Nursing Paper Example on Gastrointestinal Disease: Gastroesophageal Reflux Disease (GORD)

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Nursing Paper Example on Gastrointestinal Disease: Gastroesophageal Reflux Disease (GORD)

Introduction

Gastroesophageal Reflux Disease (GORD) is a prevalent gastrointestinal ailment affecting millions worldwide. Characterized by the backward flow of stomach acid into the esophagus, GORD poses significant discomfort and potential health risks if left untreated. The lower esophageal sphincter’s weakened state allows gastric contents to regurgitate, causing symptoms like heartburn, chest pain, and regurgitation. While the exact prevalence varies across demographics, GORD is commonly associated with factors such as obesity, smoking, and certain medications. Understanding the underlying mechanisms of GORD is crucial for effective management and prevention of complications. This essay explores the causes, symptoms, etiology, pathophysiology, diagnosis, treatment regimens, and patient education strategies related to GORD, shedding light on its impact on individuals’ daily lives and the importance of comprehensive management approaches. (Nursing Paper Example on Gastrointestinal Disease: Gastroesophageal Reflux Disease (GORD))

Nursing Paper Example on Gastrointestinal Disease: Gastroesophageal Reflux Disease (GORD)

Causes

Gastroesophageal Reflux Disease (GORD) stems from various factors, primarily centered around the malfunctioning of the lower esophageal sphincter (LES), a muscular ring separating the esophagus from the stomach. This weakening or relaxation of the LES allows stomach acid and partially digested food to flow backward into the esophagus, leading to the characteristic symptoms of GORD.

One of the significant causes of LES dysfunction is obesity. Excess weight puts pressure on the abdomen, which can force stomach contents upward into the esophagus, particularly when lying down or bending over. Additionally, adipose tissue produces hormones and substances that may contribute to LES relaxation, exacerbating reflux symptoms in obese individuals.

Smoking is another prominent risk factor for GORD. The chemicals in cigarette smoke can weaken the LES and impair its ability to prevent acid reflux. Moreover, smoking reduces saliva production, which normally helps neutralize stomach acid in the esophagus. Consequently, smokers are more prone to experiencing severe and prolonged reflux symptoms.

Certain medications are known to exacerbate GORD symptoms or weaken the LES. These include nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and aspirin, which can irritate the esophageal lining and increase acid production, aggravating reflux symptoms. Other medications, such as calcium channel blockers used to treat hypertension and some sedatives, may relax the LES, facilitating acid reflux.

Dietary factors play a crucial role in triggering GORD symptoms. Spicy, acidic, and fatty foods can irritate the esophagus and stimulate acid production, exacerbating reflux. Citrus fruits, tomatoes, chocolate, caffeine, and alcohol are common culprits known to worsen symptoms in susceptible individuals. Moreover, large meals and lying down shortly after eating can increase intra-abdominal pressure, promoting acid reflux.

Pregnancy is also associated with an increased risk of GORD due to hormonal changes and elevated intra-abdominal pressure as the uterus expands. Hormones like progesterone relax the LES, contributing to reflux symptoms during pregnancy. Additionally, the growing fetus can exert pressure on the stomach, forcing acid into the esophagus.

In summary, GORD is caused by a combination of factors, including obesity, smoking, certain medications, dietary habits, and pregnancy. Understanding these underlying causes is essential for developing effective management strategies tailored to individual patients and addressing modifiable risk factors to alleviate symptoms and improve quality of life. (Nursing Paper Example on Gastrointestinal Disease: Gastroesophageal Reflux Disease (GORD)

Signs and Symptoms

Heartburn:
Heartburn is the hallmark symptom of Gastroesophageal Reflux Disease (GORD), characterized by a burning sensation in the chest or throat. It typically occurs after eating or when lying down and is caused by stomach acid refluxing into the esophagus. Heartburn can range from mild discomfort to severe pain and is often exacerbated by certain foods, beverages, or lying flat.

Regurgitation:
Regurgitation is the involuntary return of partially digested food or stomach contents into the mouth or throat. Individuals with GORD may experience a sour or bitter taste in their mouth as stomach acid regurgitates into the esophagus. Regurgitation can occur shortly after eating or when bending over and is often accompanied by a sensation of fluid moving up the chest.

Chest Pain:
Chest pain, also known as acid indigestion, is a common symptom of GORD that can mimic heart-related conditions such as angina or a heart attack. The pain may be sharp or burning and is typically located behind the breastbone. It may worsen when lying down or after consuming acidic or fatty foods. While chest pain in GORD is usually non-cardiac in nature, it should be evaluated by a healthcare professional to rule out serious cardiac conditions.

Difficulty Swallowing:
Some individuals with GORD may experience dysphagia, or difficulty swallowing, due to inflammation and irritation of the esophagus caused by acid reflux. Dysphagia can manifest as a sensation of food sticking in the throat or chest, discomfort or pain while swallowing, or the need to swallow repeatedly to move food down. Severe dysphagia may indicate complications such as esophageal strictures or narrowing.

Persistent Cough:
A chronic cough that persists despite treatment for other respiratory conditions may be a symptom of GORD. The reflux of stomach acid into the esophagus can irritate the throat and trigger coughing. This cough is often dry and persistent, particularly at night or after eating. While coughing is a common symptom of GORD, it can also be indicative of other respiratory or gastrointestinal disorders, necessitating proper evaluation by a healthcare provider.

In conclusion, GORD manifests through various signs and symptoms, including heartburn, regurgitation, chest pain, difficulty swallowing, and persistent cough. These symptoms can significantly impact an individual’s quality of life and may vary in severity depending on the frequency and extent of acid reflux. Recognizing these manifestations is crucial for timely diagnosis and management of GORD to alleviate discomfort and prevent complications. (Nursing Paper Example on Gastrointestinal Disease: Gastroesophageal Reflux Disease (GORD))

Nursing Paper Example on Gastrointestinal Disease: Gastroesophageal Reflux Disease (GORD)

Etiology

Genetic Predisposition: While the exact cause of Gastroesophageal Reflux Disease (GORD) remains multifactorial, genetic predisposition plays a significant role in its development. Studies have identified a familial aggregation of GORD, suggesting a genetic component to the condition. Specific genetic variations may influence the function of the lower esophageal sphincter (LES) or alter gastric motility, predisposing individuals to reflux symptoms.

Obesity: Obesity is a well-established risk factor for GORD, with excess body weight contributing to increased intra-abdominal pressure. This pressure can weaken the LES, allowing gastric contents to reflux into the esophagus more easily. Adipose tissue also produces inflammatory cytokines and hormones that may further disrupt esophageal function and exacerbate reflux symptoms in obese individuals.

Hiatal Hernia: A hiatal hernia occurs when a portion of the stomach protrudes through the diaphragm into the chest cavity, disrupting the normal anatomy of the gastroesophageal junction. This structural abnormality can impair the function of the LES, leading to GORD symptoms. While not all individuals with hiatal hernias develop GORD, the presence of a hiatal hernia increases the risk of reflux and complications.

Smoking: Cigarette smoking is associated with an increased risk of GORD due to its effects on LES function and gastric motility. The chemicals in tobacco smoke can relax the LES, making it more prone to reflux. Smoking also reduces saliva production, which normally helps neutralize stomach acid in the esophagus. Consequently, smokers are more likely to experience severe and prolonged reflux symptoms.

Dietary Factors: Certain dietary habits and food choices can exacerbate GORD symptoms. Spicy, acidic, and fatty foods can irritate the esophagus and stimulate acid production, leading to increased reflux. Common trigger foods include citrus fruits, tomatoes, chocolate, caffeine, and alcohol. Large meals and lying down shortly after eating can also promote acid reflux by increasing intra-abdominal pressure. Identifying and avoiding trigger foods is essential for managing GORD symptoms.

Medications: Several medications are known to exacerbate GORD symptoms or weaken the LES, increasing the risk of reflux. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and aspirin can irritate the esophageal lining and increase acid production, aggravating reflux symptoms. Additionally, calcium channel blockers used to treat hypertension and certain sedatives may relax the LES, facilitating acid reflux.

The etiology of Gastroesophageal Reflux Disease involves a complex interplay of genetic predisposition, obesity, hiatal hernias, smoking, dietary factors, and medications. Understanding these underlying contributors is essential for developing targeted management strategies and addressing modifiable risk factors to alleviate symptoms and improve quality of life. (Nursing Paper Example on Gastrointestinal Disease: Gastroesophageal Reflux Disease (GORD)

Pathophysiology

Lower Esophageal Sphincter Dysfunction: Gastroesophageal Reflux Disease (GORD) primarily involves dysfunction of the lower esophageal sphincter (LES), a muscular ring that acts as a barrier between the esophagus and the stomach. In individuals with GORD, the LES fails to close properly or relaxes inappropriately, allowing gastric contents, including stomach acid and partially digested food, to reflux into the esophagus. This malfunctioning of the LES is central to the pathophysiology of GORD and leads to the characteristic symptoms associated with the condition.

Impaired Esophageal Clearance: Another aspect of GORD’s pathophysiology involves impaired esophageal clearance mechanisms. Normally, the esophagus has efficient mechanisms, including peristalsis and salivary neutralization, to clear refluxed material back into the stomach and neutralize gastric acid. However, in individuals with GORD, these clearance mechanisms may be compromised, leading to prolonged exposure of the esophageal mucosa to acidic gastric contents. This prolonged exposure contributes to esophageal mucosal injury and inflammation, exacerbating symptoms and potentially leading to complications such as erosive esophagitis or Barrett’s esophagus.

Esophageal Mucosal Injury and Inflammation: Repeated exposure of the esophageal mucosa to gastric acid and other corrosive contents leads to mucosal injury and inflammation in individuals with GORD. The acidic nature of gastric contents irritates the esophageal epithelium, causing tissue damage and inflammation. This inflammatory response further compromises esophageal function and exacerbates symptoms such as heartburn, regurgitation, and chest pain. Over time, chronic inflammation may contribute to the development of complications such as esophageal strictures, Barrett’s esophagus, or even esophageal adenocarcinoma in severe cases.

