Patho NUR 512 DISCUSSION 2
/in Uncategorized /by Nursing Homework DeskHematopoietic:
J.D. is a 37 years old white woman who presents to her gynecologist complaining of a 2-month history of intermenstrual bleeding, menorrhagia, increased urinary frequency, mild incontinence, extreme fatigue, and weakness. Her menstrual period occurs every 28 days and lately there have been 6 days of heavy flow and cramping. She denies abdominal distension, back-ache, and constipation. She has not had her usual energy levels since before her last pregnancy.
Past Medical History (PMH):
Upon reviewing her past medical history, the gynecologist notes that her patient is a G5P5with four pregnancies within four years, the last infant having been delivered vaginally four months ago. All five pregnancies were unremarkable and without delivery complications. All infants were born healthy. Patient history also reveals a 3-year history of osteoarthritis in the left knee, probably the result of sustaining significant trauma to her knee in an MVA when she was 9 years old. When asked what OTC medications she is currently taking for her pain and for how long she has been taking them, she reveals that she started taking ibuprofen, three tablets each day, about 2.5 years ago for her left knee. Due to a slowly progressive increase in pain and a loss of adequate relief with three tablets, she doubled the daily dose of ibuprofen. Upon the recommendation from her nurse practitioner and because long-term ibuprofen use can cause peptic ulcers, she began taking OTC omeprazole on a regular basis to prevent gastrointestinal bleeding. Patient history also reveals a 3-year history of HTN for which she is now being treated with a diuretic and a centrally acting antihypertensive drug. She has had no previous surgeries.
Case Study Questions
- Name the contributing factors on J.D that might put her at risk to develop iron deficiency anemia.
- Within the case study, describe the reasons why J.D. might be presenting constipation and or dehydration.
- Why Vitamin B12 and folic acid are important on the erythropoiesis? What abnormalities their deficiency might cause on the red blood cells?
- The gynecologist is suspecting that J.D. might be experiencing iron deficiency anemia.
In order to support the diagnosis, list and describe the clinical symptoms that J.D. might have positive for Iron deficiency anemia. - If the patient is diagnosed with iron deficiency anemia, what do you expect to find as signs of this type of anemia? List and describe.
- Labs results came back for the patient. Hb 10.2 g/dL; Hct 30.8%; Ferritin 9 ng/dL; red blood cells are smaller and paler in color than normal. Research list and describe for appropriate recommendations and treatments for J.D.
Cardiovascular
Mr. W.G. is a 53-year-old white man who began to experience chest discomfort while playing tennis with a friend. At first, he attributed his discomfort to the heat and having had a large breakfast. Gradually, however, discomfort intensified to a crushing sensation in the sternal area and the pain seemed to spread upward into his neck and lower jaw. The nature of the pain did not seem to change with deep breathing. When Mr. G. complained of feeling nauseated and began rubbing his chest, his tennis partner was concerned that his friend was having a heart attack and called 911 on his cell phone. The patient was transported to the ED of the nearest hospital and arrived within 30 minutes of the onset of chest pain. In route to the hospital, the patient was placed on nasal cannula and an IV D5W was started. Mr. G. received aspirin (325 mg po) and 2 mg/IV morphine. He is allergic to meperidine (rash). His pain has eased slightly in the last 15 minutes but is still significant; was 9/10 in severity; now7/10. In the ED, chest pain was not relieved by 3 SL NTG tablets. He denies chills.
Case Study Questions
- For patients at risk of developing coronary artery disease and patients diagnosed with acute myocardial infarct, describe the modifiable and non-modifiable risk factors.
- What would you expect to see on Mr. W.G. EKG and which findings described on the case are compatible with the acute coronary event?
- Having only the opportunity to choose one laboratory test to confirm the acute myocardial infarct, which would be the most specific laboratory test you would choose and why?
- How do you explain that Mr. W.G temperature has increased after his Myocardial Infarct, when that can be observed and for how long? Base your answer on the pathophysiology of the event.
