1. Provide three differential diagnoses based on Janet’s subjective and objective data and discuss your reasoning for each.

Hay fever, food allergies and viral infection that presents as a cold with allergic symptoms would be the top three indications based off of the signs and symptoms being presented by Janet (Mayo Clinic, 2019b). Hay fever causes seasonal allergies along with a clear runny nose, post-nasal drip and irritated nares. Food allergies can cause eczema and allergic symptoms affecting the ear note and throat (Mayo Clinic, 2017). A viral infection such as the common cold can also exacerbate a runny nose, sneezing, post-nasal drainage and inflamed lymph nodes (Mayo Clinic, 2019a).

2. What additional history questions would be useful in your evaluation of Janet?

You can ask valid questions such like when did the symptoms begin? Have you been around anyone else who is sick? What makes the symptoms worse? Have you had a recent in change in environment or food? What makes the symptoms seem worse or better? Have you tried taking any medication and if so, what has worked/not worked? Does anyone in your family suffer from any allergies? Have you had seasonal/food allergies ever checked? 

3. Discuss the pathophysiological process of your primary diagnosis.

Janet is suffering from Hay fever during the changes in seasons during Spring and Fall which is when pollen counts are elevated. According to Mayo Clinic (2019) Hay fever, also called allergic rhinitis, causes cold-like signs and symptoms, such as a runny nose, itchy eyes, congestion, sneezing and sinus pressure. But unlike a cold, hay fever isn’t caused by a virus. Hay fever is caused by an allergic response to outdoor or indoor allergens, such as pollen, dust mites, or tiny flecks of skin and saliva shed by cats, dogs, and other animals with fur or feathers (pet dander).

4. Differentiate the types of hypersensitivity mechanisms.

Type I hypersensitivity is also known as immediate or anaphylactic hypersensitivity. The reaction may involve skin (urticaria and eczema), eyes (conjunctivitis), nasopharynx (rhinorrhoea, rhinitis), bronchopulmonary tissues (asthma) and gastrointestinal tract (gastroenteritis). The reaction may cause a range of symptoms from minor inconvenience to death. The reaction usually takes 15 – 30 minutes from the time of exposure to the antigen, although sometimes it may have a delayed onset of 10-12 hours (Ghaffar, 2016).

Type II hypersensitivities are also known as cytotoxic hypersensitivities and may affect a variety of organs and tissues. The antigens are normally endogenous, although exogenous chemicals (haptens) which can attach to cell membranes and lead to type II hypersensitivity. Drug-induced hemolyticanemia, granulocytopenia and thrombocytopenia are examples. The reaction time is minutes to hours. Type II hypersensitivity are primarily mediated by antibodies of the IgM or IgG classes and complement. Phagocytes and K cells may also play a role (Ghaffar, 2016).

Type III hypersensitivity is also known as immune complex hypersensitivity. The reaction may be general such as serum sickness or may involve individual organs including skin like systemic lupus erythematosus, an Arthur reaction, kidneys, lupus-nephritis, lungs-aspergillosis, blood vessels-polyarteritis, joints-rheumatoid arthritis, or other organs. This reaction may be the pathogenic mechanism of diseases caused by many microorganisms.

Type IV hypersensitivity is involved in the pathogenesis of many autoimmune and infectious diseases (tuberculosis, leprosy, blastomycosis, histoplasmosis, toxoplasmosis, leishmaniasis, etc.) and granulomas due to infections and foreign antigens. Another form of delayed hypersensitivity is contact dermatitis such as with poison ivy, and heavy metals (Ghaffar, 2016).

5. As per your analysis, what type of hypersensitivity reaction is Janet experiencing?

Allergic disorders (type I hypersensitivity) associated with asthma, hay fever, and drug reactions, as well as parasitic infections (particularly with metazoan parasites) are often cited as causes. Allergic reactions can present as the patient having and increased number in eosinophilia is an absolute increase (more than 450/μL) in the total numbers of circulating eosinophils (McCance&Huether, 2014).

References

Ghaffar, A. (2016, April 2). Hypersensitivity reactions. Retrieved from http://www.microbiologybook.org/ghaffar/hyper00.htm

Mayo Clinic. (2019, April 20). Common cold Symptoms and causes. Retrieved from https://www.mayoclinic.org/diseases-conditions/common-cold/symptoms-causes/syc-20351605

Mayo Clinic. (2017, May 2). Food allergy Symptoms and causes.Retrieved from https://www.mayoclinic.org/diseases-conditions/food-allergy/symptoms-causes/syc-20355095

Mayo Clinic. (2019, March 19). Hay fever symptoms and causes.Retrieved from https://www.mayoclinic.org/diseases-conditions/hay-fever/symptoms-causes/syc-20373039

McCance, K., Huether, S. (2014). Pathophysiology: The Biologic Basis for Disease in Adults and Children, (7th Ed). Mosby, St. Louis, Missouri. [Vital Book File]. HASDOIHFOCINDLKCNBION

 Nursing Theories: An OverviewSource Link: http://currentnursing.com/nursing_theory/nursing_theories_overview.html

Prompt: 

What is my experience with nursing theory?  Have I ever seen nursing theory in practice?  How important do I think nursing theory is to nursing practice? What do I find most interesting about what I am learning about nursing theory? Is my mind and heart open to learning to see nursing from a different perspective?

