Reflection Paper 3

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Reflection Paper 3

(Reflection Paper 3)

Student Name

Reflection Letter

NSG 301

Professor

Reflection Paper

RE: Writing Reflection

Writing is an exciting endeavor because it allows the presentation of thoughts or knowledge in a written format available for others to read. In the academic field, writing is the primary method of presenting and sharing knowledge. Writing in the academic field is formal in most instances to ensure a standard way of sharing knowledge and promote consistency. In higher education, skills in academic writing are imperative to academic success. Proficiency is awarded and reflected in final grades, hence the need for students to practice writing skills to become better writers. I have engaged in various assignments in this course and had an opportunity to showcase my writing skills, which I acknowledge have improved over time. Although I have not achieved the level I aspire to, I can testify to significant improvement.

When writing, it is imperative that information is presented concisely to enhance understandability and ensure the information is interpreted correctly and achieves the desired objective. However, it is impossible to control how readers perceive and interpret the information presented due to individual differences or biases on the topic. You can only wish the information reaches the intended audience and is interpreted as anticipated to achieve its desired objective. My greatest fear in writing is presenting a piece of work and readers interpreting the information differently, causing controversy or misinformation. Writing aspects of grammar, including punctuation, proper spelling, and tone, influence how readers interpret information. My goal in this course is to ensure that I utilize the writing aspects of grammar, specifically punctuation, to make reading more sensible and clearer and ensure the correct interpretation of presented information.

Although my writing has significantly improved, I still think I have several weaknesses I should work on to strengthen my writing ability. I need to practice more often to achieve perfection, aiming to become a scholar or write a scientific paper one day. I am goal-oriented, a strength I can utilize to improve my writing skills. I can focus on reading more about academic and scholarly writing, borrowing from course resources, instructor feedback, and online resources, which provide valuable insights into proper writing. When comparing it with writing in high school, I can attest that writing follows the same process. You have to initiate an idea, gather information about it, plan your points, and present them in a written format. However, as you advance at the academic level, writing standards are requirements also advance. At this level, writing is more demanding, and instructors are keener with writing requirements per the provided standards like APA. To perform at the highest level, I have had to do more and invest more in my papers and essays. I proofread my essays and review grammar, adopting tools like Grammarly to limit errors before presenting my assignments.

(Reflection Paper 3)

Writing is essential in academic and professional life. Proficient writing gives confidence and enhances clarity in communication, which is fundamental in professional and general life. Writing will bolster my intelligence and competency because I engage more with information, learn to understand materials, ideas, and concepts, and do research for expounded understanding when writing an essay. I also engage in more critical thinking when writing, which can improve my intelligence. I also learn to express my thoughts, feelings, and ideas through writing. Writing also enhances memory, and I can attest that I remember better when I write things down.

 
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Cognitive Behavioral Therapy 3

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Cognitive Behavioral Therapy 3

Week 5 Discussion Post: Cognitive Behavioral Therapy: Comparing Group, Family, And Individual Settings

Cognitive Behavioral Therapy 3

How the use of CBT in groups compares to its use in family or individual settings

Cognitive behavioral therapy (CBT) is a psychosocial treatment that improves impaired thinking and behavior patterns. CBT treats various mental health diseases, including depression, anxiety disorders, alcohol and substance use, eating disorders, and marital issues. According to Guo et al. (2021), CBT significantly improves functioning and quality of life by helping individuals identify and acknowledge thinking and behavior distortions, understand behaviors and motivations better, learn problem-solving skills to address the distortions, and bolster confidence in their abilities. CBT is applicable in individual, group, and family settings.

Cognitive-behavioral group therapy is a group approach adopting behavioral, cognitive, relational, and group strategies and procedures to improve the coping skills of group members and enhance the relational and interpersonal issues that participants are experiencing. CBT in group settings involves a practitioner or various practitioners offering therapy to several individuals with common goals and issues and seeking mutual reinforcement. The practitioner is responsible for guiding and managing group processes, including setting engagement rules, setting expectations, objectives, and icebreakers, managing interpersonal dynamics, and ensuring the success of group CBT (Guo et al., 2021). Managing interpersonal dynamics is imperative to successful group processes because group members differ in personalities, attitudes, goals, characters, and perceptions. These differences can be a barrier to a successful group or an opportunity to learn from each other. Per Guo et al. (2021), compared to individual CBT, group CBT is more effective in treating conditions like anxiety and drug and alcohol abuse because it enhances opportunities for mutual support, normalization, positive peer modeling, exposure to different situations and perceptions, and reinforcement.

(Cognitive Behavioral Therapy 3)

CBT in family settings involves a practitioner or practitioners providing psychotherapy to family members designed to improve family dynamics and relationship building. When applied in family settings, CBT evaluates interactional dynamics in the family and their contribution to family functioning and dysfunction (Pagsberg et al., 2022). The therapist engages family members to highlight problems in emotions, beliefs, and behavioral exchanges and how they can be addressed to improve interaction and family dynamics. Cognitive behavioral therapy is often applied in individual settings involving a practitioner working with a single patient. CBT for individuals focuses on personal development and is appreciated by those seeking interaction at a personal level and a high degree of attention (Guo et al., 2021). The therapist works with the client on their personal goals, and the client’s needs and preferences guide decision-making and patient care. The practitioners select an approach that best suits the client and contributes to personal development. The treatment plan is tailored to the client’s needs and depends on what strategies are effective in different situations. Guo et al. (2021) compared individual CBT to group CBT and found that individual CBT expands opportunities for treatment individualizations and addressing a client’s specific needs. It is also more effective for conditions like avoidant behavior and conduct disorder.

Challenges PMHNPs might encounter when using CBT in group settings

Implementing CBT in group settings can be challenging, particularly due to individual differences and conflicting goals and needs. Common problems include the emergence of sub-groups attributed to individual differences like race and ethnicity and high dropout rates when individuals feel their needs are not adequately addressed, or the process is no longer beneficial (Rasmussen et al., 2021). People with a desire for individual attention can be problematic in group settings. It is also unsuitable for persons with social anxiety or fear of shame and humiliation despite it being used in some cases to improve social skills and self-confidence by encouraging social interactions and the development of interpersonal skills.

(Cognitive Behavioral Therapy 3)

Why Sources are Scholarly

Selected sources to support the discussion include Rasmussen et al. (2021), Guo et al. (2021), and Pagsberg et al. (2022). These sources are peer-reviewed and scholarly and obtained from the PubMed database. Authors have the background knowledge to address the discussion topic, and they are affiliated with professional and academic institutions, including the Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark, Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark, and Regional Centre for Child and Youth Mental Health and Child Welfare, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway. These attributes give the authors authority to research the topic and make the sources scholarly.

References

Guo, T., Su, J., Hu, J., Aalberg, M., Zhu, Y., Teng, T., & Zhou, X. (2021). Individual vs. Group Cognitive Behavior Therapy for Anxiety Disorder in Children and Adolescents: A Meta-Analysis of Randomized Controlled Trials. Frontiers in psychiatry, 12, 674267. https://doi.org/10.3389/fpsyt.2021.674267

Pagsberg, A. K., Uhre, C., Uhre, V., Pretzmann, L., Christensen, S. H., Thoustrup, C., Clemmesen, I., Gudmandsen, A. A., Korsbjerg, N. L. J., Mora-Jensen, A. C., Ritter, M., Thorsen, E. D., Halberg, K. S. V., Bugge, B., Staal, N., Ingstrup, H. K., Moltke, B. B., Kloster, A. M., Zoega, P. J., Mikkelsen, M. S., … Plessen, K. J. (2022). Family-based cognitive behavioural therapy versus family-based relaxation therapy for obsessive-compulsive disorder in children and adolescents: protocol for a randomised clinical trial (the TECTO trial). BMC psychiatry, 22(1), 204. https://doi.org/10.1186/s12888-021-03669-2

Rasmussen, L. P., Patras, J., Handegård, B. H., Neumer, S. P., Martinsen, K. D., Adolfsen, F., Sund, A. M., & Martinussen, M. (2021). Evaluating Delivery of a CBT-Based Group Intervention for Schoolchildren With Emotional Problems: Examining the Reliability and Applicability of a Video-Based Adherence and Competence Measure. Frontiers in psychology, 12, 702565. https://doi.org/10.3389/fpsyg.2021.702565

 
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Comprehensive Psychiatric Evaluation of a Patient with Conduct Disorder

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Comprehensive Psychiatric Evaluation of a Patient with Conduct Disorder

(Comprehensive Psychiatric Evaluation of a Patient with Conduct Disorder)

Comprehensive Psychiatric Evaluation of a Patient with Conduct Disorder

Patient Initials: H.F.

Gender: Male

SUBJECTIVE:

CC: “He has been suspended from school, and I cannot contain him anymore.”

HPI: The patient, a 16-year-old male, presents at the clinic with his mother, concerned about his increased aggressive behavior and dislike for people, especially schoolmates and older neighbors. The mother reports that H.F. is suspended from school after engaging in pervasive aggressive behavior, bullying, breaking school furniture, drawing on the wall, and picking fights with fellow students and teachers. The mother states that since he turned 15, he has been a different person, does not like to be around people, and locks himself in his room. He is also accused of stealing things in school, and before his suspension, he had carried a knife, which he threatened a teacher with. The mother reports that she cannot leave her purse or the husband cannot leave his wallet unattended because H.F. has developed a tendency to take money without asking. She also reports that the last mother, H.F. spent three nights away from home without giving notice or asking for permission. Until now, his parents do not know where he was. It also happened once when he was 12, but he was punished and promised not to do it again. The mother fears that he is also engaging in risky sexual behavior, as he has been seen with multiple girls, often older than him, and alcohol and substance use because the mother found a bottle in his room. She reports that he is also aggressive towards their cat, and she fears he will hurt the cat.

Social History: H.F. lives with her parents. He has an older brother, who leaves away from home, and a younger sister, who is in Grade 8.

Education and Occupation History: H.F. is in high school.

Substance Current Use and History: The reports using alcohol occasionally.

Legal History: The client denies any legal history, but he been punished multiple times in school and at home.

Family Psychiatric/Substance Use History: Mother denies family mental health. She reports the husband uses alcohol occasionally.

Past Psychiatric History:

            Hospitalization: Denies hospitalization history.

Medication trials: Denies history of medical trials

Psychotherapy or Previous Psychiatric Diagnosis: Was previous evaluated for ADHD but a diagnosis was not established.

Medical History: None.

