Discussion P W6 Reply to peer 2

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Assessment of glomerular filtration rate (GFR) is fundamental to clinical practice, public health, and research. The kidney has several critical functions; GFR is used as an overall assessment of these kidney functions. GFR is used to diagnose, stage, and manage chronic kidney disease (CKD) (Inker & Titan, 2021). GFR is most commonly assed through markers and creatinine levels. Strengths: GFR is a well-established clinical laboratory practice, particularly in the neonatal population. It is a property of the kidney, has a large range, and is affected by physiological, pharmacologic, and pathologic conditions. Limitations: Methods to measure GFR are laborious, expensive, and not broadly available (Bjornstad et al, 2018).  A major challenge to diagnose early kidney disease is the lack of individuals that participate in yearly doctor visits as well as those who live with hypertension unknowingly will result in kidney failure. Creatinine and/or cystatin C are most accurate once GFR is <60ml/min/1.73m2, a point at which half of renal function is already lost. Accurate measurement of GFR is also important to stratify renal injuries, monitor nephrotoxicity and guide medication dosing (Bjornstad et al, 2018). Often certain medication drugs that are nephrotoxic can lead to acute renal failure (AKI), creatinine levels, BMP as well as GFR levels must be monitor on a weekly basis to be able to treat the patient accordingly.

About 1-3% of all infants and children have a condition called vesicoureteral reflux (VUR), which means some of their urine flows in the wrong direction after entering the bladder. Some of the urine flows back up toward the kidneys and can increase the chance of developing a urinary tract infection (UTI) (2024). Most pediatric UTIs are caused by Gram negative coliform bacteria arising from fecal flora colonizing the perineum, which enter and ascend the urinary tract. Escherichia coli (E. coli) is the most common uropathogen, responsible for approximately 80% of pediatric UTIs (Tallus, 2019). Other common uropathogens include Klebsiella, Proteus, Enterobacter and Enterococcus species (Kaufman et al., 2019). Refluxing ureteral endings show structural and functional anomalies: previous studies have shown a significant decrease in alfa actin, miosin and desmin contents as well as a high rate of atrophy and muscular degeneration with disorganized muscular fibres (Arena et al., 2016). VRU can also be caused by an abnormal embryological development occurring during the early stage of fetal life. VRU occurs on both sexes however females are prone to have more UTIs due to their anatomy and a shorter urethra, in males a circumcision will favor in the prevention of UTIs.

References

Inker, L. A., & Titan, S. (2021, November). Measurement and estimation of GFR for use in clinical practice: Core curriculum 2021 – American journal of kidney diseases. National Kidney Foundation. https://www.ajkd.org/article/S0272-6386(21)00707-1/fulltext

Bjornstad, P., Karger, A. B., & Maahs, D. M. (2018). Measured GFR in Routine Clinical Practice-The Promise of Dried Blood Spots. Advances in chronic kidney disease, 25(1), 76–83. https://doi.org/10.1053/j.ackd.2017.09.003

Vesicoureteral reflux (VUR) in Infants & Children. National Kidney Foundation. (2024, October 26). https://www.kidney.org/kidney-topics/vesicoureteral-reflux-vur-infants-children

Kaufman, J., Temple-Smith, M., & Sanci, L. (2019, September 24). Urinary tract infections in children: An overview of diagnosis and management. BMJ pediatrics open. https://pmc.ncbi.nlm.nih.gov/articles/PMC6782125/

Tullus K. Fifteen-minute consultation: why and how do children get urinary tract infections? Arch Dis Child Educ Pract Ed (2019. 10.11)36/archdischild-2018-315023.

Arena, S., Iacona, R., Impellizzeri, P., Russo, T., Marseglia, L., Gitto, E., & Romeo, C. (2016, November 29). Physiopathology of vesico-ureteral reflux. Italian journal of pediatrics. https://pmc.ncbi.nlm.nih.gov/articles/PMC5129198/ 

Discussion P W6 Reply to peer 1

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GFR is a key indicator of kidney function, reflecting how well the kidneys filter blood. The most accurate method of measuring GFR involves using exogenous markers such as inulin clearance, which is freely filtered by the glomerulus and neither reabsorbed nor secreted by renal tubules (Levey et al., 2020). However, inulin clearance is time-consuming and not practical for routine clinical use. Instead, creatinine clearance is commonly used, though it has limitations since creatinine undergoes some tubular secretion, leading to an overestimation of GFR. Serum creatinine-based equations, such as the CKD-EPI or MDRD formulas, provide a more practical estimation, adjusting for variables like age, sex, and body surface area (Inker et al., 2021). Another alternative is cystatin C, a protein filtered by the glomerulus, offering a more reliable marker in certain populations, such as children and those with fluctuating muscle mass (Sharma et al., 2022).

