Week 5 Interprofessional Collaboration Discussion

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 Week 5 Interprofessional Collaboration Discussion

How My Facility Promotes Interprofessional Collaboration During Times of Patient Transitions

Interprofessional collaboration is critical in helping patients transition into various healthcare services by establishing seamless and robust patient care pathways. Patients, especially older and those experiencing chronic conditions requiring constant engagement with providers, experience multiple and concurrent transitions in different situations and healthcare settings. Interprofessional collaboration ensures a healthy and safe transition for clients and their family members. Healthy patient transitions encompass relationship well-being, role mastery, and subjective well-being (Zielińska-Tomczak et al., 2021). Therefore, promoting interprofessional collaboration during patient transition is imperative to ensure healthy transitions.

 Week 5 Interprofessional Collaboration Discussion

To promote interprofessional collaboration during patient transitions, the organization fosters the development of professional partnerships among interdisciplinary professionals, subjective norms like appropriate legal regulations, and perceived behavioral controls, including increased practitioner awareness regarding the qualification of team members and interpersonal skills that can promote or impede the patient transition process. Patient-centered partnerships between healthcare team members utilize combined knowledge and skills to enhance patient transition and improve patient care (Zielińska-Tomczak et al., 2021). Collaboration between physicians, nurses, and pharmacists is emphasized at the organization to ensure high-quality health services and patient transition achieves its desired objective.

The Role of The Nurse in Patient Transitions

The transition points are vulnerable points for patients, caregivers, and family members that can increase the risk of poor health outcomes. Nurses understand regulatory requirements, can access core information regarding how patients will manage at home and other recommended healthcare settings, and establish expectations regarding the effective transition from hospitals to home health settings and other institutional settings (Elliott & DeAngelis, 2017). Moreover, nurses are central to care coordination activities at the various transition points and can enhance healthcare delivery by improving transitions. Nurses interact closely and more frequently with patients, families, or caregivers at vulnerable points, learning information vital to successful transition planning (Camicia & Lutz, 2019). Nurses develop and evaluate transition plans and identify and communicate any barriers to successful transitions. Such barriers include a lack of family or caregiver capacity to effectively offer care for the post-discharge and limited financial ability to pay for out-of-pocket expenses of PAC. Nurses identify and communicate the information to interprofessional teams during patients’ hospital stay to ensure the transition plan caters to these patient and family needs. Nurses also help ensure the care settings the patient is transitioning to match the patient’s needs to avoid unnecessary readmissions (Camicia & Lutz, 2019). Conclusively, nurses ensure safe, timely, and efficient patient transitions across various care settings by promoting effective information transfer and informing optimal collaboration and coordination.

(Week 5 Interprofessional Collaboration Discussion)

Gaps In this Process Related to Quality of Care

Communication failure, lack of a single point person to promote care continuity, incomplete information transfer, limited access to critical services, and inadequate patient and family education are barriers to quality of care identified to hinder successful patient transitions (Earl et al., 2020). Communication failure can occur due to heavy workloads because of working overtime and increased patient needs, burnout, and lack of collaboration between physicians, nurses, and pharmacists. Home-based care points can experience limited access to critical services and resources to ensure optimal care. Inadequate or lack of patient and family education implies that family members or caregivers lack the capacity and knowledge to care for the patient at home effectively. Improved collaboration between healthcare staff, patients, and families can help close these gaps.

References

Camicia, M., & Lutz, B. J. (2019). Nursing’s role in successful transitions across settings. Stroke, 47(11), e246-e249.

Earl, T., Katapodis, N., & Schneiderman, S. (2020). Care transitions. In Making Healthcare Safer III: A Critical Analysis of Existing and Emerging Patient Safety Practices [Internet]. Agency for Healthcare Research and Quality (US).

Elliott, B., & DeAngelis, M. (2017). Improving patient transitions from hospital to home: Practical advice from nurses. Nursing2022, 47(11), 58-62. https://www.nursingcenter.com/journalarticle?Article_ID=4376841&Journal_ID=54016&Issue_ID=4376671

Zielińska-Tomczak, Ł., Cerbin-Koczorowska, M., Przymuszała, P., & Marciniak, R. (2021). How to effectively promote interprofessional collaboration?–a qualitative study on physicians’ and pharmacists’ perspectives driven by the theory of planned behavior. BMC health services research, 21, 1-13.

 
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Resources Needed to Successfully Write your Doctoral Project

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Resources Needed to Successfully Write your Doctoral Project

Resources Needed to Successfully Write your Doctoral Project

A doctorate project is part of the doctoral program, requiring rigorous research in the specific field. The paper should contribute to scholarly research and knowledge on the specific topic. This project requires original research grounded on current literature to ensure reliability and validity. Multiple resources are needed to successfully write a doctorate project, including research articles, journal entries, and various data collection tools.2 Conducting primary research requires first-hand data collection using tools like official records, interviews, survey results, and unanalyzed statistical data.2 These resources provide raw data and information, including immediate impressions of participants.

(Resources Needed to Successfully Write your Doctoral Project)

The doctorate project should be founded on current literature, and there are multiple resources to obtain current research studies, including medical databases like Medline, the Cochrane Library, PubMed, and EMBASE. Primary resources or current literature include books, brochures, journals, and case studies to support the research setting, context, problem, literature review, methodology and design justification, and other details in the document.1 Peer-reviewed articles are preferred for doctorate projects but can also be supported by government publications, professional organizations publications, capstones such as other dissertations, doctorate studies, project studies, and trade journal articles.1 Peer-reviewed journal articles are preferred for high relevance, accuracy, credibility, internal validity, and rigor. Non-peer-reviewed journal articles are also credible but often adopted as supplemental support for industry-specific evidence and arguments.1 Examples of non-peer-reviewed journal articles include Harvard Business Review, Nursing in Practice, and Teaching and Learning.

(Resources Needed to Successfully Write your Doctoral Project)

References

Walden University. Evidence-Based Arguments: Types of Sources to Cite in the Doctoral Capstone. 2023. https://academicguides.waldenu.edu/formandstyle/writing/arguments/sources

University of Maryland. The research process: Research resources. 2023 https://www.umgc.edu/current-students/learning-resources/writing-center/online-guide-to-writing/tutorial/chapter4/ch4-06/

 
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 Income and Mortgages Mind Map

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 Income and Mortgages Mind Map

(Income and Mortgages Mind Map)

Comparison of Providers for Home Mortgages

The three selected providers of home mortgages AmeriSave Mortgage Corporation, PenFed Credit Union, and PNC bank. AmeriSave Mortgage Corporation offers multiple types of loans, including Conventional jumbo, FHA, VA, USDA, fixed-rate, adjustable-rate, rate-and-term, cash-out and streamline refinancing, and home equity line of credit (HELOC). The loans are available throughout the United States. Its minimum credit score is 620 for conventional loans, 700 for jumbo loans, 600 for FHA loans, 600 for VA loans, and 600 for USDA loans (Ostrowski, 2023). Downpayments are 3 percent for conventional, 3.5 percent for FHA, 0 percent for USDA, and 0 percent for VA (Ostrowski, 2023). Advantages of acquiring this mortgage include the availability of prequalification and customized rate quote in a few minutes and not needing a hard credit pull in most scenarios, transparent pricing and fee structure, and time to close an average of 25 days.

 Income and Mortgages Mind Map

PenFed offers multiple mortgage selections and has an open membership charter, implying that anyone can apply for the loan. Sample mortgage rates are not on the website. It has a minimum credit score of 620 for all its available loans, including Purchase, Refinance, Home Equity, Jumbo, Fixed, Adjustable, and VA (Metzger, 2023). The minimum downpayment is 3% (Metzger, 2023). Advantages attached to this mortgage selection include multiple loan products, including low-down-payment options for first-timers and HELOCs. PenFed also has a lender credit, based on the loan amount, for purchase mortgages, and its mortgage rates and fees are low than for other lenders.

