To support your work, use your course and text readings as well as the South University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format. Patient or lay person medical information portals such as webMD, Medscape, Mayo Clinic, or any disease foundations, such as the arthritis foundation or the diabetic foundation, are not acceptable resources for your scholarly work.

Response #1 Post a response to one peer in your discussion group. In the post identify the organ damage that can occur as a result of Hypertension. Describe the pathophysiologic process of the organ damage.

Peer Post

Physiology of Blood Pressure Control

              The body’s blood pressure is a measure of the pressures within the cardiovascular system during the pumping cycle of the heart. The blood pressure or systemic arterial pressure refers to the pressure measured within large arteries in the systemic circulation.   Each heartbeat forms a pressure wave that travels down the arterial system. The peak of the wave occurs during systole when blood is under pressure from cardiac contraction making the arterial wall expand.  During diastole when the heart is briefly relaxing-the arterial walls recoil, delivering a pulse.  Systemic circulation provides oxygenated blood to all organs in the body. After perfusing the organs, blood is returned to the right atrium of the heart through the systemic venous system (Lowry, 2016).

              Cardiac output is a major factor determining blood pressure, however, as blood flows into the arterial system it meets resistance (in the form of friction) from contact with blood vessel walls.  The main resistance to blood flow occurs in the arterioles, which are smaller vessels formed from the branching of arteries (Lowry, 2016). Resistance from all blood vessels in the systemic circuit combines to produce the systemic vascular resistance, which increases blood pressure in the systemic arterial system.  These two factors together cardiac output and the systemic vascular resistance, generate actual blood pressure in the systemic arterial system (Lowry, 2016).

Overactivity of the Sympathetic Nervous System (SNS)

 Decreased arterial pressure is detected by baroreceptors, which trigger a sympathetic response.  This stimulates an increase in heart rate and cardiac contractility leading to increased blood pressure.  The sympathetic nervous system serves as the final common pathway for controlling the smooth muscle tone of the blood vessels.  Most of the sympathetic preganglionic fibers that control vessel function originate in the vasomotor center of the brain stem and travel in the intermediolateral column of the spinal cord and exit with the ventral nerves; they then synapse with postganglionic fibers in the paravertebral ganglia.  Increasing sympathetic activity causes constriction of some vessels, such as those of the skin, gastrointestinal tract, and kidneys (Porth, 1998).

Overactivity of the Renin-Angiotensin-Aldosterone System (RAAS)

 The renin-angiotensin-aldosterone system is an essential regulator of arterial blood pressure.  The system relies on several hormones that act to increase blood volume and peripheral resistance.  It begins with the production and release of renin from juxtaglomerular cells of the kidney.  They respond to decreased blood pressure, sympathetic nervous system activity, and reduced sodium levels within the distal convoluted tubules of the nephrons.  In response to these triggers, renin is released from the juxtaglomerular cells and enters the blood where it comes in contact with angiotensinogen which is produced continuously by the liver.  The angiotensinogen is converted into angiotensin I by renin.  The angiotensin I then make its way to the pulmonary vessels, where the endothelium produces the angiotensin-converting enzyme (ACE).  Angiotensin I is then converted to angiotensin II by ACE (Shahoud et al., 2020).  Angiotensin II is a potent vasoconstrictor.  It acts directly on the kidney to increase sodium reabsorption in the proximal convoluted tubule.  Sodium is reabsorbed via the sodium-hydrogen exchanger.  Angiotensin II also promotes the release of aldosterone (Lowry, 2016). 

A complex interaction involving insulin-resistance and endothelial function

 The endothelium, which lies between the blood and the vascular smooth muscle, serves as the physical barrier for vasoactive substances that circulate in the blood.  The endothelium plays an active role in controlling vascular function.  In capillaries, which are composed of a single layer of endothelial cells, the endothelium is active in transporting cell nutrients and wastes.  In addition to its function in capillary transport, the endothelium removes vasoactive agents such as norepinephrine from the blood, and it produces enzymes that convert precursor molecules to active products (Porth, 1998).