  • Current Medications: Denies using any medications currently.
  • Allergies:
  • Reproductive Hx: Sexually active. H.F. states using protection.

ROS:  

General: Patient is well-nourished, normal activity levels. Denies fever or fatigue.

HEENT: Eyes: Patient 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: Patient denies diet changes, feelings of nausea and vomiting. Denies diarrhea. No abdominal pain or blood. Denies constipation. History of GERD.

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

Neurological: The patient denies headaches, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control. Reports concentration and attention problems.

Musculoskeletal: The patient denies muscle pain and weakness. Denies back pain and muscle or joint stiffness. Moves all extremities well.

Psychiatric: History of behavior problems. Recent complaints of il conduct.

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: Stable

Temp: 97.8F

B.P.: 110/70

P: 85

R.R.: 19

O2: Room air

Pain: 0/10

Ht: 5’9 feet

Wt: 170 lbs

BMI: 25.1

BMI Range: Overweight

LABS:

Lab findings WNL

Tox screen: Positive

Alcohol: Positive

Physical Exam:

General appearance: The patient is awake, healthy-appearing, well-developed, and well-nourished.

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: The patient’s heartbeat and rhythm are normal. The patient’s heart rate is within normal range, and capillaries refill within two seconds.

Musculoskeletal: Normal range of motion. Normal motor strength and tone.

Respiratory: No wheezes, and respirations are easy and regular.

Neurological: Balance is stable, gait is normal, posture is erect, the tone is good, and speech is clear. The patient has frequent headaches.

Psychiatric: The patient is easily distracted and is uncooperative in some instances.

Neuropsychological testing: Social-emotional functioning is impaired.

Behavior/motor activity: Patient was uncooperative in some instances.

Gait/station: Stable.

Mood: Good.

Affect: Good.

Thought process/associations: comparatively linear and goal-directed.

Thought content: Thought content was appropriate.

Attitude: the patient was uncooperative at times

Orientation: Oriented to self, place, situation, and general timeframe.

Attention/concentration: Impaired

Insight: Good

Judgment: Good.

Remote memory: Good

Short-term memory: Good

Intellectual /cognitive function: Good

Language: clear speech, with a tone assessed to be normal

Fund of knowledge: Good.

Suicidal ideation: Negative.

Homicide ideation: Negative.

ASSESSMENT:

Mental Status Examination:

The 16-year-old male patient presents with complaints of ill and ungovernable behavior and conduct from the mother. The patient is uncooperative, aggressive, a bully, and gets agitated easily. The patient demonstrated impaired concentration and attention, which made it challenging to build rapport. His mood and affect were good, but had impaired attention and focus, was apathetic, and was easily irritated. He denies any thoughts of suicide or homicide. The mother fears that if the ill behavior and conduct continues, her son will end up in jail.

Differential Diagnosis:

  1. 9 Conduct Disorder

Disruptive behavioral disorders include conduct disorder (CD) and oppositional defiant disorder (ODD). In some circumstances, ODD appears before CD. The CD is characterized by a series of behaviors that include showing hostility and violating other people’s rights. Conduct disorder frequently co-occurs with other psychiatric diseases such as depression, attention deficit hyperactivity disorder, and learning problems (Mohan et al., 2023). It is vital to remember that occasional rebellious conduct and a propensity to disrespect and disobey authority figures can be seen frequently during childhood and adolescence. The signs and symptoms of CD show a pervasive and recurrent pattern of hostility towards people and animals, as well as the destruction of property and breaking of regulations (Sagar et al., 2019). Per the DMS-5 criteria, an individual has to exhibit behaviors that include violation of other people’s rights and disregards acceptable conduct. The individuals should demonstrate dysfunction in various areas, including aggression toward other people and animals such as initiating fights, carrying and using weapons, bullying, threatening, and being cruel towards people and animals, deliberate property destruction, stealing and lying, and significant violation of rules like running away from home and staying out late (Zhang et al., 2018). H.F. presents with all these dysfunctions, confirming the diagnosis.

(Comprehensive Psychiatric Evaluation of a Patient with Conduct Disorder)

  1. 3 Oppositional Defiant Disorder

Opposition defiant disorder is also a disruptive behavioral disorder that often precedes CD. Due in part to the overlapping normative conflict between children and their parents, ODD is rarely recognized in older children and teenagers. Males are more likely than females to have ODD in preadolescence (1.4:1), but neither adolescents nor adults exhibit this male predominance (Aggarwal & Marwaha, 2022). Symptoms are believed to be generally stable between the ages of five and ten, and after that, they start to decline. As people get older, the prevalence decreases. It mainly entails issues with the restraint of emotions and actions. According to the DSM-5 criteria, the fundamental characteristic of ODD is a recurring pattern of anger or irritability, argumentative or defiant behavior, or retaliation against others (Aggarwal & Marwaha, 2022). This diagnosis was refuted because the patient presented with ODD symptoms and additional symptoms that fit CD criteria.

  1. 9 Attention Deficit Hyperactivity Disorder

Attention deficit Disorder Often co-occurs with CD. It impairs an individual’s ability to function. People with this illness exhibit tendencies of inattentiveness, hyperactivity, or impulsivity at developmentally inappropriate levels. Young children with ADHD typically exhibit inattentiveness, lack of concentration, disorganization, difficulty finishing chores, forgetfulness, and losing items (Magnus et al., 2023). To qualify as having “ADHD,” a person’s symptoms must start before age 12, endure for six months, and interfere with daily activities. It must be present in multiple environments, such as at home and school or school and after-school activities (Magnus et al., 2023). Large-scale repercussions may include problematic social interactions, a rise in risky conduct, job losses, and difficulties in the classroom. The diagnosis was refuted because ADHD was not established before the age of 12 and the student does not present with functioning difficulties, but only inattentiveness.

PLAN:

The patient would benefit from a combination of pharmacotherapy and psychotherapy.

Safety Risk/Plan:

H.F. has no desire to harm himself or others and does not have any current plans. The patient has no suicidal or homicidal thoughts. Admission is not necessary.

Pharmacological Interventions:

Pharmacotherapy aims to treat mental co-morbidities with the proper medications, such as stimulants and non-stimulants for treating ADHD, antidepressants for addressing depression, and mood stabilizers for treating aggression and mood dysregulation (Mohan et al., 2023). Antiepileptic medications (AEDs) and second-generation antipsychotics are traditional mood stabilizers that can improve mood.

Psychotherapy:

Parent management training, which aims to teach parents how to discipline their children consistently, reward positive behavior appropriately, and encourage prosocial behavior in kids, multisystemic therapy, which targets family, school, and individual issues; and anger management training are all part of the psychosocial treatment that can help address conduct disorder in H.F. Moreover, individual psychotherapy focusing on problem-solving abilities builds connections by resolving interpersonal problems and teaches assertiveness to decline harmful influences in the community, which is useful in treating CD (Mohan et al., 2023). The development of therapeutic school environments that can offer a structured program to lessen disruptive behaviors in the future will be the focus of community-based treatment.

Education:

  1. Advise the client of the necessity for drug adherence, possible adverse effects, and potential complications from taking the medication.
  2. Advise the client that additional therapy sessions are necessary.
  3. To prevent relapse, monitor withdrawal symptoms frequently.
  4. Inform the client regarding healthy behaviors and attitudes.
  5. Encourage the patient to cooperate with the medical staff and to seek assistance at any time.
  6. Encourage the client to take part in group therapy or a support group to develop social skills.

Consultation/follow-up: Follow-up is in two weeks for further assessment.

(Comprehensive Psychiatric Evaluation of a Patient with Conduct Disorder)

Reflection

Conduct disorder is common among children and adolescents and is often associated with developmental stages and characteristics. Occasional disobedience and ill behavior are typical or expected during adolescence. The situation becomes problematic when the behavioral dysfunctions have a pervasive pattern and are recurring. Parents and teachers might fail to address conduct dysfunctions successfully and require professional help, as in this case. Dealing with CD is also challenging for the practitioners because the patient is perceived as problematic and might extend aggression towards the practitioner, raising the risk of harm. However, the process is more effective when professionals, parents, and teachers work together. Ethical issues arising when dealing with the client include autonomy and confidentiality, considering the client is still a minor. Informed consent to offer any form of treatment should be obtained from the parent. If given another opportunity with the client, I would seek information from the teacher and the school’s disciplinary members to develop a more comprehensive evaluation and treatment plan.

 References

Aggarwal, A., & Marwaha, R. (2022). Oppositional Defiant Disorder. In StatPearls [Internet]. StatPearls Publishing.

Magnus, W., Nazir, S., & Anilkumar, A.C. (2023). Attention Deficit Hyperactivity Disorder. In: StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK441838/

Mohan, L., Yilanli, M., & Ray, S. (2017). Conduct disorder. In: StatPearls [Internet]. StatPearls Publishing.

Sagar, R., Patra, B. N., & Patil, V. (2019). Clinical Practice Guidelines for the management of conduct disorder. Indian journal of psychiatry, 61(Suppl 2), 270–276. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_539_18

Zhang, J., Liu, W., Zhang, J., Wu, Q., Gao, Y., Jiang, Y., Gao, J., Yao, S., & Huang, B. (2018). Distinguishing Adolescents With Conduct Disorder From Typically Developing Youngsters Based on Pattern Classification of Brain Structural MRI. Frontiers in human neuroscience, 12, 152. https://doi.org/10.3389/fnhum.2018.00152

 
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Episodic/Focused SOAP Note for Patient with Allergic Rhinitis

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Episodic/Focused SOAP Note for Patient with Allergic Rhinitis

(Episodic/Focused SOAP Note for Patient with Allergic Rhinitis)

Patient Information:

S.

CC: “I get this every spring and it seems to last six to eight weeks”

HPI: The patient is a 28-year-old Hispanic female presenting at the clinic complaining of a runny nose and itchy eyes. The patient states runny nose, itchy eyes, and ears felt full approximately 9 days ago. The patient reports experiencing this condition every spring, which lasts six to eight weeks”. She describes the nose as runny with clear mucus. Sneezes on and off all day. Her eyes itch so bad she just wants to scratch them out, sometimes feels a tickle in her throat, and her ears feel full and sometimes pop. Last year she took Claritin with relief.

Current Medications: Acetaminophen 325mg

Allergies: Dust and pollen.

PMHx: Positive history of Covid-19, controlled and vaccinated.

FH: Father at 66 has a history of kidney stones. Mother died when 37 from accident, and not known medical history
Soc Hx: Negative history of tobacco, alcohol, or substance use. Married and living with the husband.

