lstigma against mental illnes

Response 1:
Despite our advancement and so-called progressivism, there is still a stigma against mental illness. A stigma occurs at several levels such as intrapersonal, interpersonal, and structural (Knaak et al., 2015). Intrapersonal stigmas people with mental illness report are feeling devalued, dismissed, and dehumanized by many healthcare professionals. Feeling this way discourages people with mental illness from seeking much-needed further care. The key themes that lead to these feelings include feeling excluded from making decisions, receiving subtle or overt threats of coercive treatment, being made to wait excessively long when seeking help, and being given insufficient information about one’s condition, among others (Knaak et al., 2015). Major obstacles stem from organizational culture rather than individual factors. System changes that can help overcome these obstacles are creating a culture of acceptance by raising awareness and education on mental health illnesses. The ARNP in an administrative position, can create policies and initiatives that help their facility support those with mental health issues. Programs that focus on crisis intervention prevention have proven effective at decreasing suicide among U.S veterans and can be initiated at healthcare facilities (Hester, 2017). Although healthcare professionals do not experience the same stress level as veterans, they experience similar feelings of depression and anxiety that lead them to burnout and substance abuse.
Nurses across all fields can help those with mental illness get the attention they need. Through education and empowerment, nurses can help their patients promote their health. The advanced practice nurse can use social work and case management resources to find patients outpatient care or therapies that may be useful. The advanced practice nurse can talk to insurance companies on their patient’s behalf to help them get the support they need. Partnering with available support systems during the care plan process can make them aware of any crisis prevention or damage control plans for when the patient is in crisis. The advanced practice nurse can also continue to follow-up with their patients after leaving their care.
Response 2:
Mental health is an essential and integral health component involving an individual’s state of well-being in which they can productively work and contribute to their communities, cope with everyday life stressors, and realize their abilities. In workplaces, mental health stigma is a significant challenge where most employees with employer-provided insurance feel uncomfortable approaching the employer for help due to workplace reprisals. Despite all this, system changes can improve fear of workplace reprisals, how nurses can get more individuals to seek mental health, and support patients and their families once they leave care despite insurance barriers.
According to the American Psychiatric Association (2019), while 70% of employees with benefits are familiar with ways of accessing mental health care and 62% of them are somewhat at ease about obtaining services via their employer, workers exceeding one-quarter are not sure of ways of accessing mental health services via their employer. Most employees get worried about being fired or retaliation when seeking mental health services. To improve this situation, workplace wellness programs can be incorporated to identify those at risk of mental health issues, link them to treatment, and offer support systems to aid individuals to cope with and minimize stress (CDC, 2019). Developing psychological health in workplaces “how to” guide would offer assessment tools and notify effective program designs to establish if current programs are successful and have an impact (Goetzel et al., 2018). Further, there is a necessity to have a distinct set of metrics, mainly when working with community partners, insurance companies, wellness vendors, and mental health providers.
In mental health care, promoting health is considered a process-oriented intervention that establishes that health is a developmental process, and the relationship between a patient and a nurse is significant since they impact one another. Also, the result of promoting health is dependent on the interaction quality. The essence in promoting mental health is practical support, educational support, and empowerment portrayed via a good alliance. The alliance involves a conversation concerning two or more people and a nurturing interaction centered on a personal relationship, mutuality, and trust to promote health. Conversely, the development of the alliance is achieved when nurses develop a relationship with the patient as an individual, have smiling faces, are kind, and continue interacting with the patient expansively.
When individuals develop mental illness, they usually require long-term care that the insurance company must cater to the cost. However, insurance company physicians who never personally attend to the patient typically deny long-term care, despite the disapproval of the psychiatrist treating them. An incident is illustrated by Pelley (2015) concerning Ashley, who suffered from bipolar disorder and was denied long-term treatment. In cases like this, APRNs should follow up with their patients once they leave care since most are susceptible to suicide. Also, APRNs can aid outpatient individuals by volunteering or starting outreach programs that cater to their requirements. Other options include participating in local health events targeting those not insured and educating them about national and state programs that are accessible to offer them services. Workplaces that support individuals with mental disorders and promote mental health are more capable of benefiting from related economic advances, increasing productivity, and reducing absenteeism. Working is beneficial for mental health, but a negative work setting leads to mental and physical health complications. Therefore, individuals need to seek mental health care to enhance their functional capability and productivity in the community with nurses at the frontline to curb mental-health-related stigma in the workplace.

