Nutrition week 8 discussion 1
Discuss the effects of diet on health concerning at-risk populations.
11 words
Discuss the effects of diet on health concerning at-risk populations.
11 words
Henderson believed nurses have the responsibility to assess the needs of the individual patient, help individuals meet their health needs, and provide an environment in which the individual can perform activities unaided. What is an opportunity in your nursing practice that would benefit from application of Henderson’s theory? How does this align with the ANA’s definition of nursing? Provide at least one evidenced-based research article to support this recommendation.
Your initial posting should be at least 400 words in length and utilize at least one scholarly source other than the textbook.
Discuss nutritional precautions taken for clients who are immunicompromised.
Focus on a “current event” ethical dilemma in public health. Apply the principles of the ethical practices of public health to resolve the issue. You may integrate recommendations based on conclusions from public health acts and principles to support your position.
Why do cancer prevention recommendations suggest red meat intake be limited?
11 words
design a 1-2 page health newsletter that would be appropriate for their workplace. Newsletters should contain content appropriate for health promotion concerning the workplace that they have chosen for their project. Also, links for additional facts and information and graphics should be included.
Please click the Newsletter Guideline and Rubric
to learn more about the assignment and to access the grading rubric.
nursing work
Reply to Hollie
Question 1—Postpartum Depression
Postpartum depression (PPD) is a major depressive disorder that occurs up to one year after birth (Hackley & Kriebs, 2017). Common symptoms of postpartum depression include: anhedonia; sleep disturbance; feelings of loneliness, isolation, or guilt; poor concentration; anxiety; and somatic complaints (Hackley & Kriebs, 2017). Mothers with postpartum depression are also less responsive to their infants and often need help caring for their infant (Hackley & Kriebs, 2017). Studies have shown that postpartum depression can impact child development, behaviors in childhood, and children’s cognitive function (Hackley & Kriebs, 2017).
The Edinburgh Postnatal Depression Scale (EPDS) is the screening tool used at my preceptor’s clinic to assess for postpartum depression. Hackley and Kriebs (2017) state that because postpartum depression has bimodal peaks at 2 and 6 months, the optimal time to screen for postpartum depression is between 2 weeks and 6 months postpartum. The American College of Obstetricians and Gynecologists (ACOG) recommends screening at the patient’s 6-week comprehensive postpartum visit (ACOG, 2018). However, because postpartum depression can occur at any time, studies and the American Academy of Pediatrics (AAP) are now supporting the use of EPDS screenings for mothers at the 2 month, 4 month, and 6 month well child visits (Emerson, Mathews, & Struwe, 2018).
The cutoff score for depression on the EPDS ranges from 9 to 13. The AAP (n.d.) recommends women with a score of 9 or more be further evaluated for depression. A score of more than 12 is considered likely for postpartum depression (Hackley and Kriebs, 2017). Women with these scores should be clinically evaluated, started on treatment, or referred to a a mental health clinician (Hackley and Kriebs, 2017). A score of less than 9 should not rule out depression if clinical suspicion of PPD is present. Any woman indicating suicidal thoughts on the EPDS or during the comprehensive clinical exam should be immediately assessed to determine if hospitalization is needed (Hackely & Kriebs, 2017). For those at high risk, the patient should be taken to the emergency room (Hackley & Kriebs, 2017).
References
AAP. (n.d.). Edinburgh postnatal depression scale. Retrieved from https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/practicing-safety/Documents/Postnatal%20Depression%20Scale.pdf
ACOG. (2018). Screening for perinatal depression. American College of Obstetricians and Gynecologists, 132(5), 208-212. Retrieved from https://www.acog.org/-/media/Committee-Opinions/Committee-on-Obstetric-Practice/co757.pdf?dmc=1&ts=20190310T2001493232
Emerson, M., Mathews, T., & Struwe, L. (2018). Postpartum depression screening for new mothers at well child visits. American Journal of Maternal/Child Nursing, 43(3), 139-145. doi: 10.1097/NMC.0000000000000426
Hackley, B. K., & Kriebs, J. M. (2017). Primary care of women(2nd ed.). Burlington, MA: Jones & Bartlett Learning.
Reply Angela
uestion 2: 6-Week Postpartum Visit
At the 6-week postpartum visit a full physical assessment is done including gynecological exam. Assessment for postpartum depression continues as well as infant bonding and parenthood and transitioning to regular gynecological care (ACOG. Org, 2018). If there were issues with preeclampsia and eclampsia or gestational diabetes these areas are addressed as well. Providing the patient’s primary care provider with the prenatal and post-natal history is recommended as well to help the patient receive care that is complete and collaborative. ACOG (2018) recommends an initial postpartum visit in three weeks which may just include a phone conversation but is not a complete physical exam and then a six week to twelve weeks visit that will include a comprehensive exam. It is recommended that the postpartum visit be no later than 12 weeks postpartum.