(Income and Mortgages Mind Map)

PNC bank is available online and offline and offers multiple loan products, including conventional mortgages, FHA, VA, USDA mortgages, jumbo mortgages, grants and specialty mortgages, and HELOCs. The minimum credit score is 620, and the minimum down payment is 3% (Mortgage Reports, 2023). The best features attached to this mortgage selection include competitive rates and fees and a strong-branch network. However, the customer services scores are mid-range compared to the other lenders. Nonetheless, its mortgage rates are lower than some major competitors, including Well Fargo, Freedom Mortgage, and Rocket Mortgage. For instance, in 2021, its average 30-year interest rate was 3.08%, compared to Wells Fargo’s 3.14%. The median total loan costs were $3,820, and the median origination fee was $1,110.

Figure 1: Mind Map

(Income and Mortgages Mind Map)

Analysis

AmeriSave Mortgage Corporation is the lender of choice for a home mortgage because of its flexibility and offering rate-and-term, cash-out and streamline refinancing, and loans can be closed in days. The application fee is $500, and the underwriting fee is $295 (Ostrowski, 2023). It suits people looking for less common loan types, such as non-QM mortgages. AmeriSave offers multiple loan products, including conventional, jumbo, FHA, VA, USDA, fixed-rate, adjustable-rate; rate-and-term, cash-out and streamline refinancing; home equity line of credit (HELOC). It has great flexibility in its minimum credit score across the various loan products, including 620 for conventional loans; 700 for jumbo loans; 600 for FHA loans; 600 for VA loans; 600 for USDA loans (Ostrowski, 2023). The minimum down payment also varies across the loan products, including 3 percent for conventional, 3.5 percent for FHA, 0 percent for USDA, 0 percent for VA. Its loan services are also available across the United States. AmeriSave’s HELOC has a variable-rate line of credit that allows individuals to tap up to $249,900 of their home’s equity during a 10-year draw period and repay the loan over the next 10-year period (Ostrowski, 2023). HELOC is suitable for individuals making large purchases.

References

Metzger, P. (2023, January 20). PenFed Credit Union Mortgage Review 2023. https://www.nerdwallet.com/reviews/mortgages/penfed-credit-union-mortgage-loans

Mortgage Reports. (2023). PNC Mortgage Review for 2023. https://themortgagereports.com/47799/pnc-mortgage-lender-review

Ostrowski, J. (2023). AmeriSave Mortgage Corporation Review 2023. https://www.bankrate.com/mortgages/reviews/amerisave-mortgage-corporation/

 
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Focus SOAP Note: ADHD

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Focus SOAP Note: ADHD

Patient Verification

Name: K.T.

DOB: November 29th, 2013

Minor: Yes

Accompanied by: Mother

Demographic: 9-year-old African American

Gender Identifier Note: Female

SUBJECTIVE:

CC: “I’m depressed.”

Understanding ADHD - Symptoms, Causes, and Treatments

HPI:

A 9-year-old African American female presented at the clinic accompanied by her mother. The patient states she feels depressed. The mother also states the patient has been complaining of feeling depressed. The mother reports that patient was diagnosed with ADHD in 2020 at the age of 7 years. The mother is away most of the time because of her job. Her sister is also away, while she is at home with her brothers, who she claims are mean to her most of the time. The patient states she felt lonely because she has no one to play with or talk to. She has five friends in school who are foreigners from different countries. The patient states she does not want to go to school and does not feel like getting up in the morning to go to school. The mother reports the patient is always crying, and she does not want it to get worse, hence the reason they came for evaluation. The patient is struggling in school, especially in math, and her grades are low. However, she is respectful in class, and she loves art and writing, drawing, painting, and sketching but finds it very hard to learn new subjects. She has problems with concentration. Painting and sketches make her less sad. The patient reports that she does not express her feelings in school but in her head. The mother reports patient has problems sleeping and decreased appetite. The client denies suicidal and homicidal thoughts and intent to hurt others. However, she has sometimes made her lips bleed twice and sometimes slapped herself on the wrist.

Social Hx: Mother, 38 years, has a history of bipolar 1 disorder with borderline traits and PTSD. Patient has 3 siblings, two brothers and one sister. Sister has a history of anxiety and she is not around most of the time. Mother is also not around mostly due to her job. Parents are divorced, and dad, 41, has no visitation right or custody.

Legal Hx: Denied.

Medical Hx: Denied.

Surgical Hx: Denied

Psychiatric Hx: Patient has history of ADHD. Mother has a history of bipolar 1 disorder with borderline traits and PTSD. Sister has a history of anxiety

Psychiatric medication use: Denied.

Substance Abuse history: Denied.

ROS:

General: Denies weight loss, fever, chills, weakness, or fatigue.

HEENT: Eyes: denies visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.

Skin: No rash or itching.

Cardiovascular: Denies chest pain, chest pressure, or chest discomfort. No palpitations or edema.

Respiratory: Denies wheezes, shortness of breath, consistent coughs, and breathing difficulties while resting.

Gastrointestinal: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood. Reports decreased appetite.

Genitourinary: Denies burning on urination, urgency, hesitancy, odor, odd color

Neurological: Denies headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control. Reports difficulties concentrating and paying attention.

Musculoskeletal: Denies muscle, back pain, joint pain, or stiffness.

Hematologic: Denies anemia, bleeding, or bruising.

Lymphatics: Denies enlarged nodes. No history of splenectomy.

Endocrinologic: Denies sweating, No reports of cold or heat intolerance. No polyuria or polydipsia.

OBJECTIVE

Vital Signs

Temp: 98.3 F

BP: 117/59

HR:71

R: 18; non-labored

O2: 96% room air

Pain: Negative

Ht:4ft, 7 inches

Wt.: 71.2 lbs.

BMI:17.9

BMI Range: Healthy Weight

Physical Exam: General appearance: The patient appears to be healthy and well-fed. She routinely engages in discussion with the medical personnel; however, she easily gets distracted and abruptly leaves the subject under discussion. The mother steps in to assist with replying.

HEENT: Normocephalic and atraumatic. Sclera anicteric, No conjunctival erythema, PERRLA, oropharynx red, moist mucous membranes.

Neck: Supple. No JVD. Trachea midline. No pain, swelling or palpable nodules.

Heart/Peripheral Vascular: Regular rate and rhythm noted. No murmurs. No palpitation. No peripheral edema to palpation bilaterally.

Cardiovascular: Although the patient’s heartbeat and rhythm are regular, there are murmurs and other sounds coming from her chest. The patient’s heart rate is constant and capillaries refill in two seconds.

Musculoskeletal: Normal range of motion. Regular muscle mass for age. No signs of swelling or joint deformities.

Respiratory: No wheezes and respirations are easy and regular.

Neurological: Balance is stable, gait is normal, posture is erect, tone is good, and speech is clear.

Psychiatric: The patient’s fast switching from one discussion or topic to another indicates inattentiveness. Patient is easily distracted, yet occasionally appears to pay attention to the mother and the practitioner.

Neuropsychological testing: Patient has difficulties executing functions where he is required to prioritize, plan, inhibit behavior, and attend to processing speed, especially schoolwork.

ASSESSMENT

MSE: K.T. underwent a mental health assessment. The patient was dressed appropriately for the setting and the season. Despite being highly talkative, she remained seated during the interview, was compliant, and displayed no signs of discomfort. The patient denied having hallucinations, suicidal or homicidal thoughts, paranoia, insomnia, appetite loss, or auditory or visual hallucinations.

DSM5 Diagnosis

  1. F90.9. Attention-Deficit hyperactivity disorder (Confirmed):

Attention-deficit/hyperactivity disorder (ADHD), a chronic mental health condition that frequently worsens as people age, affects millions of children. ADHD’s enduring symptoms include hyperactivity, impulsive behavior, and difficulties paying focus. For those with ADHD, especially children, common issues include low self-esteem, troubled relationships, and lack of involvement (Magnus et al., 2017). Impulsivity, disorganization, poor time management, difficulty setting priorities, difficulty focusing, difficulties multitasking, excessive activity and restlessness, poor planning, and a low threshold for irritability are some symptoms of ADHD.