abdominal cholecystectomy

Response 1:
Chief Complaint: A 42-year-old patient post op abdominal cholecystectomy. complains of left calf pain just below the knee and states it is swollen, warm, and painful to touch. She denies other symptoms, significant history, or allergies.
A 42-year-old patient is 3 days post-op from abdominal cholecystectomy. She is currently taking only antibiotics and hydrocodone. Today she complains of left calf pain just below the knee and states it is swollen, warm, and painful to touch. She denies other symptoms, significant history, or allergies. I would ask when did the pain began? I would ask what will make the pain worse ?  I would ask the patient to describe what symptoms she has when she dorsiflexes the leg.  I would ask if the pain radiates anywhere else. I would ask how often she goes for walks? I would ask if she has noticed any discoloration on left calf. I would ask If she wears any compression stockings post-surgery. I would ask what is how much pain medicine does she take in a day? I would ask if she has had any injuries to her calf ? I would ask if there are any open wounds in the left calf? Has she been able to walk on both legs?
Ears, Nose, Mouth, and Throat: Sore throat, slight cough no phlegm, difficulty hearing, reports no sinus issues
Neurological: Dizziness, stable gait, fatigued , no double vision, no tremors, reports no fainting
Cardiac: no chest pain, no significant weight gains recently
Respiratory: Shortness of breath, persistent cough not coughing up blood or any phlegm
GI: Heartburn, constipation, no diarrhea, no blood in stools, no nausea or vomiting, change in bowel habits
GU: Painful urination, recent UTI, burning urination, bladder issues
Skin: no rashes on the skin, skin pale in color
Musculoskeletal: left swollen left calf, unsteady gait does to pain on left calf
Psychiatric: no Depression, reports slight anxiety and sadness, no suicidal ideations,
O – Objective:
Patient Alert x4, calm and cooperative, able to speak full sentences,
I will be pulling this patient’s vital signs, I would pull patients physical exams, I would like to perform a physical inspection of Bilateral lower extremity , I would like to see both the limbs and check for symmetry, I would like to see unilateral swelling , skin changes, I would like to see if the patient had any varicose veins, I would like to check for heat with your hand above the suspected area of DVT before palpation, I would like to check for pulses on both legs, I would also check capillary refills, I would want to see if the patient could bare weight on BLE, I would order CBC, CMP, lactic level, , CK , D- Dimer, I would also order proximal leg vein ultrasound
Working Diagnosis – Popliteal Deep Vein Thrombosis
Pertinent positive: post op, abdominal surgery, today she complains of left calf pain just below the knee and states it is swollen, warm, and painful to touch, (2020)
Pertinent negative- none
Differential Diagnosis: : Cellulitis of Left lower extremity
Pertinent positive- swelling and painful left calf, warm to touch
Pertinent negative-none.
– Plan
I would order PT/INR CBC, CMP, lactic level, , CK , D Dimer, I would also order proximal leg vein ultrasound, have an accurate weight on the patient, I would start patient on Lovenox Pharmacy to dose based on kidney panel and patients weight, Drug, (2021). I would like to have a follow up 2 weeks later to see the respond to the medication.
What were your strengths in this course? – My strengths would be gaining knowledge on assessment and how to stop looking superficially but diving in deep to assess a patient snd their symptoms.
What was challenging? – I think what was most challenging was coming up with working diagnosis/differential diagnosis and figuring out the pertinent negative/pertinent positives for these.
What new learning or insight was developed? – I believe the new insight would be the SOAP. It allows the nurse to organize her discovery and able to solve the puzzle.
What new clinical skills have you gained? – I gained how to become a better interviewer and digging deep to able to give us a clear image of what the patient is going through.
Response 2:
2. A 66-year old woman complains of shortness of breath, numbness and heaviness of her arms when walking up the hill to her house. The pain subsides when she stops to rest.
S – Subjective
CC – Patient stating “Whenever I walk up the hill to my house, I get short of breath and I feel my arms get numb and heavy. I also get chest pain when walking, but that pain goes away when I stop to rest.”
HPI – Patient is a 66-year old woman who complains of shortness of breath, numbness and heaviness of her arms when walking up the hill to her house. She states that there is chest pain which subsides when she stops to rest.
PMH – Some questions to ask this patient would include: Do you have a history of heart issues? Do your mother and father have/had heart issues? Do you take any medications for heart issues? Please describe the pain you are feeling in your chest. Does the pain radiate anywhere else in the body? How long does the pain last? Is there anything you do to treat the pain? Have you gone to the hospital or emergency department before for this thing in the past?
MEDS – Are you taking any medications currently? Do you take medications for heart issues? Do you take any medications for your pain?
Allergies – Are you allergic to any medications? Are you allergic to any foods? Are you allergic to anything in the environment such as dust, pollen, pet dander?
FH – Does anyone in your family have or had any heart issues issues? Has anyone in your family died of a heart attack? Does anyone in your family have issues with cholesterol?
Social history – Do you smoke cigarettes, if so how often? Do you smoke marijuana? Do you take recreational drugs? Do you drink alcohol, if so much and how often?
Health related behaviors – Do you exercise? Are you active in your lifestyle? Explain what you normally do for work. What do you do on your free time? What does your diet consist of? What do you normally eat?
Review of Systems:
Constitution/General – I would ask the patient how she is generally currently feeling. I would ask if she feels tired, unwell, or lethargic.
Neurological – I would ask her if she has any issues with double vision, issues with walking, issues with balance. I would ask if she has had dizziness or fainting spells.
Respiratory – I would ask her if she has current shortness of breath, if it hurts when she breathes in, if the chest pain hurts when breathing out. I would ask when she gets short of breath when walking up the hill how long it takes for her to catch her breath. I would ask if she uses oxygen at home.
Cardiac – I would ask her if she has any feelings of racing heart beat, skipping heart beat, feeling like she can faint, swelling of arms or legs, what her chest pain feels like and do an OLDCART assessment, and if anything that makes it feel better. I would ask about her lifestyle and what she does. I would ask if she has had previous chest pain like this in past.
Psychiatric – I would ask the patient about a history of depression, anxiety, feelings of worthlessness, suicidal ideations, hearing voices or thoughts of harming self or others.
O – Objective
I would obtain vital signs, numeric pain scale, oxygen saturation and temperature. I would obtain lab results such as a CBC, CMP, lipid panel, troponin, EKG, and order a cardiac stress test.
General – Patient is awake, alert, oriented to time, place, person, situation. Appropriate in speech and language, clear and logical. No acute distress noted.
Cardiac – S1 and S2 auscultated, no murmurs or gallops present, heart rate and rhythm WNL, pulses palpable BL all extremities +2. Patient skin warm to touch and normal turgor. BP = 143/89, HR = 98. Patient is obese BMI 35.
Respiratory – Chest wall is symmetric, atraumatic, lung sounds WNL in all quadrants, SpO2 98%.
Psychiatric – Patient is calm and cooperative, patient has good judgement and insight, denies suicidal or homicidal ideations.
A – Assessment
Working Diagnosis – Angina pectoris, unspecified – 2022 ICD-10-CM Diagnosis Code I20.9
Pertinent positive: Chest pain that subsides with rest. Chest pain that subsides with rest or medication (nitroglycerin) is a common symptom of stable angina (Sullivan, 2018).
Pertinent negative: Patient is obese and has high blood pressure. These are risk factors for having stable angina (Sullivan, 2018).
Differential Diagnosis – Acute ischemic heart disease, unspecified – 2022 ICD-10-CM Diagnosis Code I24.9
Pertinent negative: Sudden numbness and heaviness with shortness of breath are symptoms of an acute coronary event such as a myocardial infarction (Mayo Clinic, 2021).
Differential Diagnosis – Nonrheumatic aortic (valve) stenosis – 2022 ICD-10-CM Diagnosis Code I35.0
Pertinent negative: Shortness of breath when walking short distances, chest pain, fatigue on exertion are all signs and symptoms of aortic valve stenosis (American Heart Association, 2020).
P – Plan
The patient states she has chest pain on exertion. In order to make sure the patient isn’t having an active myocardial infarction an EKG will be done along with troponin. My working diagnosis is stable angina or angina pectoris due to the chest pain relief on rest. Since that is my working diagnosis I would still perform an EKG and also a stress test. A stress test may show EKG changes on exercise and will also show me if the patient gets symptomatic again with exercise (Sullivan, 2018). I also would like to order an ECHO as well to rule out aortic valve stenosis due to patient’s age at 66 years-old and similar symptoms (American Heart Association, 2020). The ECHO will show me valve changes and will confirm my diagnosis. If lifestyle changes are not met to reduce symptoms, medication such as nitroglycerin can be given. If nitroglycerin stops working, further measures such as a coronary angiography will be needed to see the extent of a multi-vessel disease and possible coronary bypass will be needed.
Referral: Cardiologist. If interventions are needed for an acute MI an interventional cardiologist will be recommended. If bypass is needed for advanced blockage, cardiothoracic surgery will be consulted.
Treatment: Since we are in the beginning stages of a cardiovascular event such as stable angina I would recommend to the patient lifestyle changes first. Eating a heart healthy diet with fruits, whole grains, and vegetables, along with moderate exercise daily, and smoking cessation can help with advancing heart disease (Sullivan, 2018).
Medications: If lifestyle alone cannot fix symptoms nitroglycerin can be prescribed. Nitroglycerin 0.4 mg sublingual tablets are prescribed as place one tablet under the tongue. If pain does not completely subside in 5 minutes, take another tablet. Take a max of 3 tablets in 15 minutes. If pain does not subside in 15 minutes, call 911. It is also recommended to take 1 tablet 5-10 min before exercise (Aremu, 2021). One of the more common side effects of nitroglycerin tablet is complaint of headaches, dizziness, weakness, nausea, and fast heart rate. Do not drink alcohol with this medication as it can cause low blood pressure (Aremu, 2021).
Follow-up: If the patient is still symptomatic with nitroglycerin and lifestyle changes, further examination will be done in order to rule out multi-vessel disease and possible interventions such as PCI or bypass. Patient will need to follow up in at least a week with cardiologist to assess effectiveness of medications and treatment.

