Polycystic ovarian syndrome

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A 29-year-old female presents to the clinic with a complaint of hirsutism and irregular menses. She describes irregular and infrequent menses (five or six per year) since menarche at 11 years of age. She began to develop dark, coarse facial hair when she was 13 years of age, but her parents did not seek treatment or medical opinion at that time. The symptoms worsened after she gained weight in college. She got married 3 years ago and has been trying to get pregnant for the last 2 years without success. Height 66 inches and weight 198. BMI 32 kg.m2. Moderate hirsutism without virilization noted. Laboratory data reveal CMP within normal limits (WNL), CBC with manual differential (WNL), TSH 0.9 IU/L SI units (normal 0.4-4.0 IU/L SI units), total testosterone of 65 ng/dl (normal 2.4-47 ng/dl), and glycated hemoglobin level of 6.1% (normal value ≤5.6%). Based on this information, the APRN diagnoses the patient with the polycystic ovarian syndrome (PCOS) and refers her to the Women’s Health APRN for further workup and management.

Question:
What is the pathogenesis of PCOS?
How does PCOS affect a woman’s fertility or infertility?

The pelvic inflammatory disease

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A 30-year-old female comes to the clinic with a complaint of abdominal pain, foul-smelling vaginal discharge, and fever and chills for the past 5 days. She denies nausea, vomiting, or difficulties with bowels. Last bowel movement this morning and was normal for her.

Nothing has helped with the pain despite taking ibuprofen 200 mg orally several times a day. She describes the pain as sharp and localizes the pain to her lower abdomen. Past medical history noncontributory. GYN/Social history for having had unprotected sex while at a fraternity party. Physical exam: thin, Ill appearing anxious-looking white female who is moving around on the exam table and unable to find a comfortable position. Temperature 101.6F orally, pulse 120, respirations 22 and regular.

Review of systems negative except for chief complaint. Focused assessment of abdomen demonstrated moderate pain to palpation left and right lower quadrants. Upper quadrants are soft and non-tender. Bowel sounds diminished in bilateral lower quadrants. Pelvic exam demonstrated adnexal tenderness, cervical motion tenderness, and copious amounts of greenish thick secretions. The APRN diagnoses the patient as having the pelvic inflammatory disease (PID).

Question:
What is the pathophysiology of PID?

Psychosis and schizophrenia

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Psychosis and schizophrenia greatly impact the brain’s normal processes, which interfere with the ability to think clearly. When symptoms of these disorders are uncontrolled, patients may struggle to function in daily life. However, patients often thrive when properly diagnosed and treated under the close supervision of a psychiatric mental health practitioner. For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat patients presenting with psychosis and schizophrenia.
To prepare for this Assignment:
Review this week’s Learning Resources, including the Medication Resources indicated for this week.
Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients with schizophrenia-related psychoses.
The Assignment: 5 pages
Examine Case Study: Pakistani Woman With Delusional Thought Processes. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.
At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.
Introduction to the case (1 page)
Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
Decision #1 (1 page)
Which decision did you select?
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #2 (1 page)
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #3 (1 page)
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Conclusion
Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

Neurological and Musculoskeletal Disorders

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Knowledge Check Wk6 : Neurological and Musculoskeletal Disorders

• In this exercise, you will complete 5-essay type questions in the Knowledge Check to gauge your understanding of this module’s content.
• Each question will hold one to two parts asked to be addressed and each part will need at least one citation, at least two citations if asked two parts to the question from the textbook and/or current peer-reviewed journals.
• Each question is worth 4 points. I would expect substantive paragraphs per answer (a paragraph would include 6-10 sentences).

KC each essay needs a citation(s) and reference(s), if using textbook apply correct page(s)
Basic book citation format
The APA in-text citation for a book includes the author’s last name, the year, and (if relevant) a page number.
In the reference list, start with the author’s last name and initials, followed by the year. The book title is written in sentence case (only capitalize the first word and any proper nouns). Include any other contributors (e.g. editors and translators) and the edition if specified (e.g. “2nd ed.”).
Format Last name, Initials. (Year). Book title (Editor/translator initials, Last name, Ed. or Trans.) (Edition). Publisher.
Reference entry Anderson, B. (1983). Imagined communities: Reflections on the origins and spread of nationalism. Verso.
In-text citation (Anderson, 1983, p. 23)
QUESTION 1

