Client Questions

Poverty and Community What is the poverty level in your community? How many people live below the poverty level in your community? What does this mean for your community (what issues arise from the poverty level and the number of people below the poverty level)? Justify your answers with resources.

Please respond to the following 2 posts , with atleast two scholarly references , APA format , plagiarism free. Thanks Response One:  Amenorrhea and Dysmenorrhea       Amenorrhea, the absence of menstrual flow, is often attributed to anatomic abnormalities, genetic disorders, endocrine disorders, medication use, illegal drug use, or oral contraceptives. The disorder can be divided into primary and secondary disorders. Primary amenorrhea is when menarche never occurred, whereas secondary amenorrhea is the result of a cessation of menstruation in an individual who previously experienced a menstrual cycle (Hubert and VanMeter, 2018). Dysmenorrhea results from painful menstruation and also has primary and secondary features. Primary dysmenorrhea occurs when ovulation starts, and secondary dysmenorrhea develops from pelvic disorders such as endometriosis, uterine polyps or tumors, or pelvic inflammatory disease (Hubert and VanMeter, 2018). Common Presenting Symptoms      Primary amenorrhea symptoms include the absence of menstruation in which an individual has never had a menstrual cycle. The main symptom is absence of the menstrual cycle, but can also include headache, visual changes, nausea, extra facial hair, hair loss, changes in breast size, and milky fluid or discharge from the breasts (American Academy of Family Physicians, 2020). Secondary amenorrhea is the cessation of menstruation in an individual who previously experienced menstrual cycles. The primary symptom is missing several menstrual cycles in a row, and the same symptoms of primary amenorrhea.      Patients experiencing primary and secondary dysmenorrhea may experience discomfort the day before and during the first 24-48 hours of menses which can be cyclic, acyclic, and/or accompanied by urinary or bowel symptoms; nausea, vomiting, diarrhea, headaches, and muscle cramps can also accompany the disorder (Sachedina and Todd, 2019). Secondary dysmenorrhea symptoms include progressively worsening pain, chronic pelvic pain, midcycle or acyclic pain, and irregular or heavy menstruation (Sachedina and Todd, 2019). Diagnosis      Primary amenorrhea is routinely diagnosed by performing a history and physical on the patient and collecting a series of labs for evaluation. Providers routinely perform a pregnancy test initially to rule out pregnancy as the underlying cause of amenorrhea. Other labs for evaluation include serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), and thyroid – stimulating hormone (TSH), and prolactin levels (Klein, Paradise, and Reeder, 2019). Providers may decide to perform a pelvic ultrasound or magnetic resonance imaging (MRI) to identify abnormal reproductive anatomy or to detect an androgen-secreting tumor (Klein et al., 2019). If the pregnancy test is negative, evaluation of the hormone levels will assist in diagnosing the cause of amenorrhea, such as hypothalamic dysfunction, outflow tract obstruction, ovarian insufficiency, or chromosomal defects.      Secondary amenorrhea is routinely diagnosed in a similar manner beginning with a complete history and physical, review of medications, including contraceptives and illicit drugs. Patients are also given a pregnancy test and blood collected to evaluate the same hormonal levels as primary amenorrhea. If the pregnancy test is negative, evaluation of the hormone levels is performed to discover a diagnosis. Depending on the results of the hormone levels, the cause of secondary amenorrhea can be attributed to hypothalamic disorder, hyperandrogenism, metabolic syndrome, primary ovarian insufficiency, natural menopause, or chronic disease. Patients could also have other disorders which would be visualized on an ultrasound of MRI, including neoplasm, polycystic ovarian syndrome, or tumors of the adrenal or ovaries (Klein et al., 2019).      