Respond on two different days who selected at least one different factor than you, in one or more of the following ways:Offer alternative diagnoses and prescription of treatment options for urinary tract infections.Share an insight from having read your colleague’s posting, synthesizing the information to provide new perspectives

Main Post

Urinary tract infections (UTI) are one of the most common infections in the world, and advanced practitioners must be able to diagnose and treat the varying types of UTIs. Understanding the location of the UTI, upper or lower, the pathophysiology, and specific signs and symptoms are crucial for treatment. An advanced practitioner must also be aware of the roles that gender and age play in the development of a UTI. UTIs are common in the outpatient setting but can also happen in the hospital and can also be caused by a Foley catheter, which is considered a hospital-acquired event that the hospital will not receive reimbursement.

Pathophysiology of Lower Urinary Tract Infection

A lower urinary tract infection involves the path of least resistance or the most opportunistic point of entry for an organism, usually bacterial and involves the urethra and the bladder. An infection in the urethra or bladder (cystitis) are considered a lower urinary tract infection. The microbial spectrum of UTIs consists mainly of Escherichia coli, with occasional other species of Enterobacteriaceae such as Proteus mirabilis and Klebsiella pneumoniae and other bacteria such as Staphylococcus saprophyticus (Yamamichi, Shigemura, Kitagawa, and Fujisawa, 2018).

Pathophysiology of Upper Urinary Tract Infection

The upper urinary tract consists of the kidneys and ureters. Infection in the upper urinary tract generally affects the kidneys (pyelonephritis), which can cause fever, chills, nausea, vomiting, and other severe symptoms. It can be caused by an infection that has made its way up the urinary tract and can become a complicated infection from an obstruction, such as benign prostatic hypertrophy, and calculi.

Similarities and Differences

Although the location of the infection is different many of the signs and symptoms can present the same; fever, dysuria, frequency, or urgency may be present in both. Many lower tract UTIs may be asymptomatic, and in upper tract UTIs, the symptoms may be more severe, including nausea and vomiting, flank pain, or costovertebral angle tenderness. Finding the underlying cause and treatment is the same; antibiotics for bacterial infections and analgesics for pain control. Intravenous antibiotics are preferred for upper tract UTIs in an attempt to preserve organ damage, but mat be converted to oral after initial treatment.

Gender and Age as Factors

While common in both males and females, females are more prone to community-acquired UTIs than men, basically because of anatomical differences. Lema (2015) acknowledges that the close proximity of the vagina and urethral meatus to the anal opening, the shorter length of the female urethra, and the opportunity for trauma during intercourse allows for the opportunity for a UTI to be acquired. Although this happens across the lifespan of a woman, the peak times are from mid-teens to the early forties or the sexually active years. Young children, especially females, are a high-risk group due to not being able to clean themselves properly after using the bathroom or poor technique. Older patients are also high risk; men with prostate issues cannot empty their bladder are also at risk.

Diagnosis and Treatment

Diagnosis of a lower tract UTI can be done with the assessment of signs and symptoms and urine culture, midstream is preferred. Research by Lee (2018) acknowledges that patients with non-febrile uncomplicated UTIs, active pain control and minimal use of antibiotics should be prioritized, including uncomplicated cystitis. Pain in acute cystitis is a natural consequence of the inflammatory response, and pain-mediated urinary frequency or urgency is the chief complaint of patients. Painkillers, including nonsteroidal anti-inflammatory drugs (NSAIDs), are a good choice for managing symptoms while reducing the usage of antibiotics. Urinalysis and urine culture confirms the diagnosis of acute pyelonephritis and according to the Infectious Diseases Society of America (2019) a urine culture showing at least 10,000 colony-forming units (CFU) per mm3 and symptoms compatible with the diagnosis. Symptoms management and oral antibiotic therapy are needed, and in severe cases, hospitalization with intravenous antibiotic therapy may be required.

Conclusion

As future practitioners, understanding the pathophysiologies of an upper tract UTI and a lower tract UTI is paramount to obtaining a diagnosis. Untreated and under treated UTIs can lead to life-threatening complications. Management of the signs and symptoms is important, but the treatment of the underlying cause can stop a lower tract UTI from spreading into the upper urinary tract. Age and gender play significant roles in UTIs, women of childbearing years, and older men who have trouble emptying their bladder are at high risk. Assessment and quality interviews can assist the practitioner in prevention through education.