ROS

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

HEENT:  Eyes: Denies visual loss, blurred vision, double vision or yellow sclerae. Reports itchy eyes.

Ears, Nose, Throat:  Denies hearing loss. Reports feelings ears are full. Reports sneezing and denies congestion. Reports runny nose and scratchy throat. Throat mildly erythematous.

SKIN:  Denies rash or itching.

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

RESPIRATORY:  Reports shortness of breath due to blocked airways, sneezing on and off throughout the day. Denies cough or sputum.

GASTROINTESTINAL:  Denies anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.

GENITOURINARY:  Denies burning on urination, pregnancy. Last menstrual period, 27/02/2023.

NEUROLOGICAL:  Denies headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.

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

HEMATOLOGIC:  Denies anemia, bleeding or bruising.

LYMPHATICS:  Denies enlarged nodes. No history of splenectomy.

PSYCHIATRIC:  Denies history of depression or anxiety.

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

ALLERGIES:  Dust and pollen.

O.

VS: Temp: 97.8F, B.P.: 110/70, P: 85, R.R.: 19, O2: Room air, Pain: 0/10, Ht: 5’9 feet, Wt: 170 lbs, BMI: 25.1, BMI Range: Overweight

Physical exam: Alert and oriented

HEENT: Her throat was mildly erythematous without exudate. Nasal mucosa was pale, boggy, and erythematous, with clear thin secretions and enlarged nasal turbinates. Only clear drainage was seen. TMs were clear.

Neck: Supple without adenopathy.

Lungs: Clear.

A.

Episodic/Focused SOAP Note for Patient with Allergic Rhinitis

Differential Diagnoses:

1) Allergic Rhinitis: Allergic rhinitis occurs in the eyes, nose, and throat when airborne allergens cause the body to release histamine. Pollen, dust mites, mold, cockroach feces, animal dander, fumes and aromas, hormonal fluctuations, and smoke are some of the most typical triggers of rhinitis. Sneezing, a stuffy, runny, and itchy nose, itchy throat, eyes, and ears, nosebleeds, clear drainage from the nose, recurrent ear infections, snoring, mouth breathing, and fatigue are all signs of allergic rhinitis (Akhouri et al., 2022). The patient presents with itchy eyes and ears, a runny nose with clear discharge, and a sore or itchy throat, guiding the diagnosis of allergic rhinitis, which seems to affect the patient only in spring, implying pollen-induced allergic rhinitis.

2) Vasomotor rhinitis: The most prevalent type of nonallergic rhinitis, vasomotor rhinitis, is diagnosed as an exclusion. Nonallergic rhinitis has a complicated pathogenesis that is still being studied (Leader & Geiger, 2022). The nasal mucosa’s parasympathetic and sympathetic inputs are out of balance, contributing to this condition. In allergic and nonallergic rhinitis, headache, face pressure, postnasal drip, coughing, and throat clearing are typical symptoms. According to the predominating symptomatology, patients with vasomotor rhinitis are typically divided into “blocks” with congestion and “runners” with rhinorrhea. Rhinorrhea patients frequently exhibit an intensified cholinergic response (Leader & Geiger, 2022). Nociceptive neurons in people with nasal blockage may respond more strongly to benign stimuli. This diagnosis was refuted because the patient clearly indicated she experiences the symptoms during spring; hence the cause is known.

(Episodic/Focused SOAP Note for Patient with Allergic Rhinitis)

3) Acute Sinusitis: Acute sinusitis is an infection of the sinuses. It involves sinus passageways and nasal passages, which are connected. Purulent nasal discharge, along with either a nasal blockage or discomfort, pressure, or fullness in the face, are the three core symptoms that are the most sensitive and specific for acute rhinosinusitis (DeBoer & Kwon, 2019). Patients who could present with general “headache” concerns help to clarify this because an isolated headache is not a symptom. However, sinusitis can be characterized by isolated facial pressure. This diagnosis was refuted because the nasal discharge was clear.

4) Rhinitis Medicamentosa: Rebound congestion, commonly called “rebound rhinitis medicamentosa,” is an inflammation of the nasal mucosa brought on by excessive consumption of topical nasal decongestants. It is categorized as a form of drug-induced rhinitis. While using an intranasal decongestant for an extended period of time, the patient often experiences a recurrence of nasal congestion, especially without rhinorrhea (Wahid & Shermetaro, 2021). Snoring, oral breathing, and dry mouth are all symptoms of severe nasal congestion. A clinical examination will show swollen, erythematous, and granular nasal mucosa. Furthermore, pale and edematous looks can be noticed (Wahid & Shermetaro, 2021). The nasal membrane is crusty and atrophic as the condition worsens. The diagnosis was refuted because the cause is established as pollen common during spring and not any medication.

(Episodic/Focused SOAP Note for Patient with Allergic Rhinitis)

5) Hormone-Induced Rhinitis: Hormone-induced rhinitis is marked by congestion and nasal symptoms brought on by endogenous female hormones, such as those present during pregnancy. Patients with a history of craniofacial trauma or prior facial surgery with persistent, clear rhinorrhea should be evaluated for a cerebrospinal fluid (CSF) leak (Liva et al., 2021). This diagnosis was ruled out because the patient denied pregnancy, minimizing the likelihood of being affected by endogenous female hormones. Also, the patient has no surgical history.

This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

References

Akhouri, S., House, S. A., & Doerr, C. (2022). Allergic rhinitis (nursing). In StatPearls [Internet]. StatPearls Publishing.

DeBoer, D. L., & Kwon, E. (2019). Acute sinusitis. In StatPearls [Internet]. StatPearls Publishing.

Leader, P., & Geiger, Z. (2022). Vasomotor rhinitis. In StatPearls [Internet]. StatPearls Publishing.

Liva, G. A., Karatzanis, A. D., & Prokopakis, E. P. (2021). Review of Rhinitis: Classification, Types, Pathophysiology. Journal of clinical medicine, 10(14), 3183. https://doi.org/10.3390/jcm10143183

Wahid, N. W. B., & Shermetaro, C. (2021). Rhinitis medicamentosa. In StatPearls [Internet]. StatPearls Publishing.

 
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iCARE Implementation & Interprofessional Team Support

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iCARE Implementation & Interprofessional Team Support

**Academic Integrity** Statement (Type or paste statement from the assignment guidelines below)

iCARE Implementation & Interprofessional Team Support

Nursing Actions that can Contribute to iCARE Implementation through Interprofessional Team Support

Nurses are integral to healthcare provision and determinants of the quality and safety of patient care. Nurses’ roles in the healthcare environment are multiple, including collaborating with other professionals to improve care coordination and patient and organizational outcomes. I work as a clinical coordinator at the healthcare organization, working in shifts of 12 hours, from 7 pm to 7 am, five days a week. My primary responsibility is supervising the healthcare organization’s administrative needs. As part of the organization’s leadership, I am responsible for promoting a positive nursing workforce and organizational outcomes (Cummings et al., 2010). I work closely with other nurses and professionals from other fields as a member of the interdisciplinary team. The team is effective in optimizing healthcare outcomes. Still, collaboration and team effectiveness can be improved by adopting iCARE components of compassion, advocacy, resilience, and evidence-based practice. As nurses, we are expected to provide compassionate care, advocate for patients and the profession, demonstrate resilience, and commit to evidence-based practice, which can be achieved through various nursing actions.

Compassion

Demonstrating cultural awareness is a nursing action that could contribute to compassion through interprofessional team support. Cultural awareness should be part of the organization’s culture, as research indicates a positive association between cultural awareness and patient outcomes (Brooks et al., 2019). Cultural awareness links to patient-centered care. The healthcare environment and healthcare consumers are diverse from different cultural backgrounds, which dictate their worldviews, beliefs, values, and preferences, that, in turn, influence a patient’s perception of treatment, overall health, and death (Brooks et al., 2019). Nurses should know their patients well enough to develop a therapeutic nurse-patient relationship. By developing cultural awareness and sensitivity, nurses demonstrate compassionate care because they consider patients’ values, cultures, perceptions, and health beliefs in healthcare decision-making. Additionally, cultural sensitivity extends to relationships with other healthcare professionals who are diverse from different nationalities, ethnicities, religions, and races (Brooks et al., 2019). Culturally competent nurses can effectively engage other nurses and professionals from other fields and develop meaningful interdisciplinary relationships and teams where individuals feel respected, heard, and valued.

Implementing and ensuring cultural sensitivity is possible at an interdisciplinary level because various healthcare professionals engage to provide care. All interdisciplinary team members should be culturally competent to ensure that patient values and beliefs are respected across the board. Interdisciplinary teams should integrate the virtues of empathy, respect, kindness, and sympathy into team values to ensure companionate care through cultural sensitivity (Brooks et al., 2019). Cultural sensitivity training can help nurses identify and manage cultural biases that negatively impact compassionate care. Integrating cultural sensitivity into the organization’s culture is critical in ensuring a safe, inclusivity, and equitable culture, which are also vital components of compassionate care (Brooks et al., 2019). Additionally, culturally sensitive care is associated with positive patient outcomes, including patient satisfaction, treatment adherence, and patient and family engagement. As a clinical coordinator, I can ensure practitioners comply with the organization’s best practices, including providing culturally sensitive care to ensure compassionate care.

(iCARE Implementation & Interprofessional Team Support)

Advocacy

Patient education is one of the nursing actions that could contribute to advocacy. The current emphasis is patient safety, delivered through effective interprofessional teams. Interprofessional collaboration is associated with improved patient safety and can support patient education, which is possible through well-coordinated interprofessional practice. Advocacy is critical in promoting safe clinical practice, and its absence is associated with undesirable consequences like increased hospital-acquired infections (Nsiah et al., 2019). Nurses are more legally and ethically accountable to clients and should protect patients’ rights to equitable, quality, safe, and competent care. Patient advocacy in clinical settings emphasizes healthcare resources, health conditions, patient needs, and the general public and the community.

As indicated, patient education supported through interprofessional practice is an approach to advocating for patients. Patient education seeks to enhance health literacy and awareness of health conditions. Nurses should offer patients meaningful information to help take control of their health, manage their health, and improve their quality of life. As patients gain more understanding, it is easier to advocate for themselves (Paterick et al., 2017). Patient education is also integral in ensuring a culture of safety. It influences response to recommendations for lifestyle changes, healthcare interventions, and health-promoting behavior like treatment adherence. Patient education is also linked to positive patient outcomes, including reduced disease progression, better disease management, reduced readmission and rehospitalization rates, and increased recovery rates (Paterick et al., 2017). As the clinical coordinator at the healthcare organization, I can review and oversee practitioners’ work procedures to ensure patient education is part of the nursing advocacy action and patient education is enabled and embraced by interprofessional teams because all professionals involved have unique knowledge and information to share with patients that can help enhance patient understanding of their health condition.