Primary and secondary dysmenorrhea are diagnosed in a similar fashion as amenorrhea. The health care provider should begin with a complete history and physical including the age of menarche, duration of menses, amount of bleeding, time elapsed between onset of menarche and dysmenorrhea. An evaluation of pain should include the onset, duration, severity, aggravating and alleviating factors, and when it occurs in relation to the menstrual cycle, dyspareunia, history of sexually transmitted or pelvic infections, and sexual violence (Sachedina and Todd, 2019). Providers would also complete an examination of the pelvis to determine the exact location of the pain and internal pelvic examination for the determination of tenderness on palpation. Standard Treatment Plan      The standard treatment plan for primary amenorrhea depends on the underlying cause. If the individual does not have any underlying conditions, obstruction or congenital abnormalities, then the provider may recommend waiting for the menstrual cycle to start especially if there is a family history of late onset menstruation. Individuals with genetic or chromosomal abnormalities may require surgery. For secondary amenorrhea, birth control pills or other hormonal medications may be required to restart the menstrual cycle, or medication to stimulate ovulation. Estrogen replacement therapy is an option for women with an imbalance of hormonal levels. Patients experiencing a pituitary tumor may be prescribed medications to shrink it. Surgical management is uncommon but can be performed in the presence of uterine scarring by performing a hysteroscopic resection in order to restore the menstrual cycle (Eunice Kennedy Shriver National Institute of Child Health and Human Development, 2017).      Treatment for primary and secondary dysmenorrhea can include Nonpharmacological and pharmacological regimens such as application of heat, exercise, or medications such as nonsteroidal anti-inflammatory (NSAID) medications such as Ibuprofen or Advil, and oral contraceptives (Hubert and VanMeter, 2018). Link(s) to Routine Screening and Treatment Guidelines      Routine screening is not recommended for amenorrhea or dysmenorrhea. In primary amenorrhea, individuals are not evaluated for the condition unless there is an absence of menses and secondary sexual characteristics by the age of fourteen; or the absence of menses by the age of sixteen, regardless of the presence of normal growth and development (Lowdermilk, Perry, Cashion, and Alden, 2016). For secondary amenorrhea, evaluation is not completed unless the individual has missed several menstrual cycles in a row unless they are determined to be pregnant.      Primary and secondary dysmenorrhea have the same guidelines as amenorrhea. Routine screening is not recommended. Individuals are evaluated if they exhibit symptoms. Treatment guidelines depend upon the causative factors for the discomfort. Individuals can be referred to the following links for treatment options for primary or secondary dysmenorrhea: https://www.nichd.nih.gov/health/topics/amenorrhea/conditioninfo/treatments https://www.uptodate.com/contents/evaluation-and-management-of-primary-amenorrhea?topicRef=104218&source=see_link https://www.uptodate.com/contents/dysmenorrhea-in-adult-women-treatment https://www.acog.org/patient-resources/faqs/gynecologic-problems/dysmenorrhea-painful-periods Response Two  Breast Cancer Breast cancer is the malignant growth of abnormal cells in the breast tissue. Most breast cancers begin in the milk ducts that supply milk to the nipple while others may originate in the glands that produce breast milk. Less common breast cancers include phyllodes tumors and angiosarcoma (American Cancer Society, 2020). The majority of breast cancer cases occur in women over the age of fifty. Familial history supports a strong genetic predisposition of the development of breast cancer and is connected to the BRCA-1 and BRCA-2 genes. Hormonal connection, specifically Estrogen is also strongly supported. Experiences such as early onset of menstruation and late onset of menopause, nulliparity, or advanced age with first childbirth all increase length of time to high level Estrogen exposure, increasing risk for developing breast cancer (Hubert &VanMeter, 2020). Early detection is key