Potential Complications: GORD can lead to various complications due to chronic esophageal mucosal injury and inflammation. These complications may include erosive esophagitis, characterized by erosions or ulcers in the esophageal mucosa, which can cause pain and bleeding. Long-term untreated GORD may also result in the development of Barrett’s esophagus, a condition characterized by changes in the esophageal lining that predispose individuals to esophageal adenocarcinoma, a type of cancer. Additionally, severe and recurrent reflux can lead to esophageal strictures, narrowing of the esophagus that can cause difficulty swallowing and food impaction.

The pathophysiology of Gastroesophageal Reflux Disease involves dysfunction of the lower esophageal sphincter, impaired esophageal clearance mechanisms, mucosal injury, and inflammation. Chronic inflammation and mucosal injury may lead to complications such as erosive esophagitis, Barrett’s esophagus, and esophageal strictures if left untreated. Understanding the underlying pathophysiological mechanisms is essential for the effective management and prevention of complications associated with GORD. (Nursing Paper Example on Gastrointestinal Disease: Gastroesophageal Reflux Disease (GORD)).

Nursing Paper Example on Gastrointestinal Disease: Gastroesophageal Reflux Disease (GORD)

DSM-5 Diagnosis

Clinical Evaluation: Diagnosing Gastroesophageal Reflux Disease (GORD) typically involves a comprehensive clinical evaluation based on the patient’s medical history, symptom presentation, and physical examination. Healthcare providers often rely on the presence of characteristic symptoms such as heartburn, regurgitation, chest pain, and difficulty swallowing to initiate further diagnostic investigations.

Diagnostic Criteria: While the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) does not provide specific diagnostic criteria for GORD, it emphasizes the importance of assessing symptom severity and functional impairment in making a diagnosis. Healthcare providers use standardized questionnaires or symptom scales to evaluate the frequency, intensity, and impact of reflux symptoms on the patient’s daily functioning and quality of life.

Objective Measures: In addition to clinical assessment, objective measures such as upper gastrointestinal endoscopy, esophageal pH monitoring, and esophageal manometry may be employed to confirm the diagnosis of GORD and assess the extent of esophageal mucosal injury and dysfunction. Upper gastrointestinal endoscopy allows direct visualization of the esophageal mucosa and the identification of erosions, ulcers, or other pathological changes indicative of GORD. Esophageal pH monitoring measures the frequency and duration of acid reflux episodes, providing valuable information about the severity and pattern of reflux. Esophageal manometry evaluates esophageal motility and LES function, helping to identify underlying motor disorders contributing to GORD symptoms.

Differential Diagnosis: Diagnosing GORD requires differentiation from other conditions that may present with similar symptoms, such as peptic ulcer disease, gastritis, esophageal motility disorders, and cardiac conditions like angina or myocardial infarction. Healthcare providers consider the patient’s medical history, risk factors, symptom pattern, and response to initial interventions to rule out alternative diagnoses and confirm GORD.

Multidisciplinary Approach: Diagnosing GORD often involves a multidisciplinary approach, with collaboration between primary care physicians, gastroenterologists, and other healthcare professionals. This collaborative effort ensures comprehensive evaluation, appropriate diagnostic testing, and tailored management strategies to address individual patient needs and optimize outcomes.

Diagnosing Gastroesophageal Reflux Disease relies on a comprehensive clinical evaluation, standardized symptom assessment, and objective measures to confirm the diagnosis and assess the severity and impact of symptoms. While the DSM-5 does not provide specific diagnostic criteria for GORD, it underscores the importance of evaluating symptom severity and functional impairment in making a diagnosis. Differential diagnosis and a multidisciplinary approach are essential to differentiate GORD from other conditions with similar presentations and ensure optimal management and outcomes for affected individuals. (Nursing Paper Example on Gastrointestinal Disease: Gastroesophageal Reflux Disease (GORD)

Treatment Regimens

Lifestyle Modifications: Effective management of Gastroesophageal Reflux Disease (GORD) often begins with lifestyle modifications aimed at reducing reflux symptoms and improving esophageal health. Patients are advised to avoid trigger foods and beverages known to exacerbate reflux, such as spicy, acidic, and fatty foods, caffeine, alcohol, and carbonated drinks. Additionally, consuming smaller, more frequent meals and avoiding lying down or bending over shortly after eating can help reduce intra-abdominal pressure and minimize reflux episodes.

Weight Management: Obesity is a significant risk factor for GORD, and weight management is an integral component of treatment. Patients are encouraged to achieve and maintain a healthy weight through a balanced diet and regular physical activity. Weight loss can alleviate pressure on the abdomen, reduce reflux symptoms, and improve overall esophageal health.

Elevating the Head of the Bed: Elevating the head of the bed by 6 to 8 inches can help prevent acid reflux during sleep by utilizing gravity to keep stomach contents in the stomach. Patients can achieve this elevation by using bed risers or placing blocks under the bed frame’s legs. Sleeping on a wedge-shaped pillow can also provide similar benefits by elevating the upper body during sleep.

Smoking Cessation: Smoking is a modifiable risk factor for GORD, and smoking cessation is an essential aspect of treatment. Patients are encouraged to quit smoking to reduce LES relaxation, improve esophageal motility, and decrease reflux symptoms. Healthcare providers can offer support and resources to help patients quit smoking, such as counseling, nicotine replacement therapy, or prescription medications.

Medications: Pharmacological interventions are often employed to manage GORD symptoms and reduce esophageal mucosal injury. Proton pump inhibitors (PPIs), such as omeprazole, lansoprazole, and esomeprazole, are commonly prescribed to suppress gastric acid production and promote esophageal healing. H2 receptor antagonists, such as ranitidine and famotidine, can also be used to reduce acid secretion and alleviate reflux symptoms. Antacids may provide symptomatic relief by neutralizing stomach acid, although they are less effective at healing esophageal mucosal damage.

Surgical Intervention: In refractory cases or when complications arise, surgical intervention may be considered to improve LES function and prevent reflux. Fundoplication is a surgical procedure in which the upper part of the stomach is wrapped around the LES to strengthen its closure and reduce reflux. Endoscopic procedures, such as transoral incisionless fundoplication (TIF) or radiofrequency ablation (RFA), may also be performed to tighten the LES and improve reflux control. (Nursing Paper Example on Gastrointestinal Disease: Gastroesophageal Reflux Disease (GORD)

Patient Education: Patient education is essential for empowering individuals to actively participate in their GORD management and achieve optimal outcomes. Patients should be educated about the importance of adhering to lifestyle modifications, including dietary changes, weight management, and smoking cessation, to minimize reflux symptoms and prevent complications. Healthcare providers should discuss the rationale behind recommended interventions, potential side effects of medications, and expected outcomes to enhance patient understanding and adherence.

Monitoring and Follow-Up: Regular monitoring and follow-up are crucial components of GORD management to assess treatment efficacy, adjust interventions as needed, and address any emerging concerns or complications. Patients should be encouraged to report any persistent or worsening symptoms, side effects of medications, or difficulties adhering to recommended lifestyle modifications during follow-up visits.

The management of Gastroesophageal Reflux Disease involves a multifaceted approach encompassing lifestyle modifications, pharmacological interventions, surgical options, and patient education. Tailored treatment regimens should address individual patient needs and preferences while emphasizing the importance of adherence to lifestyle modifications and regular monitoring to achieve optimal symptom control and improve esophageal health.

Conclusion

Gastroesophageal Reflux Disease (GORD) is a complex gastrointestinal disorder with multifactorial etiology and diverse clinical manifestations. This essay has provided an overview of the causes, signs and symptoms, etiology, pathophysiology, DSM-5 diagnosis, treatment regimens, and patient education strategies related to GORD. By emphasizing the importance of simple yet formal language, concise paragraphs, and clear transitions, this essay has sought to enhance readability and comprehension while maintaining a formal tone. Effective management of GORD requires a comprehensive approach that encompasses lifestyle modifications, pharmacological interventions, surgical options, and patient education. By addressing modifiable risk factors, empowering patients through education, and individualizing treatment regimens, healthcare providers can improve symptom control, prevent complications, and enhance the quality of life for individuals living with GORD. (Nursing Paper Example on Gastrointestinal Disease: Gastroesophageal Reflux Disease (GORD).

References

http://Clarrett DM, Hachem C. Gastroesophageal Reflux Disease (GERD). Mo Med. 2018 May-Jun;115(3):214-218. PMID: 30228725; PMCID: PMC6140167.

 
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Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis

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Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis

Introduction

Gastrointestinal (GI) diseases pose significant health challenges worldwide, impacting millions annually. Among these ailments, “Gastro,” formally termed gastroenteritis, stands out as a prevalent condition characterized by inflammation of the stomach and intestines. While its colloquial name suggests a focus on the stomach, Gastro affects the entire gastrointestinal tract, causing distressing symptoms and discomfort. Understanding the intricacies of Gastro is essential for effective management and prevention, given its widespread occurrence and potential for complications, especially in vulnerable populations such as children and the elderly. This exploration dives into various aspects of Gastro, including its causes, signs, and symptoms, etiology, pathophysiology, diagnosis according to the DSM-5, treatment regimens, and patient education. By exploring these facets, we aim to gain a comprehensive understanding of this gastrointestinal ailment and its impact on individuals and communities. (Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis)

Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis

Causes

Gastro, formally known as gastroenteritis, is primarily caused by viral or bacterial infections that affect the gastrointestinal tract. The most common viral pathogens responsible for Gastro include norovirus, rotavirus, and adenovirus. These viruses are highly contagious and can spread rapidly through contaminated food, water, or direct contact with an infected individual. Norovirus, for example, is notorious for causing outbreaks in crowded settings such as schools, cruise ships, and nursing homes, highlighting its contagious nature and the ease of transmission.

