PHARMACOTHERAPY FOR GASTROINTESTINAL AND HEPATOBILIARY DISORDERS

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Week 4
Nathan Scott Wende

All Sec�ons

Hi everyone-

I hope everything is going well. This week we will be working on the GI system. There is an
assignment this week as you will be writing a paper on a scenario. I will say that there could be a
few different diagnoses that this could be, however, I am looking more for signs that you choose a
diagnosis and can support that based on your research. And as always, I will be looking for solid
medication recommendations.

Please use the following case for your paper:

DC is a 46-year-old female who presents with a 24-hour history of RUQ pain. She states the pain
started about 1 hour after a large dinner she had with her family. She has had nausea and on
instance of vomiting before presentation.

PMH: Vitals:

HTN Temp: 98.8oF

Type II DM Wt: 202 lbs

Gout Ht: 5’8”

DVT – Caused by oral BCPs BP: 136/82

HR: 82 bpm

Current Medications: Notable Labs:

Lisinopril 10 mg daily WBC: 13,000/mm3

HCTZ 25 mg daily Total bilirubin: 0.8 mg/dL

Allopurinol 100 mg daily Direct bilirubin: 0.6 mg/dL

Multivitamin daily Alk Phos: 100 U/L

AST: 45 U/L

ALT: 30 U/L

Allergies:

This announcement is closed for comments

Search entries or author

Latex

Codeine

Amoxicillin

PE:

Eyes: EOMI

HENT: Normal

GI:bNondistended, minimal tenderness

Skin:bWarm and dry

Neuro: Alert and Oriented

Psych:bAppropriate mood

Talk to you all soon!

Nathan

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Collegiality how to

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Collegiality how to

assist wk2

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Assignment: Hypothesize the Processes to Manage Quality Outcomes

This week, you learned about the process to manage quality outcomes, how policies create the course of action and the limitations to that action, and you were introduced to the gold standard for assessing quality, the Donabedian Quality Framework of Structure, Process, and Outcomes.

To complete your assignment this week, you will prepare a Proposal Paper that contains the action plans (also known as the measures of performance) needed to determine if a healthcare organization is meeting each principle of quality health care as described by the World Health Organization (2018). The WHO describes quality health care as being effective, safe, people-centered, timely, equitable, coordinated, and efficient. For example, as the healthcare administrator, how (what action will you take) to know if the health care provided in your organization is effective. 

In your Proposal Paper, be sure to include an
introductory section that continues your discussion from the summary section in your Week 1 research paper where you discussed the development of the Donabedian Quality Framework and its use in healthcare quality management. Be sure to review any feedback provided by your professor on this summary section. 

The
body of your Proposal Paper will contain your in-depth discussion of each of the seven principles of quality health care and their contribution to patient outcomes. You will also include your rationale to support each of your action plans for the seven principles of quality health care.

Your paper will include a
summary section on how the organization's structure and the processes effects healthcare outcomes through the management of quality action plans.

In addition to your narrative, you will create a table that contains a synopsis of your action plans and rationale. Your table will be an
appendix to your Proposal Paper and the columns in the table will include the Principles of Quality Health Care, the Action Plans, and your Rational to support your action plans. Your synopsis may be presented using bullet points. Be sure to follow APA standards for the use of appendices.

Principles of Quality Health Care (WHO, 2018)

Action plans (measures of performance)

Rationale to support your action plans

Effective

 

 

Safe

 

 

People-centered

 

 

Timely

 

 

Equitable

 

 

Coordinated

 

 

Efficient

 

 

5 pages, not including title page, reference page, or Appendix page

Include a minimum of 3 peer-reviewed resources.

