Pediatric – Week 9 Discussion 1st REPLY

Please reply to the following discussion with one reference. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates.
MB discussion attached.

1. What are three differential diagnoses of leg pains in school-age children? Include the pathophysiology of the three differentials.

Growing Pains

This medical condition is defined as a throbbing pain in the legs. It more specifically occurs in the front of thighs, calves, or behind the knees. It tends to impact both legs and occurs during nighttime. It may also awaken the child from sleep (Lehman & Carl, 2017). The mechanism of disease is unclear. However, research suggests that an increased level of physical activity can cause growing pains and growth spurts. It commonly occurs in children between the ages of four and twelve. A heating pad, stretching, and massages help relieve the symptoms.  Pediatric – Week 9 Discussion 1st REPLY

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Leukemia

Leukemia refers to the cancer of the blood-producing tissues of the body. These include the lymphatic system and the bone marrow. Among patients with leukemia, the bone marrow generates an additional amount of dysfunctional white blood cells. As a result, among leukemia’s common signs and symptoms are bone pain and tenderness (Kolivand et al., 2018). The mechanism by which leukemia causes a cancerous transformation of pluripotent hematopoietic stem cells, leading to the growth of both myeloid and lymphoid precursors (Kolivand et al., 2018). In acute leukemia, these cancerous cells are usually immature and poorly distinguished. Abnormal leucocytes also referred to as blasts, can be either myoblasts or lymphoblast (Imai, 2017). In addition, they may go through clonal growth and multiplication. This interferes with the production and functioning of healthy blood products and replaces them with cancerous cells, causing clinical symptoms.

Restless Legs Syndrome (RLS)

This condition is characterized by an uncontrollable compulsion to move legs, generally due to a painful sensation. It typically occurs during the evening or night when the patient is resting. It may disrupt sleep that eventually disrupts daytime activities. Patients generally define RLS as uncomfortable and abnormal sensations in their legs or feet. These sensations are described as aching or throbbing. A positive history of dominant inheritance is reported among 40% of the cases of RLS. This suggests a genetic foundation as a mechanism by which RLS is caused (Didato et al., 2020). The symptomatic reaction with levodopa and dopamine agonists paves the path to ascertain that dysfunction of the dopaminergic system possibly contributes to the pathophysiology of RLS. This system is proximal to the hypothalamus’ circadian control centers, which could explain the indicative alteration of RLS diagnosis based on circadian patterns (Didato et al., 2020). The metabolism of iron in the brain could also play a role in the pathogenesis of RLS. This is mainly because iron is a tyrosine hydroxylase cofactor. This refers to a rate-limiting phase in the alteration of dopamine from levodopa. This suggests that a decline in iron levels can affect dopamine levels. In addition, circadian variations have been reported in the tyrosine hydroxylase’s activity (Didato et al., 2020). This could suggest the aggravating of RLS during the nighttime.    Pediatric – Week 9 Discussion 1st REPLY

2. What laboratory or radiographic studies are appropriate for children with leg pains? Explain

Laboratory studies appropriate for children with leg pain may include a negative antinuclear antibody (ANA) test, an erythrocyte sedimentation rate (ESR), and a complete blood count. The results of these tests may help diagnose or rule out the possibility of infection, cancer, and complete lupus erythematous (Lizano, 2019). It is recommended that plain radiography must be the initial choice of radiologic study. It generally supports the exclusion of certain conditions such as cancer. They can be further supportive concerning fracture or bony lesions. Magnetic resonance imaging (MRI) has been reported to have the highest sensitivity levels when an inflammatory cause is suspected for the leg pain (Lizano, 2019).