Response 1: Cerebral palsy (CP) is an umbrella term for a group of permanent mov

Response 1:
Cerebral palsy (CP) is an umbrella term for a group of permanent movement and posture development disorders caused by disturbances in the fetal or infant brain (London et al., 2014). Children with CP experience activity, sensory, perceptual, cognitive, communicative, and behavioral problems. Prognosis depends on the level of developmental delay, and often, children need assistance with mobility and activities of daily living, such as bathing and feeding. In addition, those with CP require therapies such as physical, speech, and occupational, along with multiple medications and surgeries to improve function. Parents and families of children with CP must adjust their lives to care for the various needs of this chronic condition. Children with CP are dependent for life, and parents either take on the task alone or use resources such as home health nursing or prescribed pediatric extended care (PPEC).
The Centers for Disease Control (CDC) state that the estimated cost of lifetime care for someone with CP is almost $1 million (2020). The CDC also points out that medical costs for children with CP are ten times higher than those without CP (2020). Kamaralzaman et al. highlight four types of expenses families incur when caring for children with CP, and not all of them are covered by health insurances (2018). First, direct healthcare costs include rehabilitation services, medicine, diagnostic tests, consultation, and surgery fees, which amount to the “highest-burden” of all types (Kamaralzaman et al., 2018). Direct non-healthcare costs include transportation and accommodation costs. Third, development costs include nursing aids, special education, dietary supplements like formulas, gastric tubes, feeding pumps, daily necessities like diapers, wet tissues, and special lotions and soaps. Finally, indirect costs for parent and child and total productivity loss when parents take unpaid leave or resign from their jobs to care for their child.
The economic impact of family caregiving for individuals with CP takes a toll on family resources over time. If parents do not have stellar health insurance, many of the costs mentioned are paid out of pocket. As children age and turn 18 years old, they lose the benefits they received as children and must transfer services to adult facilities and insurance programs. Mothers of children with CP have poorer mental health and physical outcomes than mothers of children who do not (Shih et al., 2018). From personal experience, parents of children with CP that I have cared for express those concerns. They state that they feel “exhausted,” “burnt-out,” and “struggling” to find resources for themselves and their children. Over time, caregiving becomes physically challenging as the child grows, and some parents express that “it was easier when they were a baby, but now [the child] weighs more than me.” Costs do not decrease over time, and adults with CP still have higher medical and out-of-pocket expenses than those without CP (Whitney et al., 2019).
Response 2:
A chronic illness represents a long-lasting mental or physical disorder that necessitates constant treatment or monitoring and causes functional restrictions. Chronic diseases constitute the United States’ costliest and prevalent health conditions, and approximately half of all Americans have at least one chronic illness (Raghupathi & Raghupathi, 2018). Among the common chronic illnesses is chronic kidney disease (CKD), involving a compromise of the normal blood-filtering process by the kidneys. Universally, CKD has approximate mortality of 1.2 million and a prevalence of 13.4%, with the primary cause of death being complete kidney damage extending to 4 months (Kakitapalli et al., 2020). Cost to U.S. health plans increases exponentially with each CKD stage progression, with ESRD costs being even higher. According to the CDC (2021), nearly 15% of U.S. adults with CKD get early cardiovascular disease and kidney failure without proper treatment. With the development of treatment complications for patients with CKD, understanding family caregiving and related economic impacts for adults is vital.
CDC (2021) remarks that CKD surmounts to 7% in claims costs paid to Medicare, or $80,000 per person, or total Medicare spending (excluding prescription drugs) of $36.6 billion in 2018. Besides, the management of CKD poses a significant financial burden for households and patients through out-of-pocket expenditure that challenges supportive care. CKD accounts for increased family caregiving costs associated with accessing assistive devices, home dialysis setups, illness-related home modifications, home-care assistance, and transport (Gilbertson et al., 2019). Other cost-related burdens for family caregiving correlate to self-management in households experiencing financial distress and economic hardships. The family caregiving burden is high with CKD given its societal implications on patients, such as their inability to work that proliferates estimated disability insurance costs and reduced household productivity. A large percentage of patients also seek therapeutic care out-of-pocket. In this case, the burden falls to family members and caregivers who step in to help with CKD’s worrisome treatment side effects and comorbidities.
Concerning the overall economic impacts of CKD, minority communities may have less access to healthcare which places them with higher treatment costs and fewer resources for care. Studies found that one-third of Hispanics, 20% of African Americans, and 1 out of 3 American Indians were uninsured (National Kidney Foundation, 2021). CKD costs impacting family caregiving for adults may include outpatient expenses and annualized costs per patient for Medicare. The National Kidney Foundation (2021) illustrated a 2.4-times higher Medicare spending for kidney failure with replacement therapy (KFRT) patients in 2018. CKD warrants extreme care involving appointments, especially if dialysis is incorporated to treat kidney failure. The task is overwhelming for primary caregivers, especially when they have no one to help them financially. The increased disease complications and related economic impacts on family caregiving warrant additional interventions to mitigate its progression to later years of development or adulthood. Disease management will improve if family members and family-focused nurses can access significant resources for disease management and effective delivery of intense therapies through financial support.

