NR 507 Week No. 6 Discussion:

PART No. 1:

You are contacted by an attorney representing a client who has been charged with child abuse and whom faces loss of her child and 15 years in prison. The record indicated that the child was 4 years old and presented to the ER room with a broken arm and a broken leg. There also appeared to be multiple previous fractures. Now, you examine the child and find blue sclera, a sunken chest wall, severe scoliosis, and you observe a triangular face and prominent forehead. You confirm that there have been multiple previous fractures by evaluating the previous X-rays. This is a genetic disorder.

• What      is the most likely genetic disease that this presents and why?
• What      is the molecular basis of this disease?
• Before,      calling the police what should the initial clinician have done?

PART No 2:

Johnny is a 5-year-old Asian boy who is brought to a family practice office with a “runny” nose that started about 1 week ago but has not resolved.  He has been blowing his nose quite frequently and “sores” have developed around his nose.  His mother states, “The sores started as ‘big blisters’ that rupture; sometimes, a scab forms with a crust that looks like “dried maple syrup” but continues to seep and drain.”  She is worried because the lesions are now also on his forearm.  Johnny’s past medical and family histories are normal.  He has been febrile but is otherwise asymptomatic.  The physical examination was unremarkable except for moderate, purulent rhinorrhea and 0.5- to 1-cm diameter weeping lesions around the nose and mouth and on the radial surface of the right forearm.  There is no regional lymphadenopathy.

• Write      a differential of at least three (3) possible diagnoses and explain how      each may be a possible answer to the clinical presentation above.      Remember, to list the differential in the order of most likely to less      likely.
• Based      upon what you have at the top of the differentials how would you treat      this patient?
• When      would you allow the student back to school? Elaborate on your reasoning?

PART No. 3:

Keisha, a 13-year-old female, has come into your urgent care center. She has red conjunctiva, a cough and a fever of about 104 F, She also has a rash on her face a possibly the beginning of a rash on her arms. About 10 days ago she was around another student who had similar symptoms.

• Write      three (3) differential diagnoses?
• What      are some of the complications of this disease, assume that the top of your      differential is the definitive?
• Assume      that the second item you place on your differential is the definitive      diagnosis. What are some complications of that disease?

PEER:

NR 507 Week No. 6 Quiz Solutions:

1. Considering the pathophysiology of osteoporosis, which cytokines and hormones decrease receptor activator of RANKL expression?(Points : 2)

2. Rhabdomyolysis is characterized by (Points : 2)

3. Which type of osteoporosis would a person develop after having the left leg in a cast for 8 weeks to treat a compound displaced fracture of the tibia and fibula? (Points : 2)

4. Considering the pathophysiology of osteoporosis, what are the effects of extracellular signal regulated kinases (ERKs) and receptor activator of RANKL on osteoblasts and osteoclasts? (Points : 2)

5. What is the diagnosis of a person who has tennis elbow characterized by tissue degeneration or irritation of the extensor carpi brevis tendon? (Points : 2)

6. Which statement is false about giant cell tumors? (Points : 2)

7. What pattern of bone destruction is described as not well defined and not easily separated from normal bone? (Points : 2)

8. The pain experienced in Legg-Calvé-Perthes disease is referred to as involving (Points : 2)

9. In osteomyelitis, bacteria gain access to the subperiosteal space in the metaphysis, which is considered the “path of least resistance.” What factor makes this route for bacteria the path of least resistance? (Points : 2)

10. Molecular analysis has demonstrated that osteosarcoma is associated with (Points : 2)

11. Ewing sarcoma arises from (Points : 2)

12. Which serum laboratory test is elevated in all forms of osteogenesis imperfecta? (Points : 2)

13. The _____ is cartilage that retains the ability to form and calcify new cartilage and deposit bone until the skeleton matures. (Points : 2)

14. Osteochondrosis is caused by a(n) (Points : 2)

15. An insufficient dietary intake of vitamin _____ can lead to rickets in children. (Points : 2)

16. In latex allergies, which immunoglobulin is associated with an immediate reaction? (Points : 2)

17. Chickenpox may be followed years later by (Points : 2)

18. Cutaneous vasculitis develops from the deposit of _____ in small blood vessels as a toxic response allergen. (Points : 2)

19. Which malignancy is characterized by slow-growing lesions that usually have depressed centers and rolled borders and are frequently located on the face and neck? (Points : 2)

20. Scleroderma is more common in women and is associated with a(n) (Points : 2)

21. Thrush is a superficial infection that commonly occurs in children and is caused by (Points : 2)

22. What is the cause of chickenpox? (Points : 2)

23. Which vascular anomaly is a congenital malformation of dermal capillaries that does not fade with age? (Points : 2)

24. What is a common source of tinea corporis? (Points : 2)

25. Which contagious disease creates a primary skin lesion that is a pinpointed macule, papule, or wheal with hemorrhagic puncture site?(Points : 2)

