Impact of nutritional changes on nonalcoholic fatty liver disease.

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Directions: 

More people are becoming interested in detox diets and organ health. As a health educator, one of your roles is differentiating evidence versus popular media and marketing. In this discussion, we will explore evidence that supports the role of nutrition in liver health to add to your ability to differentiate nutrition science from media.

Initial post:  

Start by reading the article titled, Impact of nutritional changes on nonalcoholic fatty liver disease.

Focus on the general concepts, as opposed to understanding every word. After completing the reading, answer the following question for your initial post: “What evidence-based general nutrition recommendations would you share with patients interested in liver health?”

Use the assigned article, with appropriate APA citations, to support your position with at least 5-6 sentences to support your case.

How do I find evidence-based practice articles? Or nursing best practices?

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For this written assignment, select one recent (within the past two years) evidence-based article from a peer reviewed nursing journal that describes a “best practice” in an area of nursing you are interested in. For example, if you would like to be a pediatric nurse, select an article that discusses a best practice in pediatric care.

Cite the article and provide a brief overview of how the results or findings were obtained. Then describe the “best practice.” Conclude your discussion by explaining whether you thought the research findings supported the conclusions and the best practice.

This assignment must be no more than 3 pages long. It should include all of the required elements. Use APA Editorial format 7th edition, and attach a copy of the article. A Grammarly plagiarism report is also required. 

Submit your completed assignment by following the directions linked below.

A 41-year-old male patient presents at the community walk-in clinic with complaints of severe elbow pain radiating into the forearm.

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A 41-year-old male patient presents at the community walk-in clinic with complaints of severe elbow pain radiating into the forearm. His 13-year-old daughter is serving as a translator because her father is unable to speak English and understands only a few words in English. The daughter explains that he has been taking Tylenol to manage pain, but the pain is getting worse and is keeping him from working. You ask the daughter to describe the type of work her father does, and you notice she is hesitant to respond, first checking with her father. He responds, and she translates that he works in construction. Based on the response and the apparent concern, you suspect that the patient may be an undocumented worker. Further conversation reveals that several members of the family are working with the same local construction company.

  1. You suspect the pain reported as coming from the elbow and radiating down the forearm is caused by repetitive motions, perhaps indicating lateral epicondylitis. What can you do to confirm this diagnosis?
  2. While performing the physical examination, you ask the patient, through his daughter, if he has reported this injury to his employer, because the injury is most likely work-related. The daughter responded without consulting her father that this is an old injury that happened before he started working at his current place of employment. You could tell that she was becoming more distressed. What is the most likely explanation for her concern?
  3. Visual inspection reveals erythema around the affected area with no evidence of overlying skin lesions, scars, or deformities. What other assessments should you perform?
  4. How is lateral epicondylitis treated?
  5. When discussing possible treatment approaches, you notice that the patient is very worried and seems to suggest to his daughter that they should leave. The daughter begins trying to explain why they have to leave right away. What would you tell the patient and his daughter to help them feel comfortable staying for treatment?
  6. Post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.

Describe your clinical experience for this week.

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Describe your clinical experience for this week.

  • Did you face any challenges, any success? If so, what were they?
  • Describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and at least 3 possible differential diagnosis with rationales.
  • Mention the health promotion intervention for this patient.
  • What did you learn from this week’s clinical experience that can beneficial for you as an advanced practice nurse?
  • Support your plan of care with the current peer-reviewed research guideline.
  •  Post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.

You are now ready to evaluate the effectiveness of the interventions and whether your goals for the client have been met. Remember, the nursing process is cyclical and ongoing. The evaluation phase includes assessment and reassessment.

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You are now ready to evaluate the effectiveness of the interventions and whether your goals for the client have been met. Remember, the nursing process is cyclical and ongoing. The evaluation phase includes assessment and reassessment.

For example, if you set a goal to lose 10 lbs in one month, maybe it wasn’t realistic to set this goal during the holiday season. Maybe your interventions should have included eliminating sugary drinks in addition to French fries.

This is like weighing yourself after one week of being on a new diet. Perhaps your goal was to lose one pound in 7 days. Your interventions included reducing the number of French fries you consume in a week and eating one apple a day for 7 days. After 7 days, your intervention was to reassess your weight. You step on the scale, and you gained two pounds!