Scenario 1: Gout
A 68-year-old obese male presents to the clinic with a 3-day history of fever with chills, and Lt. great toe pain that has gotten progressively worse. Patient states this is the first time that this has happened, and nothing has made it better and walking on his right foot makes it worse. He has tried acetaminophen, but it did not help. He took several ibuprofen tablets last night which did give him a bit of relief.
HPI: hypertension treated with Lisinopril/HCTZ .
SH: Denies smoking. Drinking: “a fair amount of red wine” every week. General appearance: Ill appearing male who sits with his right foot elevated.
PE: remarkable for a temp of 100.2, pulse 106, respirations 20 and BP 158/92. Right great toe (first metatarsal phalangeal [MTP]) noticeably swollen and red. Unable to palpate to assess range of motion due to extreme pain. CBC and Complete metabolic profile revealed WBC 15,000 mm3 and uric acid 9.0 mg/dl.
Diagnoses the patient with acute gout.
Question:
Explain the pathophysiology of gout.

QUESTION 2
1. Scenario 1: Gout

A 68-year-old obese male presents to the clinic with a 3-day history of fever with chills, and Lt. great toe pain that has gotten progressively worse. Patient states this is the first time that this has happened, and nothing has made it better and walking on his right foot makes it worse. He has tried acetaminophen, but it did not help. He took several ibuprofen tablets last night which did give him a bit of relief.

HPI: hypertension treated with Lisinopril/HCTZ .

SH: Denies smoking. Drinking: “a fair amount of red wine” every week. General appearance: Ill appearing male who sits with his right foot elevated.

PE: remarkable for a temp of 100.2, pulse 106, respirations 20 and BP 158/92. Right great toe (first metatarsal phalangeal [MTP]) noticeably swollen and red. Unable to palpate to assess range of motion due to extreme pain. CBC and Complete metabolic profile revealed WBC 15,000 mm3 and uric acid 9.0 mg/dl.

Diagnoses the patient with acute gout.

Question:
Explain why a patient with gout is more likely to develop renal calculi.

QUESTION 3
1. Scenario 2: Osteoporosis
A 78-year-old female was out walking her small dog when her dog suddenly tried to chase a rabbit and made her fall. She attempted to try and break her fall by putting her hand out and she landed on her outstretched hand. She immediately felt severe pain in her right wrist and noticed her wrist looked deformed. Her neighbor saw the fall and brought the woman to the local ER for evaluation. Radiographs revealed a Colles’ fracture (distal radius with dorsal displacement of fragments) as well as radiographic evidence of osteoporosis. A closed reduction of the fracture was successful, and she was placed in a posterior splint with ace bandage wrap and instructed to see an orthopedist for follow up.
Question:
Discuss what is osteoporosis and how does it develop pathologically?

QUESTION 4
1. Scenario 3: Rheumatoid Arthritis
A 48-year-old woman presents with a five-month history of generalized joint pain, stiffness, and swelling, especially in her hands. She states that these symptoms have made it difficult to grasp objects and has made caring for her grandchildren problematic. She admits to increased fatigue, but she thought it was due to her stressful job.
FH: Grandmothers had “crippling” arthritis.
PE: remarkable for bilateral ulnar deviation of her hands as well as soft, boggy proximal interphalangeal joints. The metatarsals of both of her feet also exhibited swelling and warmth.
Diagnosis: rheumatoid arthritis.
Question:
The pt. had various symptoms, explain how these factors are associated with RA and what is the difference between RA and OA?

QUESTION 5
1. Scenario5: Multiple Sclerosis (MS)
A 28-year-old obese, female presents today with complaints for several weeks of vision problems (blurry) and difficulty with concentration and focusing. She is an administrative para-legal for a law firm and notes her symptoms have become worse over the course of the addition of more attorneys and demands for work. Today, she noticed that her symptoms were worse and were accompanied by some fine tremors in her hands. She has been having difficulty concentrating and has difficulty voiding. She went to the optometrist who recommended reading glasses with small prism to correct double vision. She admits to some weakness as well. No other complaints of fevers, chills, URI or UTI
PMH: non-contributory
PE: CN-IV palsy. The fundoscopic exam reveals edema of right optic nerve causing optic neuritis. Positive nystagmus on positional maneuvers. There are left visual field deficits. There was short term memory loss with listing of familiar objects.
DIAGNOSIS: multiple sclerosis (MS).
Question:
Describe what is MS and how did it cause the above patient’s symptoms?