The patient reported experiencing depressive, lonesome, and melancholy feelings, typical of many ADHD patients. The DSM-5 diagnostic criteria for people with ADHD include five or more inattention symptoms, several of which must have appeared before the age of 12, several of which must have appeared in two settings, evidence that the symptoms impair or negatively affect social or academic functioning, and symptoms that do not only coexist with another psychotic disorder (Magnus et al., 2017). The patient demonstrates continuous loss of focus and attention and has previously been diagnosed with ADHD. The patient claims to be depressed and exhibits many symptoms of depression. However, ADHD patients also report decreased appetite, symptoms resembling sleep deprivation, and are more likely to engage in non-suicidal and suicidal self-harm, which may account for the patient’s bleeding lips and slapping of oneself. The primary diagnosis, according to the examination, is ADHD.

  1. F32.9 Major Depressive Disorder

A prolonged sense of sadness and passivity are two features of depression. All depressive disorders have the symptoms of sadness, emptiness, or irritability, as well as other physical and mental changes that significantly restrict the patient’s capacity to function (Chand et al., 2021). Patients who are depressed have noticeably lower interest in or excitement for nearly all endeavors for the majority of the day, essentially every day. According to the DMS-5 criteria, a diagnosis requires five of the following symptoms: trouble sleeping, loss of intrigue or pleasure, feelings of inadequacy or helplessness, fatigue or erratic energy, problems concentrating or listening attentively, fluctuations in appetite or weight, psychomotor issues, suicidality, and depressed mood (Agostino et al., 2021). The patient claims to feel down, melancholy, and lonely. Moreover, the patient has trouble falling asleep and has less desire to eat. The patient disputes any suicidal thoughts. Many depressive symptoms are present in the patient; however, the diagnosis was ruled out because the patient did not exhibit a protracted state of sadness.

  1. F41.9. Generalized Anxiety Disorder

Excessive, exaggerated anxiety and worry about everyday events without an apparent reason are characteristics of generalized anxiety disorder (GAD) (Munir et al., 2021). 3.1% of the population, or more than 6.8 million people, are affected. Although it can begin at any age and progress gradually, the risk is most between the ages of five and middle age. Biological variables, family history, life events, and other stressors all contribute to GAD, despite the exact caause being unknown (Toussaint et al., 2020). Looking for symptoms like excessive, persistent worry and tension, unrealistic views of problems, restlessness or a feeling of being “edgy,” difficulty focusing, quickly becoming exhausted, increased crankiness or irritability, trouble sleeping, and muscle tension can help diagnose general anxiety disorder. Individuals with GAD frequently see doom coming and worry excessively about everyday occurrences like going to work. GAD is diagnosed when a person has uncontrollable worrying, which K.T. does not have.

PLAN

Pharmacologic interventions:

  • Start Venlafaxine 18.75-75 mg/day; may increase to 150 mg/day after 4 weeks

Psychotherapy

Behavioral psychotherapy: With the use of behavioral therapy and the appropriate medication, it is possible to improve ADHD symptoms while enhancing executive function, lowering anxiety, and reducing hyperactivity (Magnus et al., 2017).

Psychosocial interventions: Psychosocial therapies, including applied relaxation interpersonal psychotherapy, short-term psychodynamic psychotherapy, and social skills instruction, can assist in lessening the symptoms of ADHD and anxiety (Magnus et al., 2017).

Cognitive therapy: Cognitive-behavioral therapy helps reduce anxiety and restlessness sensations that arise when performing tasks, improve focus and time management, and improve mood (Lopez et al., 2018).

Patient education

  • Talk to the patient and parent about risks and benefits of medication, including non-treatment, probable side effects.
  • Discuss with patient and parent when to stop medication, how to recognize, and when to report adverse events.
  • Talk to the patient and parent about the dangers of combining prescription pharmaceuticals with OTC, illicit, or natural substances.
  • Educate patient and parent to develop structured daily routines, daily schedule, and minimize changes.
  • Engage patient in skills training.
  • Encourage patient and parent to make time for exercise every day.
  • Educate the patient to accept herself and her limitations and to interact with people that accept her.
  • Teach patient to create a system for prioritizing the day and create deadlines for activities.
  • Advice parent to create more time to spend with patient.

Follow-up: Patient should follow-up after one week for psychotherapy.

References

Chand, S. P., Arif, H., & Kutlenios, R. M. (2021). Depression (Nursing). In: StatPearls [Internet]. StatPearls Publishing.

Lopez, P. L., Torrente, F. M., Ciapponi, A., Lischinsky, A. G., Cetkovich-Bakmas, M., Rojas, J. I., Romano, M., & Manes, F. F. (2018). Cognitive-behavioural interventions for attention deficit hyperactivity disorder (ADHD) in adults. The Cochrane database of systematic reviews, 3(3), CD010840. https://doi.org/10.1002/14651858.CD010840.pub2

Magnus, W., Nazir, S., Anilkumar, A. C., & Shaban, K. (2017). Attention deficit hyperactivity disorder (ADHD).

Munir, S., Takov, V., & Coletti, V. A. (2021). Generalized Anxiety Disorder (Nursing). StatPearls [Internet].

Toussaint, A., Hüsing, P., Gumz, A., Wingenfeld, K., Härter, M., Schramm, E., & Löwe, B. (2020). Sensitivity to change and minimal clinically important difference of the 7-item Generalized Anxiety Disorder Questionnaire (GAD-7). Journal of affective disorders, 265, 395-401.

 
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Discussion Post Change Agent

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Discussion Post Change Agent

How I see yourself as a change agent guiding others to move from a process focus to outcomes focus

Change is rapid, disruptive, and expected in the nursing environment. Most changes are adopted to improve healthcare processes and their efficiency to optimize outcomes, which is the primary focus of most healthcare organizations today. As care delivery becomes more patient-centered, there is a shift to outcomes rather than processes because patients are more concerned about their health outcomes than the processes adopted to achieve them. Therefore, I see myself as a change agent when I advocate for my patients and adopt positive changes like technology and evidence-based practice that are shaping the efficacy of the healthcare system (Charlotte Davis, 2019). I encourage reception to change because it is imminent and often unpredictable.

Discussion Post Change Agent

I collaborate and communicate with my team to identify barriers and actors affecting the efficiency and effectiveness of healthcare processes and people. I invite collective and meaningful engagement to develop solutions or interventions to improve processes and people to optimize patient and organizational outcomes. I also engage the public, colleagues, and policy-makers regarding healthcare policies that can help address issues such as understaffing, resource acquisition and availability, healthcare affordability, healthcare access, and adverse events that impact patient and organization outcomes (Rafferty, 2018). Driving these changes helps efforts to improve patient outcomes, including safety, satisfaction, and experience.

I am a registered nurse and see myself as an educator in the field, educating my patients, colleagues, and new nurses throughout my daily shifts. I like sharing information that can help improve service delivery and patient outcomes. I engage colleagues and patients on factors affecting care and perform environmental screening to identify these factors and potential solutions. I emphasize patient education because it is the best preventative measure that seeks to empower patients to take control of their health and advocate for themselves. I educate patients regarding healthy habits and lifestyles and attitudes towards treatment adherence and seeking healthcare services proactively.

(Discussion Post Change Agent)

The rationale behind the change from process to outcomes

Many healthcare actors, especially patients, financiers, and health insurance companies, adopt outcome measures rather than process measures to evaluate the performance of healthcare organizations and practitioners. The healthcare reforms have seen a shift to patient-centered, holistic care, value-based systems, and high-reliability organizations, all of which appreciate outcomes, the byproduct of effective and efficient processes and people (Pantaleon, 2019). There is also an emphasis on the relationship between healthcare services and health outcomes. This shift is behind the change from process to outcome.

References

Charlotte Davis, B. S. N. (2019). Change agents wanted. Nursing Made Incredibly Easy.

Pantaleon L. (2019). Why measuring outcomes is important in health care. Journal of veterinary internal medicine, 33(2), 356–362. https://doi.org/10.1111/jvim.15458

Rafferty A. M. (2018). Nurses as change agents for a better future in health care: the politics of drift and dilution. Health economics, policy, and law, 13(3-4), 475–491. https://doi.org/10.1017/S1744133117000482

 
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Parse s Human Becoming Theory Case Study Assignment

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 Parse’s Human Becoming Theory Case Study Assignment

 Introduction

(Parse s Human Becoming Theory Case Study Assignment)

Nurses’ primary role is to help patients and families through their illnesses and recovery journey. Nursing theory guides nursing practice and provides insights into how nurses should relate to patients and what approach they should take to ensure the utmost patient experience. Hospice nursing is an area demanding compassion and high-level interpersonal skills. Hospice nurses emphasize care, comfort, and quality of life as individuals approach the end of life. Ann is at a point where it is impossible to care for her illnesses, and the benevolent thing would be to ensure she is as comfortable as possible. The theory of human becoming is suitable in such situations as its main emphasis is the quality of life and the consideration of the wholeness of an individual, including their spirituality and perception of life and death. This paper analyzes the application of human Becoming theory to a case study involving hospice care, the theory’s characteristics, strengths, and weaknesses, challenges in healthcare that call for applying this theory, and alternative theories that can be applied in similar situations.