References

Acute pyelonephritis. (2019). Retrieved July 18, 2019, from https://www.idsociety.org/clinical-practice/patient-care/patient-care/

Lee, S. (2018). Recent advances in managing lower urinary tract infections. F1000Research, 7, 1964. https://doi-org.ezp.waldenulibrary.org/10.12688/f1000research.16245.1

Lema, V. M. (2015). Urinary Tract Infection In Young Healthy Women Following Heterosexual Anal Intercourse: Case Reports. African Journal Of Reproductive Health, 19(2), 134–139. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=mnh&AN=26506666&site=eds-live&scope=site

Yamamichi, F., Shigemura, K., Kitagawa, K., & Fujisawa, M. (2018). Comparison between non-septic and septic cases in stone-related obstructive acute pyelonephritis and risk factors for septic shock: A multi-center retrospective study. Journal Of Infection And Chemotherapy: Official Journal Of The Japan Society Of Chemotherapy, 24(11), 902–906. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jiac.2018.08.002

1. As nurse practitioners and certified nurse midwives fight to achieve primary care provider (PCP) status, what laws, regulations, and policies should every advanced practice nurse be familiar with to remove these barriers?   What can an APN do as an individual and what can APNs do collectively to address these barriers?
2. How might the executive leadership of your health care system (e.g., chief executive office, chief financial officer, chief operating officer, chief medical officer/chief nursing officer, and the governing board) assist in the process to remove barriers to practice, reimbursement or any other impediments to APNs’ functioning to the fullest scope of education and experience?
3. What are some ramifications of certain elements of the Patient Protection and Affordable Care Act for APN practice?

Assignment 2: Week 6 Practicum Journal: Reimbursement Rates

Reimbursement rates and medical coding can be almost as complicated as treating some mental illnesses. As a PMHNP, you will be faced with varying rates that may be different than other health care providers you may work with.

In this Practicum Journal Assignment, you will analyze reimbursement rates for mental health treatments you will likely use in your practice and compare those rates to other provider rates.

Learning Objectives

Students will:

• Analyze reimbursement rates for mental health treatments

To prepare for this Practicum Journal:

• Research reimbursement rates for various treatment modalities.
• Compare NP rates to other provider rates.

For this Practicum Journal:

Complete the Reimbursement Rate Template in your Learning Resources using the five types of services you are likely to use in your practice.

  Week 7 Assignment: Essay – Creating Your Ideal State

• Due   Sunday by                  11:59pm
• Points 160
• Submitting a file upload

Required Resources
Read/review the following resources for this activity:

• Textbook: Chapter 15, 16, 17
• Lesson

Instructions
Your country just overthrew its  dictator, and you are the newly elected President. Unfortunately, due to  the divisions in the country and the years of war, economic, military,  and political structures are non-existent. A group of loyalists to the  old dictator have been detonating bombs, murdering civilians,  assassinating leaders, and terrorizing towns with help from a  neighboring country’s dictator.

Create a comprehensive plan for your new government. While creating  this government identify 1) the governing style of your government and  the principles that govern your leaders (see rubric); 2) the functions  of various branches of government; 3) how to maintain public good in  domestic areas through at least two programs; 4) an economic structure  that is most beneficial to your citizens; 5) ways to create national  unity; 6) ways to combat terrorism and violence; and, 6) international  organizations to join.

See rubric for specific ways to meet the requirements of the paper.

Paper headings: (Use of APA paper format with headings required!)

• Introduction (1 paragraph)
  • Introduce your country
  • Briefly outline all of the parts of the paper
• Domestic Concerns (1-2 pages)
  • Identify governing style and principles that correlate to this style
  • Identify the branches of government and its functions
  • Development of two public good domestic programs and how they will meet the public good
  • Economic structure and reason why this should be used
  • Socializing citizens is noted with rationale for how it creates national unity
• Foreign Concerns (1-2 pages)
  • Two international organizations are noted, one for economics and one for security
  • Descriptions of both organizations
  • Rationales for joining these organizations
  • Steps to joining
  • Two ways your country will combat the neighboring country’s terrorist threat and the domestic threat
  • Two ways these will be effective
• Conclusion (1 paragraph)
  • Summarize information

Writing Requirements (APA format)

• Length: 3-4 pages (not including title page or references page)
• 1-inch margins
• Double spaced
• 12-point Times New Roman font
• Title page
• References page (minimum of 2 scholarly sources)

Grading
This activity will be graded based on the essay rubric.

