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

Below is the website for the American Academy of Gastroenterology Clinical Guidelines (ACG) for the updated H. Pylori therapy. Feel free to consult other peer-reviewed articles within 5 years of publication. 

APA guidelines

 http://gi.org/wp-content/uploads/2017/02/ACGManagementofHpyloriGuideline2017.pdf 

Chemistry week 3 learning Activities

 

Ionic and Molecular Compounds

1. Name each of the following molecular compounds

a. CO2

b. N2O

c. P2O5

d. N2S3

e. CF4

2. Write the formula of the following molecular compound

a. Carbon tetrachloride

b. Sulfur dioxide

c. Phosphorus pentafluoride

d. Dinitrogen tetroxide

e. Chlorine dioxide

3. Classify each of the following as ionic or molecular and give its name

a. Na2SO4

b. Fe(OH)3

c. CCl4

d. OF2

e. CaS

4. Identify the group in the periodic table of the element X in each of the following ionic compounds

a. XSO4

b. XF3

c. XCl

d. XO

e. X2CO3

5. Classify the bonds in each of the following compounds as ionic bond, polar covalent bond, or non polar covalent bond

a. MgS

b. H-Cl

c. Br-Br

d. H-O-H

e. NaCl

APA- NURSING ASSIGNMENT

 

Assignment:

Identify an older adult age 65 +, use a 1st and last initial. Execute a therapeutic assessment interview with them for at least two interview sessions assessing their self-identified: Demographics, life time education and career/employment Two most significant (positive) times in their lives What past hardship or loss has the client successfully negotiated in the past? Two personal strengths Engage them in identifying what is healthy versus non-healthy coping skills
Inquire of 2 healthy coping skills they have used in the past and/or now Three (3) pieces of advice they would give to their younger self if they could? Support the client in taking the Geriatric Depression Scale.pdf Support the client in taking the Fulmer SPICES Assessment.pdf Perform a Mini Mental State Exam.pdf and Patient_Stress_Questionnaire.pdf (attach here) Perform a Hall, Ryan, Hall, Richard, and Chapman Article.pdf Report the findings from the Geriatric Depression Scale, Fulmer Spices, Patient stress questionnaire and the mini mental status exam Discuss your older adult’s level of ego integrity vs. despair as described by psychoanalyst Erik Erikson. If you had to rate them on a scale of 1-10, with 1 representing a full state of despair and 10 representing full ego integrity, what rating would you give your older adult? Describe at least two nursing diagnoses for this client.   Create a plan of care for the client to include at least three nursing goals with two nursing interventions each.

The assignment should be written in an APA-formatted essay. DO NOT COPY OR PLACE THE ASSESSMENTS INTO YOUR PAPER- JUST SUMMARIZE THEM IN PARAGRAPH FORMAT.  The essay should be at least 1500 words in length and include at least two scholarly sources other than provided materials. Don’t forget the format of an APA essay paper includes the title page, intro, assignments, conclusion, and references. Note that in this assignment when you interview the older adult, it is ok to just denote their responses- you do not have to quote them or use personal communication citations- I know that you are interviewing them.  Please do not give full names of your interviewees, just give their initials or say, Mrs. S. or something like that. 

replies w13 DB

1-A.G

Childhood asthma is a frequent clinical occurrence associated with respiratory impairments and airway inflammation, which requires immediate treatment and long-term care. The discussed disorder can considerably worsen overall health conditions, reduce the quality of life, and increase the risk of life-threatening implications. The provided asthma-associated case study can be beneficial for reviewing short-term and long-term treatment options efficient for treating the given patient. Furthermore, one’s potential education can be ultimately useful for achieving sufficient treatment outcomes as well as organizing appropriate preventive and therapeutic actions.  

