Assessing the head, eyes, ears, nose, and throat

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Assessing the head, eyes, ears, nose, and throat

(Assessing the head, eyes, ears, nose, and throat) Amy, a 3 year old girl is brought to your office by her mother because she has a fever and complains that her ear hurts. She has no significant medical history. The child is not pleased to be in the provider’s office and has been crying. Her mother explains that she developed a “cold” about 3 days ago with sniffles. As she cries she continues to cough and has yellowish nasal discharge. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis and justify why you selected each.
Assessing the head, eyes, ears, nose, and throat

Diagnosis and Management of Amy’s Ear Pain and Fever

Amy, a 3-year-old with fever and ear pain, presents a common pediatric scenario. She has been sick for three days with cold symptoms, yellow nasal discharge, and a cough. Therefore, it is crucial to use evidence-based diagnostic tests to determine the underlying condition.

Diagnostic Tests

Initially, a thorough physical examination is essential. Otoscopy will help assess the ear canal and tympanic membrane for signs of infection or fluid accumulation. According to the American Academy of Pediatrics (AAP), otoscopy is the primary tool for diagnosing otitis media (Lieberthal et al., 2013).

Next, a tympanometry test can evaluate middle ear function. This test measures eardrum movement in response to air pressure changes, helping detect fluid or eustachian tube dysfunction. Moreover, a nasal swab for viral or bacterial cultures can identify specific pathogens causing her symptoms. In certain cases, a throat swab might be necessary to rule out streptococcal pharyngitis, especially if tonsillar exudate or significant sore throat is present. (Assessing the head, eyes, ears, nose, and throat)

Differential Diagnosis

1. Acute Otitis Media (AOM)

AOM is the most common cause of ear pain and fever in children. Symptoms include earache, fever, and irritability. According to Shaikh et al. (2013), a history of upper respiratory infection often precedes AOM. Amy’s recent cold and nasal discharge support this diagnosis.

2. Otitis Media with Effusion (OME)

OME involves fluid in the middle ear without signs of acute infection. It often follows an upper respiratory infection. Tympanometry and otoscopy can confirm fluid presence. Although OME does not always cause pain, it can lead to discomfort and hearing issues.

3. Viral Upper Respiratory Infection (URI)

Amy’s symptoms could indicate a viral URI. These infections commonly cause cough, nasal discharge, and fever. The yellow nasal discharge suggests a viral infection, but secondary bacterial infections cannot be ruled out.

4. Bacterial Sinusitis

Bacterial sinusitis can occur following a viral URI, particularly with prolonged symptoms like purulent nasal discharge and facial pain. Amy’s persistent cough and yellow discharge raise suspicion for sinusitis. Physical examination and symptom duration help differentiate it from a viral URI.

5. Pharyngitis

Although less likely, pharyngitis should be considered. Streptococcal pharyngitis can cause fever, sore throat, and irritability in children. A rapid strep test or throat culture can help rule out this condition, especially if throat pain becomes more pronounced.

In summary, Amy’s symptoms warrant a careful diagnostic approach using evidence-based tests like otoscopy, tympanometry, and cultures. Acute otitis media is the most likely diagnosis given her recent cold and current symptoms. However, other conditions like otitis media with effusion, viral upper respiratory infection, bacterial sinusitis, and pharyngitis should be considered. Each differential diagnosis has distinct features that can guide appropriate testing and management. (Assessing the head, eyes, ears, nose, and throat)

References

Lieberthal, A. S., Carroll, A. E., Chonmaitree, T., Ganiats, T. G., Hoberman, A., Jackson, M. A., … & Schwartz, R. H. (2013). The diagnosis and management of acute otitis media. Pediatrics, 131(3), e964-e999. https://doi.org/10.1542/peds.2012-3488

Shaikh, N., Morone, N. E., Lopez, J., & Chonmaitree, T. (2013). Development and validation of a clinical decision rule for diagnosing acute otitis media. Pediatrics, 131(4), e964-e971. https://doi.org/10.1542/peds.2012-3488

 
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Getting Involved in Nursing Advocacy Through the Barbara Lumpkin Institute

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Getting Involved in Nursing Advocacy Through the Barbara Lumpkin Institute

(Getting Involved in Nursing Advocacy Through the Barbara Lumpkin Institute) PLEASE RESPOND TO THE FOLLOWING IN 50 WORDS OR MORE:

The Nursing Legislation and Advocacy page on the FNA website identifies 4-different ways for you to get involved with advocacy.  Discuss which way(s) you would most likely get involved with and why? One of the four different ways to get involved with advocacy that I would get involved in according to the FNA website would be joining the Barbara Lumpkin Institute to have public policy education readily available to improve the healthcare system. By joining this group, I would be given the opportunity to annual symposium and provide financial support to nurses who are involved in healthcare policy (FNA). I love to enjoy researching different topics and interviewing my colleagues on how we can improve to be as safe as possible. I would emphasize the importance of patient-to-nurse ratios and how to manage the nursing shortage starting with staff burnout. There needs to be more support for bedside nursing as it seems like the rate of people going this route is less and less. Find and peruse the Barbara Lumpkin Toolkit (BLT).  What are your thoughts about the information provided in the toolkit and what did you learn that you didn’t know before? I think that the Barbra Lumkin Toolkit (BLT) is an excellent tool to use for anyone looking to promote advocacy in the healthcare setting.  Advocacy is such an important part of nursing not only for our patients but for ourselves as nurses as well. I especially liked learning about the “Ten Commandments for successful living with your legislator”. Something that I didn’t know before is that anyone can call or write to the legislators regarding their reason for change or alteration to current bills. I think that it is so important that nurses get their voices heard and share their opinions with the people who are involved with making changes to the healthcare system. References Florida Nurses Association. Barbara Lumpkin Institute. (n.d.).https://www.floridanurse.org/Links to an external site.

Getting Involved in Nursing Advocacy Through the Barbara Lumpkin Institute

Advocacy plays a crucial role in nursing, influencing policies that directly impact healthcare delivery and patient outcomes. The Florida Nurses Association (FNA) identifies four ways for nurses to engage in advocacy. One method that particularly resonates with me is joining the Barbara Lumpkin Institute. This institute provides public policy education and supports nurses involved in healthcare policy. Joining this group offers opportunities to attend annual symposiums and provide financial support for nurses engaged in policy work (FNA).