- Explain to Mr. W.G. why he was experiencing pain during his Myocardial Infarct. Elaborate and support your answer.
Submission Instructions:
- Include both case studies in your post.
- Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.
Pancreatic cancer case study
/in Uncategorized /by Nursing Homework Deskwrite a discussion for the following prompt:
J.C is an 82-year-old white man who was evaluated by GI specialist due to abdominal discomfort, loss of appetite, weight lost, weakness and occasional nausea.
Past Medical History (PMH):
Patient is Diabetic, controlled with Metformin 500 mg by mouth twice a day, Lantus 15 units SC bedtime. Hypertensive, controlled with Olmesartan 20 mg by mouth once a day. Atrial Fibrillation, controlled with Rivaroxaban 15 mg by mouth once a day and bisoprolol 10 mg by mouth once a day.
Labs:
Hb 12.7 g/dl; Hct 38.8% WBC 8.2; Glycemia 74mg/dl; Creatinine 0.8 mg/dl; BUN 9.8 mg/dl; AST 21 U/L ALT 17 U/L; Bil T 1.90 mg/dl; Ind 0.69 mg/dl; Dir 1.21 mg/dl.
Diagnostic test:
Endoscopic Ultrasound of the Pancreas. Solid mass in the head of pancreas 4 cms, infiltrating Wirsung duct. The solid mass impress to infiltrate the superior mesenteric vein. Perilesional node is detected, 1.5 cms, metastatic aspect. Fine needle aspiration (FNA) biopsy: Ductal adenocarcinoma.
Case study questions:
- Please name the potential most common sites for metastasis on J.C and why?
- What are tumor cell markers and why tumor cell markers are ordered for a patient with pancreatic cancer?
- Based on the case study described, proceed to classify the tumor based on the TNM Stage classification. Why this classification important?
- Discussed characteristic of malignant tumors regarding it cells, growth and ability to spread.
- Describe the carcinogenesis phase when a tumor metastasizes.
- Choose the tissue level that is affected on the patient discussed above: Epithelial, Connective, Muscle or Neural. Support your answer.
Submission Instructions:
- Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
- You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.)
- All replies must be constructive and use literature where possible.
- Please post your initial response by 11:59 PM ET Thursday, and comment on the posts of two classmates by 11:59 PM ET Sunday.
- You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date.
Case study
/in Uncategorized /by Nursing Homework DeskHematopoietic:
J.D. is a 37 years old white woman who presents to her gynecologist complaining of a 2-month history of intermenstrual bleeding, menorrhagia, increased urinary frequency, mild incontinence, extreme fatigue, and weakness. Her menstrual period occurs every 28 days and lately there have been 6 days of heavy flow and cramping. She denies abdominal distension, back-ache, and constipation. She has not had her usual energy levels since before her last pregnancy.
Past Medical History (PMH):
Upon reviewing her past medical history, the gynecologist notes that her patient is a G5P5with four pregnancies within four years, the last infant having been delivered vaginally four months ago. All five pregnancies were unremarkable and without delivery complications. All infants were born healthy. Patient history also reveals a 3-year history of osteoarthritis in the left knee, probably the result of sustaining significant trauma to her knee in an MVA when she was 9 years old. When asked what OTC medications she is currently taking for her pain and for how long she has been taking them, she reveals that she started taking ibuprofen, three tablets each day, about 2.5 years ago for her left knee. Due to a slowly progressive increase in pain and a loss of adequate relief with three tablets, she doubled the daily dose of ibuprofen. Upon the recommendation from her nurse practitioner and because long-term ibuprofen use can cause peptic ulcers, she began taking OTC omeprazole on a regular basis to prevent gastrointestinal bleeding. Patient history also reveals a 3-year history of HTN for which she is now being treated with a diuretic and a centrally acting antihypertensive drug. She has had no previous surgeries.
Case Study Questions
- Name the contributing factors on J.D that might put her at risk to develop iron deficiency anemia.
- Within the case study, describe the reasons why J.D. might be presenting constipation and or dehydration.