in treating breast cancer and the prevention of breast cancer spreading to other organs of the body. Presenting Symptoms  Most patients present due to an abnormal mammogram. However, the presence of a breast mass undetected on a mammogram or formed between screenings account for 45% of identified breast cancer masses (Joe, 2020). The classic characteristics of a cancerous mass are hard, singular, non-moveable with irregular boarders. If the mass advances the patient may present with axillary adenopathy or changes in the skin to include erythema and dimpling of the skin known as peau d’orange (Joe, 2020). A patient may also notice retraction of the nipple or a discharge from the nipple (Hubert & VanMeter, 2018). If a breast mass is identified during a self-breast exam or due to visual changes to the breast or axillary area, the patient will need to see a physician to determine the nature of the mass and malignancy. Routine Diagnosis  A majority of breast cancer masses are identified via mammography studies. Supplemental mammographic views and possible ultrasound conduction will be used for further identification and characterization. The BI-RADS (Breast Imaging Reporting and Data System) is used to determine the likelihood of a mass being cancerous. If a mammogram is given a zero, further imaging studies are used for characterization. A BI-RADS score of 4-5 denotes that a malignant is highly suspected and further diagnostic studies such as a biopsy is needed (Esserman & Joe, 2019). Part of the course of diagnosis in breast cancer is also to determine the stage of malignancy and the extent of the disease, such as metastasis. Standard Treatment Plan  Treatments are individualized depending on the stage of progression of the disease and other factors such as risk factors for recurrence and if the patient has other comorbidities. Early stage breast cancer patients may undergo surgery to remove the mass (lumpectomy) or to remove the breast (mastectomy) depending on what option is right for them (Taghian, & Merajver, 2020). In addition, a patient may also be treated adjuvant therapy such as chemotherapy and radiation to resolve any undetected micrometastases that remain after surgery. Other forms of treatment include hormone therapy. If a tumor proves to be responsive to estrogen, then the estrogen hormone stimulation is removed. This is done by way of removal of the ovaries in premenopausal patients and by hormone blocking agents in post-menopausal women (Hubert & VanMeter, 2018).   Links to Routine Screening and Treatment             Breast self-examination is recommended for all women over the age of 20 and for men at high risk for breast cancer (see Surprise Nugget section for more information on male breast cancer). The U.S. Preventive Services Task force recommends biennial screening mammography for women ages 50-74 years, and earlier if at higher risk for breast cancer. All screening recommendations can be found at https://uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening. Additional screening tools such as step-by-step instructions on completing a breast self-examination can be found at https://www.breastcancer.org/symptoms/testing/types/self_exam. Routine visits to a primary care physician related to women’s health is also recommended for routine screening support and education. Surprise Nugget The incidence of male breast cancer has increased 26% in the past 25 years (Gradishar & Ruddy, 2020). Male breast cancer is often linked with a family history in a first-degree relative and often presents in the same fashion as female breast cancer. Alterations in estrogen and androgen rations may also increase risk for male breast cancer. These alterations could result from hepatic dysfunction, obesity, thyroid disease, marijuana use, and inherited conditions such as Klinefelter syndrome. In Klinefelter syndrome, there is an inheritance of an additional X chromosome causing atrophic tested, gynecomastia, increased levels of follicle-stimulating and luteinizing hormones, and a decrease in testosterone. It is recommended that men with Klinefelter syndrome understand the affiliation and how to conduct self-examinations for breast cancer (Gradishar & Ruddy, 2020).