Assignment 3: Policy Analysis Paper

In previous Discussions and Assignments, you have examined various aspects of the policy process: exploring the unintended consequences of policies, agenda setting, and analyzing policy recommendations. In this Assignment, you will have the opportunity to further develop your analysis skills by working through the policy analysis process. To be an effective agent for social change, you must be able to logically and critically analyze policy from multiple perspectives and contexts and then present your insights in a succinct and professional manner. This exercise will afford such an experience.

For this Assignment, you will examine a particular policy of interest to you (perhaps the one you selected for this week’s Discussion) and apply a policy analysis framework to understand the impact associated with the implementation of the policy. You will then develop a policy analysis paper, which is due day 5 of Week 11. This paper will also serve as your Major Assessment for this course.

To prepare:

Select a health care policy and a policy analysis framework to utilize for this Assignment. You may use the policy and framework you identified in this week’s Discussion or change your selection.

To complete:

Write an 8- to 10-page analysis paper (including references) in which you succinctly address the following:

1) An introduction

2) Part 1: Define the policy issue.

a) How is the issue affecting the policy arena?

b) What are the current politics of the issue?

c) At what level in the policy making process is the issue?

3) Part 2: Apply a policy analysis framework to explore the issue using the following contexts:

a) Social

b) Ethical

c) Legal

d) Historical

e) Financial/economic

f) Theoretical underpinnings of the policy

Include in this section:

a) Who are the stakeholders of interest?

b) Is there a nursing policy/position statement on this health care issue? If so, who developed it?

4) Part 3: Policy options/solutions

a) What are the policy options/solutions for addressing the issue? Include at least three levels of options/solutions: no change; partial change; radical change or maximum change.

b) What are the theoretical underpinnings of the policy options/solutions?

c) What are the health advocacy aspects and leadership requirements of each option?

d) How does each option/solution provide an opportunity or need for inter-professional collaboration?

e) What are the pros and cons of each suggested change? Include the cost benefits, effectiveness, and efficiency of each option along with the utility and feasibility of each option.

5) Part 4: Building Consensus

a) Outline a plan for building consensus around your recommended option/solution for solving the policy issue.

6) A Conclusion 

7) Part 5: References

a) Limit your references so this section is no more than 2 pages.

Your written assignments must follow APA guidelines. Be sure to support your work with specific citations from appropriate Learning Resources and additional scholarly sources as appropriate. Refer to the Publication Manual of the American Psychological Association to ensure that your in- text citations and reference list are correct.

Required Readings

Blackman, V. S. (2005). Putting policy theory to work: Tobacco control in California. Policy, Politics, & Nursing Practice, 6(2), 148–155. doi: 10.1177/1527154405276289

In this article, the author applies Kingdon’s multiple streams theory to agenda setting and the public policy issue of tobacco use. In addition, the author points out two limitations of Kingdon’s model—the need to build alliances and the varying power levels among stakeholders.

Craig, R. L., Felix, H. C., Walker, J. F., & Philips, M. M. (2010). Public health professionals as policy entrepreneurs: Arkansas’s childhood obesity policy experience. American Journal of Public Health, 100(11), 2047–2052.

Fawcett, J., & Russell, G. (2001). A conceptual model of nursing and health policy. Policy, Politics, & Nursing, 2(2), 108–116. doi: 10.1177/152715440100200205

Fawcett and Russell provide a five-level conceptual model of nursing and health policy and diagram the relationship between the model and new health policies. Guidelines for health policy analysis and evaluation are also provided.

Hewison, A. (2007). Policy analysis: A framework for nurse managers. Journal of Nursing Management, 15(7), 693–6 99. doi: 10.1111/j.1365-2934.2006.00731.x

Initially, this article presents a broad analysis of policy making and then provides a specific framework of policy analysis for nurse managers. The author focuses on the necessity for nurses to become involved in health care policy making

Policy analysis: A framework for nurse managers. Journal of Nursing Management, 15(7) by Hewison, A. Copyright 2007 by BLACKWELL PUBLISHING – JOURNALS. Reprinted by permission of BLACKWELL PUBLISHING – JOURNALS via the Copyright Clearance Center.