(Parse s Human Becoming Theory Case Study Assignment)

How the Nurse Should Actualize Parse’s Theory of Human Becoming

The human becoming theory emphasizes the wholeness of an individual and the adoption of holistic care that integrates biological, psychological, sociological, cultural, and spiritual aspects. According to the theory, people cannot be separated from the environment because they continuously interact with it (Mitchell, 2019). The nurse has to adopt the themes of meaning, rhythmicity, and transcendence to actualize the theory. The nurse has to be present, listen to Ann and Ben, invite or ask open-ended questions, understand the patient’s and family’s perception of the situation, and develop alternative meanings and paths for the patient and family. It is possible when the nurse begins by establishing a therapeutic and strong nurse-patient relationship, which views the patient as a whole person living experiences via their environment rather than focusing on fixing problems. With a strong nurse-patient relationship, the nurse can help the patient find personal meaning in this situation and visualize the reality per the patient’s experiences with the environment (Barros et al., 2017). In this case study, Ann has lived a long life as a woman, mother, and wife, and the husband describes some of the experiences Ann had with her environment. Through these experiences, the hospice nurse can help the patient find personal meaning in life as a mother and wife and other lived experiences she admires and appreciates.

The nurse must help the patient and family achieve rhythmicity or develop patterns relating to the universe or the environment. Rhythmicity is about people co-creating with the environment in rhythmic patterns (Barros et al., 2017). It is about the nurse acknowledging the values and beliefs of Ann and Ben. For instance, the husband mentions that their daughter died giving birth. Once, they saw two shooting starts and believed they represented their daughter and the baby. The husband believes in life after death, and Ann will join their daughter and grandchild. It implies that the family is spiritual and relates to the universe. The nurse should respect these beliefs, guide the patient and the family through their spirituality, and complement Ben’s belief that the two shooting stars are their daughter and baby, and Ann will join them as the third shooting starts. This way, Ben will feel that their beliefs and spirituality are respected and understood, fostering the care experience. The end of life can be a lonely and frightening journey. The nurse must transcend with the patient or create an environment that allows transcendence, which is going beyond the limits an individual sets (Barros et al., 2017). The nurse should accompany the patient as she travels beyond the limits and be with her throughout the end-of-life journey. It is possible through spiritual care, which involves trust in transcendent. The ultimate end should be the connection with reality and helping the patient and family, Ben, in this case, let go and separate from life because it has been lived. The nurse should guide the process of reflecting and detaching to ensure a successful and comfortable transition from life.

(Parse s Human Becoming Theory Case Study Assignment)

 Parse s Human Becoming Theory Case Study Assignment

Characteristics, Strengths, and Weaknesses of Human Becoming Theory

Characteristics and Assumptions of Human Becoming Theory

The theory of Human becoming guides nurses to focus on the quality of life from each individual’s perspective. It combines biological, psychological, sociological, and spiritual attributes and perceives a person as a unitary actor in pervasive interaction with their environment. The theory is founded around the primary themes of meaning, rhythmicity, and transcendence (Barros et al., 2017). The theory assumes that people coexist while co-creating rhythmic patterns with the universe; people are open, free choosing meaning in situations and are responsible for decisions made; a person is a unitary, persistently co-creating relational patterns; and people are transcending multidimensionally with the possibles. It describes a person as more than the sum of the parts and cannot be separated from the environment. The theory perceives nursing as a human science and an art of caring that adopt an abstract body of knowledge to help individuals (Barros et al., 2017). It encourages nurses to form strong bonds and relationships with their patients because the focus is not on fixing problems, but rather quality of life.

Strengths and Weaknesses of Human Becoming Theory

The theory of Human Becoming separates nursing from other fields, guiding care and valuable administration. The theory adopts the humanistic and interactive approach that perceives people as humans before patients. The theory also encourages individuals to explore their views of their unique experiences, and it does not seek to fix problems but instead maintain the quality of life. However, the research linked to this theory is perceived as a closed circle, and the results are unquantifiable (Marginson, 2019). Comparing results to other research studies is challenging due to the lack of a control group or standardized questions. Furthermore, the Human Becoming theory does not adopt the nursing process and invalidates the idea that each individual participates in a unique lived experience. The theory is inaccessible to new nurses and is challenging to apply in acute, emergent care.

Challenges Existing for Healthcare Institutions to Switch to This Nursing Approach

Healthcare institutions face issues relating to the quality of care, compassion fatigue, patient satisfaction, and scope of nursing and identity (Oleribe et al., 2019). The Human Becoming Theory can be applied to address these challenges. The theory describes nursing as a human science and an art of caring. It emphasizes the quality of life, achieved through proper, holistic, and interactive care. It emphasizes nurses developing therapeutic relationships with their patients, which can aid in understanding patients better, including their needs, preferences, beliefs, and values, and integrating these into healthcare plans to ensure the utmost patient experience and positive patient outcomes. Additionally, therapeutic relationships have proven effective in addressing compassion fatigue, a barrier to quality of care and patient satisfaction and experience with care.

How Parse \’S Understanding of Transcendence Might Guide the Nurse, As Ann \’S death Became a Reality to Ben

Parse’s theory describes transcendence as the human going beyond reality and the desired hopes and dreams via pushing-resisting to create alternatives to viewing reality. Per this theme or principle, the human can create a path moving from the current moment to one that is not yet here. The person can overcome destitution, change views, and start a new life. The understanding of transcending can help the nurse aid Ben in detaching and separating from a life already lived and starting a new one (Pentaris & Tripathi, 2022). The nurse will help Ben reflect on the life already lived and detach from it as Ann’s death becomes more of a reality. The nurse will be present and demonstrate compassion, give hope and affirmation to Ben of life as fruitful, and help him find meaning in existence without Ann.

Alternative Nursing Theory and Plan of Care

Watson’s Theory of Transpersonal Care is also applicable to this case study. The theory focuses on how nurses express care to their clients, emphasizing humanistic nursing aspects as they interact with scientific knowledge and nursing practice. Per the theory, nursing care is about health promotion, prevention of illness, caring for the sick, and restoring health (Aghaei et al., 2020). In hospice care, only the role of caring for the sick applies and should be actualized through a holistic approach that takes into account spirituality. It persists that the human should be valued, respected, nurtured, understood, and care for as a functional integrated self.

A plan of care linked to this case study would focus on grieving and death anxiety as Ann breathes her last. Ben might be experiencing death anxiety and grieving that can be related to the perceived death of Ann, evidenced by worrying about the impact of Ann’s death, powerlessness over Ann’s death, and the fear of the process of dying. The desired outcome would be that Ben identifies and expresses feelings appropriately, continues with normal living and plans for the future, verbalizes understanding of the dying process and associated feelings, and demonstrates personal empowerment in spiritual strengths to find purpose and meaning in life, loss, and grief. The Human Becoming theory’s primary themes of meaning and transcending and the Transpersonal care theory’s assumption of nursing as a holistic approach that considers spirituality and spiritual practice would be the theoretical underpinning of this care plan. The nurse would assess the patient’s view of life and death and monitor signs of hopelessness, expression of anger, guilt, despair, and intrapersonal conflict. The nurse should also determine how Ben will understand and respond to death. Possible interventions include creating an open, nonjudgmental environment, encouraging Ben to verbalize thoughts and concerns like sadness and anger and acknowledge that these feelings are normal, and developing a trusting relationship with Ben to help him appropriately cope and continue with life.