Response 1: Sample case: Mrs. C, a 30-year-old female, woke up from a nap and no

Response 1:
Sample case: Mrs. C, a 30-year-old female, woke up from a nap and noticed her inability to voluntary move the right side of her face. Along with that, she also could not close the right side of her eye and had a noticeable slight droop at the corner of the mouth. Her husband, who was aware of the signs of a stroke, noticed the signs that matched some of the signs of a stroke, so he called 911 to rush her to the hospital. She presented to the hospital where stroke was ruled out based on her imaging and insignificant health history. She was, however, diagnosed with Bell’s palsy.
SUBJECTIVE – 30 y/o female presented to the hospital with complaints of rapid and progressive weakness of the eyebrows, forehead, and angle of the mouth. She also reports inability to close the eyelid and lip on one side of the mouth. Additionally, she reports a difference in taste, sensitivity to sound, dry eye that worsens after a full day’s work looking at a computer screen. The symptoms have been progressing throughout the past week.
OBJECTIVE – Noted partial to complete weakness of the forehead. Facial droop on right, as well as drooping at the right side of the mouth are present. Speech slightly slurred and some drooling noted. The House-Brackman Facial Nerve Grading System is at 4/6.
ASSESSMENT – Bell’s palsy is a non-progressive neurological disorder of the 7th cranial nerve. It is characterized by the sudden onset of facial paralysis which may also be preceded by a mild fever, pain behind the ear, a stiff neck, or stiffness of on side of the face. Paralysis results from decreased blood supply to or compression of the 7th cranial nerve. The exact cause of bell’s palsy is unknown, but viral and immune disorders are frequently implicated as the cause (National Organization for Rare Disorders, 2021).
PLAN – Cranial nerve assessment; electromyography for confirm diagnosis and measure extent of never damage; lubricating eyedrops, glasses, or temporary patching to help protect exposed eye from corneal abrasion or any other damage if unable to close it; corticosteroid regimen consisting of 60 to 80mg a day for a week, which is the mainstay pharmacologic treatment for bell’s palsy (Warner, et. al, 2021).
The topic of bell’s palsy as demonstrated by the short case study, can mimic some of the signs and symptoms of stroke, and therefore, it is a very appropriate condition for graduate nursing students to be familiar with as misdiagnosis is not uncommon. Treatment does not always result in immediate resolution, and therefore, such condition is primarily managed in the outpatient setting where FNPs can manage the patient, so it is important to know the clinical guidelines on treatment, in addition to knowing its clinical manifestations and careful assessment to differentiate it from other more or less serious conditions. As mentioned previously, it can mimic stroke like symptoms, and so I would say that I can certainly expect to see this in the inpatient setting initially where patient may receive their initial bell’s palsy diagnosis. However, for those who have established diagnosis of such condition, I expect to see it managed primarily in the outpatient setting.
Response 2:
Acute Otitis Media in Children
Acute otitis media is one of the most common diseases in childhood. According to Mousseau et al. (2018), about 75 percent of children have at least one episode of acute otitis media before their first birthday. Acute otitis media is an infection of the middle ear space. It can be viral, bacterial, or a coinfection. The most common causing bacteria are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. The most common causing viral pathogens are respiratory syncytial virus (RSV), coronavirus, influenza viruses, adenoviruses, human metapneumovirus, and picornaviruses (Danishyar & Ashurst, 2021). When I think about acute otitis media, I think about my 8-year-old son, Elijah. He endured ear infections from age 2 months to 14 months old. The symptoms that he had included crying, irritability, poor feeding, and fever. Elijah had about 10 ear infections in a year. At 16 months of age, he had ear tubes placed. He had a speech delay, acid reflux, and recurrent ear infections. The doctor recommended that Elijah have ear tubes placed because of his speech delay and the recurrent ear infections. Placing ear tubes reduces the risk of future ear infections, restores hearing loss caused by middle ear fluid, improves speech and balance problems, and improves behavior and sleep problems (ENT Health, 2019).
I chose acute otitis media in children because graduate nursing students should learn about how to treat acute otitis media and how to diagnose a patient with ear problems. According to Deniz et al. (2017), there is emerging antimicrobial resistance for acute otitis media and should have selective antibiotic prescribing. Not all ear problems are related to otitis media, and it is up to the provider to differentiate between prescribing antibiotics or not. For children with acute otitis media, about 50 percent of children are prescribed antibiotics. In the U.S., about 80 percent of children have prescribed antibiotics (Deniz et al., 2017). Acute otitis media is typically seen in the outpatient setting.
When diagnosing a patient with acute otitis media, I would take into consideration that the patient may have had an upper respiratory tract infection. The eardrum may be red and bulging. The patient may also have a fever, decreased light reflex on the eardrum, an opaque tympanic membrane, and decreased tympanic membrane mobility. Recommendations of analgesics are used for ear pain, fever, and irritability. It is important to use analgesics at bedtime because disrupted sleep is one of the most common symptoms that motivate parents to seek care. Both ibuprofen and acetaminophen are effective, and ibuprofen is preferred for a longer duration of action. The concern that comes up is antibiotic-resistant bacteria, and to improve acute otitis media the management involves deferring antibiotic therapy in patients least likely to benefit from antibiotics. Antibiotics should be prescribed for children who are 6 months or older with severe signs and symptoms such as moderate or severe otalgia, otalgia for 48 hours, or a temperature of 102.2 degrees Fahrenheit or higher. According to Harmes, et al. (2013), one study found that two out of three children will recover without antibiotics. If a child needs antibiotics, the choice is to use amoxicillin. If there is no improvement with analgesics, then antibiotics should be used to help treat acute otitis media.