   The provided clinical case exemplifies moderate persistent asthma that requires immediate intervention. It is evident that short-acting beta2-adrenergic agonists (SABA), systemic and inhaled corticosteroids, as well as anti-inflammatory medications, can provide quick symptomatic relief by reducing such aberrations as wheezing and bronchoconstriction present in the reviewed patient, normalizing respiration, and improving overall health. Furthermore, such drugs as inhaled steroids, leukotriene modifiers, nedocromil, cromolyn sodium, and methylxanthine can assist in providing long-term asthma control, stabilizing respiratory functions, and preventing possible asthma exacerbations and inappropriate lung growth in children (Woo & Robinson, 2015). It is estimated that a combination of SABAs and inhaled corticosteroids is useful for managing acute asthmatic exacerbations and maintaining normal respiratory functions (Arcangelo & Peterson, 2013). The beta2-adrenergic agonists like albuterol and levalbuterol are capable of exerting “their bronchodilatory effects through β2 adrenoceptors (β2ARs) located on airway smooth muscle (ASM) cells” and providing significant airway relaxation by activating the aforementioned receptors, whereas the steroid medications are efficient in decreasing airway inflammation and airway hyperresponsiveness by lessening the number of circulating inflammatory mast cells and eosinophils in the respiratory tract (Billington, Penn, & Hall, 2017, p. 23). Furthermore, the use of inhaled corticosteroids can be also beneficial for relieving airway obstruction, normalizing respiratory functions, asthma control, and minimizing the risk of asthmatic exacerbations. 

   Patient education is important for achieving sufficient treatment outcomes. Patients, as well as their caregivers, have to be aware that adherence to the prescribed treatment regimen and recommendations, reporting adverse effects, and regular physical evaluation along with cooperative communication with a physician can assist in stabilizing the patient’s condition and preventing asthma progression. Therefore, asthma is a severe acute or chronic respiratory abnormality that requires competent treatment and care. It is estimated that inhaled SABA, as well as inhaled and systemic corticosteroids, are efficient for achieving short-term therapy goals, whereas leukotriene modifiers, methylxanthines, and anti-inflammatory agents demonstrate normal heir efficacy in providing long-term asthma control and maintaining normal respiratory functioning. Lastly, a patient’s teaching is a critical component of successful medication. 

2-michael V.

The short-term option for this child diagnosed with asthma will be bronchodilators to quickly relieve his symptoms by opening swollen airways that are limiting breathing (Saglani, Fleming, Sonnappa, & Bush, 2019).  Long-term options include Inhaled corticosteroids, Leukotriene modifiers, Long-acting beta agonists, and Combination inhalers. Corticosteroids are the first line of treatment for severe acute asthma, because of the inflammatory process.  Steroids control airway inflammation through a number of mechanisms, such as reducing the number and activation of lymphocytes, eosinophils, mast cells, and macrophages; suppressing the production of cytokines, tumor necrosis factor-α, granulocyte-macrophage colony-stimulating factor, adhesion molecules, and inducible enzymes, including nitric oxide synthase and cyclooxygenase-2.  The step-up approach involves beginning with low-dose treatment and increasing intensity at subsequent visits if control is not achieved (Bateman et al., 2019). When selecting the medication and dosage, the provider must take into account the risk to the patient, severity of disease, and potential for impairment.

The goal of asthma treatment is to decrease symptoms and reduce airway inflammation and hyperreactivity.  Healthcare provider should develop written asthma action plan with the patient and his mother for self-management, so they know how to recognize the severity of its symptoms (peak flow) and what to do (Bateman et al., 2019).  Patient should be educated on ways to control exposures to allergens.  An allergy test will be a good plan to identify the patient’s allergy (Bateman et al., 2019).  The patient may need a referral to a pulmonologist if symptoms are uncontrolled with the current regiment.  Pulmonary function testing may be necessary in this child’s case.

References Bat

Coaching and Mentoring.

Discussion Question 1

Answer the following:

    Coaching and mentoring should be a core competency of nurses prepared at the graduate level. Do you agree or disagree with this statement? Defend your response.

    Based on your graduate specialization, identify one coaching activity that you can do in this advanced practice role. What strategies would you employ for this activity?

    Describe one mentoring activity you might complete with a mentor that would help you to acclimate to your new advance practice role. Should this activity be structured or unstructured?

Translating Evidence into Clinical Practice

Assignment Details

Translating Evidence into Clinical Practice

Choose one evidence-based practice that you see yourself using as a provider in your clinical practice and discuss how it meets the listed benefits.

