Write a brief description of a patient scenario involving the disorder and the factor you selected. Explain how the factor might impact your selected disorder, as well as potential associated alterations and symptoms. Finally, explain the pathophysiology of the associated alterations, including changes in cellular function. 

I have submitted two attempts for this question but apparently I am not doing it right so I need someone’s help with this assignment. This is the feedback from my instructor. Could someone truly help me with this homework?

Feedback I am getting: Non-Performance

Does not support description of effective patient care with current nursing and informatics theoretical ideas.

 I appreciated your discussion on effective patient care, and did a good job defining nursing informatics. However, to meet the criteria here, it is asking you to discuss a specific nursing theory or informatics theory (even a Change theory would work here as well) that supports patient care, and apply it to the examples your already provided in this section. Here are some references to help get you started in the right direction. Think about reaching out to your tutor for further clarification if needed. 1. http://ojni.org/issues/?p=2852 2. http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-18-2013/No2-May-2013/Impact-of-Evidence-Based-Practice.html 3. http://www.himss.org/right-balance-technology-and-patient-care ”

Learning Objectives Students will:  •Assess clients presenting for psychotherapy • Develop genograms for clients presenting for psychotherapy 

                                                                                                                                                                                   To prepare: • Select a client whom you have observed or counseled at your practicum site. • Review pages 137–142 of the Wheeler text and the Hernandez Family Genogram video in this week’s Learning Resources. Reflect on elements of writing a Comprehensive Client Assessment and creating a genogram for the client you selected.  

The Assignment 

Part 1: Comprehensive Client Family Assessment With this client in mind, address the following in a Comprehensive ClientAssessment (without violating HIPAA regulations):  •Demographic information  •Presenting problem  •History or present illness  •Past psychiatric history   •Medical history • Substance use history  •Developmental history  •Family psychiatric history   •Psychosocial history  •History of abuse/trauma  •Review of systems   •Physical assessment  •Mental status exam  •Differential diagnosis  •Case formulation  •Treatment plan 

Part 2: Family Genogram Prepare a genogram for the client you selected. The genogram should extend back by at least three generations (great grandparents, grandparents, and parents). 

Required Readings: 

(1) Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.

ATTACHED WITH THIS HOMEWORK IS A SAMPLE OF THIS ASSIGNMENT AND REMEMBER IT HAS TWO  PARTS.

 

MEDICAL MYSTERY FOR CHAPTER 8
 

HIS STORY:

For months, Michael was having trouble swallowing, and he often felt as if he had a lump in his throat. His voice sounded hoarse, and he had a dry cough, which he attributed to smoking. Even more troubling, Michael was plagued by mild chest pain. He was especially worried because his dad died of heart disease. Michael managed a retail store, and on the nights when he worked late, he often ate dinner right before bed. This led to indigestion and insomnia. Taking antacids usually helped his stomach and the pyrosis—but not the pain in his chest. One night, the pain was especially severe; though it eased a short time after it started, he was still having trouble swallowing. Concerned, Michael went to see his physician’s assistant the next week. Because of Michael’s concern about his heart, his PA ordered an electrocardiogram (EKG). When the results turned out to be normal, Michael wondered if his symptoms—especially the trouble swallowing—might be due to a gastrointestinal problem. His PA agreed and gave him a referral to our clinic.

THE EVALUATION:

In taking Michael’s medical history, I learned that he had an irregular eating schedule. I asked about his diet, and Michael told me that he had a passion for chocolate, spicy foods, and coffee. I performed a physical exam and did not find any abnormalities. Because Michael reported having trouble swallowing, I wanted to make sure that there was no serious damage to his esophagus from his digestive problems. I had him undergo an esophagogastroduodenoscopy, a test that involves being sedated while an endoscope is inserted into the mouth and down the stomach. The endoscope allowed me to check for a hiatal hernia. Hiatal hernias can also cause reflux and pyrosis.

THE DIAGNOSIS:

Based on Michael’s description of his symptoms, I suspected that he had gastroesophageal reflux disease (GERD), which occurs when the lower esophageal sphincter at the bottom of esophagus relaxes, allowing stomach acid to leak back into the esophagus. Over time, the stomach acid can irritate and damage the delicate lining of the esophagus. Fortunately, he did not have any significant buildup of scar tissue (in some GERD sufferers, scar tissue builds up in the esophagus, which can lead to blockages as well as cancer-causing tumors). Michael also did not have a hiatal hernia. What he had was a classic case of GERD.
 

Although most people with GERD suffer from frequent pyrosis, some do not. Some patients have chest pain, a lump in the throat, a cough, or hoarseness—which is exactly what Michael had described. Most patients can be diagnosed with GERD based on symptoms alone: iIf they respond to treatment, then the diagnosis is confirmed.

THE TREATMENT 
In order to ease his symptoms and prevent future damage, I prescribed a proton pump inhibitor (PPI) drug, which reduces the acid that is secreted in the stomach. I explained to Michael that medication was just part of the equation: He also had to make lifestyle changes. I urged Michael to limit his intake of coffee, chocolate, and fried or spicy foods, all of which can stimulate acid production in the stomach. In addition, he had to lose weight and stop smoking. GERD occurs when stomach acid leaks back into the esophagus, and smoking weakens the sphincter that separates the esophagus from the stomach. Excess weight puts pressure on the stomach, which may cause acid to back up into the esophagus. Finally, I advised him to eat smaller meals. Not only would eating smaller meals help him lose weight, but it would also prevent his stomach from becoming too full, which puts pressure on the lower esophageal sphincter and increases the chance that the food will reflux.

CASE CLOSED:

Over the next 3 months, Michael lost 8 pounds. He was taking his medication, and he had cut back his coffee consumption to one cup per day. Although he could not resist chocolate and Mexican cuisine, Michael started viewing these foods as occasional treats. He recently started a smoking cessation program at the local hospital. As a result, his chest pain had virtually disappeared, and he was no longer having trouble swallowing. His voice even sounded less hoarse. Now that his symptoms have eased, I was certain that I had diagnosed him correctly.

Discussion Questions

1. The esophagus is a muscular tube through which ingested food passes from the pharynx to the stomach. It is aided in this action by gravity and peristalsis. What is peristalsis?

2. GERD is an abbreviation for gastroesophageal reflux disease. Define the word parts that make up the word gastroesophageal.

3. The doctor decides that Michael does not have a hiatal hernia. What is this?  What are they symptoms of a hiatal hernia?

4. Michael underwent an endoscopy of his esophagus and stomach. Name two lower gastrointestinal system procedures that involve an endoscope, and describe why they are done.

i need an A