Melanoma stage 2 response

/in /by

Melanoma is a cancer that forms in the melanocytes (Brashers, Huether, & McCance, 2020).  According to Poklepovic and Luke, malignant melanoma is one of few cancers currently increasing in incidence.  New cases of malignant melanoma increased to more than 90,000 cases in 2018, up from approximately 74,000 cases in 2015 (Poklepovic & Luke, 2020).  In 2019, it was estimated that there would be 96, 480 diagnosed cases of melanoma in the United States, followed by approximately 7,230 deaths from the disease (Yushak et al, 2019).  A majority of diagnosed patients are treated with curative-intent surgical resection (Yushak et al, 2019).  However, patients with resected stage II or stage III melanoma are at increased risk for reoccurrence; whereas patients with stage IIA or stage IIIA disease have a melanoma-specific survival at five years of 94% or 93% (Yushak et al, 2019).  Patients with thicker primary melanomas (T3 or T4), ulceration, or more extensive lymph node involvement have a poorer prognosis (Yushak et al, 2019).Standard treatment for Stage II melanoma is wide excision therapy to remove the melanoma and a margin of skin around the site and sentinel lymph node biopsy (SLNB) (Poklepovic & Luke, 2020).  If the SLNB is negative, no further treatment is necessary, but close follow-up will remain important.  If the SLNB is positive, a lymph node dissection will likely be recommended, or monitoring by ultrasound every few months (Poklepovic & Luke, 2020).  Additionally, if the SLNB is positive for cancer, adjuvant (additional) treatment with an immune checkpoint inhibitor or targeted therapy drugs (if BRAF mutation exists) may be recommended to reduce the risk of reoccurrence (Poklepovic & Luke, 2020).  In BRAF mutant melanoma, targeted therapy offers a response rate of 60-70% with a median progression-free survival from 11 to 15 months (Poklepovic & Luke, 2020).Immunotherapy is treatment that includes use of medication to stimulate the patient’s own immune system to recognize and destroy cancer cells.  Immune checkpoint inhibitors target checkpoint proteins, which helps them restore the immune response against melanoma cells (American Cancer, Society, 2021).  These medications include pembrolizumab (Keytruda), nivolumab (Opdivo), atezolizumab (Tecentriq), and ipilimumab (Yervoy).  Ipilmumab has been associated with long-term survival in approximately 21% of treated patients with advanced melanoma (Poklepovic & Luke, 2020).  According to Poklepovic and Luke, pembrolizumab and nivolumab have confirmed survival outcomes and are considered the default standard of care for melanoma (2020).  Pembrolizumab and nivolumab have consistent response rates of 30-40% (Poklepovic & Luke, 2020).Man-made versions of Interleukin-2 (IL-2) are occasionally used to treat melanoma as well.  While IL-2 can shrink advanced melanomas, it’s not used as frequently as in the past as immune checkpoint inhibitors have shown to be more effective with fewer side effects (American Cancer Society, 2021).  For earlier stages of melanoma, if the melanoma has reached nearby lymph nodes, it is more likely to appear in another part of the body; IL-2 may be injected into tumors to prevent spread (American Cancer Society, 2021).Oncolytic viruses are lab altered viruses used to infect and kill cancer cells and alert the patient’s immune system to kill cancer cells.  Talimogene laherparepvec (lmlygic) is a oncolytic virus that is used to treat skin or lymph nodes that can’t be removed with surgery (American Cancer Society, 2021).  This virus is injected directly into tumors approximately every two weeks (American Cancer Society, 2021).Other, less frequently used treatments include the Bacille Calmette-Guerin (BCG) vaccine and Imiquimod cream.  The BCG vaccine may be injected directly into the tumor to activate the immune system (American Cancer Society, 2021).  Imiquimod cream is applied to skin to stimulate a local immune response against the melanoma cells; it may be used in cases where surgery could be disfiguring or against melanomas that have spread along the skin (American Cancer Society, 2021).ReferencesAmerican Cancer Society. (n.d.). Immunotherapy for Melanoma Skin Cancer.https://www.cancer.org/cancer/melanoma-skin-cancer/treating/immunotherapy.html.Huether, SE., McCance, K.L., & Brashers, V.L. (2020). Understanding Pathophysiology.  Elsevier.Poklepovic, A. & Luke, J. (2020).  Considering adjuvant therapy for stage II melanoma.  Cancer (126)6, 1166-1174. https://dx.doi.org/10.1002%2Fcncr.32585.Yushak, M., Mehnert, J., Luke, J., & Poklepovic, A. (2019). Approaches to High-Risk Resected Stage II andIII Melanoma. American Society of Clinical Oncology Educational Book, 39.