Howie, W. O. (2009). Mandatory reporting of medical errors: Crafting policy and integrating it into practice. Journal for Nurse Practitioners, 5(9), 649–654. doi:10.1016/j.nurpra.2009.07.012

John, P. (2003). Is there life after policy streams, advocacy coalitions, and punctuations: Using evolutionary theory to explain policy change? Policy Studies Journal, 31(4), 481–4 98. doi: 10.1111/1541-0072.00039

This article advances the use of evolutionary theory as policy theory. The author proposes that aspects of evolutionary theory such as randomness, competition, and selection be applied to policy theory but cautions that more research regarding its applicability is needed.

Rawat, P., & Morris, J. C. (2016). Kingdon’s “Streams” model at thirty: Still relevant in the 21st century? Politics & Policy, 44(4), 608-638. doi: 10.1111/polp.12168

Russell, G., & Fawcett, J. (2005). The conceptual model for nursing and health policy revisited. Policy, Politics, & Nursing, 6(4), 108–116. doi: 10.1177/1527154405283304

In this article, Russell and Fawcett revise their 2001 conceptual model of nursing and health policy and provide guidelines for nursing-specific research.

Optional Resources

Bardach, E. (2004). Presidential address—The extrapolation problem: How can we learn from the experience of others? Journal of Policy Analysis and Management, 23(2), 205. doi: 613545361

Respond on two different days who selected different factors than you, in one or more of the following ways:

Share insights on how the factor you selected impacts the pathophysiology of diabetes mellitus and diabetes insipidus.

Offer alternative diagnoses and prescription of treatment options for diabetes mellitus and diabetes insipidus.

Validate an idea with your own experience and additional research.

Main Post

Pathophysiology of Diabetes Insipidus

Diabetes insipidus is either the loss of antidiuretic hormone (ADH) action or secretion. ADH is secreted by the posterior pituitary and causes water reabsorption from the collecting ducts. Increases of ADH increases water reabsorption; this results in concentrated urine and more dilute serum. Decreases of ADH decreases water reabsorption, this results in an increase and dilute urine output, and the by-product is a more concentrated serum because ADH is lost with DI, urine output increases and leaves behind a more concentrated hypernatremic serum. There are two categories of DI, central and nephrogenic. Central DI involves a decrease of ADH in the posterior pituitary; this is usually secondary to head trauma, encephalitis, meningitis, and the like. Nephrogenic DI consists of a kidney sensitivity to the decrease of ADH; this form is typically hereditary or congenital and originates from the kidneys (Berkowitz, 2007). Signs and symptoms of DI are much like those of DM and can be, polyuria, polydipsia, and nocturia. Treatment is based on the type of DI and may involve ADH replacement (Huether & McCance, 2017).

Pathophysiology of Diabetes Mellitus

DM is broken down into type I and type II. Type I was previously known as insulin-dependent, and type II was formerly known as non-insulin dependent, that is no longer how these two disorders are classified. Type I is more common in adolescents and associated with the human leukocyte antigen (HLA). Ketone development commonly occurs in type I, and islet cell antibodies are in 90% of patients within the first year. Type I is thought to be caused by infectious or toxic environment that insults the B cells of the pancreas in a genetically predisposed person. Type II DM makes up greater than 90% of the DM cases in the United States. Type II is an inadequate production of insulin; this can be caused by tissue insensitivity and results in impaired insulin production or resistance. There is no link to the islet cell antibodies or HLA. With Type II, there is an association with abnormal lipid profile, obesity, and hypertension. Signs and symptoms of type I and II resemble DI in regards to polyuria, polydipsia. Type I involves weight loss, fatigue, and weakness. Type II includes weight gain, peripheral neuropathy, blurred vision, and chronic skin infections. Treatment might be insulin, oral antidiabetic choices, diet, and exercise (Barkley, 2018).

Patient Behavior and Ethnic Factors

First degree relatives and infection, infection and illness, are contributing factors to DM type I. Family history, sedentary lifestyle, obesity, women with polycystic ovary syndrome, gestational diabetes, insulin resistance, and impaired glucose tolerance are all patient and behavior factors that contribute to DMII. DM is more prevalent with African-Americans, Hispanic/Latino Americans, Asian-Americans, Native-Americans, Alaska Natives, and Pacific Islanders (WedMD, 2019). For DI there are no apparent contributing patient behaviors or ethnic links.

References

Barkley, T. (2018). Adult-gerontology primary care nurse practitioner. West Hollywood, CA: Barkley & Associates.Berkowitz, A. (2007). Clinical pathophysiology made ridiculously simple. Miami, FL: Medmaster.Huether, S. E., & McCance, K. L. (2012). Understanding pathophysiology (Laureate custom ed.). St. Louis, MO: Mosby.WebMD. (2019). What increases my risk of diabetes? Retrieved from https://www.webmd.com/diabetes/guide/risk-factors-for-diabetes#1