As a reminder, an overview of the Nursing Process Project and the project resources can be found in Module 3: Nursing Process Project: Overview.

Instructions

The final part of the Nursing Process Project requires you to complete the evaluation section on the Nursing Process Project template. Follow these steps to complete this part of the project.

Step 1: Complete the evaluation section of the Nursing Process Project template. If a category is non-applicable, simply write NA in that section of the template.

Step 2: Implement instructor comments and edits to previous sections of the Nursing Process Project template.

Assessment

Diagnosis

Planning

Implementation

Step 3: Submit the entire Nursing Process Project template for final instructor review.

Assessment of the Abdomen

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The assignment is to make a Power Point which the title is: “Assessment of the Abdomen”. This Power point should have 20 slides and I want it to have photos and the content.

The Power Point must expose the steps in order of the abdomen assessment, the definition of each one of these steps, photos of how each one is performed. The slides may also include examples of pathological findings in each of the assessment steps.

It is known that the abdomen is divided into nine quadrants. Therefore, I would like to expose the most frequent diseases located in each one of the nine quadrants. For example: If I am examining a patient with pain in the right hypochondrium (upper right quadrant) what pathologies or diseases can we suspect with the pain located in that area? Also I want to include photos and definition of the following pathologies: Cirrhosis, Bulge, Ascites, Abdominal Hernia, and Mc Burney’s Point.

The assignment is to make a Power Point which the title is: “Assessment of the Abdomen”. This Power point should have 20 slides and I want it to have photos and the content.

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The assignment is to make a Power Point which the title is: “Assessment of the Abdomen”. This Power point should have 20 slides and I want it to have photos and the content.

The Power Point must expose the steps in order of the abdomen assessment, the definition of each one of these steps, photos of how each one is performed. The slides may also include examples of pathological findings in each of the assessment steps.

It is known that the abdomen is divided into nine quadrants. Therefore, I would like to expose the most frequent diseases located in each one of the nine quadrants. For example: If I am examining a patient with pain in the right hypochondrium (upper right quadrant) what pathologies or diseases can we suspect with the pain located in that area? Also I want to include photos and definition of the following pathologies: Cirrhosis, Bulge, Ascites, Abdominal Hernia, and Mc Burney’s Point.

You are now ready to evaluate the effectiveness of the interventions and whether your goals for the client have been met.

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You are now ready to evaluate the effectiveness of the interventions and whether your goals for the client have been met. Remember, the nursing process is cyclical and ongoing. The evaluation phase includes assessment and reassessment.

For example, if you set a goal to lose 10 lbs in one month, maybe it wasn’t realistic to set this goal during the holiday season. Maybe your interventions should have included eliminating sugary drinks in addition to French fries.

This is like weighing yourself after one week of being on a new diet. Perhaps your goal was to lose one pound in 7 days. Your interventions included reducing the number of French fries you consume in a week and eating one apple a day for 7 days. After 7 days, your intervention was to reassess your weight. You step on the scale, and you gained two pounds!

As a reminder, an overview of the Nursing Process Project and the project resources can be found in Module 3: Nursing Process Project: Overview.

Instructions

The final part of the Nursing Process Project requires you to complete the evaluation section on the Nursing Process Project template. Follow these steps to complete this part of the project.

Step 1: Complete the evaluation section of the Nursing Process Project template. If a category is non-applicable, simply write NA in that section of the template.

Step 2: Implement instructor comments and edits to previous sections of the Nursing Process Project template.

Assessment

Diagnosis

Planning

Implementation

Step 3: Submit the entire Nursing Process Project template for final instructor review.

This discussion requires you to access the ATI Testing website. To access ATI, use the ATI Testing link in the Canvas Navigation Menu or select this ATI Testing Links to an external site. link to access your login page.

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This discussion requires you to access the ATI Testing website. To access ATI, use the ATI Testing link in the Canvas Navigation Menu or select this ATI Testing Links to an external site. link to access your login page.

Instructions

Once logged in, go to My ATI, select the “Apply” tab, and select the “Video Case Studies RN 3.0.” Watch the video case study Critical Thinking/Clinical Reasoning/Clinical Judgement: Rapid Response/Clinical Emergencies (3:34). The nurse in the video you are about to watch uses the nursing process to care for the client.