Response

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Respond using at least two scholarly references/ APA format

 

Current National Healthcare Issue and its Impact on the Work Setting

            One of the most significant healthcare issues to date is the lack of insurance coverage for patients and the continued high costs of healthcare.  As a whole society needs healthcare, but fewer can afford it even with working full-time jobs. Here in the U.S., our method for paying for healthcare is where patients pay a fee for the services provided. When doing this, it devalues the primary care aspect of healthcare and supports a more volumed-based system so that the providers can increase the monetary gain for a payment model system (Park et al., 2018). There is no consistent way to make things perfect across the board, but there are ways to help such as bundling care and treatments and implementing monthly payments (Park et al., 2018). The social determinant that most affects this issue is the ability to have access to quality healthcare. Multiple inequalities affect patients in healthcare such as ethnic groups, social status, and economic (Broome, M., & Marshall, E. S.,2021). In 2020, the United States healthcare costs reached 4.1 trillion dollars (AAMC, 2023). “Nearly one in five Americans has medical debt, and affordability is still an issue for a large proportion of the population, whether uninsured or insured, which suggests that policymakers should focus on patients’ costs.” (Association of American Medical Colleagues, 2023). With that number of Americans being in debt due to healthcare, we need to focus on how to change the way we are billing our services as providers, offering insurance to the public as a country, and a way to offer more affordable services.

How the National Healthcare Issue Affects the Work Setting

In the clinic where I work our patients often must reschedule the procedures that they are scheduled for their pain management treatments due to insurance denying them. They will either pay out of pocket or reschedule. This impacts the practice as a whole: the nursing staff must rearrange the whole schedule, and change the documentation, and the patients will miss their much-needed treatments. Our case manager then works closely with the insurance companies to see what we can do to get the patient’s procedures approved. It has often taken up to 6 months to get just one injection approved. This process often makes the patient feel depressed and angered and leaves the staff feeling hopeless.

political

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The Roles of Congress and The Presidency

Discussion

Required Resources

Read/review the following resources for this activity:

· Textbook: Chapters 4 and 10

· Lesson: Read this Week's Lesson which is located in the Modules tab

· Initial Post: minimum of 2 scholarly sources (must include your textbook for one of the sources). Follow-Up Post: minimum of 1 scholarly source for your Follow-Up Post.

· Your Initial Post and your Follow-Up Post must be based on the same Option that you chose in order to receive credit for both posts. 

Initial Post Instructions

For the initial post, respond to one of the following options, and label the beginning of your post indicating either Option 1 or Option 2:

·
Option 1: Political scientists disagree on the exact causes of low representation of women in Congress. Why do you think there are so few women in Congress in comparison to men? How likely is it that these patterns of representation will dramatically change over your lifetime? For this discussion question, you will have to do some research online.

·
Option 2: What characteristics do you think voters look for when choosing a president? Do you think voters choose the characteristics they are looking for depending on the socioeconomic and political environment – lack of jobs, riots, COVID-19, environmental concerns and other issues etc.? Explain your answer.

Be sure to make connections between your ideas and conclusions and the research, concepts, terms, and theory we are discussing this week.

Follow-Up Post Instructions

Respond to the same Option you chose for your Initial Post (i.e., if you chose Option 1 for your Initial Post, your Follow-Up Pst should also be for Option 1). Respond to at least one peer. Further the dialogue by providing more information and clarification. Minimum of 1 scholarly source which can include your textbook or assigned readings or may be from your additional scholarly research.

Writing Requirements

· Minimum of 2 posts (1 initial & 1 follow-up)

· Minimum of 2 sources cited (assigned readings/online lessons and an outside source) for your Initial Post, and 1 scholarly source for your Follow-Up Post.

· APA format for in-text citations and list of references

EBOOK: The Struggle for Democracy, 2018 Elections and Updates Edition

https://bookshelf.vitalsource.com/reader/books/9780135246849/pageid/227 or

· email:
[email protected]

· pwd: Bryanthierry@09

Disease pathophysiology

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Choose a disease or diagnosis from the following list:

a) Type I Diabetes. b) Type II Diabetes. c) Hypovolemic Shock. d) Cardiogenic Shock

e) Septic Shock. f) Surgical site infection. g) Stage 3 pressure injury. h) Lupus

i) Rheumatoid arthritis. j) Anaphylaxis. k) HIV/AIDS. l) Cancer (any type) 