Why should we, as healthcare providers, use evidence-based practice?

Evidence-based practice benefits: Leads to highest quality care and patient outcomes Reduces health care costs Reduces geographic variations in the delivery of care Increases healthcareprovider empowerment and role satisfaction Reduces healthcare provider turnover rate Increases reimbursement from 3rd party payers Reduces complications and payment denials Meets the expectation of an informed public

Include 3 evidence-based articles to support your work that are less than 3 years old.

Before finalizing your work, you should: be sure to read the Assignment description carefully (as displayed above); consult the Grading Rubric (under the Course Home) to make sure you have included everything necessary; and utilize spelling and grammar check to minimize errors.

Your writingAssignment should: follow the conventions of Standard English (correct grammar, punctuation, etc.); be well ordered, logical, and unified, as well as original and insightful; display superior content, organization, style; and use APA 6th Edition format as outlined in the APA Progression Ladder.

Anorexia.Power Point

  

Anorexia

1-Definition

2-Epidemiology in united states

2-Symptoms and signs

3-Diagnosis Criteria

4-Differential diagnosis

5-Treatment

6-Criteria for hospitalization 

7-Other diseases related with inadequate calories intake 

8-Underweight and growth failure definition 

At least 15 slides. APA format.turtinitin report

Research Paper Assignment about Premature Ejaculation Disorders

The paper assignment must include the following structure and it must comply with APA written standards:

Title page (1)

Abstract page (1)

Content pages (5)

Conclusion page (1)

And Reference page (1): You must provide the 3 journals from the FNU database to support your paper.

Therefore, there must be a minimum of nine (9) pages per project.

You must include at least three (3) professional journal articles (Primary Sources) from the FNU Database for journals in Psychology. Include in-text citations for any information taken, quoted or paraphrased from references sources.

Use APA citation style in the body of your paper so I know where the information came from (like your text does). This is the (Author, date) you see in your text. It gives credit to original author’s research and are alphabetized by the author’s last name.

Remember to read carefully all the instructions for this assignment:

It is an APA style format. Information is provided in a paragraph format and with Times New Roman, Font #12, and double space.

No Graphs are allowed or pictures! This will increase your similarity rate tremendously!

Use your information and elaborate on the topic.

No copy or paste is allowed and you will receive 0.00 score for this assignment.

You need nine (9) pages to complete the whole project and you must follow the break down provided in class on the TAB session for Research paper.

Assignment: Change Implementation and Management Plan

 

It is one of the most cliché of clichés, but it nevertheless rings true: The only constant is change. As a nursing professional, you are no doubt aware that success in the healthcare field requires the ability to adapt to change, as the pace of change in healthcare may be without rival.

As a professional, you will be called upon to share expertise, inform, educate, and advocate. Your efforts in these areas can help lead others through change. In this Assignment, you will propose a change within your organization and present a comprehensive plan to implement the change you propose.

To Prepare: Review the Resources and identify one change that you believe is called for in your organization/workplace. This may be a change necessary to effectively address one or more of the issues you addressed in the Workplace Environment Assessment you submitted in Module 4. It may also be a change in response to something not addressed in your previous efforts. It may be beneficial to discuss your ideas with your organizational leadership and/or colleagues to help identify and vet these ideas. Reflect on how you might implement this change and how you might communicate this change to organizational leadership.

The Assignment (5-6-minute PowerPoint presentation):

Change Implementation and Management Plan

Create a narrated PowerPoint presentation of 5 or 6 slides with video that presents a comprehensive plan to implement the change you propose.

Your presentation should be 5–6 minutes in length and should include a video with you as presenter.

Your Change Implementation and Management Plan should include the following: An executive summary of the issues that are currently affecting your organization/workplace (This can include the work you completed in your Workplace Environment Assessment previously submitted, if relevant.) A description of the change being proposed Justifications for the change, including why addressing it will have a positive impact on your organization/workplace Details about the type and scope of the proposed change Identification of the stakeholders impacted by the change Identification of a change management team (by title/role) A plan for communicating the change you propose A description of risk mitigation plans you would recommend to address the risks anticipated by the change you propose. 5 references

assessment 4 class 3

see attached