As you watch the video, consider the following questions.

  • What are the steps of the nursing process?
  • How does the nursing process assist in prioritizing nursing care?

DO NOT respond to the questions following the video case study. Instead, write 200–250 words responding to the discussion prompts provided. Then, respond to at least two of your peers’ posts.

Discussion Prompts

  • Why is the nursing process used when providing client care?
  • What is a focused nursing assessment?
  • Name one example of a client situation in which you would use a focused nursing assessment vs. the entire nursing process. Explain why.

Prescription drug abuse is a significant problem in today’s society.

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Prescription drug abuse is a significant problem in today’s society. Fatal prescription overdoses went from 1.4/100,000 deaths in 1999 to 5.4/100,000 deaths in 2011 (Haffejee et al, 2015). Much has changed in practices in the last 15 years as a result of these problems with a goal of curbing addiction and overdose. Prescription drug monitoring programs have been developed in response to the alarming rate of incidences. Initially, rates of the program was low at around 35% of prescribers enrolled (Haffajee, 2015). However with a mandatory requirement of a query before prescribing, a reduction in prescription drug abuse was found (Haffajee, 2015).

Impacts for health are complicated as controlled medications are now limited which are easy temporary fixes but other avenues of treatment are now utilized such as therapy and and other non pharmacological means. Insurers benefit as they do not have to deal with the sequalae of cost for addiction treatment and overdoses. Prescribers are encouraged to think outside of the box and not rely so heavily on pharmacological means of treating pain/sleep issues and seek other causes/treatments to these problems.

 

Haffajee RL, Jena AB, Weiner SG. Mandatory Use of Prescription Drug Monitoring Programs. JAMA. 2015;313(9):891–892. doi:10.1001/jama.2014.18514

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Over the past several decades, there have dramatic changes in the use of narcotics, barbiturates, and sleep medications due to their high risk for abuse.  Narcotic prescriptions began to dramatically increase in the 1990’s with the release of OxyContin, which is thought to be a central cause to the opioid epidemic in later decades.   In contrast, barbiturate use has dramatically decreased and replaced by benzodiazepines because they have been found to be safer and more effective (Weaver, 2015).  However, in recent years benzodiazepines prescriptions have increased and following the exponential increase of anxiety during the COVID-19 pandemic, have the potential to become its own epidemic (Sarangi et al., 2021).  As a result, there have been new guidelines released to guide prescribers to make decisions that will decrease their patient’s risk of abuse.  The Centers for Disease Control in 2022 released their latest guidelines for prescribing opioids, that addresses the concerns of abuse and providing guidance to providers (Dowell et al., 2022).  The guideline is quite expansive and addresses many conditions that cause pain with additional guidelines.  In contrast, according to the Agency for Healthcare Research and Quality, there is no agreed upon guideline for the prescription of benzodiazepines and the department is working develop evidenced based practice guidelines that are widely accepted by the medical community (Agency for Healthcare Research and Quality, 2022).  The question remains is how these changes in guidelines will affect our patients, insurance, and prescribers.  Patients can expect fewer opioid prescriptions, use of nonopioids, and increase in adjunct methods to manage their pain when coming into their primary care for management of their pain (Dowell et al., 2022).  While insurance companies will likely over time change the medications that they choose to cover with specific conditions related to pain.  Prescribers in my opinion, will have the one of the hardest jobs, applying all these new evidenced based practice guidelines into their practice.  As a result, these prescribers must be knowledgeable about alternatives for opioids, which can be as simple as recommending over the counter ibuprofen to understanding how certain antidepressants can be used effectively as adjuncts.   As our knowledge base on alternative medications continues to grow, the hope is we will see a decrease in narcotic and benzodiazepine usage that will result in better, safer outcomes for patients.

Dowell, D., Ragan, K. R., Jones, C. M., Baldwin, G. T., & Chou, R. (2022, November 4). CDC clinical practice guideline for prescribing opioids for pain. Centers for Disease Control; Centers for Disease Control MMWR Office. https://doi.org/10.15585/mmwr.rr7103a1

Links to an external site.