3. How do musculoskeletal injuries in children differ from those in adults? In terms of injury type and location?

Differences between musculoskeletal injuries in children and adults are mainly attributed to the variance in the physiology of the growing bones. For instance, the elasticity of the metaphysis is reported to be higher among children than adults. This suggests that fractures are usually incomplete in children (Locquet et al., 2019). Also, the origin of the tibia of the anterior cruciate ligament (ACL) in children possibly avulse a fragment of bone. On the other hand, a similar mechanism of injury in the adult tend to disrupt it mid-substance (Locquet et al., 2019). This suggests significant variance between musculoskeletal injuries in children and adults.

4. How does the nurse practitioner decide the extent of the diagnostic work-up in a child with extremity pain?

The nurse practitioner can decide the range of diagnostic work-up in a child with extremity pain based on the clinical features presented by the child. For instance, identifying if the pain is out of proportion to clinical findings, it is recommended to order ESR (Lizano, 2019). When a severe rheumatic cause is suspected, the nurse practitioner must thoughtfully utilize the laboratory test. For instance, ANA can be utilized for a patient suspected to be suffering from juvenile rheumatoid arthritis (Lizano, 2019). The nurse practitioner can determine the need for appropriate laboratory tests based on patient history and findings of the physical exam. These may include atypical symptoms or abnormal findings during the physical exam of a child with extremity pain. Radiologic studies are warranted in such cases (Lizano, 2019). Pediatric – Week 9 Discussion 1st REPLY

5. What fractures are common in pediatric patients, and what are the ages associated with them?

The most common fractures among children up to 24 months include 25% of supracondylar or distal humerus fractures and 29% of distal radial buckle fractures (Baig, 2017). The most common fractures among children aged three to six include 10% of ulnar metaphysis or radial fractures and 32% of distal radial/buckle fractures and supracondylar or distal humerus fractures each (Baig, 2017). For children between seven to 12 years, the most common fractures include nine percent of ankle fractures, 12% of supracondylar fractures, and 37% of buckle or radial fractures (Baig, 2017).

6. Choosing one of the diagnoses you’ve come with; how would you treat the condition?

Growing pains have been identified not to have any particular treatment. It often improves without treatment in a year or two. The intensity of pain reduces after a year (Lehman & Carl, 2017). During this time, growing pains are managed through easing associated discomfort by self-care measures. These may include gently massaging the affected leg and using the heating pad to soothe sore muscles. Medication treatment may consist of administering a pain-relieving medication such as children’s Motrin, Advil, or Tylenol (Lehman & Carl, 2017). In addition, parents can be guided to take their child to a physiotherapist to learn about exercise that helps muscles stretch. Performing stretching exercises in the day may provide pain relief during the nighttime.

References

Baig, M. N. (2017). A review of the epidemiological distribution of different types of fractures in the pediatric age. Cureus, 9(8), 1-9. https://doi.org/10.7759%2Fcureus.1624.

Didato, G., Giacomo, R., Rosa, G. J., Dominese, A., Curtis, M., & Lanteri, P. (2020). Restless legs syndrome across the lifespan: Symptoms, pathophysiology, management and daily life impact of the different patterns of disease presentation. International Journal of Environmental Research and Public Health, 17(10), 1-18. https://doi.org/10.3390/ijerph17103658.

Imai, K. (2017). Acute lymphoblastic leukemia: Pathophysiology and current therapy. The Japanese Journal of Clinical Hematology, 58(5), 460-470. https://doi.org/10.11406/rinketsu.58.460.

Kolivand, H., Rehman, A., Abbas, N., Saba, T., Rahman, S. I., & Mehmood, Z. (2018). Classification of acute lymphoblastic leukemia using deep learning. Microscopy Research and Technique, 81(11), 1310-1317. https://doi.org/10.1002/jemt.23139.

Lehman, P. J., & Carl, R. L. (2017). Growing pains: When to be concerned. Sports Health, 9(2), 132-138. https://doi.org/10.1177%2F1941738117692533.

Lizano, M. P. (2019). The Limping Child. Pediatric Orthopedics, An Issue of Pediatric Clinics of North America, 66(5), 119-138. https://doi.org/10.1106/po.pcna.2019.05.030.