On the bacterial front, Escherichia coli (E. coli), Salmonella, and Campylobacter are among the leading culprits behind bacterial gastroenteritis. Contaminated food, especially undercooked meat, poultry, eggs, and unpasteurized dairy products, serves as a common source of bacterial infections. Improper food handling, inadequate sanitation practices, and cross-contamination during food preparation contribute to the spread of these bacteria, emphasizing the importance of food safety measures in preventing Gastro outbreaks. (Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis)

Apart from viral and bacterial infections, parasitic organisms such as Giardia lamblia and Cryptosporidium can also trigger gastroenteritis, albeit less frequently. These parasites typically contaminate water sources, leading to waterborne outbreaks of gastroenteritis, especially in regions with inadequate sanitation infrastructure.

In addition to infectious agents, certain non-infectious factors can contribute to the development of Gastro. These include consuming contaminated food or water while traveling to regions with poor sanitation, exposure to toxins or chemicals, and adverse reactions to certain medications or dietary supplements. Furthermore, individuals with compromised immune systems, such as those with HIV/AIDS or undergoing immunosuppressive therapy, are at increased risk of developing severe or prolonged episodes of gastroenteritis due to their reduced ability to fight off infections.

The causes of Gastro are multifaceted, involving a range of infectious agents, poor hygiene practices, contaminated food and water sources, and underlying health conditions. Understanding these various contributors is essential for implementing effective preventive measures and mitigating the impact of gastroenteritis on public health. (Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis)

Signs and Symptoms

Gastro, or gastroenteritis, manifests with a spectrum of signs and symptoms affecting the gastrointestinal tract. These manifestations typically arise suddenly and can vary in severity, ranging from mild discomfort to debilitating illness. Understanding the diverse array of signs and symptoms associated with Gastro is crucial for timely diagnosis and management.

Nausea: Nausea, often described as a queasy or uneasy sensation in the stomach, is a common early symptom of Gastro. It may precede other symptoms and is frequently accompanied by an urge to ’omit. Nausea can vary in intensity, ranging from mild discomfort to persistent feelings of unease.

Vomiting: Vomiting, the forceful expulsion of stomach contents through the mouth, is a hallmark symptom of Gastro. It often follows nausea and may provide temporary relief from gastrointestinal discomfort. Vomiting episodes can be frequent and may lead to dehydration if fluid intake is inadequate.

Diarrhea: Diarrhea, characterized by loose, watery stools, is a prevalent symptom of Gastro. It results from inflammation of the intestinal lining and increased fluid secretion into the bowel. Diarrhea episodes can be frequent and may be accompanied by abdominal cramping and urgency to defecate. (Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis)

Abdominal Pain: Abdominal pain, ranging from mild discomfort to severe cramping, is a common feature of Gastro. It typically arises due to inflammation of the stomach and intestines and may be localized or diffuse. The intensity and duration of abdominal pain can vary among individuals.

Fever: Fever, characterized by an elevated body temperature above the normal range, is a systemic response to infection commonly observed in Gastro. It indicates an immun’ system reaction to the underlying viral or bacterial pathogen. Fever accompanying Gastro is usually low-grade but may spike in severe cases.

Dehydration: Dehydration, resulting from fluid loss through vomiting and diarrhea, is a significant complication of Gastro. It can manifest with symptoms such as increased thirst, dry mouth, decreased urine output, and lethargy. Dehydration requires prompt intervention to prevent complications such as electrolyte imbalances and organ dysfunction. (Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis)

Loss of Appetite: Loss of appetite, or anorexia, is a common symptom of Gastro due to gastrointestinal discomfort and systemic illness. Individuals affected by Gastro may experience a decreased desire to eat, leading to reduced food intake and potential nutritional deficiencies.

Fatigue: Fatigue, characterized by excessive tiredness and lack of energy, is a prevalent symptom of Gastro. It results from the body’s response to infection, immune activation, and fluid loss. Fatigue accompanying Gastro can interfere with daily activities and may persist beyond the resolution of other symptoms.

Muscle Aches: Muscle aches, or myalgia, are often reported by individuals with Gastro. These aches and pains may result from systemic inflammation, dehydration, and the body’s immune response to infection. Muscle aches can contribute to overall discomfort and may worsen with movement.

Headache: Headache, characterized by pain or pressure in the head, is a common symptom associated with Gastro. It may result from dehydration, electrolyte imbalances, or the body’s inflammatory response to infection. Headaches accompanying Gastro can vary in intensity and duration.

Gastro presents with a constellation of signs and symptoms affecting the gastrointestinal tract and systemic health. Recognizing these indicators is essential for prompt diagnosis and appropriate management of this common gastrointestinal ailment. (Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis)

Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis

Etiology

The etiology of Gastro is multifactorial, encompassing various infectious and non-infectious factors that contribute to its development and transmission.

Infectious Agents: Viral and bacterial pathogens are the primary culprits behind infectious gastroenteritis. Norovirus, rotavirus, and adenovirus are among the most common viral pathogens responsible for Gastro. These viruses are highly contagious and can spread rapidly through fecal-oral transmission, contaminated food, water, or close contact with infected individuals. Bacterial gastroenteritis, on the other hand, can result from pathogens such as Escherichia coli (E. coli), Salmonella, and Campylobacter. These bacteria typically contaminate food, especially undercooked meat, poultry, eggs, and unpasteurized dairy products, leading to gastrointestinal illness upon ingestion.

Parasitic Infections: Parasitic organisms such as Giardia lamblia and Cryptosporidium can also cause gastroenteritis, albeit less frequently than viral and bacterial infections. These parasites typically contaminate water sources, leading to waterborne outbreaks of gastroenteritis, especially in areas with inadequate sanitation infrastructure.

Non-Infectious Factors: Non-infectious factors can also contribute to the development of Gastro. These include exposure to toxins or chemicals, adverse reactions to certain medications or dietary supplements, and underlying health conditions such as inflammatory bowel disease (IBD) or irritable bowel syndrome (IBS). Additionally, consuming contaminated food or water while traveling to regions with poor sanitation can predispose individuals to gastroenteritis. (Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis)

Immune Status: The immune status of an individual plays a crucial role in determining their susceptibility to gastroenteritis. Individuals with weakened immune systems, such as those with HIV/AIDS, undergoing immunosuppressive therapy, or elderly individuals, are at increased risk of developing severe or prolonged episodes of gastroenteritis due to their reduced ability to fight off infections.

Environmental Factors: Environmental factors, including poor hygiene practices, inadequate sanitation infrastructure, and crowded living conditions, contribute to the transmission and spread of gastroenteritis. Improving sanitation, promoting hand hygiene, and implementing food safety measures are essential for preventing gastroenteritis outbreaks in communities.

The etiology of Gastro encompasses a diverse range of infectious and non-infectious factors that contribute to its development and transmission. Understanding these underlying causes is crucial for implementing effective preventive measures and mitigating the impact of gastroenteritis on public health. (Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis)

Pathophysiology

Gastro involves a complex interplay of pathophysiological mechanisms that lead to inflammation and dysfunction of the gastrointestinal tract.

Infectious Agent Invasion: Gastroenteritis typically begins with the ingestion of infectious agents such as viruses, bacteria, or parasites. These pathogens invade the lining of the stomach and intestines, where they replicate and trigger an inflammatory response.

Inflammation and Tissue Damage: The presence of infectious agents in the gastrointestinal tract stimulates the release of pro-inflammatory cytokines and chemokines by immune cells. These signaling molecules activate inflammatory pathways and recruit immune cells to the site of infection. The resulting inflammation leads to tissue damage, disruption of the epithelial barrier, and increased permeability of the intestinal mucosa. (Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis)

Increased Fluid Secretion: In response to infection and inflammation, the intestinal epithelial cells secrete fluid into the lumen of the gastrointestinal tract. This increased fluid secretion, coupled with decreased absorption due to epithelial damage, results in diarrhea, a hallmark symptom of gastroenteritis. The loss of fluid and electrolytes through diarrhea contributes to dehydration and electrolyte imbalances in affected individuals.

Altered Gastrointestinal Motility: Gastrointestinal motility, the rhythmic contractions of the digestive tract muscles, is altered in individuals with gastroenteritis. Inflammation and infection disrupt normal peristalsis, leading to abdominal cramping, bloating, and discomfort. These alterations in motility contribute to the symptoms of nausea, vomiting, and abdominal pain commonly experienced in gastroenteritis.

Immune Response: The immune system plays a critical role in the pathophysiology of gastroenteritis. Innate immune cells such as macrophages, dendritic cells, and neutrophils respond rapidly to the presence of infectious agents, initiating the inflammatory cascade. Adaptive immune responses, including the production of antibodies and activation of T cells, also contribute to the clearance of pathogens and resolution of infection. (Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis)

Resolution and Recovery: In uncomplicated cases, the inflammatory response resolves within a few days, and the gastrointestinal tract undergoes repair and regeneration. However, in severe or prolonged cases of gastroenteritis, persistent inflammation and tissue damage can lead to complications such as malabsorption, nutrient deficiencies, and electrolyte imbalances, requiring medical intervention.

The pathophysiology of gastroenteritis involves a complex interplay of inflammatory responses, altered gastrointestinal motility, fluid secretion, and immune activation. Understanding these underlying mechanisms is crucial for elucidating the clinical manifestations and guiding the management of this common gastrointestinal ailment.

DSM-5 Diagnosis

Gastro is a common gastrointestinal ailment characterized by inflammation of the stomach and intestines. While the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), primarily focuses on mental health conditions, healthcare providers diagnose gastroenteritis based on clinical presentation and laboratory findings rather than specific DSM-5 criteria.