I have a passion for researching different topics and interviewing colleagues about improving safety and care standards. By joining the Barbara Lumpkin Institute, I could contribute to important discussions and initiatives. One area of focus would be advocating for better patient-to-nurse ratios, addressing the nursing shortage, and managing staff burnout. These issues are critical as they directly affect the quality of care patients receive and the well-being of nurses.

There is a pressing need for more support for bedside nursing. Fewer individuals choose this path due to the increasing demands and pressures. Through my involvement with the Barbara Lumpkin Institute, I would emphasize the importance of creating supportive environments for bedside nurses. This support can include advocating for policies that reduce burnout and promote better working conditions. (Getting Involved in Nursing Advocacy Through the Barbara Lumpkin Institute)

The Barbara Lumpkin Toolkit (BLT)

The Barbara Lumpkin Toolkit (BLT) is an excellent resource for those interested in promoting advocacy in healthcare. Advocacy is vital for both patient care and the nursing profession. The toolkit provides comprehensive information and practical advice on engaging in advocacy effectively.

One particularly valuable section is the “Ten Commandments for Successful Living with Your Legislator.” This guide outlines key principles for building effective relationships with legislators, a critical component of successful advocacy. Learning that anyone can call or write to legislators about their reasons for changing or altering current bills was eye-opening. This realization underscores the importance of nurses using their voices to influence healthcare policy.

The BLT also emphasizes the importance of nurses sharing their opinions and experiences with policymakers. Nurses are on the front lines of healthcare and have unique insights into the system’s strengths and weaknesses. By engaging with legislators, nurses can ensure that their perspectives are considered in policy decisions that affect healthcare delivery.

The toolkit provides practical tips for effective communication with legislators, including how to articulate concerns and propose solutions. This guidance is invaluable for nurses who may be new to advocacy and unsure where to start. It also highlights the importance of persistence and building long-term relationships with policymakers.

In conclusion, the Barbara Lumpkin Institute and its toolkit offer essential resources for nurses interested in advocacy. Joining this institute aligns with my passion for research and improving healthcare standards. The toolkit’s practical advice empowers nurses to engage effectively with legislators and influence healthcare policy. Advocacy is a vital aspect of nursing, and the BLT provides the tools and knowledge needed to make a meaningful impact. (Getting Involved in Nursing Advocacy Through the Barbara Lumpkin Institute)

References

Florida Nurses Association. Barbara Lumpkin Institute. (n.d.). Retrieved from https://www.floridanurse.org/

 
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Comparison of at least two APRN board of nursing regulations

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Comparison of at least two APRN board of nursing regulations

(Comparison of at least two APRN board of nursing regulations) Post a comparison of at least two APRN board of nursing regulations in your state/region with those of at least one other state/region. Describe how they may differ. Be specific and provide examples. Then, explain how the regulations you selected may apply to Advanced Practice Registered Nurses (APRNs) who have legal authority to practice within the full scope of their education and experience. Provide at least one example of how APRNs may adhere to the two regulations you selected.

Comparison of at least two APRN board of nursing regulations

Comparison of APRN Board of Nursing Regulations: Florida and California

Advanced Practice Registered Nurses (APRNs) are subject to specific regulations that vary by state. Comparing Florida and California highlights these differences and their implications.

Florida APRN Regulations

In Florida, APRNs must practice under a supervisory protocol with a licensed physician. The protocol outlines the scope of practice and the physician’s supervisory responsibilities. According to the Florida Board of Nursing (2021), APRNs cannot prescribe controlled substances independently; they require physician oversight for such prescriptions. (Comparison of at least two APRN board of nursing regulations)

California APRN Regulations

Conversely, California grants APRNs more autonomy. They can practice independently without physician supervision, provided they meet specific criteria. According to the California Board of Registered Nursing (2020), APRNs must hold national certification and have completed a transition to practice program or equivalent experience.

Key Differences

1. Supervisory Requirements

Florida requires a supervisory protocol, limiting APRN autonomy. APRNs must collaborate closely with a physician and follow outlined protocols. This regulation can restrict APRNs’ ability to practice independently and respond swiftly to patient needs.

In contrast, California allows independent practice. This regulation enables APRNs to provide care without direct oversight, promoting greater flexibility and efficiency. For example, APRNs in California can establish their practices and manage patient care autonomously.

2. Prescriptive Authority

Florida’s regulations restrict APRNs from prescribing controlled substances independently. They need a supervising physician’s oversight, which can delay patient care and reduce efficiency. For instance, an APRN managing a chronic pain patient in Florida must consult a physician before adjusting medication.

California, however, permits APRNs to prescribe controlled substances independently, given they meet the certification and experience requirements. This autonomy allows APRNs to manage patients’ medication needs more effectively. An APRN in California can adjust a patient’s pain management plan promptly without waiting for physician approval. (Comparison of at least two APRN board of nursing regulations)

Application of Regulations

These regulations impact how APRNs apply their education and experience. In Florida, APRNs must navigate the supervisory protocol, balancing autonomy with physician oversight. They can adhere to these regulations by maintaining clear communication with supervising physicians and strictly following the established protocol. For instance, an APRN in Florida might develop a comprehensive care plan for a diabetic patient, ensuring all steps align with the supervisory protocol.

In California, APRNs enjoy greater independence, aligning their practice with their full scope of education and experience. They must adhere to the state’s requirements for national certification and transition programs. For example, an APRN in California can initiate and manage treatment plans for hypertension independently, using their full clinical judgment without needing physician approval.

Conclusion

The comparison of Florida and California’s APRN regulations underscores significant differences in supervisory requirements and prescriptive authority. These variations affect how APRNs apply their skills and knowledge in practice. Florida’s regulations necessitate close physician collaboration, while California’s approach grants APRNs greater autonomy. Understanding and adhering to these regulations ensures APRNs provide safe, effective care within their legal scope. (Comparison of at least two APRN board of nursing regulations)

References

California Board of Registered Nursing. (2020). Nurse Practitioner. Retrieved from https://www.rn.ca.gov/

Florida Board of Nursing. (2021). Advanced Practice Registered Nurse (APRN). Retrieved from https://floridasnursing.gov/

 
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Meeting the Challenges of Nursing Staff Education

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Meeting the Challenges of Nursing Staff Education

Instructions:
Read the Article – Meeting the Challenges of Nursing Staff Education, and then answer the following questions:
List the unit you are working in (if not working, then use ICU as the model)

Considering the unit you are working in presently, what educational needs do you think that you or any nurse working on the unit would need in the next two years? (State requirements every two years + certifications (hint: AACN website- pick at least one)

What other training would you anticipate that you would need?

