saying this is matter beyond the province of mortal man,” the Hershbergers’ attorney John Oberholtzer told WKYC. “You have to have a kind of faith that a lot of us don’t have…they absolutely have that faith.” He added that Sarah’s parents might take the case to the Ohio Supreme Court, and that it could potentially set a legal precedence with regards to who should hold the rights over a child’s medical decisions when it’s a life or death situation. “There has never been an allegation of parental unfitness, nor has the hospital or anyone else requested legal or physical custody of this child,” Akron Children’s Hospital said in a statement. “This involves a disagreement between providers and parents over what course of treatment is best for their child.” The hospitals’ chief medical officer Robert McGregor said last week that they had a moral and legal duty to ensure that Sarah receives the treatment that is in her best interest.

Bushak, L. (2013, Aug. 9). Court rules that Sarah Hershberger, Amish girl battling cancer, should be appointed legal guardian after parents stop her chemotherapy.  Medical Daily. Retrieved from http://www.medicaldaily.com/court-rules-sarah-hershberger-amish-girl-battling-cancer-should-be-appointed-legal-guardian-after

Address the following questions regarding the case study

1. What are the facts of the case? This should include: what do we need to know, who is involved in the situation, where does the ethical situation take place, and when does it occur?
2. What is the precise ethical issue in regards to autonomy, nonmaleficence, beneficence, fidelity, and justice?
3. Identify the major principles, rules, and values of the case.  Values are sets of beliefs about good and bad, right and wrong, and about many other aspects of living and interacting in the society with others. A principle is a personal rule that governs personal behavior. A rule is generally imposed by a figure of authority, and used to guide and govern people.
4. Are there alternative to the actions completed in this case by both the parents and healthcare facility?
5. Do you feel, in this case, the hospital is honoring the religious and cultural beliefs of the patient and her family? Can a hospital take a Jehovah Witness to court to receive a medically needed blood transfusion?  Is this case different due to the age of the patient? Explain and support your answer.
6. If you were a member of the ethics committee at this facility, what actions would you recommend in this case? Would you be in support of the facility or family? Explain and support your decision.

For the case study, an APA formatted paper should be used, and needs to include a title page, level headings, references and citations. This assignment should include at least 2 references and should be at least five pages in length. Students should address the proposed questions providing ample detail, examples, and additional support.

Assignment Expectations:  

• Length:
  • answers must thoroughly address each question in a clear, concise manner; complete answers will likely take 5-6 pages
• Structure:
  • Reference page required
  • address each question in a numbered list
• References:
  • Two references required

Read

1. Legal and Ethical Issues for Health Professionals: Chapters 7-8 (Pages: 59)
2. Aspen Library
   • Court intervenes in cancer treatment of Ohio Amish child. (2013, Oct.). Church & State, 66, 21. 
   • Court sides with Ohio hospital on Amish girl care. (2013, Aug 29). Bismarck Tribune.
   • Seewer, J. (2013, Nov 28). Amish family flees from chemo doctors say girl will die; Parents say she’s better. Journal – Gazette. 
   • Banfield, A., Conley, M., Valencia, N., & Sashin, D. (2013). Black friday brings out millions; amish girl in hiding; sisters held captive; bride loses groom in honeymoon accident. Atlanta: CQ Roll Call. Retrieved from https://search.proquest.com/

  DISCUSSION 1 

TO.

Disorder: Depression

I chose to complete the scenario on a 70-year-old male presenting with symptoms of depression.  

Background information: 

70-year-old Hispanic male 

Death of mother at a young age 

Occasional back pain & stiff shoulders 

Insomnia 

Poor concentration 

Montgomery Asberg Depression Rating Scale 51 I indicates (severe depression). 

I would not prescribe phenelzine 15mg TID because it’s an MAOI and could interact with common tyramine foods such as processed meats, cheese, & avocado commonly found in the diet of Hispanic people. 

Common barriers to treatment of depression in Hispanics include lack of information about mental health services, fewer linguistically & culturally trained providers representative of the Hispanic community (Camacho et al.,2018). 

SSRIs are the first-line treatment for major depression (McCance & Huether, 2019). 

I chose to treat the patient with an SNRI (Venlafaxine). I believe it would benefit the patient by treating his to major depression & chronic pain. Other benefits of Venlafaxine include it is deemed to have fewer side effects, is safe in older adults, and has fewer drug interactions. 

Venlafaxine (Effexor) can be used to treat major depression & chronic pain (McCance & Huether, 2019). 

I decided to start the patient on Effexor (Venlafaxine) 37.5mg 1 PO QD. 

Pathophysiology of Venlafaxine: Venlafaxine was found to be effective in managing depression by blocking Norepinephrine and serotonin reuptake. It also has weak blocking of dopamine reuptake (McCance & Huether, 2019). 

As a result of this, the patient returns in 4wks with no change in depressive symptoms. I later decided to increase the dose to 75mg PO QD. A second Montgomery Depression screening was completed, the patient scored a 38. 

Next, the Client returns to the clinic in 4wks, 

reports improvement of depressive symptoms.  