 
Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!

ANP WK 1 CAT

/in /by

THIS IS A GRADUATE NURSE PRATRITIONER PROGRAM.  REPORT MUST BE OF GRADUATE LEVEL AND STANDARD WITH APPROPRIATE REFERENCE WITHIN 5 YEARS AND 7TH EDITION APA STYLE.  MINIMUM OF 300 WORDS WITH AT LEAST 2 PEER REVIEW REFERENCEDelirium is a common and often debilitating condition found in the hospitalized patient. Chapter 81 in your assigned readings goes over delirium in the hospitalized patient. After completing this week’s readings, answer one of the following questions.What is the prevalence of delirium in hospitalized patients?What are the most common causes of delirium?Why is it important to detect delirium?What are the symptoms of delirium?How can delirium be prevented and treated

 
Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!

assessment

/in /by

The needs of the pediatric patient differ depending on age, as do the   stages of development and the expected assessment findings for each   stage. In a 500-750-word paper, examine the needs of a school-aged   child between the ages of 5 and 12 years old and discuss the following:Compare the physical assessments among school-aged children.     Describe how you would modify assessment techniques to match the age     and developmental stage of the child.Choose a child     between the ages of 5 and 12 years old. Identify the age of the     child and describe the typical developmental stages of children that   age.Applying developmental theory based on Erickson, Piaget,     or Kohlberg, explain how you would developmentally assess the child.     Include how you would offer explanations during the assessment,     strategies you would use to gain cooperation, and potential findings     from the assessment.Prepare this assignment according to the guidelines found in the APA   Style Guide, located in the Student Success Center. An abstract is not required.This assignment uses a rubric. Please review the   rubric prior to beginning the assignment to become familiar with the   expectations for successful completion.

 
Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!

‘Ethic-Kant’s 3 premises and Michael Sandel’s 3 (gone baby gone)(

/in /by

” NO Plagiarism”Apply Kant’s moral philosophy to judge the MAIN FINAL action. For “Gone Baby Gone” movie  judge Patrick’s final decision Judging any other action in the movie is an automatic zero. 500 + words minimum in MLA/APA format.*You must apply Kant’s 3 premises and Michael Sandel’s 3 contrasts 50% points for bothhttps://www.youtube.com/watch?v=8rv-4aUbZxQIn the case of ” Gone Baby Gone” the philosophical process you will follow in this paper should sound as something like this:1. According to Kant’s first premise Patrick behaved moral because he returned the victim he was hired to find and without condition this is the “right” conduct for any detective in cases of kidnapping (the “First Maxim”). Here Kant speaks of doing the right prior to good.2. On Kant’s second premise Patrick acted moral because he respected the dignity of Amanda and he treated her as an end in herself and not as means to an end like everyone else was doing in the film (the “Second Maxim”). Here Kant speaks of humans as special creatures and ends in themselves. Humans are ends, not means to an end. Los seres humanos son un fin, no un medio para un fin.3. The conclusion is that a detective act morally when he reports a kidnapping to the police and this behavior should establish a universal law governing all detectives in cases of kidnapping (the “Third Maxim”). Here Kant asks us to test the universality of our action. Will it be OK if everyone does what I am about to do?(You will apply Kant’s 3 premises and Sandel’s 3 contrasts to what the detective does at the very end of the film which is call the police and report the kidnapping. It should not be difficult but you must see the videos first and see what Kant moral philosophy is all about)Kant’s Categorical ImperativeNature of the conceptThe concept of the categorical imperative is a syllogism1.The first premise is that apersonacts morally if his or herconductwould, without condition, be the “right” conduct for any person in similarcircumstances(the “First Maxim”).2.The second premise is thatconductis “right” if it treats others as ends in themselves and not as means to an end (the “Second Maxim”).3.The conclusion is that apersonacts morally when he or sheactsas if his or herconductwas establishing a universal law governingothersin similarcircumstances(the “Third Maxim”).

 
Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!