- Why Vitamin B12 and folic acid are important on the erythropoiesis? What abnormalities their deficiency might cause on the red blood cells?
- The gynecologist is suspecting that J.D. might be experiencing iron deficiency anemia.
In order to support the diagnosis, list and describe the clinical symptoms that J.D. might have positive for Iron deficiency anemia. - If the patient is diagnosed with iron deficiency anemia, what do you expect to find as signs of this type of anemia? List and describe.
- Labs results came back for the patient. Hb 10.2 g/dL; Hct 30.8%; Ferritin 9 ng/dL; red blood cells are smaller and paler in color than normal. Research list and describe for appropriate recommendations and treatments for J.D.
Cardiovascular
Mr. W.G. is a 53-year-old white man who began to experience chest discomfort while playing tennis with a friend. At first, he attributed his discomfort to the heat and having had a large breakfast. Gradually, however, discomfort intensified to a crushing sensation in the sternal area and the pain seemed to spread upward into his neck and lower jaw. The nature of the pain did not seem to change with deep breathing. When Mr. G. complained of feeling nauseated and began rubbing his chest, his tennis partner was concerned that his friend was having a heart attack and called 911 on his cell phone. The patient was transported to the ED of the nearest hospital and arrived within 30 minutes of the onset of chest pain. In route to the hospital, the patient was placed on nasal cannula and an IV D5W was started. Mr. G. received aspirin (325 mg po) and 2 mg/IV morphine. He is allergic to meperidine (rash). His pain has eased slightly in the last 15 minutes but is still significant; was 9/10 in severity; now7/10. In the ED, chest pain was not relieved by 3 SL NTG tablets. He denies chills.
Case Study Questions
- For patients at risk of developing coronary artery disease and patients diagnosed with acute myocardial infarct, describe the modifiable and non-modifiable risk factors.
- What would you expect to see on Mr. W.G. EKG and which findings described on the case are compatible with the acute coronary event?
- Having only the opportunity to choose one laboratory test to confirm the acute myocardial infarct, which would be the most specific laboratory test you would choose and why?
- How do you explain that Mr. W.G temperature has increased after his Myocardial Infarct, when that can be observed and for how long? Base your answer on the pathophysiology of the event.
- Explain to Mr. W.G. why he was experiencing pain during his Myocardial Infarct. Elaborate and support your answer.
Submission Instructions:
- Include both case studies in your post.
- Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
Literature Search Review
/in Uncategorized /by Nursing Homework DeskPlease see attached for instructions
jd
/in Uncategorized /by Nursing Homework DeskJ.D. is a 37 years old white woman who presents to her gynecologist complaining of a 2-month history of intermenstrual bleeding, menorrhagia, increased urinary frequency, mild incontinence, extreme fatigue, and weakness. Her menstrual period occurs every 28 days and lately there have been 6 days of heavy flow and cramping. She denies abdominal distension, back-ache, and constipation. She has not had her usual energy levels since before her last pregnancy.
Past Medical History (PMH):
Upon reviewing her past medical history, the gynecologist notes that her patient is a G5P5with four pregnancies within four years, the last infant having been delivered vaginally four months ago. All five pregnancies were unremarkable and without delivery complications. All infants were born healthy. Patient history also reveals a 3-year history of osteoarthritis in the left knee, probably the result of sustaining significant trauma to her knee in an MVA when she was 9 years old. When asked what OTC medications she is currently taking for her pain and for how long she has been taking them, she reveals that she started taking ibuprofen, three tablets each day, about 2.5 years ago for her left knee. Due to a slowly progressive increase in pain and a loss of adequate relief with three tablets, she doubled the daily dose of ibuprofen. Upon the recommendation from her nurse practitioner and because long-term ibuprofen use can cause peptic ulcers, she began taking OTC omeprazole on a regular basis to prevent gastrointestinal bleeding. Patient history also reveals a 3-year history of HTN for which she is now being treated with a diuretic and a centrally acting antihypertensive drug. She has had no previous surgeries.