Required elements:

a) Provide a description, in your own words, of the pathophysiology of the disease

b) Risk factors contributing to the development of the disease

c) Signs and symptoms – with description of why these would be found (a total of 6; be 

sure to include subjective and objective data)

d) Diagnostics – 2 ways the disease may be diagnosed, including a brief description of the significance of the findings

e) Nursing diagnoses – at least 3 relevant nursing diagnoses, properly phrased

f) Treatment – at least 2 medical treatments, including some discussion of how this 

treatment works 

g) Nursing interventions – at least 4 nursing interventions, including some discussion of the goals and outcomes of these interventions

h) References – refer to at least 3 current,  

Neoplasia

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Discuss what is happening on a cellular level with the disease process. Be careful to realize that patients have co-morbidities, and you may need to discuss the other diseases impact on the pathophysiology and care of the patient.  Three (3) resources after 2008 are required along with APA format. Add questions to paper

Neoplasia Case Study

You have met a 67 y.o. female patient who presents with c/o dyspnea and a chronic cough for weeks. She is a smoker since she was a teenager. This is a fo9llow-up visit after testing has been completed. Testing completed included:

Pulmonary Function Testing which show a definite blockage in her airflow;

A Chest X-Ray which shows a lesion

Bronchoscopy washings which showed malignant cells.

Histology is a squamous cell carcinoma

Her diagnosis is bronchogenic lung cancer.

1. Why did this patient have a blockage in her airflow?

2. Did her lung cancer metastasize from cancer in another location in her body, or did it arise in her lungs?

3. Why did she develop dyspnea?

4. The lining of the bronchi are normally pseudostratified columnar epithelium, not squamous cell. Why did this patients cancer develop from squamous cells?

This patient is scheduled for surgery, followed by radiation therapy and chemotherapy. Surgery will remove the bulk of the tumor, and the radiotherapy is expected to shrink the remaining tumor cells. The chemotherapy is aimed at mnetastatic liver tumors that were discovered. The patient has stopped smoking.

5. Why did the APN order a liver scan when it was discovered that the patient had bronchogenic carcinoma?

6. Why did the cancer metastasize before she had enough signs and symptoms to see out her physician?

7. Have survival rates for patients with this type of cancer improved or not in recent years with treatment? If so what are the latest survival rates published?

8. What educational information should be shared with this patient?

Week 3 ion channel —3 Peer Response 800w. due9-20-23

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Week 3 ion channel —3 Peer Response 800w. due9-20-23

Instructions:

Please read and respond to the two peers' initial postings for week 2 below. Consider the following questions in your responses.

Compare and contrast your initial posting with those of your peers.  

1. How are they similar or how are they different?

2. What information can you add that would help support the responses of your peers?

3. Ask your peers a question for clarification about their post.

4. What most interests you about their responses? 

5. Summaries at least 1 evidence based article that supports there point.

Please be sure to validate your opinions and ideas with citations and references in APA format.

·
Response 1 400 words

·

·
Week 3 Discussion: Ion Channels

Compare and contrast the two different major classes of ion channels.

The two different major classes of ion channels are ligand-gated ion channels and voltage-gated ion channels, both of which are membrane proteins that play a vital role in regulating cell membrane potential and neuron communication (Stahl, 2021). Ligand-gated ion channels are also referred to as ionotropic receptors, this is because LGIC is both a receptor and channel and thus serves a dual function (Stahl, 2021). LGIC are made of amino acids and contain multiple binding sites to bind ligands such as neurotransmitters, ions, and drugs, allowing ions to either bind to a receptor or travel through the channel (Stahl, 2021). Voltage-gated ion channels are channels that mediate nerve conduction, action potential, and neurotransmitter release (Stahl, 2021). These channels are controlled by the change in ionic charge or voltage across the cell membrane (Stahl, 2021). Voltage-gated ion channels tend to be more selective, allowing the influx of only one ion at a time, whereas ligand-gated channels are less selective in nature and allow different types of ions to pass through the channel (Alberts, 2002).

Explain the difference between full agonists, partial agonists, antagonists, and inverse agonists.

An agonist is a ligand that binds to a receptor changing its state to result in a response (Stahl, 2021). The difference between full agonist, partial agonist, antagonist, and inverse agonist is that a full agonist leads to maximum signal transduction, whereas a partial agonist does not reach maximum signal transduction even with full receptor occupancy and can act as an antagonist in the presence of a full agonist (Stahl, 2021). Antagonists, on the other hand, is a ligand that binds to a receptor inhibiting its agonist-stimulated response (Stahl, 2021). Inverse agonists are ligands that when binding to a receptor cause a decrease in signal transduction, thus, their effect is the opposite of an agonist (Stahl, 2021).