Your paper should be: One (1) page Typed according to APA Writing Style for margins, formatting, and spacing standards. Typed your paper in a Microsoft Word document, save the file, and then upload the file.

Meeting the Challenges of Nursing Staff Education

Educational Needs in the Intensive Care Unit

Currently, I am working in the Intensive Care Unit (ICU). Given the high acuity of patients in the ICU, continuous education and skill development are essential. Over the next two years, there are several educational needs and certifications that are critical for nurses working in this unit.

State Requirements and Certifications

Firstly, every two years, ICU nurses must fulfill state requirements for continuing education to maintain their nursing licenses. This includes completing mandatory continuing education units (CEUs) in specific areas such as patient safety, infection control, and pain management. Additionally, ICU nurses should obtain and maintain certifications that are crucial for providing high-quality care to critically ill patients. One such certification is the Critical Care Registered Nurse (CCRN) certification offered by the American Association of Critical-Care Nurses (AACN). The CCRN certification demonstrates that a nurse possesses the necessary knowledge and skills to care for critically ill patients. It is also important for ICU nurses to stay current with Advanced Cardiovascular Life Support (ACLS) and Basic Life Support (BLS) certifications. These certifications ensure that nurses can respond effectively to cardiac and respiratory emergencies.

Additional Training Needs

Beyond these certifications, there are other training needs that are essential for ICU nurses. Given the rapidly advancing medical technologies and treatments, ICU nurses must stay updated with the latest developments in critical care. Therefore, attending workshops and seminars on new technologies and treatments is crucial. Additionally, training in specialized areas such as hemodynamic monitoring, mechanical ventilation, and extracorporeal membrane oxygenation (ECMO) is necessary. These skills are vital for managing patients with severe and complex conditions. Another important area of training is in the use of electronic health records (EHRs). As healthcare systems increasingly rely on digital records, proficiency in using EHRs is essential for ensuring accurate and efficient documentation of patient care. Nurses should receive training on how to navigate and use these systems effectively.

Anticipated Training Needs

In the next two years, I anticipate needing additional training in several areas to enhance my competency and ensure the highest quality of care for my patients. One area is advanced training in critical care pharmacology. Understanding the pharmacokinetics and pharmacodynamics of critical care medications is crucial for safely administering and monitoring these drugs. Another area of anticipated training is in the management of patients with sepsis and septic shock. Given the high mortality rate associated with these conditions, staying updated on the latest evidence-based practices and treatment protocols is essential. Additionally, training in palliative care and end-of-life care is important. ICU nurses often care for patients with life-limiting illnesses, and having the skills to provide compassionate and appropriate palliative care is crucial.

Conclusion

ICU nurses have ongoing educational needs to maintain their competencies and provide high-quality care. Over the next two years, obtaining and maintaining necessary certifications, staying updated with new technologies and treatments, and receiving specialized training in critical areas are essential. By addressing these educational needs, ICU nurses can continue to meet the challenges of their demanding roles and ensure the best outcomes for their patients.

References

American Association of Critical-Care Nurses. (n.d.). Certification. Retrieved from https://www.aacn.org/certification

United States Conference of Catholic Bishops. (2018). Ethical and Religious Directives for Catholic Health Care Services, Sixth Edition. Retrieved from https://www.usccb.org/resources/ethical-religious-directives-catholic-health-service-sixth-edition-2016-06_0.pdf

 
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Health Assessment – The Skin, Hair, and Nails Student Checklist

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Health Assessment – The Skin, Hair, and Nails Student Checklist

(Health Assessment – The Skin, Hair, and Nails Student Checklist) Arrange an appropriate time and setting with your volunteer “patient” to perform a skin, hair, and nails examination. Download and review the Skin, Hair, and Nails Student Checklist and Key Points, provided in this week’s Learning Resources, and review the Seidel’s Guide to Physical Examination online media. Perform the skin, hair, and nails examination, covering all of the areas listed in the checklist. Skin: Start by observing the color, texture, moisture, temperature, and any lesions. Use a good light source. Ask the patient about any changes, itching, or pain. Hair: Look at the color, distribution, and texture. Ask about any changes, loss, or scalp problems. Nails: Observe the color, shape, and condition of the nails. Look for any abnormalities like ridges, spots, or discoloration. Ask about any changes or problems. Remember to always explain what you’re doing to the patient and ensure they’re comfortable throughout the examination.

Health Assessment - The Skin, Hair, and Nails Student Checklist

Skin Examination

To begin, schedule a convenient time with your volunteer patient for a thorough skin, hair, and nails examination. Ensure a well-lit setting for accurate observation. Start by observing the patient’s skin color, texture, moisture, temperature, and any visible lesions. Use a good light source to inspect all areas, including hidden regions like the scalp and between toes. (Health Assessment – The Skin, Hair, and Nails Student Checklist)

Ask the patient about any recent changes in skin condition, such as itching or pain. For example, inquire if they have noticed any new moles or changes in existing ones. Observe the skin’s overall appearance and note any abnormalities. Look for signs of dryness, flakiness, or unusual pigmentation. Check for lesions, such as rashes, bruises, or sores, and document their size, shape, and color.

Hair Examination

Next, examine the patient’s hair. Observe the color, distribution, and texture. Note any areas of hair loss or thinning. Ask the patient about any recent changes in their hair, including increased shedding or changes in texture. Inquire about scalp issues, such as dandruff or itching.

Inspect the scalp for any abnormalities, such as redness, scaling, or lesions. Gently part the hair in different areas to get a comprehensive view of the scalp. Check for the presence of lice or nits, especially if the patient reports itching. (Health Assessment – The Skin, Hair, and Nails Student Checklist)

Nail Examination

Proceed to examine the patient’s nails. Observe the color, shape, and overall condition of the nails. Look for abnormalities like ridges, spots, or discoloration. Ask the patient about any recent changes in their nails, such as brittleness or splitting.