Clinical Presentation: The diagnosis of gastroenteritis typically relies on the recognition of characteristic signs and symptoms, including nausea, vomiting, diarrhea, abdominal pain, and sometimes fever. Healthcare providers evaluate the duration, severity, and progression of symptoms to differentiate gastroenteritis from other gastrointestinal disorders. (Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis)

Laboratory Findings: Laboratory tests may be performed to support the diagnosis of gastroenteritis and identify the causative agent. Stool samples may be analyzed for the presence of infectious pathogens such as viruses, bacteria, or parasites. Additionally, blood tests may reveal markers of inflammation and electrolyte imbalances associated with gastroenteritis.

Exclusion of Other Conditions: Healthcare providers use the DSM-5 diagnostic process to rule out other medical conditions that may present with similar gastrointestinal symptoms. Conditions such as inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), food poisoning, and gastrointestinal malignancies must be considered and excluded based on clinical evaluation and diagnostic tests.

Diagnostic Considerations: The DSM-5 provides a framework for assessing and diagnosing mental health disorders, but it does not specifically address gastroenteritis. However, healthcare providers consider the Impact of gastroenteritis on mental health and well-being, particularly in cases of severe or prolonged illness leading to dehydration, malnutrition, and psychological distress. (Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis)

Comorbidity and Psychosocial Factors: While gastroenteritis itself is not listed in the DSM-5, healthcare providers consider comorbid mental health conditions and psychosocial factors that may influence the presentation and management of gastroenteritis. Patients with pre-existing mental health disorders or psychosocial stressors may experience exacerbation of symptoms and require additional support and interventions.

The DSM-5 diagnostic process is not directly applicable to gastroenteritis. Healthcare providers diagnose gastroenteritis based on clinical presentation, laboratory findings, and the exclusion of other gastrointestinal conditions. Understanding the diagnostic criteria and considerations for gastroenteritis is essential for accurate diagnosis and appropriate management of this common gastrointestinal ailment.

Treatment Regimens

The management of gastroenteritis focuses on relieving symptoms, preventing complications, and supporting the body’s recovery from the infection. Treatment regimens for gastroenteritis vary depending on the severity of symptoms, the underlying cause, and the individual’s overall health status. (Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis)

Hydration: Rehydration is a cornerstone of gastroenteritis management, especially in cases of vomiting and diarrhea leading to fluid loss. Oral rehydration solutions containing electrolytes and glucose are recommended to replace lost fluids and maintain electrolyte balance. In severe cases of dehydration, intravenous fluids may be necessary to restore hydration status.

Symptom Management: Medications may be prescribed to alleviate symptoms such as nausea, vomiting, and abdominal pain. Antiemetics, such as ondansetron, can help control nausea and vomiting, while antidiarrheal medications like loperamide may be used to reduce diarrhea frequency. Analgesics such as acetaminophen or ibuprofen may be recommended for abdominal pain and discomfort.

Antiviral and Antibiotic Therapy: In cases of viral gastroenteritis, antiviral medications are not typically prescribed, as the infection is self-limiting and resolves on its own. However, in certain situations, such as severe or prolonged illness or immunocompromised individuals, antiviral medications may be considered. Antibiotics are not routinely recommended for viral gastroenteritis but may be prescribed for bacterial gastroenteritis caused by specific pathogens such as Salmonella or Campylobacter. (Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis)

Dietary Modifications: Dietary modifications play a crucial role in gastroenteritis management. A bland diet consisting of easily digestible foods such as bananas, rice, applesauce, and toast (BRAT diet) may help alleviate gastrointestinal symptoms. Avoiding spicy, fatty, and dairy-rich foods can reduce gastrointestinal irritation and discomfort. Gradually reintroducing a regular diet as tolerated is recommended as symptoms improve.

Probiotics: Probiotics, beneficial bacteria that promote gut health, may help shorten the duration of diarrhea and reduce the risk of recurrent gastroenteritis episodes. Probiotic supplements or probiotic-rich foods such as yogurt and kefir can be incorporated into the diet during and after gastroenteritis treatment. (Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis)

Patient Education: Patient education is an integral part of gastroenteritis management. Patients should be advised on proper hydration techniques, dietary modifications, and medication adherence. They should also be educated on hand hygiene practices to prevent the spread of gastroenteritis to others.

Patients should also be educated about the importance of follow-up care in gastroenteritis management. Encouraging individuals to schedule follow-up appointments with their healthcare provider ensures ongoing monitoring of symptoms, treatment effectiveness, and resolution of gastroenteritis. Providing guidance on when to seek medical attention for persistent or worsening symptoms beyond the expected duration of gastroenteritis is essential for timely intervention and prevention of complications.

Conclusion

Gastroenteritis, commonly known as “Gastro,” presents as a significant gastrointestinal ailment characterized by inflammation of the stomach and intestines. Through an exploration of its causes, signs and symptoms, etiology, pathophysiology, diagnosis according to clinical presentation and laboratory findings, treatment regimens, and patient education, we have gained a comprehensive understanding of this condition. By emphasizing the importance of hydration, dietary modifications, medication adherence, hand hygiene practices, and follow-up care in gastroenteritis management, individuals can effectively navigate the condition and promote optimal health outcomes. Empowering patients with knowledge about gastroenteritis and its management is essential for mitigating its impact, preventing complications, and facilitating timely intervention when necessary, ultimately enhancing the quality of life for affected individuals. (Nursing Paper Example on Gastrointestinal Disease: An Overview of Gastroenteritis)

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7173482/

 
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Nursing Paper Example on Antisocial Personality Disorder (ASPD)

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Nursing Paper Example on Antisocial Personality Disorder (ASPD)

Introduction

Nursing Paper Example on Antisocial Personality Disorder (ASPD)

Antisocial Personality Disorder (ASPD), like all personality disorders represents a stable, pervasive pattern of behavior that is present for an individual’s entire life. In ASPD generally, the configuration is primarily one of a disregard for, and a violation of, the rights of others. This manifests itself in the individual fundamentally not caring about the wants, needs, and desires of others. The result of this core belief that others do not matter is behavior that mostly leads to arrest for petty offenses like theft. Though these crimes are not personality traits, the record that they create is reliable and traceable, making a good diagnostic tool. Another similar diagnostic tool is the individual’s work and school record. ASPD traits make listening to authority figures nearly impossible so most of these individuals have spotty educational and work histories.

These behavioral markers are the result of several personality traits. One of these chief characteristics is impulsiveness. Individuals with ASPD do not stop to carefully consider the consequences of their activity, rather they simply do what they want for themselves in the moment. This impulsivity can lead to reckless and dangerous activity both for their own safety and for the safety of others. They may drive with excessive speed or push others near a traffic filled intersection. If they desire the property of others and they can take it, they will. This same attitude that is used toward property is used toward other people. They will lie or con others in order to fulfill their personal desires. (Nursing Paper Example on Antisocial Personality Disorder (ASPD))

If the individual with ASPD is not able to meet their desires through theft or con, they will not stop trying to fulfill their needs. They are prone to get very irritable and often get very aggressive towards others. Fighting with others will likely be prevalent in their personal history. At the end of their theft, maltreatment, and aggressiveness they will not feel sorry for their actions. They will either not care that they have caused harm or rationalize the situation.

In order to qualify for a diagnosis three other criteria must be met:

The individual must be at least 18 years old. Individuals who are growing up and going through puberty do not have the stable personality required to be diagnosed with a personality disorder.

There must also be proof in their developmental history that the individual had antisocial traits as a child. This is demonstrated by fulfilling criteria for Conduct Disorder before age 15. Diagnosticians want to know that the individual’s personality has been set. They would like to know that the individual was like this before puberty and will be like this long after puberty before diagnosing a personality disorder.

The antisocial behavior must not be exclusively during schizophrenia or a manic episode. The behavior should not be because of an Axis I condition. (Nursing Paper Example on Antisocial Personality Disorder (ASPD))

Psychopathy & Sociopathy

In the literature there is a much greater emphasis on studying psychopathy and sociopathy than there is antisocial personality disorder. These three are related but are not identical. Antisocial personality disorder is the only one of these three terms that exists in the DSM-IV-TR. Psychopathy is defined by characteristics such as a lack of empathy and remorse, criminality, antisocial behavior, egocentricity, manipulativeness, irresponsibility and a parasitic lifestyle. It is commonly conceptualized that psychopathy is a more severe form of APD and this thinking is reasonably accurate. Almost all individuals who fulfill the requirements to receive the label of psychopathy fulfill the requirements for ASPD but most of the individuals who fulfill the requirements of ASPD do not also get the label of psychopath. The term sociopath is an attempt to demystify the term psychopath since many generalize the term psycho in psychopath to apply to other terms like psychotic. Sociopathy is also an attempt by some clinicians to explain the etiology of the condition as characterized by early socialization experiences. (Nursing Paper Example on Antisocial Personality Disorder (ASPD))

Nursing Paper Example on Antisocial Personality Disorder (ASPD)

Still Human

Subtypes

One of the diagnostic challenges with any personality diorder is that there is typically significant overlap between the personality disorders. This is due both to the diagnostic overlap in the definition of each of the personality disorders and the fact that individuals typically display many different traits throughout their lifetime. In order to get a better understanding of the common personality trait overlaps, Theodore Miller created a series of 5 subtypes of ASPD:

Coveteus—this type is purely made up of ASPD traits. This individual feels intentionally denied and deprived and seeks to get the things s/he covets but gets little satisfaction from ownership.

Nomadic—this type is ASPD with schizoid, schizotypal and avoidant features. This individual feels cast aside and is typically a drifter and societal dropout. When this individual acts out it is against that impulse.

Malevolent—this type is a mix of ASPD with paranoid personality features. This individual is typically more violent than the other personality disorder types. He expects betrayal and punishment and attempts to get revenge in a pre-emptive manner.