Rosenthal & Burchum (2021) explain a clinician has the following options if the first dose is ineffective: increase the dose of the first drug, switch to another drug in the same class, switch to another drug in a different class, or add an atypical antidepressant as a second drug. 

To prevent a relapse, I would continue the therapy for 4 to 9 mos.  I would educate the patient on continuing therapy even if there are no symptoms. I would encourage the patient to attend Behavioral Health counseling and include his family members in his plan of care. Camacho et al. (2018) suggest recruiting a bilingual psychotherapist to help promote a welcoming & safe environment for a patient to express emotions. Frequent monitoring of the patient would be necessary, to observe for s/s of suicidal ideation. 

References: 

Camacho, D., Estrada, E., Lagomasino, I. T., Aranda, M. P., & Green, J. (2018). Descriptions of depression and depression treatment in older Hispanic immigrants in a geriatric collaborative care program. Aging & Mental Health, 22(8), 1056–1062. https://doi-org.ezp.waldenulibrary.org/10.1080/13607863.2017.1332159 

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier. 

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier. 

DISCUSSION 2

L.

The psychological disorder that was presented in my presentation was bipolar I disorder. A female of Korean decent presented with bipolar disorder in a manic state. She had been recently hospitalized and discharged on lithium for mania. Prior to her follow up in the clinic the patient had decided to discontinue the medication on her own which had exacerbated her condition. When presenting to the clinic, she was labile and euphoric. I had made the decision to start her on Risperdal 1 mg orally BID. After this decision point, she returned to the clinic accompanied by her mother and was very sedated and lethargic. The mother had stated that she had been like this for about a week after her left office visit. Though I was happy that she continued to take her medication and it was obviously controlling some of her symptoms, that obviously had been too strong of a dosage. This is most likely because of her CYP2D6*10 allele from her Korean descent, simply her genetics which led her course of treatment following differently. At the second office visit, I had decided to decrease the Risperdal to 1 mg at HS With another follow-up visit in four weeks again. When the client had returned, she was much less sedated, and showing symptoms of improvement. Her young mania rating scale had been priest from 22 for 16, which was a 25% decrease in her presenting symptoms. At this point I had advised the patient to continue the same dose of Risperdal and reassess again in another 4 weeks. I wanted to see how the patient would respond while on this same dose of Risperdal as the CYP2D6*10 allele gives her a slower clearance of Risperdal from her system which is most likely what had resulted in higher than normal levels of sedation. Puangpetch et. al. 2016 states that CYP2D6 is associated with plasma concentrations of risperidone as it is a poor metabolizer and showed more serious adverse events than those without this allele. This is why the patient’s symptoms while on this medication were of that extreme for a relatively low dose especially to start with. Vuppalaanchi also states that the metabolism of risperidone specifically is again by CYP2d6 and is also is responsible for up to 20% of drugs that undergo biotransformation and is a poor metabolizer. 

References

Bipolar Therapy. (2020). http://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_04/index.html

Puangpetch, A., Vanwong, N., Nuntamool, N., Hongkaew, Y., Chamnanphon, M., & Sukasem, C. (2016). CYP2D6 polymorphisms and their influence on risperidone treatment. Pharmacogenomics and personalized medicine, 9, 131–147. https://doi.org/10.2147/PGPM.S107772

Vuppalanchi, R. (2011). Metabolism of Drugs and Xenobiotics. Retrieved from https://doi.org/10.1016/B978-0-443-06803-4.00004-6

 

Describe how providing culturally appropriate care is a challenge for the advanced practice nurse. The phenomena of communication according to Giger and Davidhizar’s model can shape care.  

How Giger and Davidhizar’s model can shape care? Or how this theory applies to care?

Describe appropriate ways to communicate with patients from various cultures.

Mention strategies that you can use to communicate appropriately to patients.

How communication influences patient care?

Should be a minimum of 350 words, scholarly written, no older than 5 years, use APA 7 formatted, and referenced.  A minimum of 2 references is required.  

Discussion: Assessing Musculoskeletal Pain

Photo Credit: Getty Images/Fotosearch RF

The body is constantly sending signals about its health. One of the most easily recognized signals is pain. Musculoskeletal conditions comprise one of the leading causes of severe long-term pain in patients. The musculoskeletal system is an elaborate system of interconnected levers that provides the body with support and mobility. Because of the interconnectedness of the musculoskeletal system, identifying the causes of pain can be challenging. Accurately interpreting the cause of musculoskeletal pain requires an assessment process informed by patient history and physical exams.

In this Discussion, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.

Case 2: Ankle Pain

A 46-year-old female reports pain in both of her ankles, but she is more concerned about her right ankle. She was playing soccer over the weekend and heard a “pop.” She is able to bear weight, but it is uncomfortable. In determining the cause of the ankle pain, based on your knowledge of anatomy, what foot structures are likely involved? What other symptoms need to be explored? What are your differential diagnoses for ankle pain? What physical examination will you perform? What special maneuvers will you perform? Should you apply the Ottawa ankle rules to determine if you need additional testing?

With regard to the case study you were assigned:

·  Review this week’s Learning Resources, and consider the insights they provide about the case study.

·  Consider what history would be necessary to collect from the patient in the case study you were assigned.

·  Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?

·  Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.