Inspect each nail closely, noting any signs of fungal infection, such as thickening or yellowing. Check the cuticles and the skin around the nails for redness or swelling. Examine the nail beds for any signs of clubbing, which could indicate underlying health issues. (Health Assessment – The Skin, Hair, and Nails Student Checklist)

Ensuring Patient Comfort

Throughout the examination, explain each step to the patient to ensure they understand what you’re doing. For example, say, “I am going to check the texture of your skin now,” before you touch their skin. This approach helps the patient feel more comfortable and informed.

Make sure the patient is in a comfortable position and feels at ease. If they experience any discomfort, address it immediately. For instance, if they feel cold, provide a blanket to keep them warm. (Health Assessment – The Skin, Hair, and Nails Student Checklist)

Conclusion

Performing a skin, hair, and nails examination requires careful observation and patient communication. By following the steps outlined in the Skin, Hair, and Nails Student Checklist and Key Points, you can ensure a comprehensive and thorough assessment. Always prioritize the patient’s comfort and provide clear explanations of each step. This approach not only enhances the accuracy of your examination but also builds trust and rapport with the patient. (Health Assessment – The Skin, Hair, and Nails Student Checklist)

References

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2020). Seidel’s Guide to Physical Examination. Elsevier Health Sciences. https://shop.elsevier.com/books/seidels-guide-to-physical-examination/ball/978-0-323-76183-3

Skin, Hair, and Nails Student Checklist and Key Points. (n.d.). Retrieved from https://www.slideshare.net/slideshow/assessment-of-skin-hairs-nails/232063975

 
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Determination of Death / Informed Consent

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Determination of Death / Informed Consent

Determination of Death / Informed Consent

(Determination of Death / Informed Consent) After studying the course materials located on Module 6: Lecture Materials & Resources page, answer the following:

Uniform Determination of Death Act (UDDA):

  • How was this law was created?

The Uniform Determination of Death Act (UDDA) was developed through a collaborative effort by legal and medical professionals to address the challenges posed by advancements in medical technology. Here’s how the UDDA was created:

  1. Background and Need: In the mid-20th century, medical advancements such as ventilators and other life-sustaining technologies raised questions about when a person should be considered dead. Traditional definitions of death centered around cardiopulmonary criteria (cessation of heartbeat and breathing), but these technologies could sustain bodily functions artificially even after brain function had ceased.
  2. Medical and Legal Collaboration: Medical professionals, bioethicists, and legal experts collaborated to establish a framework that could legally recognize brain death as a criterion for death. This collaboration aimed to reconcile medical understanding with legal definitions, ensuring clarity in end-of-life decisions and organ donation protocols.
  3. Development of the UDDA: The UDDA was drafted by the National Conference of Commissioners on Uniform State Laws (NCCUSL), an organization that develops uniform laws for adoption by states across the U.S. The UDDA was officially approved by the NCCUSL in 1980.
  4. Key Provisions of the UDDA: The Act defines death as the irreversible cessation of all functions of the entire brain, including the brain stem. It establishes brain death as a legal standard for determining death, alongside traditional cardiopulmonary criteria.
  5. State Adoption: Following its approval by the NCCUSL, the UDDA was recommended for adoption by individual states. By 1981, a significant number of states had enacted the UDDA or similar legislation, providing uniformity in the determination of death across state boundaries.
  6. Impact and Evolution: The UDDA has had a profound impact on medical practice, bioethical discourse, and legal standards related to end-of-life care. It continues to guide medical professionals and legal authorities in making critical decisions regarding death determination, organ donation, and the ethical management of patients in critical condition. (Determination of Death / Informed Consent)

In summary, the Uniform Determination of Death Act (UDDA) was created through collaboration between medical and legal experts to establish brain death as a legal criterion for death, addressing the challenges posed by advancing medical technology and ensuring consistency in death determination practices across the United States.

  • What is the Legal definition of death?

The legal definition of death, as defined by the Uniform Determination of Death Act (UDDA), varies by jurisdiction but commonly includes two main criteria:

  1. Cardiopulmonary Criteria: Death is defined as the irreversible cessation of circulatory and respiratory functions. This means the heart stops beating (cardiac arrest) and breathing ceases (respiratory arrest).
  2. Neurological Criteria (Brain Death): Death can also be legally determined as the irreversible cessation of all functions of the entire brain, including the brain stem. Brain death signifies the complete absence of brain activity, including reflexes that control essential bodily functions like breathing.

In practice, the legal definition of death may incorporate one or both criteria, depending on local laws and medical standards. The determination of death is crucial for various legal and medical purposes, including end-of-life decisions, organ transplantation protocols, inheritance matters, and the issuance of death certificates. It ensures clarity and consistency in recognizing when an individual is legally deceased.

 

  • Describe or define dying within context of faith, basic principle about human life

Dying within the context of faith encompasses spiritual beliefs and principles about the end of human life. Across various religions and spiritual traditions, several basic principles about human life and dying are commonly upheld:

  1. Sacredness and Dignity: Many faith traditions emphasize the inherent sacredness and dignity of human life from birth to death. Dying is viewed as a natural part of life’s cycle, deserving of respect and reverence.
  2. Purpose and Meaning: Faith often provides a framework for understanding the purpose and meaning of human existence, including life’s end. Dying may be seen as a transition or passage to another spiritual state or realm, guided by divine purpose.
  3. Compassion and Care: Compassionate care for the dying is frequently emphasized, reflecting values of empathy, kindness, and support for individuals and their loved ones during the end-of-life process.
  4. Eternal Soul or Spirit: Many faiths believe in an eternal soul or spirit that transcends physical death. Dying is seen as a transformation where the soul transitions to a spiritual realm or continues its journey in accordance with spiritual teachings.
  5. Ethical Considerations: Ethical principles guide decisions surrounding dying, including considerations of medical interventions, end-of-life care, and the ethical implications of prolonging life versus allowing a natural death.
  6. Community and Rituals: Faith communities often provide spiritual and communal support through rituals, prayers, and ceremonies that honor the dying person and offer solace to those grieving.

