Recent milestones in the understanding of gastric acid secretion and treatment of acid-peptic disorders include the discovery of histamine H2-receptors and development of histamine H2-receptor antagonists, identification of H+K+-ATPase as the parietal cell proton pump and development of proton pump inhibitors, and identification of Helicobacter pylori as the major cause of duodenal ulcer and development of effective eradication regimens (Schubert et al. 2008). The stimuli for acid secretions are as follows, Acetylcholine, Gastrin and Histamine. When this acid secretion combines food can digest but also it can create different issues, for example, it can facilitate digestion of protein as well as the absorption of iron, calcium, and vitamin B12. When we take medication is these secretions are necessary for absorption of certain drugs however taking too much medicine or eating the wrong foods can lead to acid-related clinical conditions. Parietal cells secrete hydrochloric acid at a concentration of approximately 160 mmol/L or pH 0.8. Acid is thought to gain access to the lumen via channels in the mucus layer created by the relatively high intraglandular hydrostatic pressures generated during secretion, approximately 17 mm Hg (Johnsson et al, 2001). The acids facilitate the ingestion of protein and absorption of iron, calcium, and vitamin B-12 as well as prevent bacterial overgrowth and enteric infection. However, if the acid levels and pepsin increase a risk of ulcers can occur. The principal of acid secretion is histamine released from ECL cells (paracrine); gastrin, released from G cells (hormonal); and ACh, released from postganglionic enteric neurons (neurocrine) (Schubert et al. 2008).

Helicobacter pylori (H. pylori) attack the lining that protects your stomach. Many people have it and won’t have any issues with ulcers until the time is right for one to start causing issues. As the host starts showing symptoms of an ulcer, the H pylori make an enzyme called urease that makes the acid in the stomach less acidic while weakening the stomach lining, furthermore the host is at a greater risk of being hurt by acid and pepsin, strong digestive fluids. That can lead to sores or ulcers in your stomach or duodenum (2024). Helicobacter pylori is the first formally recognized bacterial carcinogen and is one of the most successful human pathogens, as over half of the world’s population is colonized with this gram-negative bacterium. Unless treated, colonization usually persists lifelong. H. pylori infection represents a key factor in the etiology of various gastrointestinal diseases, ranging from chronic active gastritis without clinical symptoms to peptic ulceration, gastric adenocarcinoma, and gastric mucosa-associated lymphoid tissue lymphoma (Kusters et al., 2006). In conclusion H pylori is a bacteria that is found in all of us how it develops is how it is going to affect us, by taking simple precautions such as eating food that is cleaned thoroughly and cooked in a safe way and by drinking clean and potable water from a sanitary source that will not have bacteria. Lastly, good hand hygiene is the best way to effectively protect ourselves from these bacteria.

References

Schubert, Mitchell L. et al (2008). Control of Gastric Acid Secretion in Health and Disease

Gastroenterology, Volume 134, Issue 7, 1842 – 1860

Johansson, M. ∙ Synnerstad, I. ∙ Holm, L. (2001). Acid transport through channels in the mucous layer of rat stomach Gastroenterology; 119:1297-1304

Helicobacter pylori. Johns Hopkins Medicine. (2024, May 13). https://www.hopkinsmedicine.org/health/conditions-and-diseases/helicobacter-pylori

Kusters, J. G., van Vliet, A. H. M., & Kuipers, E. J. (2006, July). Pathogenesis of helicobacter pylori infection. Clinical microbiology reviews. https://pmc.ncbi.nlm.nih.gov/articles/PMC1539101/