References

Alberts, B. (2002). Ion channels and the electrical properties of membranes. Molecular Biology of the Cell – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK26910/

Stahl, S. M. (2021). Stahl’s Essential Psychopharmacology. https://doi.org/10.1017/9781108975292

Response 2. 400 words

1.
Compare and contrast the two different major classes of ion channels.

To start this discussion board I would like to define what are ion channels. Ion channels are membrane proteins, which play a major role in regulating cellular excitability. There are 3 major ion channels but for this homework assignment, I will compare and contrast voltage-gated ion channels and Ligand-Gated Ion Channels (LGIC).

·
Ligand-gated ion channels open when a chemical ligand such as a neurotransmitter binds to the protein (Libretexts, 2023).

·
Voltage channels open and close in response to changes in membrane potential (Libretexts, 2023). Ion channels can be classified by how they respond to the environment.

·
Ligand-gated ion channel’s permeability is greatly increased when some type of chemical ligand binds to the protein structure (Libretexts, 2023)

·
Voltage-gated channels respond to disturbances in cell membrane potential and are highly selective for specific ions such as sodium, potassium, calcium, and chloride (Ratan, 2018).

1.
Explain the difference between full agonists, partial agonists, antagonists, and inverse agonists.


Full agonists


Partial agonist


Antagonist


Inverse agonists

A molecule or chemical compound that can bind to a receptor and activate the receptor therefore causing a biological response (Agonist, partial agonist, antagonist, inverse agonist, 2019)

A molecule or chemical compound that can bind to a receptor and “weakly activate the receptor below maximum response (Agonist, partial agonist, antagonist, inverse agonist, 2019)

A molecule or chemical compound that binds to the receptor but does not cause any activation in the receptor, therefore not causing any biological response (Agonist, partial agonist, antagonist, inverse agonist, 2019)

Molecule of chemical compound that can bind to a receptor leading to deactivation, and decreasing the baseline activity of the receptor (Agonist, partial agonist, antagonist, inverse agonist, 2019)

 

 

 

 

References:

Agonist, partial agonist, antagonist, inverse agonist. PharmaEducation. (2023, August 11). https://pharmaeducation.net/agonist-partial-agonist-antagonist-inverse-agonist/

Libretexts. (2023, January 17). 10.5b: Ion Channels. Medicine LibreTexts. https://med.libretexts.org/Bookshelves/Anatomy_and_Physiology/Anatomy_and_Physiology_(Boundless)/10%3A_Overview_of_the_Nervous_System/10.5%3A_Neurophysiology/10.5B%3A_Ion_Channels

Ratan , N. (2018, October 26). Types of ion channels in the body. News. https://www.news-medical.net/health/Types-of-Ion-Channels-

DIKW

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 Give an explanation of how theoretical models and the concepts of data, information, knowledge, and wisdom relate to evidence-based practice in nursing. You must include 3 references to support your explanations. Be specific and provide examples. 

Healthcare statistics dp3

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 There are many users, sources, and purposes for health care statistics. One of the significant sources of health care statistics is the Healthcare Cost and Utilization Project (HCUP, pronounced “H-Cup”). As the HCA, you mention this to your new CEO, but he says he is not familiar with it and asks you to put together a short description of it on how you and your colleagues make use of the data and information provided.

You will prepare a 400w description of HCUP for the CEO. Include the following in your description:

  • 1–2-sentence introduction to HCUP, including the agency that administers the project and its purpose
  • What types of data and reports are provided and who uses this resource.
  • An example of a report available to anyone on the site
    • Go to the Reports tab on the Home page. Click on the tab, and then select “HCUP Statistical Briefs – Chronological List.” 
    • From the list, choose a recent brief (the most recent are listed first in the list). 
    • Open and review the brief, and describe what it contains and the types of health care statistics and graphical presentations included in it (e.g., line graphs or pie charts).
  • Finish by including your thoughts about this Web resource and what you find valuable about it.