Need a response to the following: 

Therapy guidelines for H. Pylori Treatment

H. Pylori remains to be one of the most common chronic bacterial infection affecting humans. Research shows that H. Pylori is normally acquired during childhood, with most victims being those who are socially disadvantaged and people who have migrated to North America (Chey et al., 2017). Although currently, there are no new drugs that have been developed, treatment primarily depends on a mixture of antibiotics and anti-secretory agents. H. Pylori treatment regimens are such as triple therapy, sequential therapy, quadruple treatment, and levofloxacin-based triple therapy (De Francesco et al., 2017). In selecting the best treatment regimen, it’s important to consider previous antibiotic exposure, the rate of eradication, and regional antibiotic-resistance patterns as these can affect the successful treatment of the condition (Myran & Zarbock, 2018). Additionally, it can be noted that for a treatment to be effective and successful, then host factors such as allergies and patient adherence need to be considered (Fashner & Gitu, 2015).

           Recent treatment guidelines have recommended quadruple therapy, which consists of PPI and three antibiotics (metronidazole, clarithromycin, and amoxicillin), which are to be administered concurrently (Chey et al., 2017). According to Shiotani et al. (2017), the rationale for this treatment option is that it’s not evidence-based but “hope-based” because gastroenterologists do believe that the infection would be susceptible to metronidazole or clarithromycin. 

           Patient compliance is a key factor that would determine treatment success. To minimize cases of side effects, clinicians should talk to their patients to adhere to their treatment plans and also instruct their patients on the right time to take their doses in relation to their meal (Li et al., 2019). Patients should be informed that they should avoid taking alcohol with metronidazole, avoid cheese, soy beans, and soy sauce taken with furazolidone (Li et al., 2019). Finally, it’s important to advice the patient to maintain personal hygiene by taking clean water and avoid ingesting contaminated food.

The original work is below in case you needed:

GI Case Study:

Chief complaint: “I have recurrent H. Pylori infection”. 

HPI: M.C. a 46-year-old Hispanic female presents to the GI clinic for complaint of recurrent H. Pylori infection. She was treated about 2 ½ months ago with H. Pylori triple therapy and failed treatment. She has PMH of dyspepsia, and GERD. She also indicates that she has noticed that her symptoms of dyspepsia are worsening for past 2 months. She has associated her symptoms with nausea, upset stomach with all foods. Denies associated symptoms of hematochezia, melena, hemoptysis, abdominal pain, fever, chills, pain or any other symptoms. 

PMH: 

H. Pylori infection gastritis

Diabetes Mellitus, type 2

Surgeries: None

Allergies: NKDA

Vaccination History: Up-to-date

Social history:

High school graduate, married and no children. He frequently eats out in restaurants. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago.

Family history:

Both parents are alive. Father has history of DM type 2, Tinea Pedis. Mother alive and has history of atopic dermatitis, tinea corporis and tinea pedis. 

ROS:

Constitutional: Negative for fever. Negative for chills. 

Respiratory: No Shortness of breath. No Orthopnea. 

Cardiovascular: No edema. No palpitations. 

Gastrointestinal: No vomiting. +Dyspepsia. + Nausea. No constipation. No melena. No abdominal pain.

Physical examination:

Vital Signs

Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 110/70 T 98.0 po P 80 R 22, non-labored

ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.

Labs day of visit:: Hgb 15.2, Hct 40%, K+ 4.0, Na+137, Serum Creatinine normal 1.0, AST/ALT normal. TSH 3.7 normal, glucose 98 normal

Assessment:

Primary Diagnosis: Recurrent H. Pylori infection gastritis

Secondary Diagnoses: Dyspepsia

Differential Diagnosis: Peptic Ulcer Disease

Previous medication plan: two months ago and failed.

1. Clarithromycin      500 mg po BID for 2 weeks
2. Omeprazole      40 mg po BID for 2 weeks and then po daily.
3. Cipro      500 mg po BID for 2 weeks

Plan: Tests

Pt had EGD done 2 weeks ago that showed H. Pylori positive gastritis in biopsy results. 

Urea breath test 8 weeks after treatment with H. Pylori medications. Pt needs to stop PPI’s 2 weeks prior to Urea Breath test. 

Labs: No new labs are needed.  

Referrals: may refer based on effect of medication therapy given for 2 weeks.

Follow up: return to office in 8 weeks to reevaluate symptoms.

As a future nurse practitioner, it is important that you determine the medications used for recurrent H. Pylori infection. 

Please discuss new therapy guidelines for H. Pylori treatment, and provide patient education.

Things are changing with the Affordable Care Act (ACA). Many, if not most of the class, work in environments that have been impacted by the ACA. If your organization was impacted favorably or negatively, share your information with the class. 

***Adding new information or furthering the discussion by asking a question of the class, helps to further the discussion.

Since P4P ( paid for performance) has been around for a number of years, one would think that its effectiveness should be clearly documented. However, Peter Kongstvedt says that results have been mixed. He concludes that “positive results remain ambiguous, at least on a broad basis.”

Review various P4P program results and effectiveness on the Internet or through your college’s Online Library, which you can access in the Resources tab.

Write a 1-page report of your findings. Specifically, address strengths and weaknesses of this compensation method, both from the point of view of the health plan and the physician. Cite at least two sources. List sources in APA format.

Scenario: You are speaking in a meeting with the hospital compliance officer and the hospital representative for Health Insurance Portability and Accountability Act of 1996 (HIPAA) team, and have been asked “How will we maintain patient privacy with our documents on the Internet?”

Use the university library, journals, and your experience to create a strategic plan for a 200-bed acute care facility that considers possible data privacy breaches and proposes effective methods to avoid them. Additionally, explain what is required by the Joint Commission, the Health Information on Technology for Economic and Clinical Health (HITECH) Act, and the HIPAA regulations that must be followed for the protection of individually identifiable health information.

Cite at least 4 peer-reviewed references published within the past 5 years.

 Deliverable Length:  3-5 pages excluding the title and reference pages 

See rubric attached. 

Windshield Survey

Assignment Guidelines

A. Windshield Survey 

The Windshield Survey is comprised of general qualitative observations that give you a snapshot of the community that you can capture as you drive/walk through the community. The demographic data can be obtained online, through the public library, county or township administration buildings. Please address the following in a narrative format following APA guidelines: 

1. Geographical description

 Boundaries, geographical, political, or economic, how is it seen. 

 Housing an zoning 

 Sign of decay 

2. Health Resources 

a. Type of services available: health department, private MD, dentist, hospital clinic, 

b. pharmacy, health promotion, mental health 

c. School and occupational health services 

d. Official and voluntary services 

e. Self help and support groups 

f. Service organizations, faith-based programs 

g. Stores (grocery, retail, drug, dry cleaning, etc. 

h. Transportation 

3. Citizen safety and protective services 

a. Police and fire 

b. Shelters for victims of abuse 

c. Others: neighborhood watch etc. 

4. Services provided by senior citizens senior centers, meals on wheels, transportation, day care, long term care. 

 a. Parks and recreational areas 

5. Community welfare services beyond city/state aid as provisions for emergency food, shelter and clothing. 

Below please see the rubric that will be used to grade your survey and due date instructions.

Assignment must be presented in an essay style using APA format in the required Arial 12 font with minimum of 1000 words. Due date is Saturday September , 2018 @ 11:59PM in the discussion tab of the black board for grading.