Response 1: Cerebral palsy (CP) is an umbrella term for a group of permanent mov

Response 1:
Cerebral palsy (CP) is an umbrella term for a group of permanent movement and posture development disorders caused by disturbances in the fetal or infant brain (London et al., 2014). Children with CP experience activity, sensory, perceptual, cognitive, communicative, and behavioral problems. Prognosis depends on the level of developmental delay, and often, children need assistance with mobility and activities of daily living, such as bathing and feeding. In addition, those with CP require therapies such as physical, speech, and occupational, along with multiple medications and surgeries to improve function. Parents and families of children with CP must adjust their lives to care for the various needs of this chronic condition. Children with CP are dependent for life, and parents either take on the task alone or use resources such as home health nursing or prescribed pediatric extended care (PPEC).
The Centers for Disease Control (CDC) state that the estimated cost of lifetime care for someone with CP is almost $1 million (2020). The CDC also points out that medical costs for children with CP are ten times higher than those without CP (2020). Kamaralzaman et al. highlight four types of expenses families incur when caring for children with CP, and not all of them are covered by health insurances (2018). First, direct healthcare costs include rehabilitation services, medicine, diagnostic tests, consultation, and surgery fees, which amount to the “highest-burden” of all types (Kamaralzaman et al., 2018). Direct non-healthcare costs include transportation and accommodation costs. Third, development costs include nursing aids, special education, dietary supplements like formulas, gastric tubes, feeding pumps, daily necessities like diapers, wet tissues, and special lotions and soaps. Finally, indirect costs for parent and child and total productivity loss when parents take unpaid leave or resign from their jobs to care for their child.
The economic impact of family caregiving for individuals with CP takes a toll on family resources over time. If parents do not have stellar health insurance, many of the costs mentioned are paid out of pocket. As children age and turn 18 years old, they lose the benefits they received as children and must transfer services to adult facilities and insurance programs. Mothers of children with CP have poorer mental health and physical outcomes than mothers of children who do not (Shih et al., 2018). From personal experience, parents of children with CP that I have cared for express those concerns. They state that they feel “exhausted,” “burnt-out,” and “struggling” to find resources for themselves and their children. Over time, caregiving becomes physically challenging as the child grows, and some parents express that “it was easier when they were a baby, but now [the child] weighs more than me.” Costs do not decrease over time, and adults with CP still have higher medical and out-of-pocket expenses than those without CP (Whitney et al., 2019).
Response 2:
A chronic illness represents a long-lasting mental or physical disorder that necessitates constant treatment or monitoring and causes functional restrictions. Chronic diseases constitute the United States’ costliest and prevalent health conditions, and approximately half of all Americans have at least one chronic illness (Raghupathi & Raghupathi, 2018). Among the common chronic illnesses is chronic kidney disease (CKD), involving a compromise of the normal blood-filtering process by the kidneys. Universally, CKD has approximate mortality of 1.2 million and a prevalence of 13.4%, with the primary cause of death being complete kidney damage extending to 4 months (Kakitapalli et al., 2020). Cost to U.S. health plans increases exponentially with each CKD stage progression, with ESRD costs being even higher. According to the CDC (2021), nearly 15% of U.S. adults with CKD get early cardiovascular disease and kidney failure without proper treatment. With the development of treatment complications for patients with CKD, understanding family caregiving and related economic impacts for adults is vital.
CDC (2021) remarks that CKD surmounts to 7% in claims costs paid to Medicare, or $80,000 per person, or total Medicare spending (excluding prescription drugs) of $36.6 billion in 2018. Besides, the management of CKD poses a significant financial burden for households and patients through out-of-pocket expenditure that challenges supportive care. CKD accounts for increased family caregiving costs associated with accessing assistive devices, home dialysis setups, illness-related home modifications, home-care assistance, and transport (Gilbertson et al., 2019). Other cost-related burdens for family caregiving correlate to self-management in households experiencing financial distress and economic hardships. The family caregiving burden is high with CKD given its societal implications on patients, such as their inability to work that proliferates estimated disability insurance costs and reduced household productivity. A large percentage of patients also seek therapeutic care out-of-pocket. In this case, the burden falls to family members and caregivers who step in to help with CKD’s worrisome treatment side effects and comorbidities.
Concerning the overall economic impacts of CKD, minority communities may have less access to healthcare which places them with higher treatment costs and fewer resources for care. Studies found that one-third of Hispanics, 20% of African Americans, and 1 out of 3 American Indians were uninsured (National Kidney Foundation, 2021). CKD costs impacting family caregiving for adults may include outpatient expenses and annualized costs per patient for Medicare. The National Kidney Foundation (2021) illustrated a 2.4-times higher Medicare spending for kidney failure with replacement therapy (KFRT) patients in 2018. CKD warrants extreme care involving appointments, especially if dialysis is incorporated to treat kidney failure. The task is overwhelming for primary caregivers, especially when they have no one to help them financially. The increased disease complications and related economic impacts on family caregiving warrant additional interventions to mitigate its progression to later years of development or adulthood. Disease management will improve if family members and family-focused nurses can access significant resources for disease management and effective delivery of intense therapies through financial support.