Risk-taking—this type is a mix of ASPD and histrionic features. This individual has the risk taking features of ASPD amplified heavily. They are very audacious and bold to the point of recklessness and they continuously pursue perilous adventures.

Reputation-defending—this type is a mix between ASPD and narcissistic features. This individual has a need to be thought of as unflawed and formidable and will react extremely negatively to perceived slights to status. (Nursing Paper Example on Antisocial Personality Disorder (ASPD))

Differences

Two of the most problematic differences for ASPD are Narcissistic and Histrionic personality disorder. Narcissistic Personality Disorder shows similar distorted thinking about others. They care little for the wants and needs of others and have limited empathy. Individuals with Narcissistic PD can be manipulative as well. However, Narcissistic individuals rarely show evidence of conduct disorder in youth or antisocial aggression. The underlying thought process behind their rules and norms breaking behavior is different as well. With ASPD the individual feels that they are entitled and special and that they can break the rules because of this fact. The ASPD individual does not need the rationalization, typically they do what they want because they want to do it. (Nursing Paper Example on Antisocial Personality Disorder (ASPD))

Individuals with Histrionic PD are often impulsive, show very little depth in their empathy and understanding of others. Their dramatic flair can be seen as impulsivity and can do things like maintaining affairs that can be characterized as violating social norms. However, histrionic individuals are not aggressive and will not show evidence of Conduct Disorder in typical presentation.

Symptom Overlap Between Antisocial and Narcissistic/Histrionic

 

Etiology

The nature of personality disorders makes their etiology more difficult to pin down than other disorders. ASPD requires even more evidence of prolonged atypical functioning than other personality disorders because it requires evidence of maladaptive functioning before age 18. This requirement muddies the already murky waters that are the interplay of genetics and environment and their expression in both brain anatamy and psychological activity. (Nursing Paper Example on Antisocial Personality Disorder (ASPD))

Irregularities of the serotonin network in the brain responsible for the release, use, and reuptake of the neurotransmitter are linked to individuals with ASPD. This network has been linked separately both to individuals diagnosed with ASPD and to highly impulsive behavior. The theory is that this deficit can lead either to arousal thresholds being too low in individuals who show impulsivity or the arousal threshold is too high in individuals who are cold or callous.

Psychological and family systems factors have also been shown to have an effect on the expression of ASPD. The researchers used national epidemiological survey and found individuals from a data set of alcohol users who also were antisocial, finding 1200 individuals on which to base their results. They found that significant childhood experiences of abuse and neglect significantly predict eventual display of ASPD. These early experiences of violence or abandonment have significant effects on attachment and relationship formation. (Nursing Paper Example on Antisocial Personality Disorder (ASPD))

Duggan (Duggan, et al. 2012) showed a positive relationship between early onset of alcohol use and the transition of conduct disorder to ASPD. Those who used alcohol and other substances at an earlier age more often wound up being diagnosed with ASPD than those who did not. This effect can easily by hypothesized to have an etiological function in either biological or social bases. Perhaps the drug use affected neurological pathways to make the individuals more susceptible. Perhaps early onset drug use was indicative of a social network that was more conducive to reinforcing antisocial behavior.

Gender Gap

There is a very wide diparity between the number of men and women who meet the criteria for diagnosis with ASPD. Epidemiological research suggests that as many as 3% of men have ASPD while less than 1% of women do. Some theorists, like Miller, have argued that the disparity in men and women in ASPD is mirrored by the same disparity with the diagnosis of Borderline Personality Disorder. Women are proportionately more likely to receive that diagnosis than men are to receive a diagnosis of ASPD. This may be due to the fact that the criteria for APD are heavily gender biased. Where men will use naked aggression in a way that leads to multiple arrests (criteria A-1 and criterion A-4) women tend to use relational aggression which has very different outcomes. The same underlying etiology and pathology lead to very different behaviors because these behaviors are mediated by cultural norms. The masculine ideal in the United States contains many antisocial traits. Men are encouraged to be self-reliant, independent, and to use physical force when necessary. They are taught to be stoic and unemotional. This antisocial personality is an overextension of that ideal. Women, on the other hand, are not taught to be unemotional or physically violent, so they manifest that same aggression in different ways. Alegria (Alegria, et al. 2013) found that women have to have a significantly higher lifetime loading of abuse and neglect to show antisocial traits than men do. (Nursing Paper Example on Antisocial Personality Disorder (ASPD))

The top theoretical explanations for antisocial personality traits unfortunately leave little for individual agency. The difficulty is that the diagnosis of ASPD requires that the individual gain their personality traits when they are least able to defend against them – during or before their teen years. The biological explanation leaves basically no room for personal agency. It is impossible to willfully change your brain chemistry. Other theoretical standpoints argue that childhood maltreatment and neglect are to blame. A neglected or abused child has little ability to even avoid their maltreatment, let alone recover from their own psychological load. One simple step that is clear from the literature is to delay the onset of alcohol and substance use. Using substances at an early age is a significant loading factor for ASPD. Avoiding early alcohol use can positively affect brain chemistry and alter future habitual activity for the better.

Hypothetical Conceptualization

Psychodynamic

Psychodynamic theorists conceptualize ASPD begins in the early childhood phase of trust vs. mistrust. Children who will later show evidence of conduct disorder and then ASPD do not have adequate social relationships as children. These inadequate relationships center on a lack of parental love. A lack of parental love can lead a child in many different pathological directions and is not necessarily indicative of ASPD in and of itself. Some subset of these children respond to the lack of love demonstrated by their parents by becoming emotionally aloof. They begin to develop the relational style that they are taught at home by bonding with others through overt power dynamics instead of a shared emotional bond. Psychodynamic theorists can point to the evidence of pervasive early childhood trauma in individuals who eventually develop ASPD as proof of their conceptual framework. (Nursing Paper Example on Antisocial Personality Disorder (ASPD))

Unfortunately, psychodynamic theoretical framework is largely ineffective. There are a number of hypothesized reasons for this therapeutic failure. The first is that almost no one with ASPD is in treatment voluntarily. In addition to this difficulty, individuals with ASPD also have no conscience and little motivation to change who they are naturally which further compounds treatment difficulty. Antisocial individuals also tend to have a very low frustration tolerance which makes seeing treatment through to its conclusion very difficult. (Nursing Paper Example on Antisocial Personality Disorder (ASPD))

Cognitive-Behavioral

Cognitive-Behavioral therapists conceptualize antisocial activity as a modeled behavior. Children may be reenacting the violent behavior that they experience in a far too personal manner. Theorists also believe that the negative acting out and violent behaviors may be reinforced by the attention that they receive. Parents may give in to violent outbursts simply to restore the peace once individuals have acted out.

Cognitive-behavioral therapists do not attempt to repair the causes of ASPD, consistent with their treatment modalities. They target problem behavior. Therapists attempt to give APD individuals skills to understand moral issues and conceptualize the needs of others. Some prisons and hospitals have tried to put ASPD individuals in group settings to teach responsibility. This approach does not seem to have any effect in most cases. (Arntz, Cima and Lobbestael 2013). (Nursing Paper Example on Antisocial Personality Disorder (ASPD))

Biological Theories

Biological theorists have begun using psychotropic medications on individuals with ASPD. Atypical Antipsychotic drugs have been used to treat ASPD. These newer antipsychotic medications bind to multiple dopamine receptor but also have an effect on serotonin. These therapies have not been evaluated in large scale trials to date. (Brook and Kosson 2013)

Biological models have many findings pertinent to individuals with ASPD. First, as was stated in depth earlier, serotonin deficits may be responsible for ASPD traits, especially in individuals who display highly impulsive behavior. Another area of research is the frontal lobes. Many individuals with ASPD have smaller or deficient frontal lobes. Lastly, it appears that many individuals with ASPD have very low resting levels of anxiety. Low levels of anxiety explain why it is difficult for individuals to learn from past negative experiences. (Boccaccini, et al. 2012)The biological model theorizes multiple etiologies for these deficiencies. They may come from genetic factors that cause malformation as children, nutritional deficiencies at key periods in development, the effect of viruses, or from physical harm such as brain lesions. (Nursing Paper Example on Antisocial Personality Disorder (ASPD))

Conclusion

Antisocial Personality Disorder is a difficult but influential disorder. It is an important problem both for the psychological community and for society. The psychological community has not been able to offer any meaningful therapeutic approaches. Part of the reason that this is the case has to do with the very recalcitrant nature of the disorder itself. Another significant part of that reason is that the psychological community cannot decide where to focus its research. Many very distinguished individuals have been trying to dissect a tiny subset of the APD population because they are very scary and are good for getting grant money. Society at large has a vested interest in ASPD because it makes up such a significant portion of the prison population. These individuals are likely to recidivate and likely to commit violent crimes. Understanding this population better is vital for long term meaningful prison reform. (Lewis, Olver and Wong 2013)

In addition to failing individuals with ASPD in terms of treatment, it is relevant to note that society is failing individuals with ASPD in their formative years. Recurrent episodes of neglect and abuse are run-of-the-mill for individuals with ASPD. Society at large needs to do a better job of policing this kind of abuse and neglect and provide safe, rehabilitative experiences for those who are victims of it. (Nursing Paper Example on Antisocial Personality Disorder (ASPD))

References

https://pubmed.ncbi.nlm.nih.gov/31536279/

 
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Health Care Policy and Determinants

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Health Care Policy and Determinants

(Health Care Policy and Determinants)
Part 1: The Importance of Health Care Policy and Its Impact on Determinants

Health care policy plays a critical role in shaping health outcomes and ensuring equitable access to health services. Policies guide the allocation of resources, regulation of providers, and delivery of care. Health care determinants—such as socioeconomic status, education, environment, and access to care—are heavily influenced by these policies. For instance, a policy expanding Medicaid eligibility directly improves access to health care services for low-income populations, positively affecting their health outcomes. Additionally, health care policy influences preventive care efforts, insurance coverage, and public health programs. Through well-crafted policies, disparities in health care delivery and outcomes can be addressed effectively. Therefore, policies not only serve as administrative tools but also as instruments for social justice and public health improvement.