Liver injury labs are as follows ammonia levels, INR, fibrinogen, glucose, and lactate. Other abs include Alanine transaminase (ALT): 0 to 55 units per liter (U/L) Aspartate transaminase (AST): 0 to 48 U/L. Alkaline phosphatase (ALP): 30 to 129 U/L. Gamma-glutamyltransferase (GGT): 8 to 61 U/L. Bilirubin: 0.1 to 1.2 milligrams per deciliter (mg/dL). Prothrombin time (PT): 10.9 to 12.5 seconds. Albumin: 3.5 to 5.0 grams per deciliter (g/dL). Total proteins: 6.3 to 7.9 g/dL. Once diagnosed liver injury the medications can be adjusted based on the lab results. Also discontinuing of any acetaminophen orders also any other nephrotoxic medications will also be recommended (2022). rising burden of liver disease is mainly a reflection of the three the most common causes: alcohol-related liver disease, non-alcoholic fatty liver disease and viral hepatitis, although autoimmune liver disease is also a significant contributor.4 The burden of liver disease in children differs from that in adults, as although non-alcoholic fatty liver disease (NAFLD) is seen in all ages, reflecting the rise in childhood obesity, disease associated with injecting drug use and alcohol are rarely encountered (Newsome et al., 2018). Acute hepatitis A virus (HAV) infection highly contagious. People who get hepatitis A may feel sick for a few weeks or several months but usually recover completely and do not have lasting liver damage. In rare cases, hepatitis A can cause liver failure and even death. This is more common in older people and in people with other serious health issues, such as chronic liver disease (2022).

           Hepatitis A virus (HAV) is one of the well-known viruses that cause hepatitis all around the globe. Although this illness has decreased in developed countries due to extensive immunization, numerous developing and under-developed countries are struggling with this virus, HAV can be contained and prevented with vaccination. HAV can spread through oral fecal contact and through contaminated foods and water. Acute viral hepatitis is a systemic illness that mainly affects the liver. Hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis D virus (HDV), and hepatitis E virus (HEV) are the viruses that cause almost all instances of acute viral hepatitis, Hepatitis can be present with little or no symptoms, although it frequently results in jaundice, anorexia, and malaise. Hepatitis infection is divided into two types: acute and chronic. Acute hepatitis remains for less than six months, whereas chronic hepatitis stays for an extended period (Torre et al, 2021). In conclusion, vaccination is key to control the spreading of the virus not only for HAV but for all other hepatitis viruses. Immunization has to be considered an important step, and this system will enable the early detection of epidemiologic transitions and the implementation of preventative efforts before HAV infection becomes a public health issue.

References

Newsome, P. N., Cramb, R., Davison, S. M., Dillon, J. F., Foulerton, M., Godfrey, E. M., Hall, R., Harrower, U., Hudson, M., Langford, A., Mackie, A., Mitchell-Thain, R., Sennett, K., Sheron, N. C., Verne, J., Walmsley, M., & Yeoman, A. (2018, January). Guidelines on the management of abnormal liver blood tests. Gut. https://pmc.ncbi.nlm.nih.gov/articles/PMC5754852/

https://my.clevelandclinic.org/health/diagnostics/17662-liver-function-tests. Liver Function Tests. (2022, November 9).

Hepatitis A basics | hepatitis A | CDC. (2025a, January 31). https://www.cdc.gov/hepatitis-a/about/index.html

Gholizadeh, O., Akbarzadeh, S., Ghazanfari Hashemi, M., Gholami, M., Amini, P., Yekanipour, Z., Tabatabaie, R., Yasamineh, S., Hosseini, P., & Poortahmasebi, V. (2023). Hepatitis A: Viral Structure, Classification, Life Cycle, Clinical Symptoms, Diagnosis Error, and Vaccination. The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale, 2023, 4263309. https://doi.org/10.1155/2023/4263309

Torre P., Aglitti A., Masarone M., Persico M., (2021) Viral hepatitis: milestones, unresolved issues, and future goals. World Journal of Gastroenterology.;27(28):4603–4638. doi: 10.3748/wjg. v27.i28.4603

complete doc attavhed

Problem-Focused SOAP Note Format

Demographic Data 

• Age and gender (must be HIPAA compliant) 

Subjective 

• Chief Complaint (CC): A short statement about why they are there 
• History of Present Illness (HPI):  Write your HPI in paragraph form. Start with the age, gender, and why they are there (example: 23-year-old female here for…). Elaborate using the acronym OLDCART: Onset, Location, Duration, Characteristics, Aggravating/Alleviating Factors, Relieving Factors, Treatment 
• Past Med. Hx (PMH): Medical or surgical problems, hospitalizations, medications, allergies, immunizations, and preventative health maintenance 
• Family Hx: any history of CA, DM, HTN, MI, CVA?  
• Social Hx: Including nutrition, exercise, substance use, sexual hx, occupation, school, etc. 
• Review of Systems (ROS) as appropriate: Include health maintenance (e.g., eye, dental, pap, vaccines, colonoscopy) 