Case Study Questions
- Name the contributing factors on J.D that might put her at risk to develop iron deficiency anemia.
- Within the case study, describe the reasons why J.D. might be presenting constipation and or dehydration.
- Why Vitamin B12 and folic acid are important on the erythropoiesis? What abnormalities their deficiency might cause on the red blood cells?
- The gynecologist is suspecting that J.D. might be experiencing iron deficiency anemia.
In order to support the diagnosis, list and describe the clinical symptoms that J.D. might have positive for Iron deficiency anemia. - If the patient is diagnosed with iron deficiency anemia, what do you expect to find as signs of this type of anemia? List and describe.
- Labs results came back for the patient. Hb 10.2 g/dL; Hct 30.8%; Ferritin 9 ng/dL; red blood cells are smaller and paler in color than normal. Research list and describe for appropriate recommendations and treatments for J.D.
Mod 3 Assngm
/in Uncategorized /by Nursing Homework DeskUsing the “Mod 3 | Part 3” section of your Academic Success and Professional Development Plan Template presented in the Resources, conduct an analysis of the elements of the research article you identified. Be sure to include the following
Response
/in Uncategorized /by Nursing Homework DeskSee Attachment
NR week 3 Reply to Peer 2
/in Uncategorized /by Nursing Homework DeskInstitutional Review Boards (IRBs) assess the ethics and safety of research studies involving human subjects, such as behavioral studies or clinical trials for new drugs or medical devices. Health and Human Services oversees about 2,300 U.S.-based IRBs through routine or for-cause inspections to assess if they are following federal laws when reviewing research. But few IRBs are inspected. For example, one HHS agency aims to do just 3-4 routine inspections each year. Also, HHS agencies haven’t examined how many inspections are needed or if inspections could be changed to further reduce risks to human subjects (2023). More than 130 countries and international organizations have developed independent committees to approve or deny research that involves human subjects (Capili & Anastasi, 2024).
For many researchers conducting successful research is the most rewarding thing to do. But what happens when the research does not meet the IRB standards due to being biased, the truth is that many researchers find themselves facing such issues which are easy to occur when proposing a research theory. There are many things that can impact and affect the research, one can be the limited amount of information on the chosen topic, methodology and sample size. Often waiting for the review and approval from the IRB can be challenging. Four challenges identified (1) Community partners not being recognized as research partners (2) Cultural competence, language of consent forms, and literacy level of partners; (3) IRBs apply formulaic approaches to CEnR; & (4) Extensive delays in IRB preparation and approval potentially stifle the relationships with community partners (Onakomaiya et al, 2023).
In conclusion, getting research published and approved by the IRB is a tedious procedure. It requires understanding and knowledge of possible setbacks that can occur in the process of achieving the sought-out research. While these inefficiencies are an inevitable part of the research process, understanding common pitfalls can limit those hindrances (Shaffer & Huecker, 2025). Recommendations included (1) Training IRBs to understand CEnR principles to streamline and increase the flexibility of the IRB review process; (2) Identifying influential community stakeholders who can provide support for the study; and (3) Disseminating human subjects research training that is accessible to all community investigators to satisfy IRB concerns. The IRBs can benefit from more training in CEnR requirements and methodologies (Onakomaiya et al, 2023).