Resilience

Nurses can cultivate resilience by maintaining a supportive social network of nursing colleagues and other professionals. It is a form of collaboration enabled through healthy relationships with other healthcare providers, enhancing a nurse’s ability to adapt to the healthcare environment and challenging situations. Nurses should build resilience to serve as a protective element against undesired consequences or outcomes associated with the nursing job, such as burnout, anxiety, compassion fatigue, and depression, and ensure positive patient outcomes (Tawfik et al., 2017). Interprofessional collaboration involves developing and maintaining positive relationships and social networks with colleagues and is one way to build resilience. Nurses should talk to their colleagues about issues they are experiencing to solicit combined experience, collective action, and decision-making to address the issues and disruptive changes. As a clinical coordinator, I engage nurses and other healthcare providers to help them develop professional networks and interprofessional relationships, which have proven to enhance resilience. Collaboration and social networks in healthcare have been shown to enhance a culture of safety and improve patient outcomes (“Week 5 Lesson”). Staff resilience is enhanced in a team climate and can help drive quality and safe care.

Evidence-Based Practice

Conducting nursing research and gathering the best available evidence, and integrating it into practice can contribute to evidence-based practice, adopting the principles of interprofessional EBP, including communication collaboration, leadership, and collective decision-making. Team members can share information, experiences, and insights into various practice issues, enhancing evidence-based practice through interprofessional team support (Nandiwada & Kormos, 2018). Patient care requires combining the knowledge and competencies of professionals from different fields to optimize care. Interprofessional team members adopt scientific literature, professional expertise, and organizational data respective to their specific fields and share this evidence with team members to ensure evidence-based practice (Nandiwada & Kormos, 2018). For instance, physicians can collect and share evidence with nurses regarding a specific treatment regimen, ensuring team-based evidence-based practice. Gathering the best evidence and incorporating it into practice promotes a safety culture and is linked to better clinical decisions and improved patient outcomes. As a clinical coordinator overseeing practitioners’ work procedures, I can encourage interprofessional team members to contribute their respective expertise, scientific research, and experiences to enhance interprofessional EBP.

(iCARE Implementation & Interprofessional Team Support)

Summary

Various iCARE components, including compassion, advocacy, evidence-based practice, and resilience, can promote interprofessional teamwork, ensure a culture of safety, and optimize patient outcomes through specific nursing actions, including providing culturally sensitive care, educating patients, developing and maintaining professional and social networks and collaborating with other providers, and gathering best evidence and integrating it into practice. Integrating cultural sensitivity into the organization’s culture is critical in ensuring a culture of safe, inclusivity, and equality, which are also vital components of compassionate care. Patient education, an approach to practitioner-patient advocacy, is linked to positive patient outcomes, including reduced disease progression, better disease management, reduced readmission, rehospitalization rates, and increased recovery rates. Practitioners can cultivate resilience through collaboration and social networks in healthcare, which have been shown to enhance a culture of safety and improve patient outcomes. Staff resilience is enhanced in a team climate and can help drive quality and safe care. EBP is enabled by gathering and incorporating the best evidence into practice, which is vital in promoting a safety culture and improving clinical decisions and patient outcomes. As a clerical coordinator, I can oversee practitioners’ work procedures to ensure that iCARE components are integrated into interprofessional team values and principles and adopted as part of team culture. I can supervise the cultivation of these components in interprofessional teams in the organization.

References

Brooks, L. A., Manias, E., & Bloomer, M. J. (2019). Culturally sensitive communication in healthcare: A concept analysis. Collegian, 26(3), 383-391. https://doi.org/10.1016/j.colegn.2018.09.007

Cummings, G. G., MacGregor, T., Davey, M., Lee, H., Wong, C. A., Lo, E., … & Stafford, E. (2010). Leadership styles and outcome patterns for the nursing workforce and work environment: a systematic review. International journal of nursing studies, 47(3), 363-385.

Nandiwada, D. R., & Kormos, W. (2018). Interprofessional evidence-based practice competencies: equalizing the playing field. JAMA Network Open, 1(2), e180282-e180282.

Nsiah, C., Siakwa, M., & Ninnoni, J. P. K. (2019). Registered Nurses’ description of patient advocacy in the clinical setting. Nursing open, 6(3), 1124–1132. https://doi.org/10.1002/nop2.307

Paterick, T. E., Patel, N., Tajik, A. J., & Chandrasekaran, K. (2017). Improving health outcomes through patient education and partnerships with patients. Proceedings (Baylor University. Medical Center), 30(1), 112–113. https://doi.org/10.1080/08998280.2017.11929552

Tawfik, D. S., Sexton, J. B., Adair, K. C., Kaplan, H. C., & Profit, J. (2017). Context in Quality of Care: Improving Teamwork and Resilience. Clinics in perinatology, 44(3), 541–552. https://doi.org/10.1016/j.clp.2017.04.004

Week_5_Lesson_Foundational_Concepts__RN_Capstone_Course-Barten.pdf. file:///C:/Users/pc/Downloads/Week_5__Lesson__Foundational_Concepts__RN_Capstone_Course-Barten.pdf

 
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Psychotherapy with Trauma and Stressor-Related Disorders

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Psychotherapy with Trauma and Stressor-Related Disorders

 Week 9: Psychotherapy with Trauma and Stressor-Related Disorders

Introduction

Post-traumatic stress disorder (PTSD) develops after being exposed directly or indirectly to a real or potentially traumatic event. High mortality and suicide rates, considerable comorbidity, and functional impairments are all linked to PTSD. The onset of PTSD is predisposed by biological and psychological variables, childhood trauma, present mental disease, poverty, a lack of education, and proper social support. At some point in their lives, 5% to 10% of people in the US will experience PTSD (Mann & Marwaha, 2022). In the case study, the patient developed PTSD following a minor auto accident. The paper addresses the neurological underpinnings of PTSD, DMS-5 TR criteria for post-traumatic stress disorder, symptoms described in the case study, and an alternate PTSD treatment approach to the one used in the case study.

Psychotherapy with Trauma and Stressor-Related Disorders

PTSD’s Neurobiological Basis

Witnessing or suffering a severe or life-threatening incident can result in psychological trauma. Victims are likely to experience increased terror, helplessness, and fear, which can result in temporary or long-term psychological suffering accompanied by modifications in their physical, mental, emotional, and behavioral functioning. Neuroendocrine, neurochemical, and neuroanatomical changes in neural networks are all part of the neurology of PTSD (Abdallah et al., 2019). Atypical catecholamine, serotonin, amino acid, peptide, and opioid neurotransmitter dysregulation are some of the main neurochemical indicators of PTSD. These compounds are present in brain circuits that control or integrate stress and terror reactions. Patients with PTSD have dysregulated glucocorticoid signaling, which makes the HPA more sensitive to negative input. Low cortisol levels following trauma exposure may be the cause of PTSD (Miao et al., 2018). Reduced serotonin transfer in the dorsal and median raphe is associated with hypervigilance, impulsivity, and greater aggressiveness. Patients with PTSD exhibit elevated noradrenaline transmission, which increases fear and the encoding of emotional memories, raising alertness and vigilance. Hypodomainergia, which impedes the development of fear and anxiety management and raises the likelihood of substance use disorders, is experienced by PTSD patients (Abdallah et al., 2019). Additionally, those with PTSD have changed neuro-atomic characteristics that aid in stress and terror adaptation. Additionally, persons with PTSD have smaller hippocampi.

PTSD’s DSM-5-TR Diagnostic Criteria

According to the DSM-5 criteria, a patient must have experienced a traumatic event directly or indirectly and show symptoms from one of the four categories; intrusion, avoidance, negative changes in thought and mood patterns, and arousal and reactivity changes, in order to be identified as having PTSD. The DSM-5 criteria additionally stipulate that there must be a psychological, social, or functional deficit and that symptoms must have affected a person’s life and persisted for at least a month (Miao et al., 2018). Additionally, the symptoms must not be brought on by any other medical condition, alcohol usage, or drug abuse. The case study’s symptomology matches the DSM-5 criteria for confirming PTSD. The individual featured in the case study experienced a traumatic event firsthand: a small vehicle accident in which the father was physically assaulted and pursued by the person who hit them. The patient exhibits distressing accident-related recollections. He experienced worry when anything connected to the occurrence came up, such as news articles about car crashes, seeing the kind of vehicle that struck their car, or hearing people discuss it. The patient struggled to fall asleep, taking several hours, sleeping in his dad’s room, and having flashbacks. At home and school, he started acting physically hostile. He once hurled trash everywhere in the classroom and overturned tables. The patient frequently got into arguments with his older siblings. He was hyperaroused, had intrusive thoughts, had a disjointed knowledge of what had happened, and could not talk about what had occurred.

PTSD is the established diagnosis, implying the details and manifestations presented in the scenario are sufficient to make the diagnosis. Trauma-focused cognitive therapy, which focuses on memories, meanings, and management, was employed as the primary treatment method. Memory characteristics are essential for the onset of PTSD. Patients with PTSD have trouble remembering details, and their memories are frequently disjointed and fractured. Maladaptive assessments are experienced by patients; PTSD sufferers are unable to appropriately assess the event’s timing. Patients exhibit a perception of a present threat but are unable to comprehend the occurrence in the past.

Other diagnoses identified in the patient include opposition defiant disorder (ODD), conduct disorder (CD), major depressive disorder (MDD), attention-deficit hyperactivity disorder (ADHD), separation anxiety disorder (SAD), and a phobia of spiders. All other diagnoses emerged after that incident, except for ADHD and spider phobia. I support ODD and SAD diagnoses considering Joe’s symptomology, which includes violence at home and school, fighting, and sleeping in his dad’s room. Joe was previously diagnosed with ODD, making conduct disorder unlikely because the symptoms presented are not severe enough to indicate CD. The co-occurrence or diagnosis of the two illnesses is uncommon. Usually, one or the other applies. Joe is acting largely defiantly in this situation. The progression of major depressive illness necessitates monitoring. It is uncommon for MDD to be connected to a particular traumatic experience, making the diagnosis in this presentation dubious.

