1-, remarkable presentation, just to add on I would recommend the physician if he/she can consider treating the patient with hyper baric oxygen in order to increases oxygenation to the tissue, improves circulation and blood flow, to increase the ability of neutrophils to kill the Mucar and to decreases the pain and swelling.

Thank you

2-There really isn’t enough information to determine if this patient really warrants an ICU admission. Where I work, our Progressive Care Unit could most likely manage this patient. Depending on the presentation, such things to consider are vitals, face to face assessment data, respiratory efforts, heart rate and rhythm. The chest xray does show white out of the mid to lower left fields but is clear at the left apex and to the right. Hard to determine the appropriate level of care based on the limited data provided.

3-Hyperbaric oxygen would help this patient because hyperbaric therapy increases oxygenation to the tissue, improves circulation and blood flow, boosts white blood cells especially neutrophils, enhances effectiveness of antibiotics, and decreases pain and swelling

(Latham E., 2018). However, there is some precaution while taking this treatment “the fire hazard” because the use of oxygen is always high risk to fire explosion. so, any material that can explode fire is prohibited in the treatment room, for instance nurses must make sure that the patient is not using a hair spray, deodorant, electric devices or cigarette lighter and proper education should be given to the patient (Latham E., 2018).

Reference

Latham E. (2018) Hyperbaric Oxygen Therapy retrieved [online] from: https://emedicine.medscape.com/article/1464149-overview

4-I enjoyed reading your post. Over the years, I have had many diabetic patients that are diagnosed with pneumonia, but never with Mucor. You stated, “Mucor is most commonly found in uncontrolled diabetics, transplant patients, cancer patients, and others who are immunocompromised (Centers for Disease Control and Prevention, 2015).” It is interesting to know that Mucor is commonly found in uncontrolled diabetics. However, I found that there have also been cases found in well controlled diabetics. According to Panigrahi,M., Manju,R., Kumar, S.V. & Toi, P.C. (2014) “Uncontrolled diabetes, particularly diabetic ketoacidosis, predisposes patients to the development of mucormycosis; however, cases have been described even in patients with well controlled diabetes mellitus.”

Panigrahi,M., Manju,R., Kumar, S.V. & Toi, P.C. (2014). Pulmonary Mucormycosis Presenting as Nonresolving Pneumonia in a Patient With Diabetes Mellitus. Retrieved  from http://rc.rcjournal.com/content/59/12/e201

5-I agree, a sputum or tissue sample like biopsy is needed to identify the fungal infection. However, amphotericin B, posaconazole or isavuconazole iv  are very effective treatments if started early and aggressively. In addition to this and an excision of the infected tissue or organ is also needed to save the rest of the tissue or organ and life as well. Nice post.

6- Nice post, I agree, once patient is on bed rest and NPO,  pantop and low molecular weight heparin needed to be started as gastric and  DVT prophylaxis. And this patient is going to be very unstable so needed to be admitted in ICU for monitoring and further management.

Instructions:

1. Please answer all the following questions: 

Community to be used (Miami or Fort-lauderdale Florida)

Instructions:

1. Please answer all the following questions: 
   • What facilities are available for the homeless in your community? How do people access these resources?
   • What is the demographic make-up of the homeless population in your community? Primarily male or female? Family? Ethnic group?
   • What is your risk of becoming homeless? What resources would you draw on if tomorrow you woke up with no job and no housing?
   • What physical illnesses or disorders are specific to homeless people in your area? What are the greatest risks?

• Please answer all questions in a discussion APA Format including references.

 In a perfect world, research studies would be flawless however, that is not typically the case.  Inherently, flaws exist related to study design, how the study is conducted, and also the manner in which research is reported.  “Given that research is not perfect, users of research must learn to carefully evaluate research reports to determine their worth to practice through critical appraisal” (Melnyk & Fineout-Overholt, 2015, p. 92-93).  Factors that need to be assessed when critically appraising quantitative studies include validity, reliability and applicability (Melnyk & Fineout-Overholt, 2015).  