References

Lowry, M. (2016).  The Physiology of blood pressure regulation.  Retrieved on April 24, 2021 from  

https://www.nursingtimes.net.

Porth, C. (1998).  Pathophysiology: Concepts of Altered Health States. (5th ed.) Philadelphia,

          PA: Lippincott-Raven; ISBN 0-397-55413-3

Shahoud J, Sanvictores T, & Aeddula N. (2020). Physiology, Arterial Pressure Regulation.  Retrieved on       

              April 14, 2021 from: https://www.ncbi.nlm.nih.gov/books.

 

Create a board or PowerPoint presentation of important learning resources learned throughout the course. Explain approaches to community intervention and evaluation. Implement a teaching and evaluation plan. You will also review and give feedback to the presentation of 2 classmates.

To prepare for the presentation, complete the following steps:

1. Choose one topic from the prevention strategies and intervention recommendations identified in your Community Family Assessment.
   • You will be teaching your client from module 4: the family.
   • For example –  if the family assessment from Module 4 indicated they need to be taught about Diabetes, then that is your topic for this assignment. If they have communication issues, then you teach about effective communication.
2. Develop a teaching plan, including objective, content outline, teaching method, and time in a table format.
3. Develop an evaluation plan for your teaching intervention and create a tool for feedback from your learners.
   
   • For example – Use a questionnaire to confirm they learned the content.

Implement the teaching plan and evaluation during Visit 5 of your clinical experience and then:

• Summarize the outcomes of your teaching plan and evaluation.
• Include your teaching plan, evaluation tool, and summary.
• You may refer to the Presentation module 6 on attachment for guidance.

Submission Instructions:

• Produce a video by using Studio (formerly known as Arc) record (voice-over) your presentation. See instructions here (Links to an external site.).
  • Instructional Design and Technology at STU. (2020, August). How to use Studio [Video]. YouTube. https://youtu.be/lcd16g_dY5E How to Use Studio (Links to an external site.)
• Complete and submit the assignment by 11:59 PM ET Sunday.

Peer Review Submission Instructions:

• Click here to learn how to complete a peer review assignment. (Links to an external site.)

Grading Rubric 

Your assignment will be graded according to the grading rubric.

MODULE 4

• Community and Aggregate Assessment (9:00)
  NursingEducationRes. (2009, October 29). Community and aggregate assessment [Video]. YouTube. https://youtu.be/VWdM9tM1LDU
  Community Aggregate Assessment (Links to an external site.) 

Online Materials & Resources

• World Renew Disaster Relief (Links to an external site.)
  World Renew. (2020, May 5). Disasters. https://worldrenew.net/domestic-disaster-0

 The health policy I selected for this week’s discussion is H.R.2975 – Women’s Health Protection Act of 2019. In short, this policy was introduced in house in May of 2019 with the goal to allow women to have the right to choose to bear children or end an unwanted pregnancy and to protect the health care providers’ involvement in providing abortion services (Congress.gov, n.d.). The conversation of abortion, like many health topics, can be a sensitive subject and due to the controversial nature of this medical intervention there is poor data to look at actual rates of abortion in the United States (Ahrens & Hutcheon, 2020). Along with occurrence rates and trends it is also important that research is looking at safety and accessibility related to abortion (Ahrens & Hutcheon, 2020). One piece that really stands out for me is the importance of safety for medical providers to feel comfortable providing this medical procedure. Violent threats and harassment can be very stressful and create a dramatic decrease in accessibility of care for patients and providers do not feel safe practicing abortion (Hall, 2020). I believe the Women’s Health Protection Act of 2019 plays an important role in creating better data, safety and accessibility for women of our country in need of medical assistance for unwanted births.  

 

Required Resources
Read/review the following resources for this activity:

• Textbook: Chapter 21, 22, 23
• Lesson
• Minimum of 2 scholarly sources
• Assignment Template download

Instructions

Objective:
Select a publication or a newspaper article on a pathogen, apply knowledge learned in BIOS242, and write a paper.