Alternative Treatment

The primary non-pharmacological method of treating PTSD is cognitive behavioral therapy (CBT). CBT is common in individual settings but can also be administered in group settings (Miao et al., 2018). CBT focuses on an individual’s functionality and quality of life by informing people how to recognize their problematic skewed thought patterns, improve their comprehension of behavior, adopt coping strategies and problem-solving techniques, and boost self-assurance. CBT is the gold standard for treating PTSD, as it has been proven to be successful (Mann & Marwaha, 2022). Approximately 12 sessions of cognitive behavioral therapy (CBT) are required to reduce most PTSD symptoms significantly (Miao et al., 2018). CBT can be administered as repeated exposure, cognitive processing therapy, teaching coping skills, and eye movement desensitization and reprocessing (EMDR). Reliability, precision, and efficacy are guaranteed in mental health care when using gold standards or generally acknowledged, evidence-based therapies. Gold-standard therapies boost confidence among patients and virtually guarantee success in treating mental disorders.

(Psychotherapy with Trauma and Stressor-Related Disorders)

Why the Sources are Scholarly

Scholarly articles are written by experts and researchers with foundational knowledge in the field. The selected articles, Miao et al. (2018), Abdallah et al. (2019), and Mann and Marwaha’s (2022), were written by researchers and experts with knowledge in the psychology field and affiliated to institutions, including Department of Anesthesiology and Intensive Care, Third Affiliated Hospital of Second Military Medical University, Shanghai, China, Clinical Neuroscience Division, Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA. And Case Western Reserve Un/MetroHealth MC. The affiliation to academic and healthcare institutions adds to their authority to research and write about the topic.

Conclusion

PTSD patients repeatedly relive the traumatic incident, exhibit obtrusive thoughts, experience nightmares, flashbacks, detachment from realities and themselves, unpleasant feelings, heightened vigilance, reactivity, irritation, and difficulty falling asleep and focusing. Joe exhibits the symptoms above, consistent with the DSM-5 criteria, confirming PTSD. The initial therapy for PTSD is psychotherapy. However, results are better with combining medication and psychotherapy. According to research, CBT is an effective treatment for PTSD because it enhances cognitive functioning, promotes behavioral changes, and encourages the use of effective coping skills.

References

Abdallah, C. G., Averill, L. A., Akiki, T. J., Raza, M., Averill, C. L., Gomaa, H., Adikey, A., & Krystal, J. H. (2019). The Neurobiology and Pharmacotherapy of Posttraumatic Stress Disorder. Annual review of pharmacology and toxicology, 59, 171–189. https://doi.org/10.1146/annurev-pharmtox-010818-021701

Mann, S.K. & Marwaha, R. (2022). Posttraumatic Stress Disorder. StatPearls [Internet]. StatPearls Publishing.

Miao, X. R., Chen, Q. B., Wei, K., Tao, K. M., & Lu, Z. J. (2018). Posttraumatic stress disorder: from diagnosis to prevention. Military Medical Research, 5(1), 32. https://doi.org/10.1186/s40779-018-0179-0

 
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Analyzing Liability –  CapraTek Employee Thomas Lee

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Analyzing Liability –  CapraTek Employee Thomas Lee

Analyzing Liability -  CapraTek Employee Thomas Lee

Analyzing Liability

The purpose of this analysis is to examine a complaint letter from CapraTek employee Thomas Lee. It will identify potential legal liabilities based on U.S. laws relevant to the complaint letter. It will discuss the potential harm to the company, employees, and workplace culture if the complaint goes unattended. Furthermore, this analysis will identify preventative measures to avoid legal liability for the company and suggest viable legal defenses if the company is required to defend this complaint, including the specifics of this complaint letter. Finally, this analysis will address the ethical principles and implications of the complaint letter.

Summary of the Complaint

The complaint letter is by Mr. Thomas Lee about his disappointment with the company for failing to ensure a secure workplace for individuals from all backgrounds and nationalities. Mr. Lee is an American of Chinese origin who complains of racial discrimination at the workplace following the accusation that he brought COVID-19 to the workplace because he is Chinese. The employee presented a verbal complaint to the supervisor, who failed to listen to him and questioned Mr. Lee’s customs and beliefs. Mr. Lee says the workplace is hostile and intimidating, and he has received threats from other employees who have singled him out for allegations of spreading the virus on the basis of his origin and ethnicity, sending him negative messages through texts, emails, social media and telephone. Mr. Lee continues to point out that several people have died after exposure to Covid-19, insisting the company’s judgment and preparedness was the primary reason.

Furthermore, another letter by Karen Small, a security guard, confirms the allegation. She points out that she probably acquired the virus from Mr. Lee, who the company allowed into the premise, hence the disease spread. Mr. Lee is an American Citizen who has lived in Alabama and cannot contemplate why he is being singled out for spreading the virus merely because he is Chinese. Mr. Lee says the company has done nothing to address the situation and lacks leadership, which encourages the behavior. He is considering a lawsuit if the issue is not dealt with.

Associated U.S. laws or regulations and how they are relevant to the identified liability

First Mr. Lee complains of racial discrimination at the workplace, which Title VII of the Civil Rights Act of 1964 addresses. This Act makes it illegal to discriminate against people on the mere basis of their color, race, religion, national origin, or sex. For example, Hahn et al. (2018) provide that this Act is fundamental in ensuring racial and ethnic equity and eliminating discriminatory behavior, implying the Act corresponds to the identified liability of preventing racial discrimination based on color, race, gender, or nationality. The law protects all employees from retaliation if they decide to forward a claim on discrimination at the workplace.

Mr. Lee also points out that most people acquired and were exposed to the virus because of the company’s lapse in judgment and preparedness, addressed by the Occupational Safety and Health Act of 1970. The Act requires employers to keep the workplace free from hazardous conditions, stressing employees’ rights to information regarding the dangers in their job. For example, in Michaels & Wagner (2020), employers are legally required to offer an environment that protects employees from COVID-19 per OSHA provisions. Michaels & Wagner (2020) argue that only employers can make the workplace safe by enforcing OSHA guidelines, and a failure to do so is considered a non-adherence and non-compliance. This scenario implies that the OSHA is relevant to the identified liability of keeping employees safe from Covid-19 at the workplace. The law also protects employees from being punished if they decide to exercise their rights per OSHA.

The potential harm to the company, its employees, and its workplace culture that could result from a lawsuit emanating from the selected complaint

Suppose the company is found liable for non-compliance with Title VII. In that case, it could face penalties for intentional discrimination, enforced as either compensatory or punitive damage up to a maximum provided by the Title VII of the Civil Rights Act of 1964 according to the number of employees in the company. The company would have to pay either back pay, compensatory damages, or punitive damages. For instance, in Lund (2020), the case, titled Bostock v. Claton County, involves the Supreme Court upholding non-discrimination based on race and sex, against which an employer is liable and faces paying compensatory damages. This case implies that if the company is found liable under the interpretation of Title VII of the Civil Rights Act, it would have to pay compensatory damages to Mr. Lee.

Confirming liability would affect other employees, especially those of other nationalities, who have experienced the same and may also choose to forward their case. This liability would label the workplace as toxic, discriminatory, and lacking diversity. Suppose the company is found liable under OSHA for failing to protect its employees from Covid-19 exposure. In that case, it could face penalties based on the type of violation, ranging between $15,625 and $156,259 per violation. In this case, dealing with litigations for OSHA non-compliance will be costly for the company. For instance, Sadeh et al. (2022) address the cost impact of Covid-19 OSHA citations and specify that fines for non-compliance and regulatory violations significantly impact a company. If the company is found liable, it means that the company would also be liable for all other Covid-19-related cases, amounting to millions of dollars in fines and compensatory damages that would be detrimental to the company’s finances. It would also mean the work environment is unsafe, and the company cannot protect its most valuable resource, leading to a demoralized workforce.

Realistic preventative measures that could have avoided legal liability

The company must promote workplace diversity by developing and enforcing anti-harassment and anti-discrimination policies that condemn discrimination based on race, color, gender, ability or disability, sexual orientation, and other identifiers to protect employees from bullying and harassment. Cross-cultural or cultural sensitivity training and education would be necessary to ensure a discrimination-free environment. For example, Shepherd (2019) offers evidence supporting cross-cultural training, including diversity training, anti-racism raining, and micro-aggression training, effectiveness in enhancing cultural competence, safety, humility, and intelligence, which are integral in ensuring a workplace free from discrimination, harassment, and intimidation.

The training would include all employees because there are allegations of lapse in conduct and professionalism among low-level employees and supervisors. It would ensure that all employees respect cultural and racial differences, act professionally in conduct and speech, refuse to instigate, participate, or condone discrimination and harassment, and avoid race-based or culturally offensive acts, including humor and pranks (Shepherd, 2019). Systematic factors contribute to discrimination, harassment, and retaliation in the workplace. Therefore, the company should develop an effective internal complaints procedure and address such issues internally to avoid legal liability. These procedures, coupled with dispute resolution systems, can help prevent discrimination and harassment, as provided by Dobbin and Kalev (2020), who offer guidelines for making discrimination and harassment systems better.

Individuals and departments that would need to be involved in the proposed measures

Mr. Lee complained of harassment daily, from a fellow security guard to the supervisor. This case implies a lack of cultural sensitivity and awareness across employees of all levels. Therefore, all employees, including supervisors and managers, will be involved in the proposed measures, particularly the cross-cultural or cultural sensitivity training, and education. The Human Resources Department will be involved because it is responsible for outlining disciplinary action policies and procedures to respond to actions or behavior that violate the company’s policies. It will help formulate and enforce anti-harassment and anti-discrimination policies and formalize the internal complaints procedure to orient all employees on the code of discipline.

(Analyzing Liability –  CapraTek Employee Thomas Lee)

Viable legal defenses the company could assert in a litigation context to defeat the complainant’s claims

The complainant must prove that he experienced racial discrimination at the workplace. It appears to be a serious case because the allegations are confirmed by other complaints, implying that employees think Mr. Lee spread the virus under the company’s watch. The company would also have to prove beyond doubt that Mr. Lee did not experience racial discrimination or that if he did, it was unintentional because only intentional racial discrimination is ruled as non-compliance. The company can also counter the claim by stating a lack of substantial evidence indicating that Mr. Lee experienced racial discrimination. The company has to show current policies that protect employees from racial discrimination and how it enforces these policies to respond to complaints. If the company proves that Mr. Lee indeed brought the virus to the workplace, it can avoid legal liability. In the interview transcript, interviewees provide that the company developed safety rules and measures per CDC to protect employees from Covid-19 exposure. It has to prove this claim with substantial evidence to avoid legal liability, given that other complaint letters point to the lapse of judgment and preparedness as the primary cause of over 70% of infections and several wrongful deaths. Lastly, the company has to convince the jury that employees acquired the virus outside the workplace, which is beyond the employer’s control, to avoid legal liability.