(Parse s Human Becoming Theory Case Study Assignment)

Conclusion

Nursing focuses on care for individuals, families, and communities to help attain, maintain, or recover optimal health and achieve a quality life. According to the Human Becoming theory, nursing is differentiated from other healthcare dimensions because the primary focus is not solving problems but rather the quality of life. Human becoming theory can be actualized by being present and compassionate, offering hope and affirmation, helping patients and families find meaning in life, reflect on their experiences, and transcend. The theory of Transpersonal Care is an alternative to the Human Becoming theory and also adopts the holistic approach to care.

References

Aghaei, M. H., Vanaki, Z., & Mohammadi, E. (2020). Watson’s human caring theory-based palliative care: a discussion paper. International Journal of Cancer Management, 13(6).

Barros, L. B. F., Silva, L. D. F. D., Guedes, M. V. C., & Pessoa, V. L. M. D. P. (2017). Clinical care of nursing reasoned in Parse: Contribution in the transcendence process of cardiac transplantation. Revista Gaucha De Enfermagem, 38.

Marginson, S. (2019). Limitations of human capital theory. Studies in Higher Education, 44(2), 287-301.

Mitchell, G. J. (2019). Chapter 24: Humanbecoming. https://nursekey.com/humanbecoming/

Oleribe, O. O., Momoh, J., Uzochukwu, B. S., Mbofana, F., Adebiyi, A., Barbera, T., Williams, R., & Taylor-Robinson, S. D. (2019). Identifying Key Challenges Facing Healthcare Systems In Africa And Potential Solutions. International journal of general medicine, 12, 395–403. https://doi.org/10.2147/IJGM.S223882

Pentaris, P., & Tripathi, K. (2022). Palliative Professionals’ Views on the Importance of Religion, Belief, and Spiritual Identities toward the End of Life. International Journal of Environmental Research and Public Health, 19(10), 6031.

 
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Nursing Paper Example on Juvenile Idiopathic Arthritis

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Nursing Paper Example on Juvenile Idiopathic Arthritis

Juvenile idiopathic arthritis (JIA) is the most common type of arthritis in children. It is characterized by chronic inflammation of the joints, leading to pain, stiffness, and swelling. JIA can affect one or multiple joints and may be associated with systemic features. The disease primarily affects children under 16 years of age and can vary in severity. Early diagnosis and effective management are critical to reducing long-term complications and improving the quality of life for affected children.

Nursing Paper Example on Juvenile Idiopathic Arthritis

Causes

The exact cause of juvenile idiopathic arthritis remains unknown, but it is believed to result from a combination of genetic predisposition and environmental factors. Genetic studies have shown associations with specific genes, such as those related to the immune system, including the human leukocyte antigen (HLA) complex. These genes may make certain children more susceptible to autoimmune responses.

Environmental triggers, such as infections or environmental toxins, may activate these underlying genetic factors, leading to the onset of JIA. However, no single environmental factor has been definitively linked to the disease.

Signs and Symptoms

The symptoms of juvenile idiopathic arthritis can vary, but common features include joint pain, swelling, and stiffness. In some cases, the inflammation is limited to one or a few joints (oligoarticular JIA), while in other cases, multiple joints may be affected (polyarticular JIA). Morning stiffness that improves with movement is a hallmark symptom. The affected joints may appear swollen and warm to the touch.

In addition to joint symptoms, children with JIA may also experience systemic signs such as fever, fatigue, and weight loss. In more severe cases, there may be growth disturbances, as well as damage to the joints leading to functional impairment.

(Nursing Paper Example on Juvenile Idiopathic Arthritis)

Etiology

The etiology of juvenile idiopathic arthritis is complex and involves both genetic and environmental factors. It is thought that an abnormal immune response triggers inflammation in the joints. In children with JIA, the immune system mistakenly attacks healthy tissues, particularly the synovium—the lining of the joints. This leads to chronic inflammation and damage.

Genetic factors, such as the presence of certain HLA genes, play a significant role in determining susceptibility to JIA. Environmental factors like infections or trauma may also serve as triggers, but more research is needed to fully understand their role. The exact mechanism by which these factors lead to the development of JIA is still under investigation.

Pathophysiology

The pathophysiology of juvenile idiopathic arthritis involves an autoimmune response in which the body’s immune system attacks its own tissues, particularly the synovial lining of the joints. This results in inflammation, characterized by the infiltration of immune cells such as T-cells and macrophages into the synovium. These immune cells produce cytokines and other inflammatory mediators that contribute to further joint damage.

The chronic inflammation leads to the destruction of cartilage and bone, causing joint deformities and pain. In some cases, the inflammation may also affect other organs, including the eyes, leading to uveitis, or the heart and lungs. The persistence of inflammation can also affect growth and development, especially in children with systemic forms of JIA.

DSM-5 Diagnosis

There is no specific diagnosis of juvenile idiopathic arthritis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), as JIA is a physical condition and not a psychiatric disorder. The diagnosis is primarily clinical, based on the patient’s medical history, physical examination, and laboratory tests. The American College of Rheumatology (ACR) criteria are commonly used to classify JIA, which involves the presence of persistent arthritis lasting for at least six weeks in a child under the age of 16.

Blood tests may reveal elevated levels of markers of inflammation, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Imaging studies, such as X-rays or MRI, may be used to assess joint damage. A thorough clinical assessment is essential to distinguish JIA from other pediatric inflammatory conditions.

(Nursing Paper Example on Juvenile Idiopathic Arthritis)

Treatment Regimens

Treatment of juvenile idiopathic arthritis focuses on controlling inflammation, relieving pain, and preventing joint damage. The primary approach involves the use of nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation. If NSAIDs are not sufficient, disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, are often prescribed to slow disease progression.

In cases where inflammation is more severe, biologic therapies like tumor necrosis factor (TNF) inhibitors or interleukin-1 inhibitors may be recommended. Corticosteroids are sometimes used to control flare-ups, but their long-term use is limited due to potential side effects.

Physical therapy is an important component of treatment to maintain joint function and mobility. In some cases, surgery may be needed to correct joint deformities or to replace damaged joints. The treatment regimen is tailored to each child based on the severity of the disease and their response to therapy.

Patient Education

Educating parents and caregivers about juvenile idiopathic arthritis is crucial for effective management of the disease. It is important to emphasize the need for early diagnosis and treatment to prevent joint damage and improve the child’s quality of life. Parents should be instructed on how to administer medications, including NSAIDs and DMARDs, and to watch for any potential side effects. Encouraging regular physical activity and exercise is vital to maintain joint function and flexibility, but activities should be adjusted based on the child’s pain and limitations.

Families should be informed about the potential complications of JIA, such as uveitis or growth disturbances, and the importance of routine screenings for these issues. Regular follow-ups with pediatric rheumatologists are essential to monitor disease progression and adjust treatment as needed. Emotional support is also necessary, as chronic illness can be challenging for both the child and their family.

(Nursing Paper Example on Juvenile Idiopathic Arthritis)

Conclusion

Juvenile idiopathic arthritis is a chronic autoimmune disorder that affects children, leading to joint inflammation and pain. Although the exact cause remains unclear, genetic and environmental factors are thought to play a role in its development. Early diagnosis and treatment are essential to managing symptoms, preventing joint damage, and improving the child’s quality of life. The treatment plan typically includes NSAIDs, DMARDs, biologics, and physical therapy, with the goal of controlling inflammation and maintaining joint function. Patient education plays a key role in managing the disease effectively and ensuring long-term health outcomes.

References

Beukelman, T., & Gertz, R. M. (2017). Juvenile idiopathic arthritis. The Journal of Rheumatology, 44(5), 835-845. https://doi.org/10.3899/jrheum.161060

Giannini, E. H., & Ruperto, N. (2020). Clinical management of juvenile idiopathic arthritis. The Lancet, 395(10217), 2431-2442. https://doi.org/10.1016/S0140-6736(20)31283-9

Société Française de Rhumatologie. (2019). Juvenile idiopathic arthritis: Diagnosis and management. Clinical Rheumatology, 38(5), 1101-1112. https://doi.org/10.1007/s10067-019-04337-3

 
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Nursing Paper Example on Ichthyosis

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Nursing Paper Example on Ichthyosis

Ichthyosis refers to a group of skin disorders characterized by dry, thickened, and scaly skin. The condition can range from mild to severe, with varying degrees of impact on the patient’s quality of life. There are several forms of ichthyosis, including inherited types, which can manifest from birth, and acquired types, which develop later in life. The severity of symptoms varies widely, and treatment is focused on managing symptoms and improving skin appearance.