Part 2: Health Care Policy Forms Chart

Identify the four different forms of health care policy Identify an example of each form identified Classify the form identified into one of the two categories of the health care policy Describe why the health care form identified fits in the category identified (15–45 words)
1. Laws The Affordable Care Act (ACA) Regulatory Laws set standards and rules that govern the operation and delivery of health services.
2. Rules and Regulations HIPAA Privacy Rule Regulatory Regulations enforce existing laws by detailing how they will be implemented and monitored.
3. Operational Decisions Medicare reimbursement procedures Allocative These decisions allocate resources by determining payment methods and service coverage.
4. Judicial Decisions Supreme Court ruling on ACA mandate Regulatory Judicial decisions interpret and enforce laws, setting legal precedents in health care policy.

Part 3: Using Different Health Care Policy Forms to Shape Future Policies

Different forms of health care policy provide a framework for future policy development. Laws can establish foundational programs like Medicare, which may later be expanded through amendments or new rules. Regulations adapt to evolving needs by defining how existing laws are implemented. Operational decisions allow for flexible resource allocation, especially when addressing emergent health issues such as pandemics. Judicial decisions, on the other hand, clarify constitutional boundaries and influence the legality of new policies. Together, these forms allow policymakers to create responsive, evidence-based legislation that meets both current and future health care demands. They ensure that policy can be adjusted as health care systems and population needs evolve.

References

Longest, B. B. (2016). Health policymaking in the United States (6th ed.). Health Administration Press.
U.S. Department of Health and Human Services. (n.d.). HealthCare.gov. https://www.healthcare.gov

 
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Gender Beliefs in Childhood

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Gender Beliefs in Childhood

(Gender Beliefs in Childhood)

During Early Childhood, Gender-Stereotyped Beliefs

1. During early childhood, gender-stereotyped beliefs

A. first emerge.
B. strengthen.
C. weaken.
D. disappear.

2. Gender-schematic thinking is so powerful that when children see others behaving in gender-inconsistent ways, they

A. become more pronounced in their gender segregation as well as gender-role conformity.
B. experience a crisis of gender labeling that disrupts peer interactions.
C. object and tell that person not to behave in such a way.
D. often can’t remember the behavior or distort their memory to make it gender-consistent.

3. The connection between mature moral reasoning and action is

A. nonexistent due to the fact that theoretical morality and real-life morality are based on different constructs.
B. weak due to the impact of personal relationships on the decision-making process.
C. modest due to the influence of empathy, sympathy, and guilt.
D. strong due to the realization that behavior reflects thinking and judgments.

4. Dr. Arbus is interested in learning how children come to understand their multifaceted world. In her research, she asks questions like, “When do infants discover that they are separate beings, distinct from other people and objects?” Dr. Arbus is studying

A. the inner self.
B. social cognition.
C. personality development.
D. self-concept.

5. Colin says, “I’m Colin. I’m 6 years old and have two older brothers. I’m good at running and football. I’m not very good at wrestling, and I don’t like doing my chores. Sometimes I get mad at my brothers.” Colin is constructing his

A. self-concept.
B. remembered self.
C. theory of mind.
D. autobiographical narrative.

6. Research findings suggest that language is _______ teach children about gender stereotypes and gender roles.

A. the only method to
B. the primary means through which parents
C. not a factor in the way that parents
D. a powerful indirect means to

7. Twin studies reveal that empathy is _______ heritable.

A. slightly
B. highly
C. rarely
D. moderately

8. Which of the following statements is an example of recursive thought?

A. “If she doesn’t give me the book, I’m going to tell the teacher.”
B. “Mommy is mad because I hit my sister.”
C. “I thought you would think I was just kidding when I said that.”
D. “My teacher is always happy.”

9. During the evening drive home, Mr. Cruz looks at his 4-year-old daughter in the rearview mirror and asks what she’s doing. She responds, “I’m thinking inside.” Her response indicates an awareness of the _______ self.

A. categorical
B. enduring
C. remembered
D. inner

10. Eight-year-old Oren has just begun describing other people’s personalities. He is most likely to describe someone as

A. “tall and thin.”
B. “boring and dull.”
C. “angry and sad.”
D. “always fighting with people.”

11. In the United States, _______ students are the most isolated group.

A. white
B. Hispanic
C. black
D. Asian

12. Because cross-cultural findings on the reversals of traditional gender roles are inconclusive, a more
direct test of the importance of biology on gender typing could be achieved by

A. studying adolescent boys and girls in tribal villages.
B. observing other-sex play in children who score high in androgyny.
C. observing infant behavioral preferences immediately after birth.
D. testing the impact of sex hormones on gender typing.

13. To manage her emotion, 12-year-old Britney appraises the situation as changeable, identifies the difficulty, and decides what to do about it. Britney is using

A. problem-centered coping.
B. emotion-centered coping.
C. emotional self-efficacy.
D. a secure base.

14. _______ is the only emotion that males express more freely than females in everyday interaction.

A. Anger
B. Sorrow
C. Embarrassment
D. Envy

15. Which of the following four babies who went to the doctor for the same vaccination will most likely remember it better?

A. Mari, who smiled and cooed at the doctor
B. Bina, who was highly upset by the injection
C. Wyatt, who was startled by the injection, but didn’t cry
D. Juan, who remained alert throughout the appointment

16. Mastery-oriented children focus on learning goals, whereas learned-helpless children focus on _______ goals.

A. performance
B. specific
C. short-term
D. social

17. Temper tantrums tend to occur because toddlers

A. frequently compete with siblings for desired toys.
B. are easily overwhelmed and often have a difficult temperament.
C. recall that crying as an infant got them immediate adult attention.
D. can’t control the intense anger that often arises when an adult rejects their demands.

18. After seeing two little boys taunt another child on the playground, Najai tells the teacher that they should make playground rules that protect other people’s rights and welfare. Najai is requesting a common set of

A. social conventions.
B. moral imperatives.
C. moral ideals.
D. matters of personal choice.

19. In 1990, shyness in Chinese children was positively associated with being well-adjusted. However, as China’s market economy expanded and the valuing of _______ increased, the direction of the correlations shifted.
A. timidity
B. passivity
C. collectivist values
D. sociability

20. In response to the Heinz dilemma, Bill says, “You shouldn’t steal the drug because you’ll be caught and sent to jail if you do. If you do get away, the police would catch up with you any minute.” Bill is most likely in the _______ stage.

A. instrumental purpose orientation

B. punishment and obedience orientation

C. social-order-maintaining orientation

D. morality of interpersonal cooperation Childhood Development

 
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Effective EHR Communication Practices

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Effective EHR Communication Practices

(Effective EHR Communication Practices)

Health Information Systems And The Electronic Health Record

Neehr Perfect Activity: Communication Within the EHR

Overview

This activity is designed for the beginning EHR student user. The focus of the activity is how clear documentation in an EHR can facilitate communication among the healthcare team. The student will look at diagnoses and problems documented in a patient chart and the use of approved, and unapproved, abbreviations.

Prerequisites

1. Completion of Scavenger Hunts I – III

Student instructions

1. If you have questions about this activity, please contact your instructor for assistance.

2. Document your answers directly on this document as you complete the activity. When you are finished, save this document and upload it to your Learning Management System (LMS). If you have any questions about submitting your work to your LMS, please contact your instructor.

3. Screen displays are provided as a guide and some data (e.g. dates and times) may vary.

Additional resources

1. You may use any of the following resources to complete this activity:

a. The EHR: The Lexicon search on the Problems tab.

b. Websites.

c. Your textbooks.

Objectives

1. Demonstrate ability to locate necessary data from a patient chart.

2. Apply diagnosis codes according to current guidelines.

3. Identify errors in documentation within a patient chart.

 

Glossary(Effective EHR Communication Practices)

ICD-10 – The 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases. ICD-10s are very detailed in their descriptions, compared to the ICD-9s that are no longer in use.

Problem – A current or a historical health care problem. Sometimes called a diagnosis or a “complaint.”

The activity

Patient problems: communicating with the healthcare team

For patients with a 3 to 5-day hospital stay, a study revealed that an average of 30.8 clinicians could access the electronic chart, including 10.2 nurses, 1.4 attending physicians, 2.3 residents, and 5.4 physician assistants (Vawdrey et al, 2011). With those numbers alone, the importance of accurate and timely documentation in the EHR is imperative.

A problem list can summarize patient medical information, such as a patient’s major diagnoses, symptoms, past medical and/or surgical history, and recurrent complaints. This problem list can be seen by those involved in the patient’s care allowing for communication within the patient’s medical record. When documented correctly, this can ultimately lead to continuity of care, improved patient safety, and a thorough interdisciplinary approach. There are many times that healthcare team members never see one another, and the only way to communicate to others caring for the same patient is through the documentation in the patient’s medical record.

Go to the chart of Warren Olson. Notice that his active problems are listed as ICD-9 codes. In this activity, you will be updating all of the current ICD-9s to ICD-10s. Notice how the ICD-10 terms are more specific and there is a different code for left, right, and so on.

1. To update the Problems, you will be filling in the blanks in the table below. You may use any of the following resources to complete the table.

(You may be prompted to choose an Encounter Provider. Choose your instructor and click OK).

· The EHR: On the Problems tab click on New Problem. You can enter the ICD-10 code or the diagnosis. Click on Search. Once you have your answer click on Cancel to enter a new diagnosis or code. DO NOT CLICK OK AND DO NOT SAVE ANY PROBLEMS TO THIS CHART. You will not be documenting in Warren Olson’s chart. You will be entering your answers in the table below.

· Websites.