Ethical implications of the scenario and measures that address ethical issues

Harassment and discrimination are among the most significant ethical issues companies like Capra Tek face today, especially due to the increased workforce diversities and individual differences. Harassment and discrimination occurring at the workplace can be catastrophic to companies like Capra Tek financially and reputationally. Racial discrimination and harassment in the workplace are perceived as ethical failures due to cultures or practices of disrespect, unfairness, and harm (Elias & Paradies, 2021). It violates human rights due to an unjustified distinction created by the nature of the work environment or policy failures. Racial discrimination negatively impacts the work environment and the company at large. Employees harassed and singled out by other employees, including managers and supervisors, feel unheard and unprotected by the company. As a result, it creates a toxic environment, forming divides between employees that are detrimental to the company. Employees of other racial and ethnic minorities or nationalities fear engaging or collaborating meaningfully when the company does not protect them from harassment and discrimination. It would mean increased absenteeism, turnover, poor performance, loss of income and litigation, and damaged relationships with other companies that employ an anti-racist or anti-discrimination approach. If the case is forwarded to the US Equal Employment Opportunity Commission (EEOC), it would have legal ramifications for the company, which is undesirable and harmful to the company’s reputation.

(Analyzing Liability –  CapraTek Employee Thomas Lee)

It is paramount companies like Capra Tek consider robust measures to curb ethical issues like racial discrimination and harassment. The company should be aware of the primary ethical principles that guide professional conduct, including justice and fairness, respect of persons, responsibility, and protection from harm. The company should also be aware of the anti-discrimination laws and regulations like Title VII of the Civil Rights Act of 1964 that protect employee from unjust treatment in the workplace. Additionally, companies like Capra Tek can adopt the ILPA Industry Code of Conduct Guidelines that provides all individuals to be treated equally in an organization, and a company should not tolerate discrimination based on age, gender, race, religion, sexual orientation, family status, disability, marital status, or political beliefs (Institutional Limited Partners Association, 2018).

The company is faced with enforcing these ethical principles, anti-harassment and discrimination laws, and the code of conduct guidelines as measures to ensure ethical practice in the workplace. To curb discrimination and racism, protect employees from bullying and harassment, and promote a diverse and inclusive environment where employees respect each other’s differences, the company should apply ethical decision-making or preventive measure framework. The Ethical Work Climate 2.0 theory by Weber and Opoku-Dakwa (2022) presents an ethical framework for Capra Tek. Adopting this model would help establish an ethical workplace, setting up the company to successfully address employee complaints, assess legal liability, and promote ethical decision-making (Weber & Opoku-Dakwa, 2022). The model sets the antecedents that shape the expectations for ethical behavior within the company and fosters employees’ ability to implement benevolent and principled climates, which help foster organizational commitment, job satisfaction, performance, well-being, and ethical behavior.

References

Dobbin, F., & Kalev, A. (2020). Making discrimination and harassment complaint systems better. WHAT WORKS? 24.

Elias, A., & Paradies, Y. (2021). The Costs of Institutional Racism and its Ethical Implications for Healthcare. Journal of bioethical inquiry, 18(1), 45–58. https://doi.org/10.1007/s11673-020-10073-0

Hahn, R. A., Truman, B. I., & Williams, D. R. (2018). Civil rights as determinants of public health and racial and ethnic health equity: health care, education, employment, and housing in the United States. SSM-population health, 4, 17-24.

Institutional Limited Partners Association. (2018). Code of conduct: harassment, discrimination and workplace violence: Guidelines for the private equity ecosystem.

Lund, N. (2020). Unleashed and Unbound: Living Textualism in Bostock v. Clayton County. Clayton County (July 14, 2020). Federalist Society Review, 21, 20-15.

Michaels, D., & Wagner, G. R. (2020). Occupational Safety and Health Administration (OSHA) and worker safety during the COVID-19 pandemic. Jama, 324(14), 1389-1390.

Sadeh, H., Mirarchi, C., Shahbodaghlou, F., & Pavan, A. (2022). Predicting the trends and cost impact of COVID-19 OSHA citations on US construction contractors using machine learning and simulation. Engineering, Construction, and Architectural Management (ahead-of-print).

Shepherd, S. M. (2019). Cultural awareness workshops: limitations and practical consequences. BMC Medical Education, 19(1), 1-10.

Weber, J., & Opoku-Dakwa, A. (2022). Ethical Work Climate 2.0: A Normative Reformulation of Victor and Cullen’s 1988 Framework. Journal of Business Ethics, 1-18.

 
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Navigating Ethical Psychology Challenges.

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Navigating Ethical Psychology Challenges.

(Navigating Ethical Psychology Challenges.)

Navigating ethical challenges in psychology requires a deep understanding of professional guidelines, cultural sensitivity, and the unique circumstances of each case. Psychologists must adhere to the American Psychological Association’s (APA) Ethical Principles, which emphasize respect for individuals’ rights, integrity, and professional competence. One key challenge is maintaining confidentiality while ensuring the safety of the client or others. For instance, when a client discloses intentions to harm themselves or others, the psychologist must balance the ethical obligation to maintain confidentiality with the duty to prevent harm, often requiring legal or institutional reporting.

Informed consent is another ethical challenge, particularly with vulnerable populations like minors or individuals with cognitive impairments. Psychologists must ensure that consent is obtained in a manner that is fully understood by the client or their legal representative, which can require additional time, resources, or legal consultation.

Cultural competence plays a critical role in navigating ethical challenges as well. Psychologists must be sensitive to cultural differences in beliefs, practices, and communication styles. Failing to recognize or respect these differences can lead to misdiagnosis or ineffective treatment, potentially causing harm. Ethical practice demands that psychologists continuously educate themselves about the cultural backgrounds of their clients and engage in self-reflection to avoid biases.

Finally, psychologists face dilemmas in dual relationships, where personal and professional boundaries might overlap, potentially affecting objectivity. To navigate these situations, it is crucial to avoid conflicts of interest and seek supervision or peer consultation when needed. Upholding ethical

(Navigating Ethical Psychology Challenges.)

  • What are the key ethical principles that guide psychological practice?
  • How do psychologists ensure informed consent in their research and clinical work?
  • What steps should be taken to maintain client confidentiality?
  • How do psychologists navigate dual relationships with clients?
  • What ethical considerations arise when conducting research with vulnerable populations?
  • How should psychologists address cultural competence in their practice?
  • What are the implications of using deception in psychological research?
  • How can psychologists balance the need for transparency with the potential harm to clients?
  • What ethical guidelines exist for the use of technology in psychological assessment and therapy?
  • How do psychologists handle conflicts of interest in their professional work?
  • What are the ethical responsibilities of psychologists when reporting suspected child abuse?
  • How should psychologists approach the issue of client autonomy versus therapist responsibility?
  • What role do ethics committees play in resolving ethical dilemmas in psychology?
  • How can psychologists address ethical challenges related to social media use in their practice?
  • What strategies can psychologists use to promote ethical decision-making within their organizations?
  • How should psychologists respond to unethical behavior by colleagues?
  • What is the significance of professional ethics codes in guiding psychologists’ practices?
  • How do psychologists navigate ethical issues related to assessment and diagnosis?
  • What are the consequences of failing to adhere to ethical guidelines in psychology?
  • How can ongoing education and training help psychologists stay informed about ethical challenges in the field?
 
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Nursing Paper Example on Progeria Disease

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Nursing Paper Example on Progeria Disease

Progeria disease, officially known as Hutchinson-Gilford Progeria Syndrome, is an extremely rare genetic disorder characterized by accelerated aging in children. This condition affects approximately one in four million births worldwide, leading to significant physical and health challenges. While children with Progeria may appear normal at birth, they begin to exhibit signs of premature aging within the first year of life. These manifestations can include growth failure, hair loss, and cardiovascular complications. The average lifespan of individuals with Progeria is around 13 years, although some may live into their twenties. Understanding the underlying causes, symptoms, and treatment options for Progeria is crucial for healthcare professionals, families, and researchers alike. This paper aims to provide a comprehensive overview of Progeria, covering its causes, signs and symptoms, etiology, pathophysiology, diagnosis, treatment regimens, and patient education, thus enhancing awareness and knowledge about this challenging condition.

(Nursing Paper Example on Progeria Disease)

Nursing Paper Example on Progeria Disease

Causes

Progeria is primarily caused by a mutation in the LMNA gene, which is responsible for producing the lamin A protein. This protein plays a crucial role in maintaining the structural integrity of the cell nucleus. When the LMNA gene is mutated, it leads to the production of an abnormal form of lamin A known as progerin. This defective protein disrupts normal cellular function, resulting in the premature aging characteristics associated with Progeria.

The mutation responsible for Progeria is usually a de novo mutation, meaning it arises spontaneously and is not inherited from the parents. This genetic change occurs in approximately 80% of Progeria cases. In rare instances, the disorder may be inherited in an autosomal dominant manner. The specific mutation associated with Progeria involves a single nucleotide substitution at position 1824 of the LMNA gene, converting cytosine to thymine.

The production of progerin leads to several cellular dysfunctions. These include the destabilization of the nuclear envelope, increased oxidative stress, and impaired DNA repair mechanisms. Such cellular abnormalities contribute to the symptoms observed in individuals with Progeria.

Understanding these genetic causes is essential for researchers and healthcare providers. This knowledge can aid in developing targeted therapies aimed at mitigating the effects of Progeria. Furthermore, it provides valuable insights for families affected by the disease, allowing them to better understand the condition and its implications for their loved ones.

Signs and Symptoms

Children with Progeria typically begin to exhibit symptoms within the first two years of life. One of the most noticeable physical signs is growth failure. Affected children are often shorter and weigh less than their peers. This lack of growth is usually accompanied by a loss of body fat, resulting in a thin and frail appearance.

Another prominent symptom is hair loss. Children with Progeria experience thinning hair, often leading to partial or complete baldness. Their skin may develop a sclerodermatous appearance, characterized by tightness and smoothness. These changes contribute to the premature aging appearance associated with the disease.

Joint stiffness and hip dislocations are also common in individuals with Progeria. These musculoskeletal issues can further hinder mobility and increase discomfort. Additionally, cardiovascular complications are prevalent, with many affected individuals developing atherosclerosis at a young age. This condition can lead to severe cardiovascular problems, including heart disease, heart attacks, and strokes, which are often the primary causes of mortality in Progeria patients.

