Order ID 53563633773 Type Essay Writer Level Masters Style APA Sources/References 4 Perfect Number of Pages to Order 5-10 Pages Description/Paper Instructions
Discussion W6 650
Instructions for Discussion Replies to 3 DQS
DO NOT JUST REPEAT SAME INFORMATION, DO NOT JUST SAY I AGREE OR THINGS LIKE THAT. YOU NEED TO ADD NEW INFORMATION TO DISCUSSION.
1- Each reply should be at least 200 words.
2- Minimum One Peer reviewed/scholarly reference ( NO MAYO CLINIC/ AHA)
3- APA 6th edition style needs to be followed.
4- Each response should have reference at the end of each reply
5- Reference should be within last 4 years
Discussion w6 650
Q-1Mrs. Davis comes to the office today with complaints of recent unexplained weight loss. She reports that her weight loss has been sudden and severe with a loss of fifty pounds in three months. She also reports consistent diarrhea that is yellow and liquid. Along with these symptoms, she was prompted to make an appointment due to increasing fatigue, eventually impacting her daily life.
At this point, my differential diagnosis was Irritable bowel syndrome, Inflammatory Bowel Disease, Diarrhea, Malabsorption Syndrome, Dumping Syndrome, and Malnutrition (Pimentel, 2016).
When performing the health interview she reported alopecia, along with increasing fatigue. At this point, I had believed that it strengthened my differential diagnosis as a decrease in inadequate absorption would show signs of malabsorption or a gastrointestinal issue (Pimentel, 2016). However, continuing the health interview, the patient also reported that she had her parathyroid glands removed but did not know why. Upon finding out this information I also wanted to check her thyroid gland before ruling out thyroid involvement.
Upon the physical exam, the patient was noted to have “visible thyroid fullness and diffuse enlargement on palpation” which is a key indicator that the thyroid gland is overworking due to an unknown origin (Pandiyan et al., 2018). At this point, my entire differential has changed to Hyperthyroidism, Diarrhea, Malnutrition, Irritable Bowel Syndrome, and Inflammatory Bowel Disease (Pandiyan et al., 2018).
I decided to investigate this further during the lab portion of the exam, and the results showed a T4 of 22.8 and TSH of 0.01. An elevated T4 and a suppressed TSH are indicative of hyperthyroidism, even with unknown etiology (Pandiyan et al., 2018). Upon combining the subjective and objective data I felt confident that this was the diagnosis.
On a side note, the patient did mention that she was vegan, so even though she was experiencing hyperthyroidism, there was a possibility that her weight loss could have also had other contributing factors such as a poor nutritional diet (Pandiyan et al., 2018). In vegan diets, it is a common occurrence that there is a lack of appropriate nutrition even if eating the appropriate amount of calories per day (Menzel et al., 2020). However, this is easily overcome with better nutritional discipline and eating the right combination of foods that provide a total day’s worth of nutrients (Menzel et al., 2020). I wanted to explore her diet more and assess the appropriateness of the diet but the program is limited.
For the plan, I wanted to involve endocrinology as the patient has had previous endocrine-based surgeries in the past. So a referral would be made to endocrinology for further exploration and additional management of the disease process (Pandiyan et al., 2020). I could also start her on Methimazole 15mg oral daily to begin management of the disease but would defer to endocrine for any additional changes (Pandiyan et al., 2020). I would also like to see her in a month to evaluate the treatment and plan of care for this patient.
References:
Menzel, J., Biemann, R., Longree, A., Isermann, B., Mai, K., Schulze, M. B., Abraham, K., & Weikert, C. (2020). Associations of a vegan diet with inflammatory biomarkers. Scientific Reports, 10(1), 1933. https://doi-org.lopes.idm.oclc.org/10.1038/s41598-020-58875-x
Pandiyan, B., Merrill, S. J., Di Bari, F., Antonelli, A., & Benvenga, S. (2018). A patient-specific treatment model for Graves’ hyperthyroidism. Theoretical Biology and Medical Modelling, 1. https://doi-org.lopes.idm.oclc.org/10.1186/s12976-017-0073-6
Pimentel, M. (2016). Update on Irritable Bowel Syndrome Diagnostics and Therapeutics. Gastroenterology & Hepatology, 12(7), 442–445.