Objective 

• Vital Signs 
• Physical findings listed by body systems, not paragraph form- Highlight abnormal findings 

Assessment (the diagnosis) 

• At least Two (2) differential diagnoses (if applicable) with rationale and pertinent positives and negatives for each 
• Final diagnosis with rationale, pertinent positives and negatives, and pathophysiological explanation 

Plan 

• Dx Plan (lab, x-ray) 
• Tx Plan (meds): including medication(s) prescribed (if any), dosage, frequency, duration, and refill(s) (if any) 
• Pt. Education, including specific medication teaching points 
• Referral/Follow-up 
• Health maintenance: including when screenings eye, dental, pap, vaccines, immunizations, etc. are next due 

Reference 

• Compare care given to the patient with the National Standards of Care/National Guidelines. Cite accordingly. 

The Doctor of Nursing Practice (DNP) is incomplete without mindfulness because it gives students strategies to deal with academic or professional challenges. Through mindfulness, the mind is aware of the events of the present without being caught in prejudices or negative emotional responses. This is especially helpful to the DNP students, given that such learners have numerous commitments such as class, clinical practice, and family. Through the practice of mindfulness, learners can use daily practicing daily practices such as guided meditation and mindfulness of breathing to reduce their stress and anxiety levels (McNulty et al., 2021). These techniques enable learners to reduce the rate of thinking, which is recurrent in most students, thus allowing them to understand better what has been taught and improve their concentration and performance. Hence, when practiced in the context of a rigorous DNP program, it can be a helpful method of combating burnout and keeping the students in good mental health to continue being productive throughout the program.

Mindfulness also contributes positively to mental health and enhances the memorability and the inherent meaning of a learning experience through a more excellent bond with the material learned. Doing mindful practices before starting your study sessions or classes sets a mental space for you to concentrate and absorb information. Take the example of beginning your study session with a brief mindful exercise to remove the clutter in your mind and direct it on what you should do. Firth et al. (2019), also find that mindfulness enhances academic performance by reducing stress and improving cognitive function. In addition, mindfulness makes the students more present, mindful, and alert during lectures and discussions, and it aids in comprehending complex nursing practice concepts essential to critical aspects of advanced nursing practice. Further, awareness of the moment can provide students with more sophisticated insight into the details of healthcare delivery, which is necessary for the leaders they will be at work.

Furthermore, mindfulness fosters emotional intelligence and interpersonal skills necessary for DNP students in various healthcare settings. Regular exercise in mindfulness enables the students to watch thoughts and feelings pass by without instantly expelling them. Therefore, this aspect of mindfulness can be applied to manage challenging situations calmly in all settings. This is especially important in healthcare, where professionals working under such stressful conditions must make crucial decisions or communicate quickly (Firth et al., 2019). Moreover, practicing mindfulness increases students’ ability to connect with patients, colleagues, and mentors, to be more mindful, and to be more compassionate and understanding.

This discussion relates to two DNP Essentials I and II. The former identifies the importance of evidence-based practice in nursing, and the latter demands that DNP preparation graduates be leaders in healthcare systems (Waldrop et al., 2023). Mindfulness enhances analytical reasoning and self-reflection to form the basis of evidence-based healthcare delivery. Moreover, this domain of mindfulness aligns with professionalism and awareness in health care environment competencies. Together, these essentials and competencies emphasize the importance of mindfulness in preparing DNP students to become advanced nursing practice careers.

References

Firth, A. M., Cavallini, I., Sütterlin, S., & Lugo, R. G. (2019). Mindfulness and self-efficacy in pain perception, stress, and academic performance. The influence of mindfulness on cognitive processes. Psychology research and behavior management, 565-574.

McNulty, D. (2021). DNP FINAL REPORT: The Impact of Mindfulness Training on Stress, Burnout, and Mindfulness.

Waldrop, J., Reynolds, S. S., McMillian-Bohler, J. M., Graton, M., & Ledbetter, L. (2023). Evaluation of DNP program essentials of doctoral nursing education: A scoping review. Journal of Professional Nursing, 46, 7-12. https://doi.org/10.1016/j.profnurs.2022.11.009