NUR600- REPLY TO DISCUSSION LORRIE

/in /by

iscussion 4: Complementary and Alternative MedicineDiscuss the safety and effectiveness of alternative and complementary medicine for the treatment of specific illnesses such as cancer, diabetes, and hypertension.The U.S. federal government’s National Center for Complementary and Integrative Health (NCCIH), is an agency with resources allocated to the research on specific health interventions and practices not within the realm of mainstream medicine (Arcangelo et al., 2017).Arcangelo et al. (2017), highlights 5 domains of complementary and alternative medicine with a few examples:Alternative Medicine Systems- These theories and practices emerged even before conventional medicine and include homeopathic and naturopathic medicines along with traditional Chinese medicine.Mind/Body Intervention- Techniques used by the mind to affect the body’s function include biofeedback, meditation, dance therapy, and art therapy.Biologically Based Therapy- This treatment is derived from substances found in nature and include dietary herbal supplements.Manipulation and Body-Based Methods- Manipulation of body parts include massage therapy and chiropractic treatment.Energy Therapies- The use of biofield therapy to affect energy fields which penetrate the body include therapeutic touch, Reiki, and the unconventional use of bioelectromagnetic therapy.According to a recent study, Atkinson (2020), points out that despite the lack of strong evidence of efficacy, many oncology patients will use complementary and alternative medicines (CAMs). The study highlights a number of interesting points from a patient’s perspective. Atkinson (2020), states that up to 70% of cancer patients have integrated CAMs with 60% of those choosing to do so based on their own research. Aside from the 10% who’s oncologist introduced them to CAMs, the vast majority were influenced by spouses, family members, the internet, or spiritual guidance. A number of their key reasonings was that they felt the doctor only treated the disease and did not attend to their overall wellbeing (Atkinson, 2020). Chemotherapy has a great deal of side effects which the study’s participants noted, nausea, depression, anxiety, and fatigue as being among the most prevalent and impactful. CAMs enabled them to feel empowered in their care decisions, in addition to being affordable and accessible.Would you have any conflicts/concerns supporting a patient who choose holistic/allopathic medicine?As an Advanced Practice Registered Nurse, I feel our duty to is provide our patients with quality, safe, evidenced-based care to achieve optimal health outcomes. When providing individualized, patient-centered care I feel its vital to empower our patients and truly listen to what their needs are and develop a collaborative plan of treatment. We need to take the time to establish a trusting relationship and ask questions to understand their cultures and beliefs. According to Arcangelo et al. (2017), most patients do not voluntarily communicate their use of CAMs with their healthcare provider. This is an issue. We need to maintain open communications about the use of CAMs to ensure treatment adherence as well as the patient’s safety. While some CAMs such as touch therapy and meditation may be integrated into the patient’s treatment plan with therapeutic effects, other treatments such as the addition of certain nonregulated, herbal OTC medicines many cause an adverse effect with the prescribed pharmacotherapy.In conclusion, I think one of the unique characteristics a nurse can bring into medicine is our innate ability to treat our clients holistically. From the beginning of time, at least in my 22 years of bedside nursing, I have learned to improve the patient’s overall health of mind, body, and soul through a holistic approach. The crucial aspect is ensuring a trusting relationship and following up with your patient on treatment compliance and desired results or adverse reactions until a safe and effective plan is achieved.ReferencesArcangelo, P. V., Peterson, M. A., Wilbur, V., & Reinhold, A. J. (2017). Pharmacotherapeutics for Advanced Practice: A Practical Approach (4th Ed.). Wolters Kluwer/Lippincott Williams & Wilkins.Atkinson, J. (2020). Complementary medicines and chemotherapy: if you can’t beat them, join them. Australian Journal of Cancer Nursing, 21(2), 8–14. https://doi.org/10.33235/ajcn.21.2.8-14

 
Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!

Financial Analysis Methods

/in /by

Organizations rely on financial statements to carry out important business decisions. The statements are typically compiled into a cohesive document, which allow managers to evaluate, based on various financial analysis methods. This process involves a comparison of ratio outcomes from the financial statements. Collectively, the ratios are used to execute financial analysis of business operations, to assess profitability and viability. This portion of the project requires you to apply financial analysis methods, choose the best method to evaluate financial outcomes for your case, and explain why this method should be used over other methods.Submit a minimum 2-page report that:Defines and describes various financial analysis methods, such as vertical and horizontal analysis.Explains how and why each method would be used in an organization’s financial review process.Compares the similarities and differences among the methods.Using the financial statements for your case, examine how at least one of the methods can be used.Support your position with the actual ratio outcome(s).Explain WHY this method should be used over the others, based on case financial challenges.