Q-2
Mrs. Green, a 76-year-old patient, has been hospitalized with pneumonia. While rounding on your patient, her neighbors, a younger couple, state that they know she is a diabetic and is not eating correctly. The neighbors, who often take Mrs. Green to the grocery store, state that she buys ice cream and cookies and rarely fixes “proper meals.” They are concerned about her and want the nurse practitioner to notify her family. Upon examination, Mrs. Green is alert, oriented, well-groomed, and appropriate. Her glucose is 200 and she is in no distress. She states, “I like ice cream, I’m old, and I deserve it.” How should you respond?
There are great points that the neighbors make when they express their concern for their neighbors. These concerns come from a place of love and care, not any malice. However, some may feel that people are too invested in their personal lives, and that is okay as well. Every individual has boundaries and it is up to healthcare professionals to explore and educate patients appropriately to allow them to make their own informed decisions.
Diabetic management in elderly patients is dependent on the receptiveness of the individual (Ni et al., 2020). The most that healthcare professionals can do is provide correct information about the benefits of appropriate management and the risks and consequences of improper management (Ni et al., 2020). There are many barriers to any disease process and the patient’s willingness to change their behavior (Bazzano et al., 2019). Some barriers include culture, routines, family experiences, and overall unwillingness to change (Bazzano et al., 2019).
The common saying is that “you can’t help people who do not want to change”.
So honestly, I would first begin the conversation by thanking the neighbors for their concern, and inform them that I will speak to Mrs. Green on the subject. Then once I begin speaking with Mrs. Green I would gauge her understanding of her diabetes and her management of the disease process. I would evaluate her understanding of the benefits and risks of her choices to see if she fully grasps the information. If she does, then I would talk to her about her choices, and if she still has her mind made up, I would tell her I agree with her, and that she should eat ice cream and enjoy it, but to try to limit her intake overall. I would also ask her if she wants to know how well her diabetes is controlled, and if she agrees, I would order a hA1C and go over the results with her.
If she doesn’t want the test, then that is fine too, and if she doesn’t want any additional information, that is fine as well. It is essentially Mrs. Green’s life and her choices, and as long as they’re informed choices, then I would support her in her decisions.
As for the neighbors asking me to inform her family, I would only do so if Mrs. Green agrees and gives me permission to.
We can also apply this scenario to a majority of risky health behaviors in all aspects of human life. Behaviors such as smoking, alcohol intake, drugs, excessive eating, risky sexual behaviors, and many more. If the patient wants to change, they will, if not they won’t. Besides, who would deny an elderly woman ice cream after a bunch of education.
References:
Bazzano, A., Monnette, A., Wharton, M., Price-Haywood, E., Nauman, E., Dominick, P., Glover, C., Hu, G., & Shi, L. (2019). Older patients’ preferences and views related to non-face-to-face diabetes chronic care management: a qualitative study from southeast Louisiana. Patient Preference & Adherence, 13, 901–911. https://doi-org.lopes.idm.oclc.org/10.2147/PPA.S201072
Ni, M., Ayu, D., Wayan, N., & Gusti Putu Suka, A. (2020). Diabetes mellitus control among elderly patients at geriatric polyclinic of Karangasem District Hospital, Bali, Indonesia: a preliminary study. Bali Medical Journal, 9(1), 279–285. https://doi-org.lopes.idm.oclc.org/10.15562/bmj.v9i1.1664
Q-3
RUBRIC
QUALITY OF RESPONSE NO RESPONSE POOR / UNSATISFACTORY SATISFACTORY GOOD EXCELLENT Content (worth a maximum of 50% of the total points) Zero points: Student failed to submit the final paper. 20 points out of 50: The essay illustrates poor understanding of the relevant material by failing to address or incorrectly addressing the relevant content; failing to identify or inaccurately explaining/defining key concepts/ideas; ignoring or incorrectly explaining key points/claims and the reasoning behind them; and/or incorrectly or inappropriately using terminology; and elements of the response are lacking. 30 points out of 50: The essay illustrates a rudimentary understanding of the relevant material by mentioning but not full explaining the relevant content; identifying some of the key concepts/ideas though failing to fully or accurately explain many of them; using terminology, though sometimes inaccurately or inappropriately; and/or incorporating some key claims/points but failing to explain the reasoning behind them or doing so inaccurately. Elements of the required response may also be lacking. 