The goal for this project is:

• to make connections between concepts learned in the course and what is observed in a health care setting
• to understand real-life applications of Microbiology

Project Parameters:
For this assignment, you will identify a pathogen in a newspaper article or publication of your choice, apply principles learned in BIOS 242, and research the pathogen for its connection to nursing/health care. You must get approval for your chosen article and pathogen. You will then write a paper on their chosen pathogen/topic. Use the template hyperlinked above when writing your paper.

The pathogen can be a bacteria, fungus, protozoa, or virus. In addition to the article, information to include in the paper should include, morphology, gram stain characteristics, virulence factors, susceptibility to antibiotics, host cells, nutritional needs, growth conditions, mechanisms used to evade the immune system and invasion into the host(s), interactions with the hosts and diseases caused and affected body systems. Additionally, students should explain symptoms when the pathogen infects a host, as well as a diagnosis and the therapeutic intervention needed after infection. You may also add information on statistics related to infection (epidemiology) and any new research findings related to the pathogen.

Writing Requirements (APA format)

• Length: 2 pages (not including title page or references page) 
• 1-inch margin
• Double spaced
• 12-point Times New Roman font
• Title page
• References page (minimum of 2 scholarly sources)

Grading
This activity will be graded using the provided rubric.

Course Outcomes (CO): 10, 11

Due Date: By 11:59 p.m. MT on Sunday

PLEASE FOLLOW THE INSTRUCTIONS AS INDICATED BELOW:

1). ZERO (0) PLAGIARISM

2). ATLEAST 5 REFERENCES, NO MORE THAN 5 YEARS

3).  PLEASE SEE THE ATTACHMENT FOR RUBRIC DETAILS. 

4). Please review and follow the grading rubric details well, and include each component in the assignment as required. Also, follow the APA writing rules and style, introduction, conclusion.

Psychological disorders, such as depression, bipolar, and anxiety disorders can present several complications for patients of all ages. These disorders affect patients physically and emotionally, potentially impacting judgment, school and/or job performance, and relationships with family and friends. Since these disorders have many drastic effects on patients’ lives, it is important for advanced practice nurses to effectively manage patient care. With patient factors and medical history in mind, it is the advanced practice nurse’s responsibility to ensure the safe and effective diagnosis, treatment, and education of patients with psychological disorders. 

 

For this Discussion, you will select an interactive media piece to practice decision making when treating patients with psychological disorders. You will recommend the most effective pharmacotherapeutic to treat the psychological disorder presented and examine potential impacts of pharmacotherapeutics on a patient’s pathophysiology.

To Prepare

• Review this week’s interactive media pieces and select one to focus on for this Discussion.
• Reflect on the decision steps in the interactive media pieces, and consider the potential impacts from the administration of the associated pharmacotherapeutics on the patient’s pathophysiology.

Post a brief explanation of the psychological disorder presented and the decision steps you applied in completing the interactive media piece for the psychological disorder you selected. Then, explain how the administration of the associated pharmacotherapeutics you recommended may impact the patient’s pathophysiology. How might these potential impacts inform how you would suggest treatment plans for this patient? Be specific and provide examples.

 

Adult/Geriatric Depression
Hispanic Male With MDD

BACKGROUND INFORMATION

The client is a 70-year-old Hispanic American male who came to the United States when he was in high school with his father. His mother died back in Mexico when he was in school. He presents today to your office for an initial appointment for complaints of depression. The client was referred by his PCP after “routine” medical work-up to rule out an organic basis for his depression. He has no other health issues with the exception of some occasional back pain and “stiff” shoulders which he attributes to his current work as a laborer in a warehouse.

SUBJECTIVE

During today’s clinical interview, client reports that he always felt like an outsider as he was “teased” a lot for being “black” in high school. States that he had few friends, and basically kept to himself. He describes his home life as “good.” Stating “Dad did what he could for us, there were 8 of us.” He also reports a remarkably diminished interest in engaging in usual activities, states that he has gained 15 pounds in the last 2 months. He is also troubled with insomnia which began about 6 months ago, but have been progressively getting worse. He does report poor concentration which he reports is getting in “trouble” at work.