Nursing Paper Example on Ichthyosis

Causes

Ichthyosis is primarily caused by genetic mutations that affect the skin’s ability to retain moisture and regulate cell turnover. Inherited forms of ichthyosis are typically caused by mutations in specific genes, such as the keratin 1 and keratin 10 genes in ichthyosis vulgaris. These mutations lead to abnormal keratin production, which causes the skin cells to pile up, forming scales. Environmental triggers can also contribute to the condition, although the primary cause is genetic.

In some acquired forms, factors such as infections, metabolic disorders, and other systemic diseases may play a role. Inherited ichthyosis is often passed down in an autosomal dominant or recessive manner, depending on the specific form.

Signs and Symptoms

The most prominent symptom of ichthyosis is the presence of thickened, scaly skin that may cover large areas of the body. The scales can range from fine, powdery flakes to large, thick plaques that are often dry and cracked. Common sites of involvement include the limbs, torso, and scalp, although the condition can affect any part of the body. The severity of scaling varies and can worsen in cold weather or with dry skin conditions. In some forms of ichthyosis, the skin may be red, inflamed, or painful, especially during flare-ups.

Other symptoms may include itching, increased sensitivity to temperature changes, and skin fissures that can lead to secondary infections.

Etiology

Ichthyosis is caused by mutations in genes responsible for skin cell function. For example, ichthyosis vulgaris, the most common form, results from a mutation in the filaggrin gene. This protein is important for maintaining the skin’s barrier function, and its absence or dysfunction leads to skin dryness and scaling. X-linked recessive ichthyosis is another inherited form caused by mutations in the steroid sulfatase gene, which leads to a buildup of certain substances that impair skin turnover.

Other rarer forms of ichthyosis are caused by defects in proteins responsible for skin development or lipid metabolism. Acquired ichthyosis, while less common, can be associated with systemic conditions such as HIV, cancer, hypothyroidism, and sarcoidosis, all of which may lead to abnormal skin changes resembling ichthyosis.

Pathophysiology

The pathophysiology of ichthyosis involves a disruption in the normal processes of skin cell production, differentiation, and desquamation. In healthy skin, the stratum corneum, the outermost layer, is composed of dead skin cells that are continuously shed and replaced. In individuals with ichthyosis, abnormal keratinization leads to the accumulation of thickened skin cells, resulting in the formation of scales.

The defective genes responsible for ichthyosis disrupt the structure and function of the skin’s outer layer, impairing its ability to retain moisture and protect against environmental stressors. As a result, the skin becomes dry, rough, and prone to cracking. In some forms of ichthyosis, there may be an overproduction of lipids or altered lipid composition in the skin, further contributing to the formation of scales. This process not only affects the appearance of the skin but also its ability to function as a barrier, leaving individuals more vulnerable to infections and other complications.

DSM-5 Diagnosis

There is no specific diagnostic category for ichthyosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) since it is a dermatological condition rather than a psychiatric one. Diagnosis is based on clinical evaluation, including a thorough patient history and physical examination. In most cases, the characteristic appearance of the skin lesions is enough for diagnosis, although genetic testing can confirm the specific form of ichthyosis. In some cases, a skin biopsy may be performed to assess the thickness and composition of the skin layers.

Family history is also an important factor, as many forms of ichthyosis are inherited in an autosomal dominant or recessive pattern. Genetic counseling may be recommended for families affected by hereditary forms of ichthyosis to understand the inheritance pattern and potential risks for future generations.

Treatment Regimens

Management of ichthyosis focuses on alleviating symptoms and preventing complications, as there is currently no cure for the condition. Topical treatments, such as moisturizers, emollients, and keratolytics (e.g., urea, salicylic acid), are commonly used to hydrate the skin and reduce scaling. For more severe cases, prescription-strength creams containing tretinoin or corticosteroids may be used to help normalize skin cell turnover and reduce inflammation.

Oral retinoids such as acitretin may be prescribed for more widespread or severe cases, particularly in conditions like lamellar ichthyosis. In cases where ichthyosis is associated with an underlying systemic condition, treating the primary disease may help improve the skin symptoms.

It is also essential for patients to avoid triggers such as harsh soaps, hot water, and environmental irritants that can worsen dryness and scaling. Regular bathing with lukewarm water and the use of soap substitutes are often recommended to help maintain skin hydration.

Patient Education

Educating patients with ichthyosis about proper skin care is critical to managing the condition effectively. Regular moisturizing is essential, as it helps prevent the skin from becoming dry and cracked. Patients should be advised to apply moisturizers immediately after bathing to lock in moisture. Gentle skin care products, including non-soap cleansers and lukewarm water, should be used to avoid further irritation.

In addition, patients should avoid tight clothing and friction in areas where scaling is prominent, as this can worsen the condition. Sunscreen should be applied regularly to protect the skin from UV damage, as patients with ichthyosis may have increased sensitivity to the sun. Genetic counseling is recommended for patients with hereditary forms of ichthyosis to help them understand the potential risks for family members. Regular follow-up with a dermatologist is important to monitor disease progression and adjust treatment as needed.

Conclusion

Ichthyosis is a group of skin disorders characterized by dry, scaly skin due to defective skin cell production and differentiation. While the condition is often genetic in origin, environmental factors and systemic conditions can also contribute to the disease. Treatment focuses on symptom management, including moisturizing, keratolytics, and oral retinoids for severe cases. Patient education plays a key role in managing the condition, with advice on skin care, avoiding triggers, and protecting the skin from environmental damage. Despite the chronic nature of the disease, early intervention and appropriate treatment can significantly improve the quality of life for individuals affected by ichthyosis.

References

Tobin, D. J., & Gawkrodger, D. J. (2020). Ichthyosis: Clinical presentation and management. American Journal of Clinical Dermatology, 21(3), 347-357. https://link.springer.com/article/10.1007/s40257-020-00507-2

Zouboulis, C. C., & Bechara, F. G. (2021). Ichthyosis: Diagnosis, pathophysiology, and treatment. Dermatologic Clinics, 39(2), 167-183. https://doi.org/10.1016/j.det.2020.11.007

Bialynicki-Birula, R., & Wróblewska, A. (2020). The genetics of ichthyosis: Pathogenesis and clinical presentation. Journal of the European Academy of Dermatology and Venereology, 34(5), 1015-1024. https://doi.org/10.1111/jdv.16456

 
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Nursing Paper Example on Hidradenitis Suppurativa

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Nursing Paper Example on Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a chronic skin condition characterized by the formation of painful, inflamed lumps and abscesses in areas where skin rubs together, such as the armpits, groin, buttocks, and under the breasts. This condition primarily affects hair follicles and sweat glands, leading to the development of lesions that may drain pus or blood. Over time, repeated flare-ups can result in scar tissue and tunnels under the skin. HS is often misdiagnosed or dismissed as simple acne or boils, making timely treatment critical to reducing complications.

Nursing Paper Example on Hidradenitis Suppurativa

Causes

The exact cause of HS is not fully understood, but genetic and environmental factors are believed to play a role. A major contributing factor is inflammation within the hair follicles and sweat glands. The condition has a strong genetic component, as it is often seen in families, suggesting an inherited predisposition.

Environmental triggers such as obesity, smoking, hormonal changes, and friction from tight clothing can exacerbate symptoms. Lifestyle factors, particularly smoking, are significant risk factors for the disease, worsening the severity and frequency of flare-ups. Additionally, alterations in immune system functioning are thought to play a role in the abnormal inflammatory response associated with HS.

While it is not classified as an autoimmune disorder, the body’s immune system appears to mistakenly attack the skin’s hair follicles, causing the inflammation and abscesses that define the disease. However, not all cases of HS are genetically determined, and environmental triggers can also play a key role in the development and exacerbation of the condition.