Response 1: Sample case: Mrs. C, a 30-year-old female, woke up from a nap and no

Response 1:
Sample case: Mrs. C, a 30-year-old female, woke up from a nap and noticed her inability to voluntary move the right side of her face. Along with that, she also could not close the right side of her eye and had a noticeable slight droop at the corner of the mouth. Her husband, who was aware of the signs of a stroke, noticed the signs that matched some of the signs of a stroke, so he called 911 to rush her to the hospital. She presented to the hospital where stroke was ruled out based on her imaging and insignificant health history. She was, however, diagnosed with Bell’s palsy.
SUBJECTIVE – 30 y/o female presented to the hospital with complaints of rapid and progressive weakness of the eyebrows, forehead, and angle of the mouth. She also reports inability to close the eyelid and lip on one side of the mouth. Additionally, she reports a difference in taste, sensitivity to sound, dry eye that worsens after a full day’s work looking at a computer screen. The symptoms have been progressing throughout the past week.
OBJECTIVE – Noted partial to complete weakness of the forehead. Facial droop on right, as well as drooping at the right side of the mouth are present. Speech slightly slurred and some drooling noted. The House-Brackman Facial Nerve Grading System is at 4/6.
ASSESSMENT – Bell’s palsy is a non-progressive neurological disorder of the 7th cranial nerve. It is characterized by the sudden onset of facial paralysis which may also be preceded by a mild fever, pain behind the ear, a stiff neck, or stiffness of on side of the face. Paralysis results from decreased blood supply to or compression of the 7th cranial nerve. The exact cause of bell’s palsy is unknown, but viral and immune disorders are frequently implicated as the cause (National Organization for Rare Disorders, 2021).
PLAN – Cranial nerve assessment; electromyography for confirm diagnosis and measure extent of never damage; lubricating eyedrops, glasses, or temporary patching to help protect exposed eye from corneal abrasion or any other damage if unable to close it; corticosteroid regimen consisting of 60 to 80mg a day for a week, which is the mainstay pharmacologic treatment for bell’s palsy (Warner, et. al, 2021).
The topic of bell’s palsy as demonstrated by the short case study, can mimic some of the signs and symptoms of stroke, and therefore, it is a very appropriate condition for graduate nursing students to be familiar with as misdiagnosis is not uncommon. Treatment does not always result in immediate resolution, and therefore, such condition is primarily managed in the outpatient setting where FNPs can manage the patient, so it is important to know the clinical guidelines on treatment, in addition to knowing its clinical manifestations and careful assessment to differentiate it from other more or less serious conditions. As mentioned previously, it can mimic stroke like symptoms, and so I would say that I can certainly expect to see this in the inpatient setting initially where patient may receive their initial bell’s palsy diagnosis. However, for those who have established diagnosis of such condition, I expect to see it managed primarily in the outpatient setting.
Response 2:
Acute Otitis Media in Children
Acute otitis media is one of the most common diseases in childhood. According to Mousseau et al. (2018), about 75 percent of children have at least one episode of acute otitis media before their first birthday. Acute otitis media is an infection of the middle ear space. It can be viral, bacterial, or a coinfection. The most common causing bacteria are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. The most common causing viral pathogens are respiratory syncytial virus (RSV), coronavirus, influenza viruses, adenoviruses, human metapneumovirus, and picornaviruses (Danishyar & Ashurst, 2021). When I think about acute otitis media, I think about my 8-year-old son, Elijah. He endured ear infections from age 2 months to 14 months old. The symptoms that he had included crying, irritability, poor feeding, and fever. Elijah had about 10 ear infections in a year. At 16 months of age, he had ear tubes placed. He had a speech delay, acid reflux, and recurrent ear infections. The doctor recommended that Elijah have ear tubes placed because of his speech delay and the recurrent ear infections. Placing ear tubes reduces the risk of future ear infections, restores hearing loss caused by middle ear fluid, improves speech and balance problems, and improves behavior and sleep problems (ENT Health, 2019).
I chose acute otitis media in children because graduate nursing students should learn about how to treat acute otitis media and how to diagnose a patient with ear problems. According to Deniz et al. (2017), there is emerging antimicrobial resistance for acute otitis media and should have selective antibiotic prescribing. Not all ear problems are related to otitis media, and it is up to the provider to differentiate between prescribing antibiotics or not. For children with acute otitis media, about 50 percent of children are prescribed antibiotics. In the U.S., about 80 percent of children have prescribed antibiotics (Deniz et al., 2017). Acute otitis media is typically seen in the outpatient setting.
When diagnosing a patient with acute otitis media, I would take into consideration that the patient may have had an upper respiratory tract infection. The eardrum may be red and bulging. The patient may also have a fever, decreased light reflex on the eardrum, an opaque tympanic membrane, and decreased tympanic membrane mobility. Recommendations of analgesics are used for ear pain, fever, and irritability. It is important to use analgesics at bedtime because disrupted sleep is one of the most common symptoms that motivate parents to seek care. Both ibuprofen and acetaminophen are effective, and ibuprofen is preferred for a longer duration of action. The concern that comes up is antibiotic-resistant bacteria, and to improve acute otitis media the management involves deferring antibiotic therapy in patients least likely to benefit from antibiotics. Antibiotics should be prescribed for children who are 6 months or older with severe signs and symptoms such as moderate or severe otalgia, otalgia for 48 hours, or a temperature of 102.2 degrees Fahrenheit or higher. According to Harmes, et al. (2013), one study found that two out of three children will recover without antibiotics. If a child needs antibiotics, the choice is to use amoxicillin. If there is no improvement with analgesics, then antibiotics should be used to help treat acute otitis media.