Summary: The purpose of the Reflective Journal is to allow for analysis, synthesis and evaluation of nursing theory using guided questions. Reflection in Action has been referred to as a process that happens internally, privately or in isolation (Hill & Watson, 2011). Also, a useful definition of reflection has been referred to as the examination of an issue of concern, as a consequence of experience, creating clarity and meaning in terms of self, and which results in a change of perspective ( Boyd & Fales, 1983).

Boyd, E. M., & Fales, A. W. (1983). Reflective learning: Key to learning from experience, Journal of Humanistic Psychology, 23(2), 99-117.

Hill, M. & Watson, J. (2011). Creating a Caring Science Curriculum. New York, NY: Springer Publishing.

Research a health care organization or network that spans several states with in the United States (United Healthcare, Vanguard, Banner Health, etc.). Assess the readiness of the health care organization or network you chose in regard to meeting the health care needs of citizens in the next decade.

Prepare a 1,000-1,250 word paper that presents your assessment and proposes a strategic plan to ensure readiness. Include the following:

1. Describe the health care organization or network.
2. Describe the organization’s overall readiness based on your findings.
3. Prepare a strategic plan to address issues pertaining to network growth, nurse staffing, resource management, and patient satisfaction.
4. Identify any current or potential issues within the organizational culture and discuss how these issues may affect aspects of the strategic plan.
5. Propose a theory or model that could be used to support implementation of the strategic plan for this organization. Explain why this theory or model is best.

Prepare this assignment according to the guidelines found in the APA Style Guide. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. 

The practice of using herbal supplements dates back thousands of years. Today, there is a renewal in the use of herbal supplements among American consumers. However, herbal supplements are not for everyone. In fact, some herbal products may cause problems for people treatments for chronic ailments. Because they are not subject to scrutiny by the FDA or other governing agencies, the use of herbal supplements is controversial.

Herbal supplements are products made from plants for use in the treatment and management of certain diseases and medical conditions. Many prescription drugs and over-the-counter medicines are also made from plant derivatives. These products contain only purified ingredients and, unlike herbal supplements, are closely regulated by the FDA. Herbal supplements may contain entire plants or plant parts. Herbal supplements come in all forms: dried, chopped, powdered, capsule, or liquid, and can be used in various ways. Please address the followings:

1.     Discuss advantages and disadvantages of dietary supplements, including adverse reactions, drug-drug interactions, drug-food interactions, and specific laboratory issues that may arise from using these products.

2.     Discuss the position of the FDA and other governmental agencies on over the counter herbal supplements. Support your post with at least 2 evidenced-based guidelines published within the last 5 years.

 APA 6th edition format. 

Case Study I A 45-year-old female presents to your clinic today with complaints of back pain and “just not feeling good”.  Regarding her back, she states that her back pain is a chronic condition that she has suffered with for about the last 10 years. She has not suffered any specific injury to her back. She denies weakness of the lower extremities, denies bowel or bladder changes or dysfunction, denies radiation of pain to the lower extremities and no numbness or tingling of the lower extremities. She describes the pain as a constant dull ache and tightness across the low back. She states she started a workout program about 3 weeks, and she is working out with a friend that is a body builder. She states her friend suggested taking Creatine to help build muscle and Coenzyme Q10 as an antioxidant so she started those medications at the same time she began working out. She states she also takes Kava Kava for her anxiety and garlic to help lower her blood pressure. Past medication history includes: Type II diabetes since age 27, High blood pressure, Recurrent DVT’s Her other medications include: Glyburide 3 mg daily with breakfast, Lisinopril 20 mg daily and Coumadin 6 mg daily 1. What are your findings following reviewing this medication list? Explain concerns in detail. 2. Is there additional information you would obtain? If so, please discuss rationale. 3. What are your recommendations for managing this patient’s medications? 4. What are the components for educating the patient? 5. If your plan is to prescribe a medication/s, create a prescription and discuss, what are the important components necessary on the packaging or on the label? Please answer each question concisely. You do not need to write a long paragraph to prove your points. You need to provide a cover page and 1 reference page. Support answers with peer reviewed journals. Articles cannot be older than 5 years. Remember all paragraphs need to be cited properly, and the paper must be written in APA 6th format. A minimum of 3 references are required for this case study.