References
(2023, January 17). Institutional Review Boards: Actions Needed to Improve Federal Oversight and Examine Effectiveness. U.S. Government Accountability Office. https://www.gao.gov/products/gao-23-104721
Capili, B., & Anastasi, J. K. (2024). Ethical Research and the Institutional Review Board: An Introduction. The American journal of nursing, 124(3), 50–54. https://doi.org/10.1097/01.NAJ.0001008420.28033.e8
Onakomaiya, D., Pan, J., Roberts, T., Tan, H., Nadkarni, S., Godina, M., Park, J., Fraser, M., Kwon, S. C., Schoenthaler, A., & Islam, N. (2023). Challenges and recommendations to improve institutional review boards’ review of community-engaged research proposals: A scoping review. Journal of clinical and translational science, 7(1), e93. https://doi.org/10.1017/cts.2023.516
Shreffler J, Huecker MR. Common Pitfalls In the Research Process. [Updated 2023 Mar 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK568780/
NR week 3 Reply to Peer 1
/in Uncategorized /by Nursing Homework DeskThe Need for Institutional Review Boards (IRBs) and Their Impact on Research Studies
Institutional Review Boards (IRBs) play a vital role in the modern research landscape, particularly in healthcare settings where studies involve human participants. These ethics committees serve as essential gatekeepers, ensuring that research maintains high ethical standards while protecting participants from potential harm. My clinical experience working alongside nurse researchers has shown me firsthand how crucial these oversight bodies are to maintaining public trust in the research enterprise. The primary function of IRBs stems from historical ethical failures in research. The infamous Tuskegee Syphilis Study, where researchers withheld treatment from African American men with syphilis without their knowledge, and the horrific Nazi medical experiments during World War II demonstrated the dire consequences of unchecked research. These events led to the development of ethical frameworks like the Nuremberg Code and the Declaration of Helsinki, which eventually evolved into our current IRB system (Barrow et al., 2022). Today, IRBs ensure that researchers obtain proper informed consent, maintain participant privacy, minimize risks, and equitably distribute research benefits.
IRBs can significantly impact research studies in various ways. One example involves modifying participant recruitment methods. In a study by White et al. (2021), researchers examining pregnancy and birth experiences initially proposed recruiting vulnerable postpartum women through direct solicitation in hospital settings. The IRB identified potential constraint issues and required revisions to the recruitment protocol, mandating that initial contact occur through healthcare providers who had no stake in the research. This modification protected vulnerable participants from feeling pressured to participate but extended the recruitment timeline by several months. Another example of IRB impact relates to risk mitigation strategies. Stokes et al. (2017) conducted a study examining trauma-informed nursing interventions for patients with severe mental illness. The original protocol included detailed questioning about traumatic experiences without adequate psychological support mechanisms. The IRB required substantial revisions, including the addition of on-site mental health professionals during interviews, development of distress protocols, and follow-up mental health resources. While these changes enhanced participant protection, they increased study costs and necessitated additional personnel training.
IRBs can also shape data collection procedures to protect participant privacy. In my own clinical setting, I observed a nursing quality improvement project examining medication errors that initially proposed collecting identifiable information about staff members involved in errors. The IRB required removing all staff data and implementing stronger data security measures to prevent potential professional repercussions for staff. This modification protected participants but limited some analytical opportunities regarding individual-level factors contributing to errors. The structure and function of IRBs continue to evolve alongside emerging research methodologies and technologies. Modern IRBs must navigate complex issues like genetic data privacy, social media-based recruitment, and international collaborative research (Somia Abdul Same’e & Antony Sheela Anmary, 2024). While sometimes perceived as administrative hurdles, IRBs ultimately strengthen research quality and protect both participants and researchers by ensuring ethical compliance.
References
Barrow, J. M., Khandhar, P. B., & Brannan, G. D. (2022). Research Ethics. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459281/
Somia Abdul Same’e, & Antony Sheela Anmary. (2024). Navigating the Ethical Complexities. Advances in Information Quality and Management, 139–158. https://doi.org/10.4018/978-1-6684-8526-2.ch009
Stokes, Y., Jacob, J.-D., Gifford, W., Squires, J., & Vandyk, A. (2017). Exploring nurses’ knowledge and experiences related to trauma-informed care. Global Qualitative Nursing Research, 4(4). https://doi.org/10.1177/2333393617734510
White, A., Grady, C., Little, M., Sullivan, K., Clark, K., Ngwu, M., & Lyerly, A. D. (2021). IRB Decision‐Making about Minimal Risk Research with Pregnant Participants. Ethics & Human Research, 43(5), 2–17. https://doi.org/10.1002/eahr.500100
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