     Vesicoureteral reflux is a congenital or acquired condition where urine flows retrograde from the bladder into the ureters due to an incompetent vesicoureteral junction. Normally, the ureter enters the bladder at an oblique angle, forming a functional one-way valve that prevents backflow. In VUR, this angle is disrupted due to congenital abnormalities in the ureter’s insertion or bladder wall, resulting in urine reflux during bladder contraction (Shapiro et al., 2021). VUR increases the risk of urinary tract infections and renal scarring due to recurrent pyelonephritis (infection gets so bad it migrates to the kidney, resulting in kidney infection, which is a more serious infection). Higher-grade VUR can lead to progressive kidney damage and hypertension if untreated. Management varies based on severity, ranging from antibiotic prophylaxis to surgical intervention for persistent or high-grade cases.

References

Inker, L. A., Schmid, C. H., Tighiouart, H., et al. (2021). Estimating glomerular filtration rate using serum creatinine and cystatin C. The New England Journal of Medicine, 385(19), 1737-1749.

Levey, A. S., Stevens, L. A., Schmid, C. H., et al. (2020). A new equation to estimate glomerular filtration rate. Annals of Internal Medicine, 150(9), 604-612.

Sharma, A., Menon, S., Ghosh, A., et al. (2022). Cystatin C-based estimation of glomerular filtration rate in children: A systematic review. Pediatric Nephrology, 37(4), 829-840.

Shapiro, E., Tejwani, R., & Franco, I. (2021). Vesicoureteral reflux in children: Pathophysiology, diagnosis, and management. The Journal of Urology, 206(2), 265-274.

Asssigment

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4k25 research 4

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Nursing Assignment

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Attached 

Couse Outcomes and Professional Growth

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Reflection Discussion Prompt: Reflecting on Course Outcomes and Professional Growth

Overview: This course has provided you with the opportunity to strengthen your nursing practice by integrating nursing science with leadership strategies to deliver high-quality care across diverse healthcare settings. For this discussion, reflect on how this course has helped you achieve the following outcomes:

1. Integrate nursing and related sciences into the delivery of care to clients across diverse healthcare settings.

2. Create effective interdisciplinary organizational and systems leadership in the care of the client in diverse healthcare settings.

Instructions:

1. Reflect on Outcome 1:

o Discuss how the course content, assignments, or activities helped you integrate nursing and related sciences (e.g., evidence-based practice, pathophysiology, or health informatics) into client care.

o Provide a specific example of how this knowledge can be applied to diverse healthcare settings, such as acute care, community health, or primary care.

2. Reflect on Outcome 2:

o Describe how this course enhanced your understanding of interdisciplinary organizational and systems leadership.

o Share an example of how you can apply this leadership knowledge to improve collaboration, care coordination, and patient outcomes in diverse healthcare environments.

3. Link to Practice:

o Explain how these outcomes align with your current or future nursing role.

o Discuss any new insights or changes in perspective regarding client care and leadership in healthcare systems.

4. Support Your Reflection:

o Include at least one scholarly source to support your reflection. Use APA format for in-text citations and the reference list. 

HM1work

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HIT 2000 MOD 4 ASSN

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For this assignment, you will complete an EHR Go activity. Specifically, this week’s assignment will include:

  • Retrieval of Data

Please follow the instructions below, and reach out to your professor if you have any questions.

  1. Click on the Retrieval of Data Assignment Link Links to an external site.and enter your EHR Go credentials to begin. 
    • If you have not yet set up your EHR Go account, you will need to do so before you can begin. Please follow the instructions below.
  2. Download the “Retrieval of Data” activity pdf from the “Overview & Resources” tab in EHR Go..
  3. Click on the 2nd tab “Launch EHR” to review the chart and begin completing the activity.
  4. Use the activity sheet to work through the assignment and formulate your answers
  5. Complete the attached “Retrieval of Data Answer Sheet” and submit as an attachment to this assignment link

Agepsyvho

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Nursing Care of Physiologic & Psychologic Disorders 

Discuss the Nursing care of age-related Physiologic or Psychologic Disorder.

  1. Present the age-related Physiologic or Psychologic Disorder
    Choose from one: Integumentary function, Urinary function, Musculoskeletal function or Endocrine function.
  2. Describe the age-related changes and common problems and conditions.
  3. Summarize the nursing management appropriate for your Physiologic or Psychologic Disorder chosen

HIT 2000 MOD 4 DB

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Instructions: This discussion will be completed in two parts and will give you an opportunity to reflect upon this week’s content and to interact with your classmates.

  • Part 1 – Post your initial response to the discussion questions by Thursday at 11:59 pm
  • Part 2 – Post substantive feedback to two (2) classmates by Sunday at 11:59 pm

Part 1 Initial Post: Contribute a substantive initial posting that demonstrates critical thinking and understanding of the subject matter presented. Health Information technology is in a rapid and constant state of evolution. This means that the working environment is changing at the same pace that the technology evolves. Change can have a dramatic impact on people and process, and therefore we refer to the HIM professionals as being agents of change. For your initial response, discuss the impact that this rapid and constant state of change can have on a healthcare organization and it employees. Furthermore, discuss what it means to be an agent of change and the importance of being able to manage and drive change in the industry.