Trends and in the promotion of patient safety

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Instructions

Examine changes introduced to reform or restructure the U.S. health care delivery system. In a 1,000-1,250 word paper, discuss action taken for reform and restructuring and the role of the nurse within this changing environment.
Include the following:
Outline a current or emerging health care law or federal regulation introduced to reform or restructure some aspect of the health care delivery system. Describe the effect of this on nursing practice and the nurse’s role and responsibility.
Discuss how quality measures and pay for performance affect patient outcomes. Explain how these affect nursing practice and describe the expectations and responsibilities of the nursing role in these situations.
Discuss professional nursing leadership and management roles that have arisen and how they are important in responding to emerging trends and in the promotion of patient safety and quality care in diverse health care settings.
Research emerging trends. Predict two ways in which the practice of nursing and nursing roles will grow or transform within the next five years to respond to upcoming trends or predicted issues in health care.
You are required to cite to a minimum of three sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

Group B Streptococcus infection accounts for mortality

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Group B Streptococcus (GBS) is also referred to as Streptococcus agalactiae. The bacterium lives within the intestines or genital tract and does not cause harm in healthy adults. However, it is known to cause a severe ailment called Group B strep disease in children. In adults with chronic illnesses such as diabetes, Group B strep can cause serious infections. Group B Streptococcus infection accounts for mortality and morbidity rates in newborns.

prompt question:

Write a research paper focusing on extensive information regarding Group B strep infection in pregnancy and evidence-based treatment interventions.IVES

Medical Anthropology in the Time of COVID-19

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Has the Covid-19 pandemic changed everything or has it made the familiar clearer?

“In different ways and for different reasons, a sense that the COVID-19 pandemic has changed everything has come to dominate public, personal, and intellectual life…The social entanglements it created have been both for better and for worse, but they have always exceeded the pathogen’s physical effects on bodies. Anthropologists recognize in these patterns not only a rupture but also the familiar as if what can be seen now is not new but has simply been made clearer.” (Adams and Nading 2020: 461).

Vincanne Adams and Alex Nading (2020) ‘Medical Anthropology in the Time of COVID-19’. Medical Anthropology Quarterly, 34(4): 461–466.

1. Like many essay questions, there are two sides to explore in order to answer this essay well. It is worth developing an outline that takes into account both sides.

2. When you have made the first draft, consider the following questions:
a. Does your essay answer a question?
– or does it just give interesting information (without answering the question)?
– does it give evidence of having thought carefully and deeply about the question, considering it from different angles? (e.g. what, when, where, who, how, why?)

b. Is your essay research-led?
– have you read and used relevant work published in medical anthropology and other relevant disciplines as evidence/examples? Peer-reviewed journals and ethnographic monographs are particularly good. Are these appropriately and consistently referenced (e.g. using the Harvard, Chicago or Vancouver styles – see ‘Cite them Right’ for further information).
– have you critically evaluated what you have read, questioning the author, e.g. their purpose, methods used, strength of argument, possible bias etc. and communicating their opinion of it?
– are you aware of key approaches/perspectives / theoretical standpoints that medical anthropologists might have taken regarding the topic? Have you been suitably reflexive about your own experience and how it links to relevant concepts and approaches in medical anthropology?

3. Is your writing clear (grammatically and logically)? Does the essay use effective orienting sentences that refer back to the question and justify the relevance of what is being discussed?
Do you agree? Give reasons for your answer, drawing on relevant concepts and approaches introduced in Health, Illness and Society Part 1 as well as your personal experience.

Reduction of causes of frequent fall

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Reduction of causes of frequent fall among clients 65 years and older in the home setting

After reading Chapter 8 in the Curley ebook, consider and reflect on the history of the Quality improvement movement and the excellent resources, including;

  • the Quality improvement Essential Toolkit
  • Curley’s discussion of Nurse-Sensitive Process and Outcome Indicators and the HEDIS measures.

Framing your Doctor of Nursing Practice (DNP) project to better grasp how to evaluate this practice at the population level, taking us to the 21st Century and discuss the following:

1. What measurements would be important to framing a DNP practice problem, and how would you go about doing this for the patients you will be working with ( community, primary care, hospital?)

2. How could you determine, more specifically, the nature of the problem from a measurement standpoint?

3. What is the gap in practice at your organization and what QI tools could be used to measure the problem and can shed insight?