Locquet, M., Beaudart, C., Durieux, N., Reginster, J. Y., & Bruyère, O. (2019). Relationship between the changes over time of bone mass and muscle health in children and adults: A systematic review and meta-analysis. BioMed Central Musculoskeletal Disorders, 20(1), 1-13. https://doi.org/10.1186/s12891-019-2752-4. Pediatric – Week 9 Discussion 1st REPLY

 

Evidence Base Practice / Nursing Assignment

Part 3A: Critical Appraisal of Research Conduct a critical appraisal of the four peer-reviewed articles you selected and analyzed by completing the Critical Appraisal Tool Worksheet Template. Be sure to include: · An Evaluation Table20(20.00%)( paper with 2 pages and correct citations)

Levels of Achievement:

Part 3B: Evidence-Based Best Practices Based on your appraisal, suggest a best practice that emerges from the research you reviewed. Briefly explain the best practice, justifying your proposal with APA citations of the research.0(0.00%)

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Levels of Achievement: This is a paper  3 page paper  5 APA style citations  3 pages

Written Expression and Formatting—Paragraph Development and Organization:

Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria.5(5.00%) Evidence Base Practice / Nursing Assignment

Levels of Achievement:

Written Expression and Formatting—English Writing Standards:

Correct grammar, mechanics, and proper punctuation.5(5.00%)

Levels of Achievement:

Written Expression and Formatting—The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.5(5.00%) Evidence Base Practice / Nursing Assignment

Levels of Achievement:

 

Women Health – Week 7 Discussion Professor REPLY

Answer the following question based on the discussion bellow. Please provide one reference.

Question:

She would like to know if she should get Hepatitis titers also. How do you respond?

Discussion:

Questions to Ask During Screening

Assessing the patient should be done holistically. This is the first visit in 4 years since she last had access to healthcare and therefore a comprehensive assessment is needed. In addition to concentrating on the reason for the visit (abdominal and pelvic pain), other body systems should also have evaluated and screened to ensure that she does not have any other problems with the goal of disease prevention and health promotion. The questions should be appropriate for her age, gender, and socioeconomic class. Confidentiality of the patient is quite important during the assessment because she needs a conducive environment to be able to open up about serious health issues such as mental health, abuse, and sexual health. The questions I would ask in relation to her chief complaint include; Where is the pain located? Has it been gradual or sudden? Is it centralized or it radiates to other areas? When was your LMP? how would score the pain on a scale of 10? Have you been taking any medications for the pain? Are you currently using any contraceptives? Do you have time for exercise after work? How safe are you from abuse both at home and at work? Have you experienced any physical or emotional abuse? Women Health – Week 7 Discussion Professor REPLY

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Summary of Clinical findings

Ms. Bell chief complaints are abdominal and pelvic pain. She complaints of pain during sexual intercourse and even admits to trying to avoid it. The last period was last month and she is not on any contraceptives. The patient has also been having nausea, vomiting, and constipation. The last pap smear was done 4 years ago results were abnormal but due to financial and time constraints, never went for a follow-up. She additionally mentions having a lot of anxiety and has been under a lot of stress which suggests the need to review her mental health. She reports being under numerous psychosocial stressors. She rarely takes alcohol, but her husband is a regular drinker. Upon physical examination of the patient, some tenderness on the mid-epigastric region and lower abdominal area has been noted. Yellow discharge with odor is also noted.