       The validity of a study relates to obtaining results from utilizing sound methods which are scientific.  Bias and confounding variables can compromise validity of a study.  Bias can occur at any stage of the process but while assessing the reliability of the results one must look at if the study was systematic, grounded in theory, and criteria was followed for all of the processes.  If so, then the study, more than likely, is valid and reliable.  Clinicians need the ability to interpret the results so they can implement EBP into their practice (LoBiondo-Wood & Haber, 2014).  “Whether we are interpreting the research studies of others, or designing our own, we need a good understanding of research design and an ability to recognize weaknesses in intervention studies which may reduce the reliability of study findings” (Ebbels, 2017, p. 229).      Although each factor is important to quality research, I feel the most important factor is the applicability to practice.  Having the ability to appraise research, which is evidence-based, and implement EBP interventions with our patients is essential in promoting optimal patient outcomes.   

References

Ebbels, S. H. (2017). Intervention research:  Appraising study designs, interpreting findings and creating research in clinical practice. International Journal of Speech-Language Pathology, 19(3), 218-231. https://doi.org/https://doi-org.arbor.idm.oclc.org/10.1080/17549507.2016.1276215

LoBiondo-Wood, G., & Haber, J. (2014). Nursing research:  Methods and critical appraisal for evidence-based practice (8th ed.). St. Louis, MO: Mosby Elsevier.

Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing & healthcare:  A guide to best practice (3rd ed.). Retrieved from Amazon Kindle App

The most common sexually transmitted infection is human papillomavirus (Boda et al., 2018). There are over 150 known strains of human papilloma virus (HPV), with approximately 40 known strains that can be passed through sexual activity (Markowitz et al., 2014). HPV has been associated with cervical cancer, penile cancer, anogenital cancer, vulvovaginal cancer, oropharyngeal cancer, and genital warts in both males and female (Markowitz et al., 2014). Studies have shown that women are two times more likely to develop HPV infection than men, with the highest risk of acquiring HPV after becoming sexually active (Boda et al., 2018). More than half of new HPV infections occur in individuals 15 to 24 years of age (Markowitz et al., 2014).

It is estimated that the majority of sexually active individuals contract at least one strain of HPV in their lifetime (Boda et al., 2018). Fortunately, approximately 90% of HPV infections are cleared by the immune system within one to two years of infection (Boda et al., 2018). Treatment for HPV is primarily aimed at prevention (Markowitz et al., 2014). HPV vaccines are available for males and females ages 9 through 26 (Markowitz et al., 2014). It is highly encouraged that males and females begin the vaccine series between the ages of 11 and 12 (Markowitz et al., 2014). Also, safe sexual practices are promoted for prevention, including abstaining from sex, condom use, and/or limiting the number of sexual partners (Markowitz et al., 2014).  Other than prevention, there is no treatment for HPV infections (Markowitz et al., 2014). HPV associated lesions can be treated through various modalities, such as laser or electrosurgical procedures (Markowitz et al., 2014).   

Detection and monitoring for HPV is primarily done through cervical cytology (Markowitz et al., 2014). Current guidelines recommend that cervical cancer screening begin at age 21 and be performed every 3 years until the age of 29 (Markowitz et al., 2014). If abnormal cells are detected, additional testing for HPV may be performed (Markowitz et al., 2014). Routine HPV testing can be performed alongside a pap smear every 5 years for women between the ages of 30 and 65 or women may choose to continue regular pap smears every 3 years (Markowitz et al., 2014). Women that have an abnormal pap smear should be tested more frequently, often every 12 months (Markowitz et al., 2014). Women that test positive for HPV 16 or 18 should be sent for a colposcopy according to current guidelines (Markowitz et al., 2014).

References

Boda, D., Docea, A. O., Calina, D., Ilie, M. A., Caruntu, C., Zurac, S., … Tsatsakis, A. M. (2018). Human papilloma virus: Apprehending the link with carcinogenesis and unveiling new research avenues. International Journal of Oncology, 52(3), 637-655. https://dx.doi.org/10.3892%2Fijo.2018.4256

Markowitz, L., Dunne, E., Saraiya, M., Chesson, H., Curtis, C., Gee, J., … Unger, E. (2014). Human papillomavirus vaccination: Recommendations of the advisory committee on immunization practices. Morbidity and Mortality Weekly Report, 63(1), 1-30. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6305a1.htm

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