Health promotion/teaching strategies

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Perinatal Case Study – Maritzia

Escaping political persecution in El Salvador, Maritzia (28) and Carlos (26) recently
immigrated to Toronto two years ago as refugees. They have two children, aged four and two,
and Maritzia is expecting their third child. She is unsure how far along she is in her pregnancy.
They are presently living in the basement apartment of the brother of Carlos and his wife who
sponsored them to come to Canada. They were both able to obtain work permits from
Immigration, Refugees and Citizenship Canada (IRCC). Maritzia works shifts as a cashier at No Frills and Carlos works cleaning office buildings at night; both have a high school education. Maritzia speaks limited English but Carlos only speaks Spanish. She delivered her first two
babies in a public hospital in San Salvador where epidurals are not utilized for vaginal deliveries
because of the cost and belief that they are not good for the mother and baby. Maritzia states that
she would like to have a natural birth. She breastfed both children for 18 months.
During Maritzia’s pregnancy, she often suffered from swollen feet after working a shift. The
doctor at the clinic says that all her tests are normal as well as her weight gain but that they want
to watch her blood pressure and urine. They also told her at 35 weeks gestation, that she was
GBS positive and she was not immune to measles. As refugees, they were eligible for subsidized
daycare but since Carlos works long nights it is her responsibility for all the childcare, cooking, and house cleaning. Many nights she feels exhausted, she wishes she had more support but her
in-laws are just as busy working long hours as well.
At 38 weeks gestation, Maritzia started labor and baby Rodrigo was born weighing 2900 gms
after 15 hours of labor. Her delivery included an epidural, augmentation due to failure to
progress and vaginal delivery with failed forceps, vacuum extraction assistance, and 2nd degree
lacerations; the pages were 7 and 9. Rodrigo sustained bruises to his head on both temporal
areas.
During the first 24 hours, Rodrigo was sleepy and had a difficult time latching to the breast.
He was initially hypothermic with a temperature of 36 degrees Celsius but it quickly returned to
normal after skin-to-skin time with Maritzia. His discharge weight was 2700 gms and his skin
colour was slightly jaundiced. Prior to discharge, the nurse proceeded to test his bilirubin levels
and they were found to be slightly elevated but still within the normal range at 48 hours.
The day after discharge from the hospital Maritzia and Carlos brought Rodrigo back to the
hospital clinic with symptoms of lethargy, poor feeding, and increased jaundice. Rodrigo was
admitted to the hospital and Maritzia stays near him in the “care by parent” room.

 

1. Describe and provide a rationale on what you will include in Maritzia’s perinatal
assessment under the following components:
a. Physical assessment in the first trimester and postpartum period
b. Laboratory tests/screening in all trimesters and the postpartum period
2. Identify and describe four (4) priority risk factors and four (4) priority health concerns
that relate to Maritzia throughout the perinatal period. Provide a rationale for your choices.
3. Discuss three (3) priority nursing interventions and three (3) priority health promotion/
teaching strategies that should be included when caring for Martizia throughout her
perinatal experience. Provide a rationale for each.
4. Discuss two (2) priority risk factors related to infants with hyperbilirubinemia as it relates
to baby Rodrigo. Provide a rationale for your choices.
What health promotion/teaching strategies would you implement to address the two risk
factors you have discussed? Provide a rationale.
5. Identify and describe which family form Maritzia is a part of.
Identify and describe two (2) main social determinants of health impacting Maritzia’s
perinatal experience.
Discuss two (2) ways that you will provide culturally competent/sensitive care and two
(2) ways that you will incorporate core concepts of family-centered care when looking
after Maritzia and her family. Provide a rationale for your responses

Philosophies of Women and People of various Cultures

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Philosophies of Women and People of various CulturesMany women have pushed back against these accusations and misogynistic views, sparking an intellectual revolution in the process. For a long time, philosophy was seen as a boy’s club, but with Simone de Beauvoir’s views, Harriet Taylor Mill, Hypatia of Alexandria, and others, that prejudice has been dispelled. A diverse perspective is sometimes required to make progress, and a fabulous idea can originate from anybody, anywhere.

Males have definitely controlled the philosophical discourse, Marjorie, especially in terms of whose voices were taken seriously. Men have long defined women as different and. often, less than. Are female philosophers caught within a “Catch 22”? Are they marginalized as long as their gender is highlighted, as long as they continue to be called “female philosophers” instead of just philosophers? Do we ever append male to the philosopher, or do we see that as the default?

Of course, this raises some very big issues about sex and gender, with sex being defined as biological differences between males and females and gender being described as the cultural constructs that the culture attachs to sex. And we often mistake one for the other, mistake cultural constructions for biological differences.

Ursula Le Guin’s classic, award-winning science fiction novel The Left Hand of Darkness imagines a world without gender. That world’s inhabitants are not just genderless, but sexless for most of the time (on a regular cycle they become one gender or the other, not always the same gender each cycle, during which they can have sex and even reproduce). What is particularly interesting is that the story is told from the perspective of a man from Earth. And he repeatedly misreads people on this planet (sometimes to his great detriment) because he cannot get past his own assumptions about gender.

This brings us back to the issue of universality here on Earth. Do we often mistake the male experience as the universal experience?