Tests and findings

The tests that Ms. Bell requires are pregnancy test, pap smear, HIV test, and the KOH/saline test which checks for bacterial vaginosis, vaginitis, and trichomonas. A urinalysis test is also crucial for testing UTIs. Due to not using any contraceptives, this is why a pregnancy test is needed. The results indicated that she is her urine test was normal with no UTIs, she was not pregnant but had trichomonas infection. Women Health – Week 7 Discussion Professor REPLY

Diagnoses

The following differential diagnosis will allow making the primary one for Ms. Bell. Gastritis is suspected due to the presence of epigastric pain, constipation, nausea, and increased bloating. The pain is aggravated by stress and sometimes dietary changes. At the same time, there is a possibility of the patient suffering from pelvic inflammatory disease since she indicates having lower abdomen pain aggravated by activity or sexual intercourse, cervical motion tenderness, and menstrual irregularities. The sexual history of both partners and pelvic exams will confirm the diagnosis. Urinary tract infection is suspected due to the presence of lower abdominal pain that is aggravated by sexual intercourse (Perry et al., 2015). The diagnosis was confirmed by the lab test. Finally, she might suffer from vaginitis due to the presence of pelvic pain and vaginal discharge (Perry et al., 2015), which can be confirmed by the lab test.

Among the differential diagnoses mentioned above, the primary one is vaginitis due to the mentioned symptoms. The wet prep lab findings also show the presence of white blood cells and a few motile trichomonas, which is another indication of trichomonas vaginitis.

Management

The pharmacological management is by prescribing a drug for treating trichomonas vaginitis which has been confirmed as she waits for other results. For the pharmacological treatment care plan, metronidazole is prescribed to treat trichomonas vaginitis. Metronidazole dosage is 2g in a single dose or 500mg for 7 days in women found to be HIV positive. The non-pharmacological approach is by educating the patient on ways to protect herself from sexually transmitted diseases. She is advised to bring her husband for treatment to reduce the high risk of reinfection. She is also educated on various birth control methods (Fashner & Alfred, 2015). The presence of bruises indicates that the patient is the victim of domestic violence. Thus, Ms. Bell should learn about the indicators of partner violence, including verbal use, slapping, pushing, kicking, and assaults with or with no weapons since she mentions that they argue with her husband while he is at home.

References

Fashner, J., & Gitu, A. (2015). Diagnosis and treatment of peptic ulcer disease and H. Pylori infection. American Family physician, 91(4), 236-

242. https://www.aafp.org/afp/2015/0215/p236.html

Perry, A., Potter, P., & Ostendorf, W. (2015). Nursing interventions and clinical skills (6th ed.). Elsevier Health Sciences. Women Health – Week 7 Discussion Professor REPLY

Chronic Illness And Rehabilitation Paper

Develop a realistic case and Identify a chronic illness and its relationship to rehabilitation. Could be from a previous experience on your career.

1. Identify chronic illness and its relationship to rehabilitation.
   Choose from one:
   COPD, CHF, Stroke, Hip fracture
2. Create interventions that support an older adult’s adaptation to the chronic illness or disability.
3. Describe the nurse’s role in assisting older adults in managing chronic conditions.
4. From your readings and knowledge which opportunities do you think can be change in the health care system to improve care for older adults with chronic illness and disability.

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Submission Instructions:

• The work is to be clear and concise and students will lose points for improper grammar, punctuation and misspelling.
• The submission is to be 5 pages in length, excluding the title, abstract and references page.
• Incorporate a minimum of 3 current (published within last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work.
• Journal articles and books should be referenced according to APA style. Chronic Illness And Rehabilitation Paper

Agenda Comparison Grid Template

Use the Agenda Comparison Grid Template found in the Learning Resources and complete the Part 1: Agenda Comparison Grid based on the current/sitting U.S. president and the previous president, and their agendas related to the population health concern you selected. Be sure to address the following:

• Identify and provide a brief description of the population health concern you selected.
• Explain how each of the presidential administrations approached the issue.
• Identify the allocation of resources that the presidents dedicated to this issue. Agenda Comparison Grid Template

 

2. Using the information you recorded in Part 1: Agenda Comparison Grid on the template, complete the Part 2: Agenda Comparison Grid Analysis portion of the template, by addressing the following:

• Which administrative agency (like HHS, CDC, FDA, OHSA) would most likely be responsible for helping you address the healthcare issue you selected and why is this agency the most helpful for the issue?
• How do you think your selected healthcare issue might get on the presidential agenda? How does it stay there?
• An entrepreneur/champion/sponsor helps to move the issue forward. Who would you choose to be the entrepreneur/champion/sponsor (this can be a celebrity, a legislator, an agency director, or others) of the healthcare issue you selected and why would this person be a good entrepreneur/ champion/sponsor? An example is Michael J. Fox is champion for Parkinson’s disease.

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3. Using the information recorded on the template in Parts 1 and 2, develop a 1-page fact sheet that you could use to communicate with a policymaker/legislator or a member of their staff for this healthcare issue. Be sure to address the following:

• Summarize why this healthcare issue is important and should be included in the agenda for legislation.
• Justify the role of the nurse in agenda setting for healthcare issues.
• Question

  • Use your Week 1 Discussion post to help with this assignment. (covid-19 Pandemic paper)
  To Prepare:
  • Review the agenda priorities of the current/sitting U.S. president and at least one previous presidential administration.
  • Select an issue related to healthcare that was addressed by two U.S. presidential administrations (current and previous).
  • Consider how you would communicate the importance of a healthcare issue to a legislator/policymaker or a member of their staff for inclusion on an agenda.

  The Assignment: (1- to 2-page Comparison Grid, 1-Page Analysis, and 1-page narrative) with a title page. This is an APA paper. Use 2-3 course resources and at least 2 outside resources.

  Part 1: Agenda Comparison Grid
  Use the Agenda Comparison Grid Template found in the Learning Resources and complete the Part 1: Agenda Comparison Grid based on the current/sitting U.S. president (Biden)and the previous president(Trump), and their agendas related to the population health concern you selected. Be sure to address the following:
  • Identify and provide a brief description of the population health concern you selected.
  • Explain how each of the presidential administrations approached the issue.
  • Identify the allocation of resources that the presidents dedicated to this issue.

  Part 2: Agenda Comparison Grid Analysis
  Using the information you recorded in Part 1: Agenda Comparison Grid on the template, complete the Part 2: Agenda Comparison Grid Analysis portion of the template, by addressing the following:
  • Which administrative agency (like HHS, CDC, FDA, OHSA) would most likely be responsible for helping you address the healthcare issue you selected and why is this agency the most helpful for the issue?
  • How do you think your selected healthcare issue might get on the presidential agenda? How does it stay there? Agenda Comparison Grid Template
  • An entrepreneur/champion/sponsor helps to move the issue forward. Who would you choose to be the entrepreneur/champion/sponsor (this can be a celebrity, a legislator, an agency director, or others) of the healthcare issue you selected and why would this person be a good entrepreneur/ champion/sponsor? An example is Michael J. Fox is champion for Parkinson’s disease.

  Part 3: Fact Sheet
  Using the information recorded on the template in Parts 1 and 2, develop a 1-page fact sheet that you could use to communicate with a policymaker/legislator or a member of their staff for this healthcare issue. Be sure to address the following:
  • Summarize why this healthcare issue is important and should be included in the agenda for legislation.
  • Justify the role of the nurse in agenda setting for healthcare issues.