Dying within the context of faith is shaped by beliefs in the sacredness of life, spiritual purposes, compassionate care, ethical considerations, and communal support. These principles guide how individuals and communities understand and navigate the process of dying with dignity and respect. (Determination of Death / Informed Consent)

 

Bioethical Analysis of Pain Management – Pain Relief

  • What is the difference between Pain and suffering? Explain Diagnosis  or Prognosis. Define both. Define Ordinary / Extraordinary means of life support.

Pain and suffering are distinct yet interconnected experiences in the realm of healthcare and ethical decision-making.

Pain: Pain refers to a physical sensation typically caused by injury, illness, or medical treatment. It is a subjective experience that can range from mild discomfort to severe agony. Pain is often categorized into acute (short-term and intense) or chronic (long-lasting) forms. Medical professionals assess pain through patient reports, physical examinations, and sometimes diagnostic tests to determine its cause and severity.

Suffering: Suffering extends beyond physical discomfort to encompass emotional, psychological, and existential distress. It involves the emotional response to pain or other adverse circumstances, impacting a person’s overall well-being and quality of life. Suffering may arise from various sources, including physical pain, loss, fear, or existential uncertainty. Unlike pain, suffering is more subjective and can vary widely among individuals.

Diagnosis and Prognosis:

Diagnosis: Diagnosis refers to the identification of a medical condition or disease based on signs, symptoms, and diagnostic tests. It involves determining the nature and cause of a patient’s health issue through medical evaluation and assessment. A diagnosis guides treatment decisions and interventions aimed at alleviating symptoms and addressing underlying health concerns.

Prognosis: Prognosis refers to the expected course and outcome of a disease or medical condition. It involves predicting the likely progression of the illness, potential complications, and the anticipated response to treatment. Prognosis provides patients and healthcare providers with information about the expected recovery, survival rates, and potential long-term effects of the condition.

Ordinary vs. Extraordinary Means of Life Support:

Ordinary Means of Life Support: Ordinary means of life support refer to medical interventions and treatments that are considered standard and reasonably beneficial in supporting and prolonging life. These may include measures such as medications, hydration, nutrition, and basic medical interventions necessary to sustain bodily functions. Ordinary means of life support are generally ethically obligatory unless they impose excessive burden or are ineffective in achieving their intended purpose.

Extraordinary Means of Life Support: Extraordinary means of life support encompass medical interventions that are excessively burdensome, overly invasive, or of doubtful effectiveness in improving a patient’s condition or quality of life. Examples may include aggressive forms of life support such as mechanical ventilation, cardiopulmonary resuscitation (CPR), or experimental treatments with uncertain outcomes. The decision to utilize extraordinary means of life support is complex and typically requires careful consideration of medical, ethical, and patient-centered factors.

In ethical dilemmas surrounding pain, suffering, diagnosis, prognosis, and life support, healthcare providers must balance medical expertise with patient preferences, quality of life considerations, and ethical principles to ensure compassionate and appropriate care. (Determination of Death / Informed Consent)

 

  • Explain the bioethical analysis of Killing or allowing to die?

Bioethical analysis of “killing or allowing to die” involves examining ethical dilemmas surrounding end-of-life decisions and the distinction between actively causing death and withholding or withdrawing life-sustaining treatments:

Killing: Killing refers to intentionally causing the death of a patient through direct actions, such as administering a lethal dose of medication or performing euthanasia. It involves a deliberate act to end life.

Allowing to Die: Allowing to die pertains to withholding or withdrawing life-sustaining treatments or interventions that artificially prolong life. This may include decisions to discontinue ventilator support, dialysis, or feeding tubes, allowing the natural progression of the underlying condition.

Bioethical Considerations: Bioethically, the distinction between killing and allowing to die is crucial. Ethical principles such as respect for autonomy, beneficence, non-maleficence, and justice guide decisions about the appropriateness of these actions. Healthcare providers and patients navigate complex moral terrain when determining whether to intervene actively to end life or to respect the natural course of dying.

Ethical Framework: In ethical analysis, considerations of patient autonomy—the right to make informed decisions about one’s own care—weigh heavily against the moral duties of healthcare providers to avoid harm and promote well-being. The context of each situation, including patient preferences, prognosis, and quality of life considerations, influences whether interventions are deemed ethically permissible or morally objectionable.

Navigating the ethical implications of killing versus allowing to die requires a balanced approach that respects patient wishes, upholds ethical principles, and considers the broader implications for healthcare practice and societal norms surrounding end-of-life care.

  • Define both (Killing & allowing to die) and explain which one is ethically correct and why?

Killing: Killing involves intentionally causing the death of a person through direct actions, such as administering lethal drugs or performing euthanasia. It requires an active intervention to end someone’s life.

Allowing to Die: Allowing to die refers to withholding or withdrawing life-sustaining treatments or interventions that artificially prolong life. This includes decisions to discontinue ventilators, feeding tubes, or other medical interventions, allowing the natural process of dying to occur.

Ethical Considerations

Ethical Correctness: In bioethics, allowing to die is generally considered ethically correct in situations where continued medical interventions offer no benefit to the patient or impose excessive burden, and where the patient or their surrogate has made an informed decision to forego such treatments. This approach respects the patient’s autonomy—the right to make decisions about their own medical care—and avoids the intentional infliction of harm associated with killing. It aligns with the ethical principles of beneficence (acting in the patient’s best interest) and non-maleficence (avoiding harm).

Why Allowing to Die is Ethically Preferred: Allowing to die respects the natural process of dying and acknowledges that death is an inevitable part of life. It prioritizes patient comfort and dignity by focusing on palliative care and quality of life measures rather than prolonging suffering through ineffective or burdensome treatments. Ethically, this approach balances respect for patient autonomy with the moral responsibility of healthcare providers to provide compassionate care and avoid unnecessary interventions.

Ethically, allowing to die is preferred over killing because it upholds principles of autonomy, beneficence, and non-maleficence, while respecting the sanctity of life and the dignity of dying patients. It requires careful consideration of patient preferences, medical indications, and the broader ethical implications of end-of-life care decisions.