MENTAL STATUS EXAM

The client is alert, oriented to person, place, time, and event. He is casually dressed. Speech is clear, but soft. He does not readily make eye contact, but when he does, it is only for a few moments. He is endorsing feelings of depression. Affect is somewhat constricted, but improves as the clinical interview progresses. He denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment and insight appear grossly intact. He is currently denying suicidal or homicidal ideation. You administer the “Montgomery- Asberg Depression Rating Scale (MADRS)” and obtained a score of 51 (indicating severe depression).

RESOURCES

§ Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389.

  Decision Point One

Select what you should do: 

Begin zoloft 25 mg orally dailyBegin Effexor XR 37.5 mg orally dailyBegin Phenelzine 15 mg orally TID. 

(There are three different medications above; Zoloft, Effexor, and Phenelzine. Choose Zoloft 25mg for me and follow the Decision Points one, two, and three as indicated).

 Decision Point One

Begin zoloft 25 mg orally daily

RESULTS OF DECISION POINT ONE

• Client returns to clinic in four weeks
• Reports a 25% decrease in symptoms
• Client is concerned over the new onset of erectile dysfunction

  Decision Point One

Begin Effexor XR 37.5 mg orally daily

RESULTS OF DECISION POINT ONE

• Client returns to clinic in four weeks
• Client reports that there is no change in depressive symptoms at all

 Decision Point One

Begin Phenelzine 15 mg orally TID

RESULTS OF DECISION POINT ONE

• Client returns to clinic in four weeks
• Client reports that he was rushed to the Emergency Room 2 weeks ago after collapsing at the warehouse where he works. He was taken by ambulance to the local community hospital. He was diagnosed with postural hypotension
• Client was treated with fluid bolus and told to stop taking his phenelzine and to follow up with his primary care provider within one week, and you within that same time frame

Decision Point Two

Select what you should do next:

Restart Phenelzine and counsel client on dietary choices and importance of hydrationPhenelzine is not reinitiated. Instead, we began therapy with Lexapro 20 mg orally daily after an appropriate “wash out” period (5 half-lives).Re-start Phenelzine 7.5 mg orally TID 

 Decision Point Two

Restart Phenelzine and counsel client on dietary choices and importance of hydration

RESULTS OF DECISION POINT TWO

• Client reports that although he had no more episodes of passing out, he has been dizzy when he gets up at night to use the bathroom
• Client also reports that at various times throughout the day when he goes from a sitting to a standing position, he feels light-headed

 Decision Point Two

Re-start Phenelzine 7.5 mg orally TID

RESULTS OF DECISION POINT TWO

• Client returns to clinic in four weeks
• Client reported that he still has a little dizziness
• Client also reports that that his depression has improved greatly (a 35% decrease in MADR scale from 51 to 33)

 Decision Point Three

Select what you should do next:

Continue current drug dose and counsel client on dietary modifications and orthostatic hypotension safetyAugment with Lexapro 10 mg orally dailyIncrease dose of Phenelzine back to 15 mg orally TID now that the client is tolerating lower dose 

 Decision Point Three

Continue current drug dose and counsel client on dietary modifications and orthostatic hypotension safety

Guidance to Student
The initiation of an SSRI or SNRI should not begin until an adequate “wash out” period of MAOI- this is generally defined as the time it takes for 5 half-lives of the drug to be metabolized. Co-administration of SSRI, SNRI, or TCA with MAOI is contraindicated as it can cause serotonin syndrome and can actually be fatal. You can continue the current dose and counsel client as to dietary modifications as well as orthostatic hypotension safety, however, it should be remembered that he works in a warehouse and may be at risk for falls/injury due to orthostatic hypotension. A “watch and wait” approach may be appropriate if the client has failed all other antidepressants. Increasing the dose back to 15 mg orally TID is not indicated as his orthostatic hypotension will likely worsen.

“PLEASE LET ME KNOW IF YOU NEED ANY CLARIFICATION”.