· Your textbooks.(Effective EHR Communication Practices)

Current diagnosis ICD-9 Updated diagnosis term ICD-10 List your resource
Coronary Artery Disease 414.9 I25.9
Carotid Stenosis 799.9 Occlusion and stenosis of unspecified carotid artery
Cerebrovascular Accident 436.0 Occlusion and stenosis of right posterior cerebral artery
Peripheral Vascular Disease, Unspecified 443.9 I73.9
Hypertension 401.9 I10
Hearing Loss 389.9 Unspecified hearing loss, bilateral
Syncope 780.2 Syncope and collapse

2. Looking at the Problems tab in Mr. Olson’s chart, do you feel this is enough information to accurately explain why the he was admitted to the hospital? Does it present a clear enough picture to the healthcare team? Explain why or why not?

 

3. Mr. Olson also has symptoms that are documented in the admission notes that can be used to communicate presenting complaints and immediate concerns on the Problems tab. When a patient arrives to the emergency room, and before a diagnosis is entered, there are symptoms that tell the healthcare team what is going on. For example, “The patient came in complaining of being dizzy and nauseated.” These symptoms lead to assessments and tests, which in turn produce a diagnosis.

 

Complete the table below. This information was gathered from the MEDIC: ADMIT NOTE documented when the patient first arrived at the hospital. Using the same resources from question #1, locate the medical term, or problem, that would be coded with an ICD-10 code.

Symptom Medical term (or Problem)(Use the term associated with the ICD-10 code) ICD-10 code List your resource
Weakness Muscle weakness (generalized)
Slurred speech
Lightheaded Dizziness and giddiness
SOB (shortness of breath)

4. Should Mr. Olson’s symptoms have been included on the Problems tab? Explain why or why not?

Errors in communication(Effective EHR Communication Practices)

A study at a large urban hospital found that while pediatricians were able to understand 56-94% of the abbreviations used, physicians from other fields understood only 31-63% of those same abbreviations, highlighting the ambiguous nature of many abbreviations. Another study looked at a selection of abbreviations from recent hospital admissions and asked different members of a multidisciplinary care team to decipher them. They found that the average correct response rate was only 43%, with specific abbreviations better known by the professionals who used them the most. A third study in Australia that looked at error-prone abbreviations in medication orders found that of the 8,296 medication orders, 1,162 error-prone abbreviations were found, with an average of 2.4 per patient (Rodwin, B. 2013). Not only do abbreviations make it difficult for healthcare team members to understand fully what is occurring with their patient, but abbreviations are a major safety concern for the patient.

5. Go to the Notes tab of Mr. Olson’s chart and look at the following notes, MEDIC: CONSULTATION REPORT and the MEDIC: ADMIT NOTE. Read the notes. Notice the abbreviations and use of symbols. Using online resources or your textbook, decipher the following. Write your answers in the table below.

Abbreviation What it means List your resource
“s/p 3V CABG”
“s/p L CEA”
“SVG->OM”
“MJ andshrooms but no IVDU”
“Abd soft, NT/ND”
“check TTE to eval LV fxn and valvular dz”
“HEAD: NCAT”
“sig b/l weakness X 4 limbs LE more pronounced”

6. Having completed the table in #5, answer the following question. Do you feel that healthcare providers should not use abbreviations when documenting, or should they be limited on the abbreviations they can use, such as a standardized abbreviations list? Explain your answer, and provide references if any were used.

(Effective EHR Communication Practices)

References

Rodwin, B. (2013). Why you should think twice about using medical abbreviations. Clinical Correlations. Retrieved from http://www.clinicalcorrelations.org/?p=6304

 

Vawdrey, D. K., Wilcox, L. G., Collins, S., Feiner, S., Mamykina, O., Stein, D. M., Stetson, P. D. (2011). Awareness of the Care Team in Electronic Health Records. Applied Clinical Informatics, 2(4), 395–405. http://doi.org/10.4338/ACI-2011-05-RA-0034

2 Neehr Perfect Activity: Communication Within the EHR v4Archetype Innovations LLC ©2017
 
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Survey of Healthcare Management

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HE310 Survey of Healthcare Management

(Survey of Healthcare Management)

Directions: Be sure to make an electronic copy of your answer before submitting it to Ashworth College for grading. Unless otherwise stated, answer in complete sentences, and be sure to use correct English spelling and grammar. Sources must be cited in APA format. Your response should be three (3) to six (6) pages in length; refer to the “Assignment Format” page for specific format requirements.

This written assignment has two parts and involves combining the case studies from lessons 1-4. For each of the case studies, you are responsible for selecting the appropriate case at the end of the applicable chapter and response to the question. In each of the cases you will respond as if you are the hospital administrator. For part 1 of this written assignment, please see case studies relating to lessons 1-4 below. Please combine your response to these case study questions into part I of your written assignment.

Part I(Survey of Healthcare Management)

Lesson 1

Case Study 1. Better Service to Current Patient Population

You are the administrator of a 250-bed hospital. A recent report from the county tells you that the population within a 25-radius of your facility is getting younger – the median age in the area has decreased from 35 years of age to 29 years of age. This was an expected impact of the new state university campus that has opened about five miles away. What do you need to review and analyze to ensure that you can provide the services required by this changing population in your area?

Lesson 2

Case Study 2. Using Statistics to Support Expansion Plans

Evaluate the data from the Agency for Healthcare Research and Quality (AHRQ) Data & Surveys (www.ahrq.gov/data) shown in Figure 2-8 in your textbook. After reading the statistics and referencing Figure 2-8 determine what services you would recommend if you were the administrator of a health care facility in Illinois, to expand what is available at your facility. Support your recommendation with specific statistics from the table.

Lesson 3

Case Study 2. Determining Opportunities to Increase Revenues

Evaluate the data available in Figure 3-6, which is from the Health, United States, 2010 report from the US Department of Health and Human Services, available in Figure 3-7. If you were the administrator of a heath care facility, what actions would you recommend to ensure your organization can increase revenues? Support your recommendations with specific statistics from Figure 3-6.

Lesson 4

Case Study 3

“Researchers now believe that most medical errors cannot be prevented by perfecting the technical work of individual doctors, nurses, or pharmacists. Improving patient safety often involves the coordinated efforts of multiple members of the health care team, who may adopt strategies from outside health care.”

“The report reviews several practices whose evidence came from the domains of commercial aviation, nuclear safety, and aerospace, and the disciplines of human factors, engineering and organizational theory. Such practices include root cause analysis, computerized physician order entry and decision support, automated medication dispensing systems, bar coding technology, aviation-style preoperative checklists, promoting a ‘culture of safety,’ crew resource management, the use of simulators in training, and integrating human factors theory into the design of medical devices and alarms.”

Discuss this concept of utilizing standard business quality initiatives and the logic of adopting them to use in healthcare. Choose one of the practices identified in paragraph 2, research it, summarize it, and include how you might apply this concept in your healthcare facility.

The practices identified in paragraph 2 are:

  • Root cause analysis

  • Computerized physician order entry and decision support

  • Automated medication dispensing systems

  • Bar coding technology

  • Aviation-style preoperative checklists

  • Promoting a “culture of safety”

  • Crew resource management

  • The use of simulators in training

  • Integrating human factors theory into the design of medical devices and alarms

Part II(Survey of Healthcare Management)

For part II of the written assignment, explain why the following course objectives are important for hospital administrators:

  1. Identify the responsibilities of the healthcare administrator.

  2. Evaluate various types of healthcare facilities and the different types of services performed in these facilities.

  3. Analyze the financial side of healthcare, including reimbursement methodologies.

  4. Explain the link between quality of care and health care administration.

Please include at least 3 scholarly articles within your response. Overall response will be formatted according to APA style and the total assignment should be between 3-6 pages not including title page and reference page.

Grading Rubric

Please refer to the rubric on the next page for the grading criteria for this assignment.

CATEGORY

Exemplary – 25 points
Student provides all case study activities and presents information in a manner that demonstrates the skills of hospital administrator. A deeper level of critical thinking skills are displayed in case study activity responses.

Satisfactory – 20 points
Student provides all case study activities and presents information in a manner that demonstrates some skills of hospital administrator. Critical thinking skills are displayed in case study activity responses.

Unsatisfactory – 15 points
Student does not provide all case study activities or does not demonstrate skills of a hospital administrator appropriately. No critical thinking skills displayed in response.

Unacceptable – 10 points
Student does not provide all case study activities and does not demonstrate skills of a hospital administrator appropriately. No critical thinking skills displayed in response.

Exemplary – 50 points
Student applies critical thinking skills to appropriately discuss why first four learning objectives are critical to hospital administrators. Student uses more than 3 scholarly articles to substantiate response. Each objective discussion exceeds expectations and demonstrates deep level of analysis.

Satisfactory – 40 points
Student applies some critical thinking skills to appropriately discuss why first four learning objectives are critical to hospital administrators. Student uses 3 scholarly articles to substantiate response. Each objective discussion is adequately discussed, but further, deeper level of analysis is needed.

Unsatisfactory – 30 points
Student does not apply critical thinking skills to explain why first four learning objectives are critical to hospital administrators or the student uses less than 3 scholarly articles to substantiate response. Each objective discussion is not adequately discussed and some objective could be omitted.

Unacceptable – 20 points
Student does not apply critical thinking skills to explain why first four learning objectives are critical to hospital administrators and the student uses less than 3 scholarly articles to substantiate response. Each objective discussion is not adequately discussed and some objectives are omitted.

Mechanics

Exemplary – 10 points
Student does not make any errors in grammar or spelling, especially those that distract the reader from the content.

Satisfactory – 8 points
Student makes 1-2 errors in grammar or spelling that distract the reader from the content.

Unsatisfactory – 5 points
Student makes 3-4 errors in grammar or spelling that distract the reader from the content.

Unacceptable – 2 points
Student makes more than 4 errors in grammar or spelling that distract the reader from the content.