Research topic Breast cancer in young women. This week after the completion of your assigned readings and review of the (AACN Essentials I, II, IV, V, VI, and VIII) (refer to assignment section to view the list of essentials).   Think about how these essentials may apply to your paper assignment.  Additionally, discuss the theory and design phase, explain how this will benefit your research.  Please remember that your initial postings should be a minimum of 250 words, this should be posted by Wednesday and all responses should be 150 words. Do not forget in-text citations and references.

Comment1 Evaluating the outcome of an evidence-based practice project is the final step of the process.  I would probably choose one or two different methods of evaluation-starting with a survey for staff and patients.  Surveys are easy and usually have a good number of responses.  I would compare the answers to the survey done prior to the implementation of the EBP project.  Another method would be to collect data involving safety issues prior to and since the project improvements.   A survey for nurses regarding bullying would include questions to see if they are more comfortable at work with the new policy changes in place and if they would make a report if they had a bullying experience.  The main objective in reducing bullying in the nursing workforce is to attempt to reduce the number of nurses leaving and increase nurse retention.  Therefore, it would be important to make sure the message has been understood and policies enforced.  Posting results to employees communicates transparency in the process. Comment2 Evaluation for my EBP could be done through data collection. Data collection done through monitoring of rate of adherence to treatment by these patient population. Monitoring means “regularly collecting information on your project that will help you answer basic questions about your work”. (Evaluating your Project, 2015). Data collection on persistence with therapy will be one major way of evaluating my project effectiveness. Varying types of data would need to be collected to prove persistence to treatment such as,  (1) data on refill rate or medication possession rate (MPR), because as patients take their medications, they should be refilling their prescriptions. (2) data collection on increasing or decreasing reports of adverse reactions to medications for treatment. If reports of adverse reactions resulting from improper intake of these medication are on the decrease that means patients are receiving the proper education and counselling and are adhering to them (3) Patient satisfaction with treatment and monitoring trends in treatment outcomes such as decreasing rate of fracture and increase bone mineral density in patients taking these oral medications for treatment of postmenopausal osteoporosis, since these medications are found to be effective in reversing bone loss, maintain bone density and prevent fracture. (Osteoporosis Treatment Medications can Help, 2017).

Case Studies Each student will be assigned one of the case studies below. Your post should be approximately 250 words in length and contain substantive information that contributes to an understanding of the disorder under discussion. You may post graphics from online sources, but please do NOT simply cut and paste entire entries from the internet. You are expected to provide references for all the information cited. Discussion Questions 1. Relate history to the diagnosis. What risk factors are present, and how does each predispose to disease? 2. Explain the cause of the disease in this patient. 3. How could this disease have been prevented in this patient? 4. Discuss the complications that might develop in this patient. 5. Discuss the treatments available to the patient. 6. What is the probable prognosis for this patient?   Case Study# 5: Linda, a 61-year-old woman discovers a lump in her breast. She visits her gynecologist who orders a biopsy, which reveals the presence of malignant cells. The woman is married, with one child who was born when she was 32. She reports that she breastfed her child for the first three months then switched to formula. She had her first period at the age of 14 and entered menopause at age 55. She smoked as a teenager but quit after a few years. She is about 40 pounds overweight and reports that she tends to eat fast food for lunch most weekdays. Her mother also had breast cancer. She has two younger sisters, but neither of them has been diagnosed with breast cancer.

respond    Week 6: Planning and Scheduling (graded) 99 unread replies.99 replies. Assume you were appointed as project manager to lead a dozen of your classmates to write up an end-of-course summary guide that would be used to update all areas of the course (i.e., discussion questions, lectures, assignments, quizzes, and exams). You get to meet face to face periodically, but the majority of the work is done via conference call and e-mail. You plan to form subteams to work on each of these elements, each headed by a subteam leader. How would you set up your WBS? What are some of the considerations you made when you decided on this structure? Read a number of your classmates’ ideas and look for similarities and differences. Ask questions about why a person set up his or her plan as he or she did. Would you change anything about your plan after networking with others?