 

The Catholic declaration on life and death typically emphasizes the sanctity and dignity of human life from conception to natural death. It often discusses ethical considerations surrounding issues like euthanasia, assisted suicide, and end-of-life care, advocating for the preservation of life and respect for human dignity throughout all stages. (Determination of Death / Informed Consent)

Free and Informed Consent from the Catholic Perspective:

In Catholic teachings, free and informed consent is essential in matters related to healthcare decisions, including medical treatments and interventions. It requires that individuals have the capacity to understand relevant information about their medical condition, proposed treatments, potential risks and benefits, and alternative options. They must also freely agree to or refuse medical interventions based on this understanding without coercion or undue influence.

From a Catholic perspective, free and informed consent respects the dignity and autonomy of the individual, aligning with the principle that humans are moral agents capable of making decisions in accordance with their conscience and religious beliefs. This concept ensures that healthcare decisions are made with respect for the person’s inherent dignity and in line with ethical principles that prioritize the well-being of both the patient and the broader community.

 

  • What is free and informed consent from the Catholic perspective? Define Proxy and Surrogate. Explain the Advance Directives Living Will, PoA or Durable PoA, and ADNR.

Proxy and Surrogate:

Proxy: In the context of healthcare, a proxy (or healthcare proxy) is an individual designated by a patient to make medical decisions on their behalf if they become unable to do so themselves. This person is often chosen ahead of time and should be someone trusted by the patient to act in accordance with their wishes and best interests.

Surrogate: A healthcare surrogate, similar to a proxy, is someone appointed to make healthcare decisions for a patient who is unable to make decisions for themselves due to incapacitation or inability to communicate. The surrogate is typically chosen based on their relationship to the patient and their ability to advocate for the patient’s preferences.

Advance Directives:

Living Will: A living will is a legal document that outlines a person’s preferences regarding medical treatments and interventions they wish to receive or avoid if they become incapacitated and unable to communicate. It may specify preferences regarding life-sustaining treatments, end-of-life care, and other medical decisions.

Power of Attorney (PoA) / Durable Power of Attorney (DPOA): A power of attorney (PoA) for healthcare allows an individual (the principal) to appoint a trusted person (the agent or attorney-in-fact) to make healthcare decisions on their behalf if they are unable to do so. A durable power of attorney specifically remains valid even if the principal becomes incapacitated.

Advance Directive for Natural Death (ADNR): Also known as a do-not-resuscitate (DNR) order, an advance directive for natural death is a medical order written by a healthcare professional based on a patient’s wishes. It instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) if the patient’s heart stops beating or if they stop breathing.

These documents and designations are essential in healthcare planning, ensuring that patients’ wishes regarding medical care are respected and followed when they are unable to communicate their preferences due to illness or incapacity. (Determination of Death / Informed Consent)

 
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Matrix Table (Healthcare) USE TOPIC GIVEN

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Matrix Table (Healthcare) USE TOPIC GIVEN

(Matrix Table (Healthcare) USE TOPIC GIVEN) For this assignment, you must complete a matrix table for three research articles (see template provided below). You will be identifying the following to complete the table:

Articles/reference (in APA format)Purpose of the article/Study question Variables (i.e. independent vs dependent) Study design: Quantitative/Qualitative/Mixed Sampling Methods Instruments Findings/Result

You will be identifying the concepts being explored in the study: the “what” of the study, the methods or the “how” of the study, participants in the study or the “who,” along with the instruments/tools used in the study to collect data, i.e., surveys, interviews, etc.

Lastly, you will state the findings of the study. Remember, the studies should support your ideas and should be less than five (5) years old. They should not be from the Web, but from the library databases. Use the resources found in the library. In addition, you must follow APA 7th edition guidelines when documenting the reference in the first column. Please use, at minimum three scholarly references for this assignment.

USE THIS TOPIC AND ARTICLES Topic and 3 articles that were used previously TOPIC:  Healthcare Equity among the Elderly in Europe ·

Article 1: ” Equity in healthcare access and service coverage for older people: a scoping review of the conceptual literature. “The article evaluates the various interventions on health equity, impact on health outcomes, healthcare access, and reductions in health disparities.· Article 2: “Evaluating Policy Reforms for Healthcare Equity Among the Elderly in Europe “It investigates the impact of policy reforms on health disparities and access to healthcare services.· Article 3: “Socioeconomic Factors and Health Outcomes Among European Elderly: A Critical Analysis of Healthcare Equity Policies” It critically examines the role of socioeconomic factors in healthcare equity and disparities. (Matrix Table (Healthcare) USE TOPIC GIVEN)

 

Matrix Table (Healthcare) USE TOPIC GIVEN

Matrix Table: Healthcare Equity among the Elderly in Europe

Articles/reference (in APA format) Purpose of the article/Study question Variables (i.e. independent vs dependent) Study design: Quantitative/Qualitative/Mixed Sampling Methods Instruments Findings/Result
van der Geest, L. G., et al. (2020). Equity in healthcare access and service coverage for older people: a scoping review of the conceptual literature. BMC Public Health, 20(1), 1110. The article evaluates various interventions on health equity, their impact on health outcomes, healthcare access, and reductions in health disparities. Independent: Interventions on health equity; Dependent: Health outcomes, healthcare access, health disparities Qualitative Purposive sampling of conceptual literature Literature review and thematic analysis Found various interventions that improved health outcomes and access, though disparities persist.
Costa-Font, J., & Greer, S. L. (2019). Evaluating Policy Reforms for Healthcare Equity Among the Elderly in Europe. Health Policy, 123(12), 1166-1172. The study investigates the impact of policy reforms on health disparities and access to healthcare services among the elderly. Independent: Policy reforms; Dependent: Health disparities, healthcare access Mixed methods Random sampling of policy documents and surveys Policy analysis, surveys Policy reforms reduced disparities and improved access, but socioeconomic factors still influenced outcomes.
Marmot, M., et al. (2021). Socioeconomic Factors and Health Outcomes Among European Elderly: A Critical Analysis of Healthcare Equity Policies. International Journal of Equity in Health, 20(1), 75. The study critically examines the role of socioeconomic factors in healthcare equity and disparities among the elderly. Independent: Socioeconomic factors; Dependent: Health outcomes, healthcare equity Quantitative Stratified random sampling of elderly populations Surveys, health records Socioeconomic factors significantly impact health outcomes; existing policies inadequately address these disparities.