Signs and Symptoms

The hallmark symptoms of hidradenitis suppurativa are painful, inflamed lumps or abscesses in the skin’s folds, often leading to abscess formation and pus drainage. These lumps may rupture over time, releasing foul-smelling fluid. These painful lumps can recur in the same areas, causing the formation of tunnel-like structures under the skin called sinus tracts. Over time, repeated flare-ups lead to the thickening of the skin and the formation of scar tissue. The affected areas typically include the armpits, groin, buttocks, and under the breasts, but any skin fold can be involved.

Early-stage symptoms may present as small, pimple-like lumps that progress into larger abscesses. As the disease progresses, these areas may become swollen, red, and tender. Individuals may also experience an increased frequency of flare-ups, leading to chronic discomfort and even disability in severe cases. In addition to visible skin changes, patients with hidradenitis suppurativa may experience systemic symptoms such as fever and fatigue during active flare-ups.

Etiology

The precise etiology of hidradenitis suppurativa remains unclear, though it is thought to involve a combination of genetic, environmental, and immunological factors. A family history of the condition is a strong indicator of a genetic predisposition, suggesting that certain genetic mutations may contribute to its onset. Mutations in the NF-kB pathway, which regulates immune responses and inflammation, have been linked to HS. This pathway’s dysfunction can result in an exaggerated inflammatory response in the skin’s hair follicles and sweat glands.

Environmental factors, particularly smoking, obesity, and excessive friction or sweating, are known to increase the risk of HS flare-ups. Hormonal changes, especially those occurring during puberty or menstruation, are also considered important factors in the development of the disease, with many individuals noticing a worsening of symptoms during these times. The inflammation in HS is not caused by bacterial infection, though infected abscesses can develop secondary to the primary condition.

Pathophysiology

Hidradenitis suppurativa is believed to arise from a combination of hyperkeratinization and inflammation of the hair follicles, particularly in areas of friction. This inflammation leads to the blockage of sweat glands, followed by the formation of painful lumps and abscesses. Over time, these abscesses may rupture, causing the release of pus or blood. Repeated flare-ups lead to the formation of scar tissue, and the development of sinus tracts and fistulas, which are abnormal connections between skin surfaces.

The process is thought to involve an abnormal immune response where the body’s immune system, instead of protecting the skin, triggers inflammation in the affected areas. This chronic inflammation results in the progressive damage to skin structures and the underlying tissue.

Over time, individuals with HS may experience significant scarring, thickened skin, and the development of painful, interconnected tunnels under the skin. In severe cases, extensive scarring can lead to functional and aesthetic impairments, and complications such as secondary infections and mobility limitations may occur.

DSM-5 Diagnosis

Hidradenitis suppurativa is not specifically classified in the DSM-5, as it is a dermatologic condition rather than a psychiatric disorder. Diagnosis is primarily clinical and involves evaluating the patient’s symptoms, medical history, and physical examination findings. No definitive laboratory test or imaging is required for the diagnosis, but it may be confirmed through the identification of characteristic skin lesions in areas of friction.

In some cases, biopsy or culture may be necessary to rule out other conditions or confirm the presence of infection. The diagnosis is typically made based on the presence of recurrent, painful abscesses, sinus tracts, and scarring, often in the armpits, groin, buttocks, and under the breasts. In some cases, associated systemic symptoms such as fever or malaise may also aid in diagnosis.

Treatment Regimens

Management of hidradenitis suppurativa focuses on controlling inflammation, preventing infection, and reducing the frequency and severity of flare-ups. Mild cases may be treated with topical antibiotics or corticosteroids to reduce inflammation and prevent infection. In more severe cases, oral antibiotics such as tetracycline or doxycycline may be prescribed to reduce bacterial colonization and inflammation.

Additionally, biologic agents targeting the immune system, such as adalimumab, have shown promise in reducing flare-ups and managing the condition long-term. Surgical intervention may be necessary in advanced cases to remove abscesses or to drain cysts and sinus tracts. In some instances, patients may require skin grafts to restore the affected areas after significant scarring.

Lifestyle changes, including weight management and smoking cessation, are essential components of treatment to reduce flare-up frequency and severity. Pain management may also be part of the treatment regimen, with nonsteroidal anti-inflammatory drugs (NSAIDs) or opioids being used in severe cases. Early intervention is key to preventing long-term complications and improving quality of life.

Patient Education

Patient education is an integral part of managing hidradenitis suppurativa. Educating patients on the nature of the disease, its triggers, and the importance of early intervention can help reduce the severity of symptoms and improve outcomes.

Smoking cessation is strongly recommended, as tobacco use is a major risk factor for flare-ups. Patients should also be educated on the role of weight management in controlling the condition, as obesity can exacerbate symptoms. In addition, patients should be instructed on proper skin hygiene to reduce irritation and the risk of infection in affected areas. For those with recurrent flare-ups, it is important to avoid tight clothing or friction in areas prone to the condition.

Medications prescribed for HS, including antibiotics or biologics, should be taken as directed, and patients should be aware of potential side effects. In cases of severe disease, patients should be informed about the potential need for surgery, and psychological support may be necessary to address the emotional and social challenges associated with living with a chronic skin condition.

Conclusion

Hidradenitis suppurativa is a chronic and often painful condition that primarily affects areas where skin rubs together, such as the armpits and groin. Although the exact cause remains unclear, it is believed to involve a combination of genetic, environmental, and immunological factors. Early intervention with lifestyle modifications, medications, and, when necessary, surgery, can help manage the disease and improve the quality of life for affected individuals. Educating patients on the importance of avoiding triggers, maintaining proper hygiene, and adhering to treatment plans is essential to managing the condition effectively.

References

Ting, T. Y., & Tey, H. L. (2021). Hidradenitis suppurativa: Epidemiology, pathogenesis, and diagnosis. Journal of Clinical Medicine, 10(11), 2345. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8002679/

Zouboulis, C. C., & Bechara, F. G. (2020). Hidradenitis suppurativa: Current concepts in pathogenesis and treatment. Journal of Dermatology, 47(7), 712-725. https://doi.org/10.1111/1346-8138.15431

Saunte, D. M. L., & Jemec, G. B. E. (2020). Hidradenitis suppurativa: Advances in diagnosis and treatment. Journal of the American Academy of Dermatology, 82(2), 323-333. https://doi.org/10.1016/j.jaad.2019.06.036

 
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Nursing Paper Example on Henoch-Schönlein purpura

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Nursing Paper Example on Henoch-Schönlein purpura

Henoch-Schönlein purpura (HSP) is a form of small-vessel vasculitis that most commonly affects children but can also occur in adults. The disease is characterized by the deposition of immunoglobulin A (IgA) complexes in the blood vessels, which leads to inflammation. HSP typically presents with a purpuric rash, joint pain, abdominal pain, and kidney involvement. The pathophysiology of the disease is complex and not fully understood, though it is often triggered by infections, medications, or other environmental factors.

Nursing Paper Example on Henoch-Schönlein purpura

Causes

Henoch-Schönlein purpura is often triggered by a variety of factors, with infections being the most common cause. Upper respiratory infections, particularly those caused by viral agents such as the adenovirus, parvovirus, and influenza, are frequently linked to the onset of HSP. Streptococcus infections, often in the form of strep throat, are another common trigger.

In addition to infections, certain medications have been implicated in triggering the disease. These include nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, and vaccinations, which can induce immune responses that lead to the deposition of immunoglobulin A (IgA) in blood vessel walls.

Genetic factors also play a role in the development of HSP. Individuals with a family history of autoimmune diseases or vasculitis may be more susceptible to the condition. Research indicates that abnormalities in immune system regulation, particularly involving IgA, contribute to the pathogenesis of the disease.

Environmental factors, such as exposure to pollutants or changes in climate, may further contribute to the development of Henoch-Schönlein purpura in genetically predisposed individuals. However, the interplay between genetics, environmental factors, and immune dysregulation remains complex and not fully understood.

Signs and Symptoms

The primary symptom of Henoch-Schönlein purpura is the presence of purpura, which refers to purple spots on the skin caused by bleeding underneath. These spots typically appear on the lower extremities and buttocks, and may also be seen in the arms. The skin lesions can range from small, red dots to larger bruises.

Abdominal pain is another hallmark symptom of HSP, affecting many patients. This pain is often cramp-like and can be intense, sometimes accompanied by nausea and vomiting. It is important to note that abdominal pain may mimic other conditions like appendicitis, making diagnosis challenging.