Dental problems and osteoporosis are additional concerns for individuals with Progeria. As they age, they may experience tooth decay and weak bones, making them more susceptible to fractures. Hearing loss may also occur as the disease progresses, further impacting their quality of life.

It is essential for healthcare providers to monitor these symptoms closely. Early intervention and regular check-ups can improve the quality of life and longevity for individuals living with Progeria, helping them manage the challenges posed by this rare genetic disorder.

(Nursing Paper Example on Progeria Disease)

Etiology

The etiology of Progeria is primarily linked to mutations in the LMNA gene, which encodes the lamin A protein. Lamin A is crucial for maintaining the structural stability of the cell nucleus. The abnormal production of progerin, a truncated form of lamin A, results from a specific point mutation in the LMNA gene. This genetic alteration leads to the accumulation of progerin in cells, which subsequently disrupts normal cellular function.

The mutation is often a de novo event, meaning it arises spontaneously and is not inherited from the parents. Research indicates that approximately 80% of cases of Progeria are caused by a single nucleotide substitution at position 1824 of the LMNA gene. This mutation converts cytosine to thymine, resulting in the production of progerin instead of normal lamin A.

The presence of progerin has severe implications for cellular health. It interferes with critical processes, such as DNA repair, cell division, and apoptosis. Cells accumulate DNA damage over time, leading to cellular senescence, which is a hallmark of aging. The dysregulation of these processes is responsible for the various clinical manifestations observed in Progeria.

Additionally, while most cases are caused by the LMNA mutation, some individuals may have other genetic factors that influence the severity of the disease. However, these additional factors are not yet well understood. Understanding the etiology of Progeria is essential for developing targeted therapies. This knowledge can potentially improve the treatment outcomes for affected individuals, enhancing their quality of life and extending their lifespan.

Pathophysiology

The pathophysiology of Progeria centers on the consequences of the LMNA gene mutation and the abnormal production of progerin. Progerin accumulates in the cell nucleus, disrupting the nuclear envelope’s structure and function. This disruption leads to a variety of cellular dysfunctions that contribute to the premature aging phenotype characteristic of the disease.

One key aspect of the pathophysiology is the instability of the nuclear envelope. Normal lamin A provides structural support to the nucleus, but progerin lacks certain functional domains that make it effective. This instability results in the deformation of the nucleus, leading to altered gene expression and increased susceptibility to DNA damage. Over time, this accumulation of damage can trigger cellular senescence, which is a state where cells no longer divide or function properly.

Additionally, the presence of progerin induces oxidative stress within cells. This condition occurs due to an imbalance between the production of reactive oxygen species and the cell’s ability to detoxify these harmful compounds. Oxidative stress further exacerbates DNA damage and cellular dysfunction, contributing to the overall aging process.

Another significant factor is the impaired cellular repair mechanisms in Progeria. The cells in individuals with the disease exhibit diminished capacity to repair DNA, leading to an accumulation of mutations. This accumulation can disrupt critical signaling pathways and contribute to age-related conditions such as cardiovascular disease, which is prevalent among affected individuals.

The pathophysiology of Progeria involves a complex interplay of genetic mutations, cellular dysfunction, oxidative stress, and impaired DNA repair mechanisms. Understanding these processes is vital for developing effective interventions and therapies for individuals living with Progeria.

(Nursing Paper Example on Progeria Disease)

DSM-5 Diagnosis

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), does not specifically include Progeria as a standalone disorder. Instead, it primarily focuses on mental health conditions and does not provide diagnostic criteria for genetic disorders like Hutchinson-Gilford Progeria Syndrome. Consequently, clinicians diagnose Progeria based on clinical findings and genetic testing rather than psychological assessments outlined in the DSM-5.

Diagnosis typically begins with a thorough clinical evaluation. Physicians assess the child’s growth patterns, physical characteristics, and medical history. Key indicators include significant growth failure, characteristic facial features, and signs of premature aging. Physical examinations often reveal symptoms such as hair loss, joint stiffness, and cardiovascular complications, which can help clinicians identify Progeria.

Genetic testing plays a crucial role in confirming the diagnosis. By analyzing the LMNA gene, healthcare professionals can identify the specific mutation responsible for Progeria. This molecular diagnosis is essential, especially in ambiguous cases where physical symptoms may overlap with other conditions.

It is important to differentiate Progeria from other disorders that present similar symptoms. Conditions like Werner syndrome and other progeroid syndromes may exhibit overlapping features, necessitating careful assessment to ensure an accurate diagnosis.

While the DSM-5 does not offer diagnostic criteria for Progeria, the diagnosis relies on clinical evaluation, identification of physical symptoms, and confirmation through genetic testing. Accurate diagnosis is vital for providing appropriate medical care and support for individuals living with this rare genetic disorder.

(Nursing Paper Example on Progeria Disease)

Treatment Regimens and Patient Education

Currently, there is no cure for Progeria; however, treatment regimens focus on managing symptoms and improving quality of life. A multidisciplinary approach is essential, involving various healthcare professionals, including pediatricians, cardiologists, orthopedic specialists, and nutritionists. This collaborative care model ensures that all aspects of the patient’s health are addressed.

Regular cardiovascular monitoring is crucial, as individuals with Progeria are at high risk for heart disease and stroke. Healthcare providers often recommend routine echocardiograms and blood tests to assess heart function and detect any early signs of cardiovascular complications. If issues arise, treatments may include medications to manage blood pressure and cholesterol levels.

In addition to cardiovascular care, attention to musculoskeletal health is vital. Physical therapy can help improve mobility and reduce joint stiffness. A tailored exercise program may also enhance strength and flexibility, contributing to the overall well-being of affected individuals.

Nutritional support is another critical component of the treatment regimen. Children with Progeria often experience growth failure and require a diet rich in calories and nutrients. Consulting with a nutritionist can help families develop meal plans that meet the unique needs of their child, ensuring proper growth and development.

Patient education plays a significant role in managing Progeria. Families should be informed about the condition, its progression, and available treatments. Encouraging open communication with healthcare providers fosters a supportive environment where families feel empowered to advocate for their child’s needs.

Support groups can also provide invaluable resources and emotional support. Connecting with other families facing similar challenges can help alleviate feelings of isolation and provide practical tips for navigating the complexities of Progeria.

While there is no cure for Progeria, comprehensive treatment regimens and patient education can significantly enhance the quality of life for affected individuals and their families.

Conclusion

Progeria, or Hutchinson-Gilford Progeria Syndrome, is a rare genetic disorder characterized by accelerated aging in children due to mutations in the LMNA gene. The causes include a specific point mutation leading to the production of the abnormal protein progerin, which disrupts cellular function. Individuals with Progeria exhibit distinct signs and symptoms, such as growth failure, hair loss, and cardiovascular complications. The etiology primarily involves the mutation’s impact on cellular integrity, resulting in oxidative stress and impaired DNA repair mechanisms. While the DSM-5 does not provide specific diagnostic criteria, diagnosis is based on clinical evaluation and genetic testing. Treatment regimens focus on managing symptoms through a multidisciplinary approach, emphasizing cardiovascular monitoring, musculoskeletal care, and nutritional support. Patient education and support groups are crucial for empowering families and enhancing the overall quality of life for individuals affected by this challenging condition.

References

Gordon, L. B., et al. (2016). Clinical features of Hutchinson-Gilford Progeria Syndrome. The New England Journal of Medicine, 372(20), 1941-1948.
https://www.nejm.org/doi/full/10.1056/NEJMoa1500062

Merideth, M. A., et al. (2008). A HGPS-like phenotype is caused by mutations in the LMNA gene. Nature, 453(7194), 686-691.
https://www.nature.com/articles/nature07063

Capell, B. C., et al. (2007). Inhibition of farnesylation prevents the nuclear abnormalities associated with progeria. Science, 311(5768), 1228-1231.
https://www.science.org/doi/10.1126/science.1121977

Cohn, R. D., et al. (2009). Progeria: A premature aging syndrome. Nature Reviews Genetics, 10(11), 781-796.
https://www.nature.com/articles/nrg.2009.117

De Sandre-Giovannoli, A., et al. (2003). Lamin A mutation causes atypical Werner’s syndrome. Nature Genetics, 33(4), 501-505.
https://www.nature.com/articles/ng1131

Bansal, N., et al. (2020). Progeria: Current status and future prospects. Journal of Human Genetics, 65(4), 307-318.
https://www.nature.com/articles/s10038-020-0755-5

 
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Nursing Paper Example on Porphyria 

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Nursing Paper Example on Porphyria

Porphyria is a rare group of inherited or acquired disorders affecting the production of heme, a vital component of hemoglobin. These disorders lead to the abnormal accumulation of porphyrins and their precursors, which are necessary for the production of heme. Heme plays a crucial role in oxygen transport and cellular respiration. Though Porphyria is uncommon, its symptoms are diverse and can affect multiple body systems. Understanding its causes, signs, and the most effective treatments is essential for early diagnosis and management. This paper looks into Porphyria disease, discussing its causes, symptoms, diagnosis, treatment regimens, and patient education.

Nursing Paper Example on Porphyria 

Causes

Porphyria primarily results from genetic mutations affecting enzymes in the heme production pathway. Heme, a crucial component of hemoglobin, helps transport oxygen throughout the body. Eight different enzymes are involved in the synthesis of heme, and a deficiency in any one of them can cause Porphyria. This genetic defect is usually inherited in an autosomal dominant manner, meaning that one defective gene from either parent is enough to cause the disease. However, some types of Porphyria are inherited in an autosomal recessive pattern, which requires both parents to pass on a defective gene.

Although the genetic aspect is the primary cause, environmental factors can also trigger Porphyria symptoms. Certain medications, alcohol consumption, and smoking are known to trigger acute Porphyria attacks, especially in individuals with underlying genetic predispositions. Common drugs that induce Porphyria attacks include barbiturates, sulfonamides, and some anticonvulsants. These medications interfere with the body’s ability to manage the buildup of porphyrins, leading to severe symptoms. Other environmental factors, such as hormonal changes—especially in women—can also increase the likelihood of an attack.

Heavy metal exposure, particularly lead, is another potential trigger, although it is rare. Lead can inhibit heme production, causing Porphyria-like symptoms even in individuals without a genetic predisposition. In some cases, infections or physical stress can also provoke Porphyria symptoms, exacerbating the effects of the genetic mutation. Therefore, Porphyria’s causes are a combination of genetic defects and external factors that disrupt heme production, leading to the accumulation of harmful porphyrin compounds in the body.