Course Outcomes (CO): 8, 9

Due Date: By 11:59 p.m. MT on Sunday

 

Rubric

Week 7 Assignment: Essay – Creating Your Ideal State      Week 7 Assignment: Essay – Creating Your Ideal State     Criteria Ratings        Pts              This criterion is linked to a Learning Outcome  Governing style and principles of the government.              25.0                    pts                  The  governing style is understandable and the principles support the choice  of the governing style. Provides  structure of power, source of power,  ideology of power.          20.0                    pts                  The governing style is unclear, the principles are unclear, or the governing style and principles do not support each other.          15.0                    pts                  Missing one part of the governing style and principles.          0.0                    pts                  Missing both parts of the governing style and principles.          25.0 pts
This criterion is linked to a Learning Outcome  Branches of government and its functions.              20.0                    pts                  Explains each branch of government and the function of the particular branch and how they support the governing style.          16.0                    pts                  The  branches of government and their functions do not match, or the branches  are discussed without talking about their functions AND how they  support the governing style.          12.0                    pts                  Only minimally discusses branches, and their functions or the branches do not support the governing style chosen.          0.0                    pts                  Does not discuss the branches and their functions.          20.0 pts
This criterion is linked to a Learning Outcome  Maintaining public good through at least two domestic programs              20.0                    pts                  Two domestic programs are created clearly explaining how public good is maintained with these programs.          16.0                    pts                  Two domestic programs are noted, but it’s unclear how they both benefit the public good.          12.0                    pts                  Only one domestic program is noted.          0.0                    pts                  No domestic program is noted.          20.0 pts
This criterion is linked to a Learning Outcome  Economic structure              15.0                    pts                  The economic structure is named and supports the governing style with a rationale for using the structure.          12.0                    pts                  The economic structure is named and supports the governing style, but the rationale is unclear.          9.0                    pts                  The economic structure is named, but does not support the governing style and the rationale is unclear.          0.0                    pts                  The economic structure is not addressed.          15.0 pts
This criterion is linked to a Learning Outcome  Political socializing to create national unity              15.0                    pts                  There  is at least one method the new government will use to socialize citizens  to create national unity and rationales for using these methods.          12.0                    pts                  The method described will create national unity, but rationale is not provided.          9.0                    pts                  The method described will not create national unity and rationale is not provided.          0.0                    pts                  No method for national unity is addressed.          15.0 pts
This criterion is linked to a Learning Outcome  International organizations              25.0                    pts                  At  least two different international organizations, one economic and one  for security, were identified to join with brief descriptions of the  purposes of these organizations, rationale for joining, and steps on how  to join.          20.0                    pts                  At  least two different international organizations, one economic and one  for security, were identified to join with brief descriptions of the  purposes of these organizations, rationale for joining, but no steps on  how to join were included.          15.0                    pts                  At  least two different international organizations, one economic and one  for security, were identified to join with brief descriptions of the  purposes of these organizations.          0.0                    pts                  International organizations were not addressed          25.0 pts
This criterion is linked to a Learning Outcome  Combatting terrorism and violence              20.0                    pts                  Two  ways were offered to combat terrorism and violence (one to deal with  international threat and one with domestic). Effective rationale for  solutions were offered.          16.0                    pts                  Two  ways were offered to combat terrorism and violence (one to deal with  international threat and one with domestic). Effective rationale for one  or both solutions were not offered.          12.0                    pts                  Only one way to combat violence and sound rationale on why to use that solution was offered.          0.0                    pts                  Ways to combat violence is not noted.          20.0 pts
This criterion is linked to a Learning Outcome  Scholarly resources              10.0                    pts                  Uses both the book and, at least, one outside scholarly source.          8.0                    pts                  Uses only the book or a scholarly source.          6.0                    pts                  Uses only a scholarly source and the source is not scholarly.          0.0                    pts                  Does not use the book or scholarly source.          10.0 pts
This criterion is linked to a Learning Outcome  APA              5.0                    pts                  All sources are properly cited and referenced according to APA standards.          4.0                    pts                  Sources are either properly cited or referenced, missing one of those elements.          3.0                    pts                  The citation and/or reference are incorrect.          0.0                    pts                  No APA format was used.          5.0 pts
This criterion is linked to a Learning Outcome  Writing              5.0                    pts                  Presents  information using clear and concise language in an organized manner  (minimal errors in English grammar, spelling, syntax, and punctuation).          4.0                    pts                  Presents  information using understandable language but is somewhat disorganized  (some errors in English grammar, spelling, syntax, and punctuation).          3.0                    pts                  Presents  information using understandable language but is very disorganized  (many errors in English grammar, spelling, syntax, and punctuation).          0.0                    pts                  Presents  information that is not clear, logical, professional or organized to  the point that the reader has difficulty understanding the message  (numerous errors in English grammar, spelling, syntax, and/or  punctuation).