 
Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!

EATING HEALTHY AND MAINTAINING HEALTHY BODY WEIGHT

/in /by

You MUST include references for EACH question and in-text citations!How does additional bodyweight affect physical status?What are some of the barriers and challenges to losing weight in the U.S.Discuss cultural considerations when discussing weight and weight loss with clients.What would you suggest to help Mark achieve a healthy weight?

 
Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!

Nursing

/in /by

Design nursing care strategies which incorporate genetic and genomic risk factors.ScenarioYou are feeling passionate about developing information to share with your clients and families that have positive genetic testing results. A young couple approaches you concerned that they may have a child with Down syndrome as both the male and female in the relationship have siblings with Down syndrome. You decide to create an educational document that supports the family in their search for more information.InstructionsDescribe educational information that a couple may need to know before the birth of their baby. What testing can be recommended? How is this testing done and when in the gestation?After birth, what resources can be offered to this couple to care for their newborn with Down syndrome?List and describe resources this family may access now and into the future to support care for their child with Down Syndrome into adulthood.

 
Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!

I need this by Sunday. I need the APA to be 6th edition APA

/in /by

Evaluate the Health History and Medical Information for Mr. M., presented below.Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.Health History and Medical InformationHealth HistoryMr. M., a 70-year-old male, has been living at the assisted living facility where you work. He has no know allergies. He is a nonsmoker and does not use alcohol. Limited physical activity related to difficulty ambulating and unsteady gait. Medical history includes hypertension controlled with ACE inhibitors, hypercholesterolemia, status post appendectomy, and tibial fracture status postsurgical repair with no obvious signs of complications. Current medications include Lisinopril 20mg daily, Lipitor 40mg daily, Ambien 10mg PRN, Xanax 0.5 mg PRN, and ibuprofen 400mg PRN.Case ScenarioOver the past 2 months, Mr. M. seems to be deteriorating quickly. He is having trouble recalling the names of his family members, remembering his room number, and even repeating what he has just read. He is becoming agitated and aggressive quickly. He appears to be afraid and fearful when he gets aggressive. He has been found wandering at night and will frequently become lost, needing help to get back to his room. Mr. M has become dependent with many ADLs, whereas a few months ago he was fully able to dress, bathe, and feed himself. The assisted living facility is concerned with his rapid decline and has decided to order testing.Objective DataTemperature: 37.1 degrees CBP 123/78 HR 93 RR 22 Pox 99%Denies painHeight: 69.5 inches; Weight 87 kgLaboratory ResultsWBC: 19.2 (1,000/uL)Lymphocytes 6700 (cells/uL)CT Head shows no changes since previous scanUrinalysis positive for moderate amount of leukocytes and cloudyProtein: 7.1 g/dL; AST: 32 U/L; ALT 29 U/LCritical Thinking EssayIn 750-1,000 words, critically evaluate Mr. M.’s situation. Include the following:Describe the clinical manifestations present in Mr. M.Based on the information presented in the case scenario, discuss what primary and secondary medical diagnoses should be considered for Mr. M. Explain why these should be considered and what data is provided for support.When performing your nursing assessment, discuss what abnormalities would you expect to find and why.Describe the physical, psychological, and emotional effects Mr. M.’s current health status may have on him. Discuss the impact it can have on his family.Discuss what interventions can be put into place to support Mr. M. and his family.Given Mr. M.’s current condition, discuss at least four actual or potential problems he faces. Provide rationale for each.You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

 
Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!

Illustrate an interdisciplinary approach to improvement of the healthcare outcomes of the vulnerable populations

/in /by

Discussion Question: How Cultural Diversity influences Community and Public Health Nursing?Must address the topic.Rationale must be provided.·Illustrate an interdisciplinary approach to improvement of the healthcare outcomes of the vulnerable populations.250-word maximum without the references.Minimum of two references (the course textbook must be one of the references) in APA format, must have been published within last 3-5 years.PLEASE ;Do not copy paste it will be using Turnitin.

 
Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!