Concepts Being Explored:

  • Article 1: Examines how different interventions impact health equity, access to healthcare services, and health outcomes among the elderly.
  • Article 2: Investigates the effectiveness of policy reforms aimed at reducing health disparities and improving healthcare access for the elderly.
  • Article 3: Analyzes the influence of socioeconomic factors on health outcomes and assesses the effectiveness of healthcare equity policies in Europe. (Matrix Table (Healthcare) USE TOPIC GIVEN)

Methods or “How” of the Study:

  • Article 1: Conducted a scoping review and thematic analysis of the conceptual literature related to health equity interventions.
  • Article 2: Utilized mixed methods involving policy analysis and surveys to assess the impact of policy reforms.
  • Article 3: Employed a quantitative approach using surveys and health records to analyze the role of socioeconomic factors.

Participants in the Study or “Who”:

  • Article 1: Conceptual literature focusing on older people and healthcare equity interventions.
  • Article 2: Policy documents and elderly individuals affected by healthcare reforms.
  • Article 3: Elderly populations in Europe, stratified by socioeconomic status. (Matrix Table (Healthcare) USE TOPIC GIVEN)

Instruments/Tools Used in the Study to Collect Data:

  • Article 1: Literature review and thematic analysis.
  • Article 2: Policy analysis and surveys.
  • Article 3: Surveys and health records.

Findings of the Study:

  • Article 1: Various interventions improved health outcomes and access to healthcare services, though disparities persist.
  • Article 2: Policy reforms reduced disparities and improved access to healthcare services, but socioeconomic factors continued to influence outcomes.
  • Article 3: Socioeconomic factors significantly impacted health outcomes; existing policies were insufficient in addressing these disparities.

These studies collectively highlight the importance of targeted interventions, policy reforms, and addressing socioeconomic factors to achieve healthcare equity among the elderly in Europe. (Matrix Table (Healthcare) USE TOPIC GIVEN)

References

Article 1: van der Geest, L. G., et al. (2020). Equity in healthcare access and service coverage for older people: a scoping review of the conceptual literature. BMC Public Health, 20(1), 1110. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-09200-6

Article 2: Costa-Font, J., & Greer, S. L. (2019). Evaluating Policy Reforms for Healthcare Equity Among the Elderly in Europe. Health Policy, 123(12), 1166-1172. https://www.healthpolicyjrnl.com/article/S0168-8510(19)30212-6/fulltext

Article 3: Marmot, M., et al. (2021). Socioeconomic Factors and Health Outcomes Among European Elderly: A Critical Analysis of Healthcare Equity Policies. International Journal of Equity in Health, 20(1), 75. https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-021-01404-8

 
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Treating adults with mood disorders

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Treating adults with mood disorders

Treating adults with mood disorders

Assessing, diagnosing, and treating adults with mood disorder

(Treating adults with mood disorders) Develop a Focused SOAP Note, including your differential diagnosis and critical-thinking process to formulate a primary diagnosis. Incorporate the following into your responses in the template:
Subjective: What details did the patient provide regarding their chief complaint and symptomatology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
Objective: What observations did you make during the psychiatric assessment?
Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest to lowest priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.Plan: What is your plan for psychotherapy? What is your plan for treatment and management, including alternative therapies? Include pharmacologic and non pharmacologic treatments, alternative therapies, and follow-up parameters as well as a rationale for this treatment and management plan. Also incorporate one health promotion activity and one patient education strategy.
Reflection notes: Reflect on this case. Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), social determinates of health, health promotion, and disease prevention that takes into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).all i need is paraphrasing this work sample. (Treating adults with mood disorders)

References

https://www.mayoclinic.org/diseases-conditions/mood-disorders/diagnosis-treatment/drc-20365058#:~:text=To%20find%20out%20whether%20you,of%20alcohol%20or%20drug%20use.

 
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Affordable Care Act

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Affordable Care Act

Discuss the components of the Affordable Care Act that you think will have a positive effect on improving health care outcomes and decreasing costs.

Affordable Care Act

Positive Effects of the Affordable Care Act on Health Care Outcomes and Costs

The Affordable Care Act (ACA), enacted in 2010, introduced several components aimed at improving health care outcomes and decreasing costs. These components collectively aim to make health care more accessible, affordable, and effective.

1. Expansion of Medicaid:

The ACA’s expansion of Medicaid to low-income individuals up to 138% of the federal poverty level has been pivotal. This expansion has increased health care access for millions, especially in states that adopted the expansion. Consequently, preventive care utilization has risen, leading to early detection and treatment of conditions, which reduces long-term health care costs.

2. Health Insurance Marketplaces:

The creation of health insurance marketplaces allows individuals to compare and purchase insurance plans. These marketplaces provide subsidies based on income, making insurance more affordable. The increased coverage has led to a decrease in uninsured rates, resulting in better health outcomes due to regular access to health care services.

3. Pre-existing Conditions:

By prohibiting insurance companies from denying coverage based on pre-existing conditions, the ACA ensures continuous access to necessary medical care. This provision has significantly improved the health outcomes of those with chronic illnesses who previously faced barriers to obtaining insurance.

4. Preventive Services:

The ACA mandates that preventive services, such as screenings and vaccinations, be provided without out-of-pocket costs. This focus on prevention helps detect health issues early, reducing the need for more expensive treatments later. Improved preventive care reduces the incidence and severity of diseases, lowering overall health care costs.

5. Young Adult Coverage:

Allowing young adults to stay on their parents’ insurance plans until age 26 has increased insurance coverage among this demographic. Young adults now have better access to preventive and routine care, leading to healthier lifestyles and fewer emergency room visits.

6. Medicare Reforms:

The ACA implemented several reforms to Medicare, including reducing payments to Medicare Advantage plans and introducing value-based purchasing programs. These reforms aim to improve care quality while controlling costs. Hospitals are incentivized to reduce readmissions and hospital-acquired conditions, leading to better patient outcomes and lower expenses.

7. Accountable Care Organizations (ACOs):

The establishment of ACOs encourages health care providers to collaborate and coordinate care for Medicare patients. ACOs aim to deliver high-quality care while reducing unnecessary spending. This model promotes efficiency and effectiveness, leading to improved patient outcomes and cost savings.