ICD-10 codes that are used for these visits are Z39.0 encounter for care and examination of mother immediately after delivery, Z39.1 encounter for care and examination of lactating mother, Z39.2 encounter for routine postpartum follow-up. There are other codes for postpartum encounters but are more disease related. The code that is used most generally is the Z9.2 code (ICD.codes, 2019). CPT codes can be used in the numerical range of 99211 through 99215 to reflect that a postpartum patient is an established patient and is in clinic for a routine exam. The higher the number use the more intensive the visit, or the more information and procedures were provided (supercoder.com, 2018).
References
ACOG. Com. (2018). Optimizing postpartum care. Retrieved from https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Optimizing-Postpartum-Care (Links to an external site.)Links to an external site.
ICD10.codes. (2019). Code. Retrieved from https://icd.codes/icd10cm/Z712 (Links to an external site.)Links to an external site.
Supercoder.com. (2018). CPT code. Retrieved from https://www.supercoder.com/cpt-codes/99215 (Links to an external site.)Links to an external site.
Reply to Amanda
Do you take any medications?
Some medications (Lithium) are notorious for causing hypothyroid.
Have you ever been diagnosed with a thyroid disorder?
Surgeries to the thyroid may result in hypothyroid.
Are you allergic to anything?
Relevant to treatment regimen.
Have you experienced any significant life changes? Additional stress etc?
Depression may manifest similar symptoms.
PE:
Hypothyroidism is six times more common in women than men, and is most common in older women (Carson, 2009). A thorough physical assessment should be completed. Clinical signs and symptoms may include paleness, brittle appearing hair and skin, elevated blood pressure, and bradycardia (Carson, 2009). The patient may have a “puffy” appearance to her face, irregular periods, and report sustained fatigue (Roberts et al, 2009).
Differential Diagnoses
Anemia, Depression
Diagnostics
TSH – Will be elevated in Hypothyroid
Free T4 – Result will be low in Hypothyroid
Cholesterol – Often elevated with Hypothyroid
CBC – To rule out anemia
CMP – To monitor other electrolytes
EKG – to assess for any blocks, prolonged QRS, or electrolyte abnormalities
Treatment
Patients with symptomatic hypothyroidism should be treated to prevent long-term complications (Roberts et al, 2004) Depending on the results of her TSH & T4 I would initiate a daily regimen of Levothyroxine. 4-6 weeks after the initiation of Levothyroxine I would recheck the patients TSH. After the TSH has reached a therapeutic level – I would recheck it again in 6 months.
References
Carson, M. (2009). Assessment and management of patients with hypothyroidism. Nursing Standard (through 2013), 23(18), 48-56; quiz 58. Retrieved from https://prx-herzing.lirn.net/login?url=https://search.proquest.com/docview/219883523?accountid=167104 (Links to an external site.)Links to an external site.
Roberts, C. G. P., & Ladenson, P. W. (2004). Hypothyroidism. The Lancet, 363(9411), 793-803. doi:http://dx.doi.org/10.1016/S0140-6736(04)15696-1
reply to Quiana
Some questions include:
Hypothyroidism can increase lipids and alter cardiac function (Chaker, et al., 2017). EKG may reveal cardiac abnormalities. CBC can reveal anemia. The metabolic panel can reveal diabetes or problems with hepatic or renal function. Hypothyroidism continues to be researched as far as the specific link to renal and hepatic dysfunction (Chaker, et al., 2017). The depression screen serves, like the other lab orders, to exclude causes of her symptoms. The most obvious test is a thyroid panel. To assess the circulating amount of hormone in the body is to judge her thyroid function.
References
Baisier, W. V., Hertoghe, J., & Eeckhaut, W. (2000). Thyroid insufficiency. is TSH measurement the only diagnostic tool? Journal of Nutritional & Environmental Medicine, 10(2), 105-113. Retrieved from https://prx-herzing.lirn.net/login?url=https://search.proquest.com/docview/215623935?accountid=167104
Bathla, M., & Singh, M. (2016). Reply to “how prevalent are depression and anxiety symptoms in hypothyroidism?”. Indian Journal of Endocrinology and Metabolism, 20(6) doi:http://dx.doi.org/10.4103/2230-8210.192913
Chaker, L., Bianco, A. C., Jonklaas, J., & Peeters, R. P. (2017). Hypothyroidism. The Lancet, 390(10101), 1550-1562. doi:http://dx.doi.org/10.1016/S0140-6736(17)30703-1
Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2015). Primary care: The art and science of advanced practice nursing, (4th ed.). [VitalSource Bookshelf version]. Retrieved from https://bookshelf.vitalsource.com/books/9780803655621
Step 1: Open your power points to Chapter 8, slide 9-14, fig. 8.3.
Review Figure 8.3 on fluid balance
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