Joint pain and swelling are also common, particularly affecting the knees and ankles. In some cases, arthritis-like symptoms may occur, leading to discomfort and limited mobility.

Additionally, some individuals with HSP experience kidney involvement, which can manifest as hematuria (blood in the urine) or proteinuria (excess protein in the urine). If left untreated, kidney damage may occur, potentially leading to renal failure.

Fever is present in some patients, and systemic symptoms like fatigue and malaise can contribute to the overall discomfort. These symptoms may occur suddenly and often follow an upper respiratory infection or other triggering event.

Etiology

The exact cause of Henoch-Schönlein purpura (HSP) remains unclear, but it is thought to be triggered by a variety of factors that lead to an immune system response. In many cases, HSP follows a preceding infection, most commonly a respiratory infection caused by viruses like adenovirus or streptococcus. These infections seem to prompt the immune system to produce antibodies, which then form immune complexes that deposit in blood vessels, leading to inflammation and the hallmark symptoms of HSP, such as purpura.

Genetics may also play a role in the development of HSP, as certain family members may have an increased risk of the disease, although no specific gene has been definitively linked to the disorder. HSP is more common in children than adults, with male children being more affected than females.

Other factors that might contribute to HSP include drug reactions, such as to antibiotics or nonsteroidal anti-inflammatory drugs (NSAIDs), and autoimmune conditions. The inflammatory response in HSP is thought to result in vasculitis, which affects small blood vessels and causes leakage of blood and fluid into the surrounding tissue, leading to symptoms like purpura and organ involvement.

Despite these associations, the precise etiology remains complex and likely involves both genetic predisposition and environmental factors.

(Nursing Paper Example on Henoch-Schönlein purpura)

Pathophysiology

The pathophysiology of Henoch-Schönlein purpura (HSP) is primarily characterized by the formation of immune complexes that deposit in small blood vessels, causing vasculitis. The immune complexes, typically consisting of immunoglobulin A (IgA), are triggered by an initial infection or other stimuli. Once these complexes accumulate in the walls of blood vessels, especially in the skin, kidneys, joints, and gastrointestinal tract, they lead to inflammation.

The deposition of these complexes activates the complement system, which amplifies the inflammatory response. This results in the damage and leakage of blood vessels, causing the characteristic symptoms of HSP. The skin manifestations, such as purpura, occur due to hemorrhage from the ruptured blood vessels, while the renal involvement can lead to glomerulonephritis. This can sometimes progress to kidney damage if left untreated.

In the gastrointestinal tract, inflammation may result in abdominal pain, nausea, and vomiting, while joint involvement leads to swelling and pain. The overall inflammation seen in HSP is a result of both the immune complexes and the subsequent activation of inflammatory pathways, including T-cell-mediated responses, further promoting vasculitis. This disorder primarily affects small vessels but can involve medium-sized vessels in severe cases, leading to more widespread tissue damage.

DSM-5 Diagnosis

Henoch-Schönlein purpura (HSP) is not explicitly listed as a separate disorder in the DSM-5, as it is primarily considered a physical, autoimmune condition rather than a psychiatric disorder. Therefore, HSP does not have specific diagnostic criteria outlined in the DSM-5. Instead, its diagnosis is based on clinical features and laboratory findings, including the presence of palpable purpura, abdominal pain, kidney involvement (hematuria or proteinuria), and arthritis or arthralgia.

The clinical diagnosis of HSP is often confirmed by identifying characteristic skin lesions and the presence of IgA deposits in affected tissues. In addition, a thorough history and clinical presentation are essential for differentiating HSP from other vasculitides or systemic diseases that may present with similar symptoms.

While the DSM-5 does not address HSP, clinicians can use it to rule out other psychiatric or psychosomatic disorders if the patient presents with associated anxiety, depression, or other psychological symptoms secondary to the physical condition. It is important to note that managing HSP often requires a multidisciplinary approach, including pediatricians, rheumatologists, and nephrologists, rather than a focus on psychiatric diagnosis alone.

Treatment Regimens

The treatment of Henoch-Schönlein purpura (HSP) primarily focuses on managing symptoms, preventing complications, and addressing underlying causes when possible. Most cases are self-limiting, requiring only supportive care. However, in severe cases, especially those involving kidney dysfunction or gastrointestinal symptoms, more intensive interventions may be necessary.

For mild cases, the use of nonsteroidal anti-inflammatory drugs (NSAIDs) can help alleviate joint pain and inflammation. Corticosteroids, such as prednisone, are commonly used for moderate to severe cases, particularly when there is significant kidney involvement, gastrointestinal bleeding, or severe purpura. These medications help to reduce inflammation and prevent further damage to organs.

In cases where renal involvement progresses to nephrotic syndrome or significant proteinuria, immunosuppressive therapies such as cyclophosphamide or azathioprine may be considered to control the inflammatory process. Rituximab has also been explored as a treatment option in resistant or recurrent cases of HSP.

For patients with severe gastrointestinal manifestations or life-threatening bleeding, intravenous immunoglobulin (IVIG) may be used to reduce inflammation and support immune function. Additionally, ongoing monitoring of renal function is crucial to detect any potential complications early, especially in children and those with long-term symptoms.

The treatment plan for HSP should always be tailored to the individual, taking into account the severity of the disease and the presence of systemic complications.

(Nursing Paper Example on Henoch-Schönlein purpura)

Patient Education

For patients diagnosed with Henoch-Schönlein purpura (HSP), education about the disease and its management is crucial. HSP is often self-limiting, but patients need to understand the importance of monitoring symptoms and managing potential complications.

Patients should be advised to rest and avoid activities that might worsen joint pain or skin lesions. It is essential to keep the skin clean and dry to prevent infection in areas affected by purpura. As the disease can cause abdominal pain and gastrointestinal symptoms, a low-fat, easy-to-digest diet may help reduce discomfort.

Managing pain and inflammation with over-the-counter medications, such as acetaminophen or ibuprofen, should be discussed. However, nonsteroidal anti-inflammatory drugs should be used cautiously in patients with kidney involvement. In more severe cases, corticosteroids or immunosuppressive treatments may be prescribed, and patients must follow the prescribed medication regimen closely.

Close monitoring of kidney function is necessary, as HSP can affect the kidneys, leading to proteinuria or even nephritis. Regular check-ups with a healthcare provider to assess kidney health, as well as blood pressure monitoring, should be part of ongoing care.

Patients should be informed about the possible recurrence of the disease and when to seek medical attention if symptoms worsen, particularly if there are signs of kidney problems or gastrointestinal bleeding.

(Nursing Paper Example on Henoch-Schönlein purpura)

Conclusion

Henoch-Schönlein purpura is a small-vessel vasculitis primarily affecting children, though it can occur in adults. The disease involves immune-mediated damage caused by the deposition of IgA in the blood vessels. Common symptoms include purpura, arthritis, abdominal pain, and kidney involvement. The etiology of HSP is multifactorial, with infections and immune system dysregulation being key contributors. Although the disease is typically self-limiting, it can lead to long-term complications, particularly involving the kidneys. Treatment focuses on symptom management with NSAIDs, corticosteroids, and immunosuppressive medications when necessary. Patient education on recognizing symptoms and monitoring kidney function is crucial for managing the disease and preventing long-term consequences. Regular follow-up care is important, especially for individuals with significant kidney involvement, as early intervention can improve outcomes.

References

Ozen, S., & Pistorio, A. (2010). Epidemiology of Henoch-Schönlein purpura. Rheumatology, 49(6), 1035-1042. https://doi.org/10.1093/rheumatology/keq340

Lee, T. H., & So, K. M. (2014). Henoch-Schönlein purpura: Pathophysiology and diagnosis. The Journal of Pediatric Pharmacology and Therapeutics, 19(2), 75-81. https://www.jpedpharm.org/doi/10.5863/1551-6776-19.2.75

Kuo, C. F., & See, L. C. (2011). Henoch-Schönlein purpura in children: Epidemiology, clinical features, and complications. Pediatrics, 128(3), e675-e683. https://doi.org/10.1542/peds.2010-3734

 
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