8. Essential Health Benefits:

The ACA requires insurance plans to cover essential health benefits, such as maternity care, mental health services, and prescription drugs. Comprehensive coverage ensures that individuals receive necessary care, leading to better health outcomes and fewer complications.

9. Value-Based Payment Models:

Transitioning from fee-for-service to value-based payment models encourages providers to focus on the quality rather than the quantity of care. Providers are rewarded for achieving better patient outcomes and reducing costs. This shift promotes effective and efficient care delivery.

10. Health Information Technology:

The ACA incentivizes the adoption of electronic health records (EHRs) and other health information technologies. EHRs improve care coordination, reduce medical errors, and enhance patient safety. Improved information sharing leads to more informed decision-making and better health outcomes.

Conclusion

The ACA’s components collectively enhance health care accessibility, affordability, and quality. By expanding coverage, focusing on preventive care, and promoting efficient care delivery, the ACA improves health outcomes while reducing overall costs. The ongoing implementation and evolution of these provisions will continue to shape the future of health care in the United States.

References

 
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Nursing Assignment 5.2: Advocacy Action Plan Ignite Presentation: Part 1

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Nursing Assignment 5.2: Advocacy Action Plan Ignite Presentation: Part 1

Nursing Assignment 5.2: Advocacy Action Plan Ignite Presentation: Part 1

(Nursing Assignment 5.2: Advocacy Action Plan Ignite Presentation: Part 1) Title Slide: Name of Project, Student Name(s), Course Name/Number, Date [1 slide]

Roadmap (what will you cover in this presentation?) [ 1 slide]

Compelling introduction/question/quote that grabs the audience attention [1 slide]

What?: Introduce the public health issue and describe the issue that you are trying to change/impact [ 1- 2 slides]So what?: Explain why you care about this issue and why the audience should care about the issue [ 1-2 slides] (Nursing Assignment 5.2: Advocacy Action Plan Ignite Presentation: Part 1)

Now what?: Present your advocacy initiative/idea and key elements of the action plan [3-6 slides]Provide the call(s) to action [1-2 slides]

Slide 1: Title Slide

Title: “Addressing Childhood Obesity”

Student Name(s): [Your Name(s)]

Course Name/Number: [Course Name/Number]

Date: [Presentation Date]

Slide 2: Roadmap

Title: “Roadmap”

Briefly outline what you will cover in this presentation.

  • Introduction to the issue
  • Why it matters
  • Advocacy initiative
  • Action plan
  • Call to action

Slide 3: Compelling Introduction

Title: “Why Childhood Obesity Matters

“Use an attention-grabbing quote, question, or statistic to engage the audience. For example: “Did you know that nearly 340 million children and adolescents were overweight or obese in 2016? This alarming statistic is why we’re here today.” (Nursing Assignment 5.2: Advocacy Action Plan Ignite Presentation: Part 1)

Slide 4: What? – Introduction to Childhood Obesity

Title: “Understanding Childhood Obesity”

Describe childhood obesity as a public health issue.

Highlight the significance of the problem with statistics and facts.

Consider using visuals to illustrate the issue.

Slide 5: What? – Consequences of Childhood Obesity

Title: “The Consequences”

Explain the physical and long-term health consequences of childhood obesity. Use images or graphics to visualize the impact.

Slide 6: So What? – Why You Care

Title: “Why I Care”

Share your personal motivation for addressing childhood obesity. Describe your passion for this cause.

Slide 7: So What? – Why the Audience Should Care

Title: “Why You Should Care”

Convince the audience of the broader implications and importance of tackling childhood obesity. Mention the potential societal and economic benefits.

Slide 8: Now What? – Advocacy Initiative Overview

Title: “Our Advocacy Initiative”

Provide an overview of your campaign or initiative to combat childhood obesity. Highlight the goals and objectives.

Slide 9: Now What? – Key Elements of Action Plan

Title: “Action Plan Essentials”

Outline the key components of your action plan, such as education, awareness, and policy changes. Use bullet points for clarity.

Slides 10-14 (or more): Now What? – Action Plan Details Title each slide with specific action plan elements. Delve deeper into the details of your action plan, explaining each step or component. Include any research or data supporting your plan.

Title: Education Programs

  • Implement nutrition education in schools.
  • Promote physical activity and healthy eating habits.

Title: Community Outreach

  • Organize local events to raise awareness.
  • Use social media to spread information.

Title: Policy Advocacy

  • Lobby for healthier school meal programs.
  • Advocate for mandatory physical education classes.

Title: Research and Data

  • Present studies supporting the effectiveness of your action plan.
  • Show data on the impact of education and policy changes on childhood obesity rates.

Slide 15: Call to Action

Title: “Join Our Movement”

Provide a clear and compelling call to action for the audience. Explain how they can support your initiative, whether through volunteering, donations, or spreading awareness.

Slide 16: Conclusion

Title: “Together, We Can Make a Difference”

Summarize the key points of your presentation.

Reiterate the importance of addressing childhood obesity.

Slide 17: Questions

Title: “Questions? ”

Open the floor for any questions or comments from the audience. Ensure that your presentation is visually appealing, uses appropriate fonts and visuals, and keeps text concise for an engaging and impactful delivery. Feel free to add relevant images, graphs, and statistics where they enhance your message.

References

World Health Organization (WHO). (2021). Obesity and Overweight. Retrieved from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

Centers for Disease Control and Prevention (CDC). (2020). Childhood Obesity Facts. Retrieved from: https://www.cdc.gov/obesity/data/childhood.html

American Heart Association. (2016). Overweight in Children. Retrieved from: https://www.heart.org/en/healthy-living/healthy-eating/losing-weight/overweight-in-children

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). (2017). Health Risks of Overweight & Obesity. Retrieved from: https://www.niddk.nih.gov/health-information/weight-management/health-risks-overweight

Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2014). Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA, 311(8), 806-814. DOI: 10.1001/jama.2014.732

American Academy of Pediatrics (AAP). (2015). Prevention of Childhood Obesity. Retrieved from: https://pediatrics.aappublications.org/content/early/2015/08/18/peds.2015-2868

 
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