Alzheimer’s Disease 76-year-old Iranian Male BACKGROUND Mr. Akkad is a 76 year old Iranian male who is brought to your office by his eldest son for “strange behavior.” Mr. Akkad was seen by his family physician who ruled out any organic basis for Mr. Akkad’s behavior. All laboratory and diagnostic imaging tests (including CT-scan of the head) were normal. According to his son, he has been demonstrating some strange thoughts and behaviors for the past two years, but things seem to be getting worse. Per the client’s son, the family noticed that Mr. Akkad’s personality began to change a few years ago. He began to lose interest in religious activities with the family and became more “critical” of everyone. They also noticed that things he used to take seriously had become a source of “amusement” and “ridicule.” Over the course of the past two years, the family has noticed that Mr. Akkad has been forgetting things. His son also reports that sometimes he has difficult “finding the right words” in a conversation and then will shift to an entirely different line of conversation. SUBJECTIVE During the clinical interview, Mr. Akkad is pleasant, cooperative and seems to enjoy speaking with you. You notice some confabulation during various aspects of memory testing, so the PMHNP performs a Mini-Mental State Exam. Mr. Akkad scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall. The score suggests moderate dementia. MENTAL STATUS EXAM Mr. Akkad is 76 year old Iranian male who is cooperative with today’s clinical interview. His eye contact is poor. Speech is clear, coherent, but tangential at times. He makes no unusual motor movements and demonstrates no tic. Self-reported mood is euthymic. Affect however is restricted. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. He is alert and oriented to person, partially oriented to place, but is disoriented to time and event [he reports that he thought he was coming to lunch but “wound up here”- referring to your office, at which point he begins to laugh]. Insight and judgment are impaired. Impulse control is also impaired as evidenced by Mr. Akkad’s standing up during the clinical interview and walking towards the door. When the PMHNP asked where he was going, he stated that he did not know. Mr. Akkad denies suicidal or homicidal ideation. Diagnosis: Major neurocognitive disorder due to Alzheimer’s disease (presumptive) RESOURCES § Folstein, M. F., Folstein, S. E., & McHugh, P. R. (2002). Mini-Mental State Examination (MMSE). Lutz, FL: Psychological Assessment Resources. Decision Point One Select what the PMHNP should do: Begin Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg orally BID in 2 weeks: Begin Aricept (donepezil) 5 mg orally at BEDTIMEBegin Razadyne (galantamine) 4 mg orally BID Examine Case Study: An Elderly Iranian Man With Alzheimer’s Disease. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes. At each decision point stop to complete the following: Decision #1 Which decision did you select? Why did you select this decision? Support your response with evidence and references to the Learning Resources. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different? Decision #2 Why did you select this decision? Support your response with evidence and references to the Learning Resources. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different? Decision #3 Why did you select this decision? Support your response with evidence and references to the Learning Resources. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different? Also include how ethical considerations might impact your treatment plan and communication with clients. Note: : Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

The purpose of the iCARE Paper assignment is to explore the concept of interprofessional teams and patient outcomes. Nursing supportive actions of compassion, advocacy, resilience, and evidence-based practice will serve as a way to apply care concepts.

Please answer the following questions. Include the questions in the paper. Be careful with similitude has to be less than 20 %.    1. Describe a situation in which the nurse manager would use problem resolution in the workplace. Describe a situation in which the nurse manager would use negotiation to resolve a conflict (or potential conflict) in the workplace. 2. Compare and contrast strategies for resolving a conflict, using first the informal negotiation method and then the formal negotiation method. 3. Explore the American Nurses Association website for information on collective bargaining for nurses. Which states have nursing unions? Debate the issue of joining a union with another group of students. 4. PART 1: Log onto the website of your state nurses association and search for information on collective bargaining. Search for news articles, union websites, and other recent information on collective bargaining for nurses in your state. Is there a great deal of collective bargaining activity in your state? If not, why? If yes, what are the primary issues under discussion? PART 2: Review the pros and cons of becoming part of a collective bargaining unit. If you were a full-time staff nurse, would you want to join a union? Why or why not? 5

Read Chapter 10 1. In the last century, what historical, social, political, and economic trends and issues have influenced today’s health-care system?  2. What is the purpose and process of evaluating the three aspects of health care: structure, process, and outcome?  3. How does technology improve patient outcomes and the health-care system? 4. How can you intervene to improve quality of care and safety within the health-care system and at the bedside?  2. Select one nonprofit organization or one government agencies that influences and advocates for quality improvement in the health-care system. Explore the Web site for your selected organization/agency and answer the following questions: • What does the organization/agency do that supports the hallmarks of quality? •  What have been the results of their efforts for patients, facilities, the health-care delivery system, or the nursing profession? • How has the organization/agency affected facilities where you are practicing and your own professional practice? APA style (include in text citations) plagiarism FREE