Open to read the attached files….and pay attention to details in the question.

Comparison Matrix

 

Article 1

Article 2

Article 3

Title/Author(s)

 

 

 

 

 

 

 

Persistent GCU Library Link

 

 

 

 

 

 

 Purpose of the Study

What is the author’s rationale for selecting this topic? Does he/she build a strong case?

 

 

 

 

 

 

 Research Question(s)

What question(s) does the author present?  

 

 

 

 

 

 

 Literature Review

How is this organized? What are the main themes found in the review? Who are the main authors used?

 

 

 

 

 

 

 Sample Population(s)

What group(s) is/are being studied?

 

 

 

 

 

 

 Limitations

What are the limitations of the study? Why can it only encompass so much ?

 

 

 

 

 

 

 Results/ Conclusions

What did the author find through the study? Was the original question answered?

 

 

 

 

 

 

Article 4

Article 5

Article 6

Title/Author(s)

 

 

 

 

 

 

 

Persistent GCU Library Link

 

 

 

 

 

 

 Purpose of the Study

What is the author’s rationale for selecting this topic? Does he/she build a strong case?

 

 

 

 

 

 

 Research Question(s)

What question(s) does the author present?  

 

 

 

 

 

 

 Literature Review

How is this organized? What are the main themes found in the review? Who are the main authors used?

 

 

 

 

 

 

 Sample Population(s)

What group(s) is/are being studied?

 

 

 

 

 

 

 Limitations

What are the limitations of the study? Why can it only encompass so much ?

 

 

 

 

 

 

 Results/ Conclusions

What did the author find through the study? Was the original question answered?

 

 

 

 

 

Copyright 2013. Grand Canyon University. All Rights Reserved.

 

 

What is the biggest barrier you face in providing care to Bana at this point?
The biggest barrier to Bana’s care is her lack of understanding what exactly is going to be done to provide her adequate care in America. The linguistic barriers don’t allow Bana to appropriately be questioned privately or ensure her understanding of interventions and follow up. If she were experiencing intimate partner violence (IPV) her husband could interpret for her which would leave her at increased risk without the knowledge of the provider. Per JAMA (2018) she is at increased risk for IPV because of her age and her recent assault which could have been perpetrated by her husband, we are unsure because she does not understand what we are asking her. What is the priority action for you to take at this time?
My priority would be to get a medical interpreter and then proceed with the visit. I would question her further about her assault in Syria and if it included rape. The timing of her pregnancy is close to the time she was assaulted, and it should be explored. It could create another stressor for her and her husband that just adds to their financial issues and adjusting to life in a new country.What action is most important for you to take to ensure the health and safety of the fetus?
Per the CDC (2012a) refugees should have a complete H&P with comprehensive labs that include a CBC, UA, and glucose. Diseases that are easily transmittable such as TB, malaria, lead, parasites, and HIV/AIDS should be tested for as well, but HIV/AIDS is no longer tested for everyone, but I should be done as part of Bana’s pregnancy care. She is at increased risk of transmission if she was raped during her assault (CDC, 2012a). Testing for STIs should be done as part of her pregnancy care as well. Given Bana’s financial situation, you are concerned about her and her family having adequate nutrition. Which intervention would best address this concern?
Testing for anemias and deficiencies should be done. Getting a comprehensive H & P related to nutrition can help to identify long term issues from new issues with obtaining adequate nutrition. Directing Bana to local places where she can get help with food such as WIC and state aid or places where she can obtain food like local food pantries should be done (CDC, 2012b).References
Centers for Disease Control and Prevention. (2012)a. Summary checklist for the domestic medical examination for newly arriving refugees. Retrieved from https://www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/checklist.html Centers for Disease Control and Prevention. (2012)b. Guidelines for evaluation of the nutritional status and growth in refugee children during the domestic medical screening examination. Retrieved from https://www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/nutrition-growth.html JAMA. (2018). Screening for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults. US Preventive Services Task Force Final Recommendation Statement. Retrieved from https://jamanetwork.com/journals/jama/fullarticle/2708121

angela

Peer replies

1-Alberto :

Polypharmacy is an area of concern for many patients, especially the elderly.  Elderly patients are at a greater risk for adverse drug reactions (ADRs) because of the reduced drug clearance associated with aging and because of metabolic changes (Boris, Cafiero & Smith, 2014).  Some risk factors associated with polypharmacy are potential of drug-drug interactions because it is further increased by use of multiple drugs.  Another risk factor is hip fractures, associated with adverse drug reactions and losing balance or fainting (Boris, Cafiero & Smith, 2014).  Polypharmacy may sometimes lead to “prescribing cascades.”4 Prescribing cascade is said when signs and symptoms (multiple and nonspecific) of an ADR is misinterpreted as a disease and a new treatment/drug therapy is further added to the earlier prescribed treatment to treat the condition (Piere & Farrell, 2012).

       In my practice working with the elderly population, to reduce the incidence of polypharmacy medication, patients are evaluated on a monthly basis.  Additionally, a single drug is be prescribed instead of multiple drugs for the treatment of a single condition, if possible.  Another strategy we use is staring medication with the lower drug dosage and slowly increasing as indicated.

           A strategy that seems to be effective, according to research, is prescribe drugs that can be given once or twice a day instead of prescribing drugs that require to be taken three times a day (Thomas, Liao, & McCliar, 2016).  The reasoning behind this is to lower the risk of forgetting to take the medication or taking the medication together with other drugs.  Another strategy that can be employed is that if the drug taken has no therapeutic beneficial effect or clinical indication it should be eliminated. Unessential drugs should be identified and eliminated prescribed by different health care providers for the same condition/disease (Thomas, Liao, & McCliar, 2016).

2-maceda 

Polypharmacy refers to the effects of taking multiple medications concurrently to manage coexisting health problems, such as diabetes and hypertension (Piere & Farrell, 2014).  Too often, polypharmacy becomes problematic, such as when patients are prescribed too many medications by multiple healthcare providers working independently of each other. Also, drug interactions can occur if no single healthcare provider knows the patient’s complete medication picture. Nurses have a unique opportunity to help identify patients at risk for inappropriate polypharmacy and to educate patients and families about risk reduction. Nurses can use strategies such as patient teaching and consistency in care plan (Piere & Farrell, 2014). 

Some of the risk factors of polypharmacy are age and chronic conditions.  The elderly are more sensitive to the effects of certain drugs, particularly those that affect the central nervous system.  As a consequence, drug classes such as benzodiazepines should be used with caution, and if absolutely necessary, then at a reduced dose to minimize the risk of falls and other adverse events (Thomas, Liao & McCliar, 2016). In addition, age is associated with decreased regulatory functions, therefore anti-hypertensives can more easily result in postural hypotension and opiates in respiratory depression.  Communication barriers often go undetected in health care settings and can have serious effects on the health and safety of patients. Limited literacy skills are one of the strongest predictors of poor health outcomes for patients (Thomas, Liao, & McCliar, 2016).  If the patient is deaf, can’t see or is illiterate there are various strategies the nurse can use for example, advise the patient to bring someone with them to the visit.  Nurses who are responsible for checking patients in should be friendly and helpful. The length and number of forms patients are asked to fill out should be limited.