Response 1: #1 Nancy is a 24-year-old female who is sexually active with multipl

Response 1:
#1 Nancy is a 24-year-old female who is sexually active with multiple partners who presents to the clinic with painful blister-like sores on the vagina, pain when having sex, and a foul-smelling vaginal discharge for the past two weeks. She is diagnosed with genital herpes and chlamydial infection.
My chlamydia treatment plan for Nancy would be to treat the chlamydia with a single dose of Azithromycin or Doxycycline for 7 days. Nancy’s sexual partners should be tested and treated as well. Her most recent partner should be evaluated. It is recommended to expedite partner therapy to decrease reinfection. While she is being treated for the chlamydia along with her sexual partners, they should abstain from sexual intercourse for 7 days after the single-dose therapy or 7 days after the completion of a 7-day regimen. My herpes treatment plan for Nancy and her sexual partners would be to utilize antivirals such as acyclovir, famciclovir, and valacyclovir. These antivirals can be administered episodically or continuously as suppressive therapy (Woo & Robinson, 2020). I would provide Nancy with a renewable prescription so that she can have this handy and be able to self-medicate immediately if her symptoms begin to flare up. If Nancy continues to have more than six outbreaks a year, then I would recommend for her begin suppressive therapy to help reduce the frequency in her attacks. I would rescreen Nancy in 3-month intervals. I would also notify her that it is required by law that laboratories report most STIs to the state, so she would be aware that she may be contacted as well as her partners for verification of treatment. I would also utilize the CDC website to inform and educate myself in knowing which STIs are mandatory to report. I would assist Nancy in getting her sexual partners to come in for treatment by educating her that this STI has a very high rate of reinfection and notifying them for treatment as soon as possible, will decrease the chances of reinfection or spreading of the STI. Having her sexual partners be aware of it sooner and treating the STI sooner would be beneficial to them. As a nurse practitioner it is my obligation to follow my ethical and legal role, to report STDs such as the ones contracted by Nancy, which would be chlamydia according to the CDC would be mandatory (Centers for Disease Control and Prevention 2021). A fascinating article I discovered was in regards to STD reporting during this COVID-19 pandemic. It was noted that STD has actually been on the rise during this time. Results have been reported mainly from individuals sending or mailing in their results on their own. The CDC has reported that STD has been at an all-time high these recent years with prevalence in chlamydia, gonorrhea, and syphilis prior to the pandemic. The researchers found that, among asymptomatic persons with STDs, not having a physical examination did not make any difference. Even though there are limitations, the findings prove that there is a critical need for transformative strategies in STD control. There are many strategies available but are still waiting for broader implementation (Crane et al., 2020).
Response 2:
Discussion Post Reponse to Topic# 3 Maria a 19 y.o. with Latent TB.
Latent Tuberculosis (TB) is diagnosed when an individual has TB in their system but it is not active. An individual with this diagnosis does not present with symptoms and cannot infect others. An individual with Latent TB should be treated at least once in their lifetime after finding that they have latent TB to prevent activation of Latent TB to active TB. Individuals will usually be diagnosed with latent TB if they encounter having a positive tuberculin skin test (induration of 15mm or larger) or a positive TB blood test but a negative assessment outcome of active TB and negative Xray result for TB. There are now a multitude of treatment options for someone who has latent TB. Seraphin et al. (2019) mention that in their analysis of latent TB treatment completion rates, there were high levels of treatment discontinuation. They found that most patients placed on the 9 month treatment of INH stopped taking their medication after 3 months and that patients who were at higher risk of latent TB to active TB progression were more likely to stop treatment. This only leads back to the importance of patient education on why latent TB treatment is crucial for the prevention of active TB. Maria began treatment of isoniazid (INH) once a day 4 months ago but has been off the medication for the last month. With that information, it is important to determine what dose Maria was taking to determine what length of treatment she was in. INH alone, usually deems a 6 to 9 month treatment determinant by the dosage. According to the CDC a 9 month treatment would be the plan of care for Maria if she were taking 5mg/kg/day (CDC, 2018). Due to the fact that she had already completed a 3 month regimen without interruption, restarting INH treatment is not recommended. Recommendation would be to continue the 9 month therapy after conducting lab work to assess for hepatotoxicity and after a thorough assessment to rule out active TB. Education for Maria would also include the importance of adhering to treatment as required to prevent her from acquiring drug resistant active tuberculosis. She should be made aware if she continues to be non-compliant with medication treatment she increases her chances of not only acquiring active TB but of acquiring active TB that is nearly impossible to treat and can be deadly (BREATHE, 2014). It is also important that Maria understands that she comes from a country that has high levels of TB infection and that because of this the likelihood of her latent TB becoming active TB is high if she goes untreated (CDC, 2018). The CDC mentions that all patients taking Latent TB medication should be monitored monthly to assess for adverse reactions to TB medication regimen. Although Maria is young, she should have her liver assessed for enzyme elevation, hepatitis (via symptoms such as nausea, vomiting, abdominal pain, fatigue, brown urine), and damage to sensory nerves of hands and feet (tingling sensation, weakened sense of touch, pain in hands, palms, soles, and feet) (CDC, n.d.). I would also like to mention that it is important for a provider to assess the patient they have in front of them and determine the best mode of treatment. The CDC (2018) mentions that a Shorter, rifamycin-based treatment regimen generally has a lower risk of hepatotoxicity than longer 6 to 9 months of isoniazid monotherapy. Sterling et al. (2020) have also mentioned that aside from being less toxic to the liver, short treatment regimens have a higher completion rate. Woo (2019) mentions that the Black Box Warning for INH includes patients developing severe and at times fatal hepatitis. Risks that can lead to this outcome include age (highest incidents in individuals 50 to 64 years of age), chronic daily consumption of alcohol, IV drug use, Black and Hispanic women, anyone postpartum woman taking INH. As mentioned previously, it is important for patients to be assessed and evaluated throughout their treatment regimen. It is also important to clarify that as long as they stay in the latent phase, they are not contagious, therefore Maria will be assessed for active TB and if she does not have active TB, she will be informed that she is okay to go to school with no precautions but that adherence to her medication is a must. To ensure she sticks to her treatment, follow up appointments will be requested every 4 weeks.

There are two discussion questions: Identify and discuss ONE potential grant, by

There are two discussion questions:
Identify and discuss ONE potential grant, by name and URL, that you can consider for your program. What is the focus of this grant and why would it be beneficial to pursue?
What are some strategies to increase the potential of securing a grant? Identify and describe at least two (2) strategies.

There are two discussion questions: Identify and discuss ONE potential grant, by

There are two discussion questions:
Identify and discuss ONE potential grant, by name and URL, that you can consider for your program. What is the focus of this grant and why would it be beneficial to pursue?
What are some strategies to increase the potential of securing a grant? Identify and describe at least two (2) strategies.