40 points out of 50: The essay illustrates solid understanding of the relevant material by correctly addressing most of the relevant content; identifying and explaining most of the key concepts/ideas; using correct terminology; explaining the reasoning behind most of the key points/claims; and/or where necessary or useful, substantiating some points with accurate examples. The answer is complete. 50 points: The essay illustrates exemplary understanding of the relevant material by thoroughly and correctly addressing the relevant content; identifying and explaining all of the key concepts/ideas; using correct terminology explaining the reasoning behind key points/claims and substantiating, as necessary/useful, points with several accurate and illuminating examples. No aspects of the required answer are missing. Use of Sources (worth a maximum of 20% of the total points). Zero points: Student failed to include citations and/or references. Or the student failed to submit a final paper. 5 out 20 points: Sources are seldom cited to support statements and/or format of citations are not recognizable as APA 6th Edition format. There are major errors in the formation of the references and citations. And/or there is a major reliance on highly questionable. The Student fails to provide an adequate synthesis of research collected for the paper. 10 out 20 points: References to scholarly sources are occasionally given; many statements seem unsubstantiated. Frequent errors in APA 6th Edition format, leaving the reader confused about the source of the information. There are significant errors of the formation in the references and citations. And/or there is a significant use of highly questionable sources. 15 out 20 points: Credible Scholarly sources are used effectively support claims and are, for the most part, clear and fairly represented. APA 6th Edition is used with only a few minor errors. There are minor errors in reference and/or citations. And/or there is some use of questionable sources. 20 points: Credible scholarly sources are used to give compelling evidence to support claims and are clearly and fairly represented. APA 6th Edition format is used accurately and consistently. The student uses above the maximum required references in the development of the assignment. Grammar (worth maximum of 20% of total points) Zero points: Student failed to submit the final paper. 5 points out of 20: The paper does not communicate ideas/points clearly due to inappropriate use of terminology and vague language; thoughts and sentences are disjointed or incomprehensible; organization lacking; and/or numerous grammatical, spelling/punctuation errors 10 points out 20: The paper is often unclear and difficult to follow due to some inappropriate terminology and/or vague language; ideas may be fragmented, wandering and/or repetitive; poor organization; and/or some grammatical, spelling, punctuation errors 15 points out of 20: The paper is mostly clear as a result of appropriate use of terminology and minimal vagueness; no tangents and no repetition; fairly good organization; almost perfect grammar, spelling, punctuation, and word usage. 20 points: The paper is clear, concise, and a pleasure to read as a result of appropriate and precise use of terminology; total coherence of thoughts and presentation and logical organization; and the essay is error free. Structure of the Paper (worth 10% of total points) Zero points: Student failed to submit the final paper. 3 points out of 10: Student needs to develop better formatting skills. The paper omits significant structural elements required for and APA 6th edition paper. Formatting of the paper has major flaws. The paper does not conform to APA 6th edition requirements whatsoever. 5 points out of 10: Appearance of final paper demonstrates the student’s limited ability to format the paper. There are significant errors in formatting and/or the total omission of major components of an APA 6th edition paper. They can include the omission of the cover page, abstract, and page numbers. Additionally the page has major formatting issues with spacing or paragraph formation. Font size might not conform to size requirements. The student also significantly writes too large or too short of and paper 7 points out of 10: Research paper presents an above-average use of formatting skills. The paper has slight errors within the paper. This can include small errors or omissions with the cover page, abstract, page number, and headers. There could be also slight formatting issues with the document spacing or the font Additionally the paper might slightly exceed or undershoot the specific number of required written pages for the assignment. 10 points: Student provides a high-caliber, formatted paper. This includes an APA 6th edition cover page, abstract, page number, headers and is double spaced in 12’ Times Roman Font. Additionally, the paper conforms to the specific number of required written pages and neither goes over or under the specified length of the paper. GET THIS PROJECT NOW BY CLICKING ON THIS LINK TO PLACE THE ORDER
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