Sarangi, A., McMahon, T., & Gude, J. (2021). Benzodiazepine Misuse: An Epidemic Within a Pandemic. Cureus, 13(6), e15816. https://doi.org/10.7759/cureus.15816

Links to an external site.

Weaver M. F. (2015). Prescription Sedative Misuse and Abuse. The Yale journal of biology and medicine, 88(3), 247–256. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553644/

Links to an external site.

 

 

Diabetes is a chronic condition affection millions of people worldwide and requires a multifaceted approach to control. Education of the patient is one of the strongest predictors of outcome (ElSayed et al, 2023). However, there is much learning to be had including the promotion of making healthy eating choices, increasing physical activity, compliance with blood glucose monitoring as well as medication compliance. Due to these various factors, health outcomes remains a significant challenge. Between 2013-2016, only 64% of diagnosed adults met their personal A1C targets and only 23% met their glycemic targets (ElSayed et al., 2023). Although American Indians, blacks, Hispanics and Asians all have higher numbers of diabetes than whites (American Diabetes Association, 2022), some of the largest barriers to better outcomes is access to healthcare, education, and food (ElSayed et al., 2023). The homeless is estimated to be around 8% with diabetes and have no safe storage for medications as well as access to refrigeration in addition to lacking access to healthy food choices, literacy and lack of health insurance (ElSayed et al., 2023). The migrant worker population is another population that has significant challenges with managing diabetes. They are often Latino which has a proportionally higher number of diabetics (American Diabetes Association, 2022) as well as many of the issues associated with poverty such as literacy and access to healthcare and healthy food options (ElSayed et al, 2023). In 2021, national health center data accounted for 91,124 visits related to diabetes which was roughly 10% of all their visits with the migrant worker population (ElSayed et al, 2023) and this shows that diabetes is in fact significant.

 

American Diabetes Association (2022). Statistics about diabetes. American Diabetes Association.  https://diabetes.org/about-us/statistics/about-diabetes

ElSayed, N., Aleppo, G., Aroda, V., Bannuru, R., Brown, F., Bruemmer, D., Collins, B., Cusi, K., Das, S., Gibbons, C., Giurini, J., Hilliard, M., Isaacs, D., Johnson, E., Kahan, S., Khunti, S., Kosiborod, M., Leon, Jose., Lyons, S., Murdock, L., Perry, M., Prahalad, P., Pratley, R., Jeffrie Seley, J., Stanton, R., Sun, J., Woodward, C., Young-Hyman, D., Gabbay., R (2023) Introduction and Methodology: Standards of Care in Diabetes—2023. Diabetes Care.  46 (Supplement_1): S1–S4.  https://doi.org/10.2337/dc23-Sint

Links to an external site.

 

 

 

 

 

 

 

 

 

 

 

The American Diabetes Association reports that diabetes is a very common metabolic endocrine condition. As of 2022 the American Diabetes Association (ADA) estimated that 34.2% of the U.S. population had diabetes mellitus, making the illness the seventh largest cause of death in the country. Neither the pancreas nor the body can create enough insulin, which leads to metabolic diseases caused by abnormal endocrine function. Diabetes type 2 is brought on by insulin resistance. Insulin and other medications for type 2 diabetes reduce glucose levels in a variety of ways. Drugs treat diabetes by enhancing insulin sensitivity in cells, decreasing glucose synthesis in the liver, reducing gastric emptying, and stimulating the pancreas to release more insulin (Mayo Clinic, 2018). Treatment plans may be adjusted to accommodate individual patients’ conditions. Metformin, Sulfonylureas, and Meglitinides are some of the drugs prescribed to individuals with type 2 diabetes. Metformin decreases the liver’s glucose synthesis and raises the body’s sensitivity to insulin, allowing the insulin the patient takes to have a greater impact. Sulfonylureas stimulate insulin production, which benefits the patients. Meglitinides like Prandin and Starlix have the same effect as sulfonylureas in that they cause the pancreas to release more insulin, but they do it more quickly and for a shorter period of time in the body. Asian Americans, Hispanics, and African Americans have higher rates of type 2 diabetes than Caucasians.

 

 

American Diabetes Association (ADA) (2022). Statistics about Diabetes. Retrieved from https://www.diabetes.org/resources/statistics/statistics-about-diabetes