Format – APA Format, Citations, Organization, Transitions (15 Points)

Exemplary – 15 points
The paper is written in proper APA and organizational format. All sources used for quotes and facts are credible and cited correctly. Excellent organization, including a variety of thoughtful transitions.

Satisfactory – 12 points
The paper is written in proper format with only 1-2 errors. All sources used for quotes and facts are credible, and most are cited correctly. Adequate organization includes a variety of appropriate transitions.

Unsatisfactory – 8 points
The paper is written in proper format with only 3-5 errors. Most sources used for quotes and facts are credible and cited correctly. Essay is poorly organized, but may include a few effective transitions.

Unacceptable – 5 points
The paper is not written in proper format. Many sources used for quotes and facts are less than credible (suspect) and/or are not cited correctly. Essay is disorganized and does not include effective transitions.

 
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Developing Internal Advancement Strategies

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Developing Internal Advancement Strategies

(Developing Internal Advancement Strategies)

Review the Week 2 Individual Knowledge Check.

Read Ch. 5, Incident 2, “I am Qualified, Why Not Me?”

Write a 700- to 1,400-word analysis, using your research, of the incident, “I am qualified, Why Not Me?” Include the following in preparing your response:

  • Discuss whether or not you believe that Bobby has a legitimate complaint. Does any organization, like Crystal Productions, have a responsibility to provide training and development opportunities to enhance promotion from within?
  • Explain the advantages and disadvantages of a promotion from within policy and whether such a policy would be appropriate for Crystal Productions.
  • Identify, if you were the head of HR, the first step in creating the policy, who should be involved in developing the policy, and what you would do in preparing for implementation.
  • Recommend the desired goals/outcomes of such a policy and the impact your new policy would have on staffing and performance management strategies.
  • Summarize what impact the changing workforce might have on your new policy.
  • Summarize a brief policy that addresses hiring from within.

INCIDENT 2 I Am Qualified, Why Not Me?

Five years ago, when Bobby Bret joined Crystal Productions as a junior accountant, he felt that he was on his way up. He had just graduated with a B+B+ average from college where he was well liked by his peers and by the faculty, and had been an officer in several student organizations. Bobby had shown a natural ability to get along with people as well as to get things done. He remembered what Roger Friedman, the controller at Crystal, had told him when he was hired, “I think you will do well here, Bobby. You’ve come highly recommended. You are the kind of guy that can expect to move right on up the ladder.”

Bobby felt that he had done a good job at Crystal, and everybody seemed to like him. In addition, his performance appraisals had been excellent. However, after five years he was still a junior accountant. He had applied for two senior accountant positions that had opened, but they were both filled by people hired from outside the firm. When the accounting supervisor’s job came open two years ago, Bobby had not applied. He was surprised when his new boss turned out to be a hotshot graduate of State University whose only experience was three years with a large accounting firm. Bobby had hoped that Ron Greene, a senior accountant he particularly respected, would get the job.

On the fifth anniversary of his employment at Crystal, Bobby decided it was time to do something. He made an appointment with the controller. At that meeting, Bobby explained to Mr. Friedman that he had worked hard to obtain a promotion and shared his frustration about having been in the same job for so long. “Well,” said Mr. Friedman, “you don’t think that you were all that much better qualified than the people that we have hired, do you?” “No,” said Bobby, “but I think I could have handled the senior accountant job. Of course, the people you have hired are doing a great job too.” The controller responded, “We just look at the qualifications of all the applicants for each job, and considering everything, try to make a reasonable decision.”

 
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McDonald’s Strategic Case Studies

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McDonald’s Strategic Case Studies

(McDonald’s Strategic Case Studies)

Business Policy and Strategy, CSU (Case Studies – Units I – VII)

Unit I Case Study

Read the Cohesion Case on pages 27-37 in the course textbook. Create a five- to seven-page PowerPoint presentation in which you a) briefly describe your view of McDonald’s strategic position, and b) answer Step 4 of the Assurance of Learning exercise on page 37.

Unit II Case Study

Complete the Assurance of Learning Exercise 3D on page 87 of the course textbook. In addition to completing Steps 1, 2, and 3, summarize your findings in a two-page APA formatted paper and discuss your views of McDonald’s strategic

prospects based upon your analysis of the external assessment and consideration of the opportunities to grow, as well as threats from competitors and the macro environment.

Unit III Case Study

Complete the Assurance of Learning Exercises 6A and 6B on page 205 of the textbook. Use the completed SWOT and SPACE matrices to draw conclusions regarding both the long term and short term strategies you would recommend in light of your findings. Summarize in a two-page APA formatted paper. NOTE: It is not necessary to consult other students

to complete these exercises in the textbook.

Unit IV Case Study

Complete the four elements of the McDonald’s organization chart exercise in the Assurance of Learning Exercise 7A on page 248 of the textbook. Once the organizational chart recommendation is completed, create at least one high-level objective for each functional group in the organizational chart. State your rationale for each and briefly state how each

would be measured. Compile your work into a minimum two-page APA formatted paper.

Unit V Case Study

Read the Assurance of Learning Exercise 8A and 8B on page 282 of the textbook. Prepare a product positioning map, and perform the EPS/EBIT calculations given in 8B. Discuss, in a two-page APA formatted paper, how the product positioning is aligned with McDonald’s corporate strategy. Identify potential gaps in the product line or weaknesses in

positioning. Describe the relevance of the EPS/EBIT chart and why it is significant with respect to strategy implementation.

Unit VI Case Study

Follow the instructions for the Assurance of Learning Exercise 9A on page 306 of the textbook. Create a minimum two-page APA formatted paper evaluating McDonald’s strategy. Choose at least one of McDonald’s competitors and discuss its position relative to McDonald’s. Comment on McDonald’s prospects of success against this competitor.

Unit VII Case Study

Complete the Assurance of Learning Exercise 10A on page 326 of the textbook. You will be asked to analyze and to compare and contrast the code of ethics of both Starbuck’s and McDonald’s. Summarize your analysis and findings in a two-page APA formatted paper

 
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Health Reform & Stakeholder Impact

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Health Reform & Stakeholder Impact

(Health Reform & Stakeholder Impact)

HEALTH POLICY ASSIGNMENTS

Case Study Reflection

Write a 4-5 page paper. Your written assignments must follow APA guidelines. Be sure to support your work with specific citations from this week’s Learning Resources and additional scholarly sources as appropriate. Refer to the Pocket Guide to APA Style to ensure that in- text citations and reference list are correct. Submit your assignment to the Dropbox by the end of this Unit.

In 2007 San Francisco began its Healthy San Francisco Plan designed to provide health care for all San Francisco citizens. In 2007, it was estimated that San Francisco had 82,000 uninsured citizens. Under the plan, all uninsured citizens residing in San Francisco can seek care at the city’s public and private clinics and hospitals. The basic coverage includes lab work, x-rays, surgery, and preventative care. The city plans to pay for this $203 million coverage by rerouting the $104 million the city currently spends treating the uninsured in the emergency rooms, mandating business contributions, and requiring income-adjusted enrollment fees. The plan requires all businesses with more than 20 employees to contribute a percentage toward the plan. Many business owners consider this a burden and warn they will not stay in the city. The Mayor sees universal health access a moral obligation for the city.

Take one of the following positions.

· San Francisco has an obligation to provide its citizens with health access.-OR-

· San Francisco does not have an obligation to provide its citizens with health access.

Discuss the following in your assignment:

1. What is the government’s role in regulating healthy and unhealthy behavior?

2. Has the balance between personal freedom and the government’s responsibility to provide health and welfare of its citizens been eroded? Why or why not?

3. Written Assignment

4. Review the following report at:

5. https://kapextmediassl-a.akamaihd.net/healthSci/HA545/HA545_1703C/u5_as.pdf

6. Using this Congressional Report for members of Congress and your textbook, write a 5-page memorandum/paper on the topic of rulemaking.

7. You are a summer intern with Harry Smith, a Congressman from your home district. He has to advise his congressional committee on the impact of interest groups on legislation. Write the memorandum to explain the purpose and influence on rulemaking in the operation of the legislation. You should offer suggestions on the importance of the implementation phase of the legislation.

Paper

Write a 7-9 page paper with bibliography. Your written assignments must follow APA guidelines. Be sure to support your work with specific citations from this week’s Learning Resources and additional scholarly sources as appropriate. Refer to the Pocket Guide to APA Style to ensure in-text citations and reference list are correct.

You will synthesize your understanding of why Medicare Part D passed, as well as the influence of the various interest groups and governmental entities during this process. Make sure to discuss both the policy process and the policy environment—that is, the key players involved and other circumstances that shaped this policy-making effort. For this assignment, address the following questions, doing further research as needed:

· How did various stakeholder groups influence the final outcome of Medicare Part D legislation?

· What were the specific strategies and tools that were used most effectively?

· Does the fact that Medicare Part D passed corresponds with your understanding of policy and politics, or did this surprise you? Explain your response.

Paper

Write a 7-9 page paper with a References List. Your written assignment must follow APA guidelines. Be sure to support your work with specific citations from this week’s Learning Resources and additional scholarly sources as appropriate. Refer to the Pocket Guide to APA Style to ensure in-text citations and reference list are correct.

You will synthesize your understanding of why Clinton’s Health Plan was unsuccessful. Discuss the features of the Clinton health care reform plan and provide reasons why it failed and describe the influence of the various interest groups and governmental entities during this process. Make sure to discuss both the policy process and the policy environment—that is, the key players involved and other circumstances that shaped this policy-making effort. Consider and discuss the following:

1. Take a position in support or opposition

2. Discuss the context of this legislation – name the expected demanders and suppliers as outlined in our textbook, Chapter 3.

3. Describe the expected interest groups and there specific arguments.

4. Describe the expected interplay between demanders and suppliers, interest groups and analyze the public policy environment.

 
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