  Resources for references (Use 2-3 from this list)
  • Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Jones & Bartlett Learning.
  o Chapter 1, “Informing Public Policy: An Important Role for Registered Nurses” (pp. 11–13 only)
  o Chapter 2, “Agenda Setting: What Rises to a Policymaker’s Attention?” (pp. 17–36)
  o Chapter 10, “Overview: The Economics and Finance of Health Care” (pp. 171–180)
  o Chapter 12, “An Insider’s Guide to Engaging in Policy Activities”
   “Creating a Fact Sheet” (pp. 217-221)
  • DeMarco, R., & Tufts, K. A. (2014). The mechanics of writing a policy brief Links to an external site.. Nursing Outlook, 62(3), 219–224.
  • Kingdon, J.W. (2001). A model of agenda-setting with applications. Law Review M.S.U.-D.C.L Links to an external site.., 2(331)
  • Lamb, G., Newhouse, R., Beverly, C., Toney, D. A., Cropley, S., Weaver, C. A., Kurtzman, E., … Peterson, C. (2015). Policy agenda for nurse-led care coordination Links to an external site.. Nursing Outlook, 63(4), 521–530. doi:10.1016/j.outlook.2015.06.003.
  • O’Rourke, N. C., Crawford, S. L., Morris, N. S., & Pulcini, J. (2017). Political efficacy and participation of nurse practitioners Links to an external site.. Policy, Politics, and Nursing Practice, 18(3), 135–148.
  • Institute of Medicine (US) Committee on Enhancing Environmental Health Content in Nursing Practice, Pope, A. M., Snyder, M. A., & Mood, L. H. (Eds.). (n.d.). Nursing health, & environment Links to an external site.: Strengthening the relationship to improve the public’s health.
  • USA.gov. (n.d.). A-Z index of U.S. government departments and agencies Links to an external site.. Retrieved September 20, 2018, from https://www.usa.gov/federal-agencies/a
  • USA.gov. (n.d.). Executive departments Links to an external site.. Retrieved September 20, 2018, from https://www.usa.gov/executive-departments
  • The White House. (n.d.). The cabinet Links to an external site.. Retrieved September 20, 2018, from https://www.whitehouse.gov/the-trump-administration/the-cabinet/
  • Document: Agenda Comparison Grid Template (Word document) Agenda Comparison Grid Template
  Rubric for grading

  Part 1: Agenda Comparison GridExplain how each of the presidential administrations approached the issue. Identify the allocations of resources that the two presidents dedicated to this issue. The response clearly and accurately explains how the presidential administrations approached the issue and identifies the resource allocations dedicated to the issue.

  Part 2: Agenda Comparison Grid Analysis- Address the following:Which administrative agency would most likely be responsible for helping you address the healthcare issue you selected? Why is this agency most helpful?How do you think your selected healthcare issue might get on the agenda? How does it stay there?Who would you choose to be the entrepreneur/ champion/sponsor or the healthcare. The response clearly and accurately identifies an administrative agency most likely to be responsible for addressing the selected healthcare issue and why that agency is most helpful. …Response clearly and accurately explains how the healthcare issue gets on the agenda and remains there. …The response clearly and accurately identifies and justifies the entrepreneur/champion/sponsor of the healthcare issue selected.

  This criterion is linked to a Learning OutcomePart 3: Fact SheetBased on your Agenda Comparison Grid for the healthcare issue you selected, develop a 1-2-page narrative that you could use to communicate with a policy- maker/legislator or a member of their staff for this healthcare issue.Summarize why this healthcare issue is important and should be included in the agenda for legislation.Justify the role of the nurse in agenda setting for healthcare issues. Creates an accurate and thorough fact sheet. …Using sufficient evidence, the response provides an accurate synthesis of evidence on why this healthcare issue is important and should be included in the agenda for legislation. …Response accurately justifies the role of the nurse in agenda setting for healthcare issues.

  Resources- Response includes 3 or more course resources and 2 or more outside sources.

  Written Expression and Formatting: ParagraphParagraphs make clear points that support well developed ideas, low logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

  This criterion is linked to a Learning OutcomeWritten Expression and Formatting: English Writing StandardsCorrect grammar, mechanics, and proper punctuation. Uses correct grammar, spelling, and punctuation with no errors.

  Written Expression and Formatting: The paper follows correct APA format for title page, headings, font, spacing, indentations, parenthetical/in- text citations, and reference list. Uses correct APA format with no errors. Agenda Comparison Grid Template