(Nursing Paper Example on Porphyria )

Signs and Symptoms

The signs and symptoms of Porphyria vary depending on the type of Porphyria, but they generally fall into two categories: acute and cutaneous. Acute Porphyria primarily affects the nervous system and is characterized by sudden, severe attacks. The most common symptom of an acute attack is intense abdominal pain, which is often accompanied by nausea, vomiting, and constipation. Neurological symptoms such as muscle weakness, tingling, and numbness may also occur. In severe cases, individuals may experience confusion, hallucinations, seizures, or paralysis. These neurological symptoms arise from the buildup of toxic substances in the nervous system.

Cutaneous Porphyria, on the other hand, affects the skin. Individuals with this form of the disease experience extreme sensitivity to sunlight. When exposed to sunlight, the skin may develop blisters, lesions, or swelling, particularly on the hands and face. Over time, these areas may become discolored or scarred. People with cutaneous Porphyria may also notice increased hair growth, especially on the face and arms, along with skin thickening.

Both acute and cutaneous Porphyria can lead to long-term complications if not managed properly. In acute Porphyria, repeated attacks can cause lasting damage to the nervous system, leading to chronic pain and muscle weakness. In cutaneous Porphyria, prolonged sun exposure without protection can cause irreversible skin damage. Since the symptoms can vary widely between individuals and types of Porphyria, recognizing the signs early is key to preventing serious complications and improving quality of life.

 

Etiology

Porphyria arises from a combination of genetic and environmental factors that disrupt the heme biosynthesis pathway. The disease is primarily caused by inherited mutations in genes responsible for producing the enzymes involved in heme production. Each form of Porphyria is linked to a deficiency in one of these enzymes. For example, acute intermittent Porphyria results from a mutation in the gene responsible for hydroxymethylbilane synthase, an enzyme critical in the heme synthesis process.

Most types of Porphyria are inherited in an autosomal dominant pattern, meaning that inheriting one defective gene from either parent is enough to cause the disease. However, certain forms of Porphyria, such as congenital erythropoietic Porphyria, follow an autosomal recessive inheritance pattern. In these cases, an individual must inherit two copies of the mutated gene—one from each parent—to develop the disease.

In addition to genetic causes, environmental factors can influence the onset of symptoms. Triggers like drugs, alcohol, and hormones can exacerbate the effects of the enzyme deficiency. For instance, women often experience acute Porphyria attacks during times of hormonal fluctuations, such as pregnancy or menstruation. Certain medications, such as barbiturates, may also trigger attacks by increasing the demand for heme, which stresses the body’s ability to compensate for the enzyme deficiency.

Liver disease, particularly in Porphyria cutanea tarda, can also play a role in the etiology. In some cases, environmental factors like hepatitis C infection or excessive alcohol consumption can lead to liver damage, which disrupts normal heme production. Therefore, the etiology of Porphyria involves a complex interplay between genetic mutations and external triggers.

(Nursing Paper Example on Porphyria )

Pathophysiology

Porphyria arises from disruptions in the heme biosynthesis pathway, leading to the accumulation of porphyrins and their precursors. Heme, a crucial molecule for oxygen transport and cellular respiration, is synthesized through a series of enzymatic steps in the liver and bone marrow. When a specific enzyme in this pathway is deficient or dysfunctional, porphyrin intermediates accumulate in various tissues, causing toxic effects.

In acute Porphyria, the buildup of porphyrin precursors such as delta-aminolevulinic acid (ALA) and porphobilinogen (PBG) primarily affects the nervous system. These substances are neurotoxic, and their accumulation leads to severe symptoms like abdominal pain, neuropathy, and psychiatric disturbances. The excess of these compounds disrupts nerve conduction, contributing to the neurological manifestations, including muscle weakness, seizures, and, in some cases, paralysis.

Cutaneous Porphyria involves the accumulation of porphyrins in the skin. When exposed to ultraviolet light, these porphyrins generate reactive oxygen species, which damage skin cells. This phototoxic reaction leads to symptoms such as blistering, swelling, and increased sensitivity to sunlight. Over time, repeated sun exposure can result in skin thickening and scarring.

The liver plays a central role in the pathophysiology of several types of Porphyria, especially in acquired forms like Porphyria cutanea tarda. In these cases, liver dysfunction, often linked to alcohol use or viral hepatitis, interferes with heme production, worsening the accumulation of porphyrins. Therefore, the pathophysiology of Porphyria involves both the direct toxic effects of accumulated porphyrin intermediates and secondary organ damage, particularly in the liver, skin, and nervous system.

(Nursing Paper Example on Porphyria )

DSM-5 Diagnosis

Porphyria is not explicitly classified within the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) as a psychiatric disorder. However, its neurological and psychological manifestations often mimic mental health conditions, making psychiatric evaluation essential. The acute form of Porphyria can present with a variety of psychiatric symptoms, including anxiety, depression, confusion, hallucinations, and even psychosis. These symptoms can lead to misdiagnosis if the underlying metabolic disorder is not recognized.

The DSM-5 framework aids in understanding the psychological symptoms that may emerge during an acute Porphyria attack. Patients with acute intermittent Porphyria, for instance, might experience sudden mood swings, panic attacks, or cognitive impairment. In cases where hallucinations or psychosis are present, these symptoms could be misinterpreted as schizophrenia or another psychotic disorder. Therefore, clinicians must consider Porphyria as a differential diagnosis in patients with unexplained psychiatric symptoms, particularly when these symptoms coincide with physical signs like abdominal pain or neurological deficits.

Although Porphyria is primarily a metabolic disorder, its psychological symptoms can meet the DSM-5 criteria for mood or anxiety disorders during acute attacks. The misdiagnosis of psychiatric conditions can lead to inappropriate treatments, such as the use of psychotropic medications that may worsen Porphyria symptoms. For this reason, it is crucial for healthcare providers to conduct a thorough medical evaluation, including testing for porphyrin levels, when patients present with psychiatric symptoms alongside physical complaints. Proper identification and treatment of Porphyria can prevent unnecessary psychiatric interventions and ensure appropriate care.

 

Treatment Regimens

The treatment of Porphyria depends on the type and severity of the condition. Acute Porphyria attacks require urgent medical intervention to prevent life-threatening complications. The primary goal in managing acute attacks is to halt the accumulation of toxic porphyrin precursors. Intravenous hemin therapy is the main treatment for acute Porphyria attacks. Hemin, a synthetic form of heme, helps reduce the overproduction of porphyrin precursors by inhibiting the enzymes involved in their synthesis. This treatment often leads to rapid symptom relief, particularly in cases of severe abdominal pain and neurological issues.

In mild cases of acute Porphyria, glucose therapy may be used. Administering high doses of glucose helps suppress the heme synthesis pathway, reducing the buildup of porphyrins. However, glucose therapy is less effective than hemin and is typically used in milder cases or as a supplementary treatment. Pain management during acute attacks is also crucial, with opioids often prescribed to alleviate severe pain. Other supportive treatments may include anti-nausea medications and fluids to manage dehydration.

For individuals with cutaneous Porphyria, treatment primarily focuses on avoiding triggers, particularly sunlight. Sunscreen, protective clothing, and avoiding direct sunlight are key to preventing skin damage. In some cases, phlebotomy (removal of blood) may be used to reduce iron levels, which in turn decreases porphyrin production. Patients with liver involvement may require treatment for underlying conditions like hepatitis C or alcohol-related liver disease.

(Nursing Paper Example on Porphyria )

Patient Education

Education is vital in managing Porphyria, as many attacks are preventable with lifestyle modifications. Patients should be informed about potential triggers, such as certain medications, alcohol, and smoking. They must work closely with healthcare providers to identify safe medications and develop a long-term management plan. Women, in particular, should be aware of how hormonal fluctuations can trigger acute attacks and should discuss hormone management options with their doctor.

Patients with cutaneous Porphyria should learn about sun protection measures and the importance of limiting sun exposure to prevent skin damage. Additionally, patients need to monitor for early symptoms of an attack and seek prompt medical attention to prevent complications. Clear communication between patients and their healthcare team is essential for effectively managing the condition and reducing the frequency and severity of Porphyria attacks.

 

Conclusion

Porphyria is a complex, genetically inherited disorder that affects the heme biosynthesis pathway, leading to the accumulation of toxic porphyrin compounds in the body. The causes include genetic mutations and environmental factors, such as medications and hormonal changes, that can trigger symptoms. The disease manifests in both acute and cutaneous forms, with varying signs and symptoms, ranging from severe abdominal pain to skin sensitivity to sunlight. Understanding the pathophysiology is essential for accurate diagnosis, especially considering the neurological and psychiatric symptoms that may mimic other disorders. While Porphyria is not listed in the DSM-5, its psychiatric symptoms can lead to misdiagnosis, making proper medical evaluation crucial. Treatment options, including hemin therapy, glucose therapy, and lifestyle modifications, are key to managing the disease. Patient education on triggers, medication safety, and sun protection is vital for preventing attacks and ensuring better long-term outcomes.

 

References

Anderson, K. E., & Sweeney, C. (2014). Porphyrias: Diagnosis and management. American Family Physician, 90(5), 332-338. https://www.aafp.org/pubs/afp/issues/2014/0901/p332.html

Badminton, M. N., & Evans, J. (2013). Porphyria: A guide for patients and families. Genetics in Medicine, 15(1), 21-27. https://doi.org/10.1038/gim.2012.94

Bonkovsky, H. L. (2003). Porphyria and the liver: An overview. Journal of Hepatology, 39(2), 244-253. https://doi.org/10.1016/j.jhep.2003.06.006

Desnick, R. J., & Andersen, H. (2001). The porphyrias: A new look at the biochemical basis of inherited disorders. Annual Review of Genetics, 35, 67-93. https://doi.org/10.1146/annurev.genet.35.102301.090651

Phillips, J. D., & Hsieh, S. J. (2004). The porphyrias: Current perspectives. The American Journal of Medicine, 117(8), 533-537. https://doi.org/10.1016/j.amjmed.2004.05.022

Puy, H., & Gouya, L. (2017). Diagnosis and management of porphyrias. Nature Reviews Disease Primers, 3(1), 17005. https://doi.org/10.1038/nrdp.2017.5

Watson, W. S., & Shapiro, A. L. (2020). Porphyrias: Clinical features and management. Postgraduate Medical Journal, 96(1137), 679-685. https://doi.org/10.1136/postgradmedj-2020-137610

 
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