Response 1: #1 Nancy is a 24-year-old female who is sexually active with multipl

Response 1:
#1 Nancy is a 24-year-old female who is sexually active with multiple partners who presents to the clinic with painful blister-like sores on the vagina, pain when having sex, and a foul-smelling vaginal discharge for the past two weeks. She is diagnosed with genital herpes and chlamydial infection.
My chlamydia treatment plan for Nancy would be to treat the chlamydia with a single dose of Azithromycin or Doxycycline for 7 days. Nancy’s sexual partners should be tested and treated as well. Her most recent partner should be evaluated. It is recommended to expedite partner therapy to decrease reinfection. While she is being treated for the chlamydia along with her sexual partners, they should abstain from sexual intercourse for 7 days after the single-dose therapy or 7 days after the completion of a 7-day regimen. My herpes treatment plan for Nancy and her sexual partners would be to utilize antivirals such as acyclovir, famciclovir, and valacyclovir. These antivirals can be administered episodically or continuously as suppressive therapy (Woo & Robinson, 2020). I would provide Nancy with a renewable prescription so that she can have this handy and be able to self-medicate immediately if her symptoms begin to flare up. If Nancy continues to have more than six outbreaks a year, then I would recommend for her begin suppressive therapy to help reduce the frequency in her attacks. I would rescreen Nancy in 3-month intervals. I would also notify her that it is required by law that laboratories report most STIs to the state, so she would be aware that she may be contacted as well as her partners for verification of treatment. I would also utilize the CDC website to inform and educate myself in knowing which STIs are mandatory to report. I would assist Nancy in getting her sexual partners to come in for treatment by educating her that this STI has a very high rate of reinfection and notifying them for treatment as soon as possible, will decrease the chances of reinfection or spreading of the STI. Having her sexual partners be aware of it sooner and treating the STI sooner would be beneficial to them. As a nurse practitioner it is my obligation to follow my ethical and legal role, to report STDs such as the ones contracted by Nancy, which would be chlamydia according to the CDC would be mandatory (Centers for Disease Control and Prevention 2021). A fascinating article I discovered was in regards to STD reporting during this COVID-19 pandemic. It was noted that STD has actually been on the rise during this time. Results have been reported mainly from individuals sending or mailing in their results on their own. The CDC has reported that STD has been at an all-time high these recent years with prevalence in chlamydia, gonorrhea, and syphilis prior to the pandemic. The researchers found that, among asymptomatic persons with STDs, not having a physical examination did not make any difference. Even though there are limitations, the findings prove that there is a critical need for transformative strategies in STD control. There are many strategies available but are still waiting for broader implementation (Crane et al., 2020).
Response 2:
Discussion Post Reponse to Topic# 3 Maria a 19 y.o. with Latent TB.
Latent Tuberculosis (TB) is diagnosed when an individual has TB in their system but it is not active. An individual with this diagnosis does not present with symptoms and cannot infect others. An individual with Latent TB should be treated at least once in their lifetime after finding that they have latent TB to prevent activation of Latent TB to active TB. Individuals will usually be diagnosed with latent TB if they encounter having a positive tuberculin skin test (induration of 15mm or larger) or a positive TB blood test but a negative assessment outcome of active TB and negative Xray result for TB. There are now a multitude of treatment options for someone who has latent TB. Seraphin et al. (2019) mention that in their analysis of latent TB treatment completion rates, there were high levels of treatment discontinuation. They found that most patients placed on the 9 month treatment of INH stopped taking their medication after 3 months and that patients who were at higher risk of latent TB to active TB progression were more likely to stop treatment. This only leads back to the importance of patient education on why latent TB treatment is crucial for the prevention of active TB. Maria began treatment of isoniazid (INH) once a day 4 months ago but has been off the medication for the last month. With that information, it is important to determine what dose Maria was taking to determine what length of treatment she was in. INH alone, usually deems a 6 to 9 month treatment determinant by the dosage. According to the CDC a 9 month treatment would be the plan of care for Maria if she were taking 5mg/kg/day (CDC, 2018). Due to the fact that she had already completed a 3 month regimen without interruption, restarting INH treatment is not recommended. Recommendation would be to continue the 9 month therapy after conducting lab work to assess for hepatotoxicity and after a thorough assessment to rule out active TB. Education for Maria would also include the importance of adhering to treatment as required to prevent her from acquiring drug resistant active tuberculosis. She should be made aware if she continues to be non-compliant with medication treatment she increases her chances of not only acquiring active TB but of acquiring active TB that is nearly impossible to treat and can be deadly (BREATHE, 2014). It is also important that Maria understands that she comes from a country that has high levels of TB infection and that because of this the likelihood of her latent TB becoming active TB is high if she goes untreated (CDC, 2018). The CDC mentions that all patients taking Latent TB medication should be monitored monthly to assess for adverse reactions to TB medication regimen. Although Maria is young, she should have her liver assessed for enzyme elevation, hepatitis (via symptoms such as nausea, vomiting, abdominal pain, fatigue, brown urine), and damage to sensory nerves of hands and feet (tingling sensation, weakened sense of touch, pain in hands, palms, soles, and feet) (CDC, n.d.). I would also like to mention that it is important for a provider to assess the patient they have in front of them and determine the best mode of treatment. The CDC (2018) mentions that a Shorter, rifamycin-based treatment regimen generally has a lower risk of hepatotoxicity than longer 6 to 9 months of isoniazid monotherapy. Sterling et al. (2020) have also mentioned that aside from being less toxic to the liver, short treatment regimens have a higher completion rate. Woo (2019) mentions that the Black Box Warning for INH includes patients developing severe and at times fatal hepatitis. Risks that can lead to this outcome include age (highest incidents in individuals 50 to 64 years of age), chronic daily consumption of alcohol, IV drug use, Black and Hispanic women, anyone postpartum woman taking INH. As mentioned previously, it is important for patients to be assessed and evaluated throughout their treatment regimen. It is also important to clarify that as long as they stay in the latent phase, they are not contagious, therefore Maria will be assessed for active TB and if she does not have active TB, she will be informed that she is okay to go to school with no precautions but that adherence to her medication is a must. To ensure she sticks to her treatment, follow up appointments will be requested every 4 weeks.