Top of Form

Human Immunodeficiency disorder (HIV) is a viral infection.  The infection results from one of two similar retroviruses (HIV-1 and HIV-2) that destroy CD4+ lymphocytes and can impair cell-mediated immunity which increases the risk of certain infections and cancers (Cachay, 2019).  When cell-mediated immunity is impaired, the immune system weakens and makes the body more susceptible to any type of infection that sees opportunity.  HIV is spread through contact with infected body fluids such as saliva, blood, and semen.  The pathophysiology includes the HIV cells to attach and penetrate host T cells via the CD4+ molecules and chemokine receptors.  After the attachment process, HIV RNA and several HIV-encoded enzymes are released into the host cell (Cachay, 2019).  This process results in multiple replications of the infected host cell.  These mutations facilitate the generation of HIV which can resist control by the host’s immune systems and by antiretroviral drugs (Cachay, 2019).  Compensatory mechanisms are present throughout the human body and evolution is a key factor in the impairment of several disease processes.  RNAi is a novel target when directed at the viral TAR.  When this has been tested, HIV can not mutate the target site.  Instead several mutations indirectly compensated through upregulation.  The RNAi represents a novel compensatory mechanism by which viruses can tune viral transcriptional regulation as an indirect mechanism to compensate for viral suppression (Leonard, J. N., et al, 2008).  Depending on the infected host’s immune system, HIV can present as an acute febrile illness days to months after exposure to the virus.  Determination of HIV is based on the CD4+ count.  When the CD4+ count drops to <200/mcL nonspecific symptoms may worsen and succession of AIDS-defining illnesses will develop (Cachay, 2019).  Behavior seems to be the largest risk factor in the pathophysiology and diagnosis of this disease process.  Homosexual or bisexual men are at the highest risk of exposure to the infection.  Anal-receptive intercourse poses the highest risk because mucous membrane inflammation facilitates HIV transmission (Cachay, 2019).  

Systemic lupus erythematosus (SLE) is an autoimmune disease that results in multi-organ dysfunction.  SLE is characterized by a loss of self-tolerance with activation of autoreactive T and B cells which then leads to production of pathogenic autoantibodies and tissue injury (Choi, Kim, & Craft, 2012).  The kidneys are the primary targeted area that generates the initial dysfunction from this genetic pre-disposed disease.  Even though genetics is a predisposition to the development of SLE, the cause remains unknown.  The pathophysiology includes tissue injury through the release of inflammatory cytokines, as well as the aberrant activation of autoreactive T and B cells, which eventually leads to the pathogenic production of autoantibodies and then results in end-organ injury (Choi, Kim, & Croft, 2012).  End-organ injury in SLE can present as acute renal failure, spleenomegaly, and enlarged lymph nodes.  The cause of this presentation is based on an increased amount of circulating and activated basophils (Choi, Kim, & Craft, 2012).  To regulate this autoimmune disease process, CD4+ cells are present.  CD4+ T cells are critical players in the pathogenesis of SLE, they regulate B cell responses and also infiltrate target tissues, which eventually leads to tissue damage (Choi, Kim, & Craft, 2012).  

There are similarities and differences between SLE and HIV.  Each disease attacks the immune system which can cause an increased inflammatory response.  However in SLE, the immune system is overactive, where as in HIV, the immune system is underactive (2019).  Therefore, in SLE the body attacks healthy tissue and cells and in HIV, the body lacks an immune system to attack infections and the body becomes more susceptible to illness.  Both immune disorders are due to the qualitative CD4+ T cell dysfunction that occurs prior to CD4 cell depletion.  It is manifested by reduced responsiveness of CD4 cells to monocyte soluble antigens, which may include polyclonal B cell activation and reduced antibody response to specific immunogens (Fox & Isenburg, 2007).  

References

Cachay, E. R. (2019).  Human Immunodeficiency Virus (HIV) Infection – Infectious Diseases.  Retrieved from https://www.merckmanuals.com/professional/infectious-diseases/human-immunodeficiency-virus-hiv/human-immunodeficiency-virus-hiv-infection

Choi, J., Kim, S. T., & Craft, J. (2012).  Pathogensis of systemic lupus erythematosus update. Pathology, 44.  doi: 10.1016/s0031-3025(16)32688-5.  Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3508331/

Fox, R. A>, & Isenberg, D. A. (2007).  Human immunodeficiency virus infection in systemic lupus srythematosus.  Arthritis & Rheumatism, 40(6), 1168-1172.   doi: 10.1002/art.1780400623.  Retrieved from https://onlinelibrary.wiley.com/doi/pdf/10.1002/art.1780400623

Leonard, J. N., Shah, P. S., Burnett, J., C., & Schaffer, D. V. (2008).  HIV Ecades RNA Interference Directed at TAR by an Indirect Compensatory Mechanism.  Cell Host & Microbe, 4(5), 484-494. n doi:  10.1016/j.chom.2008.09.008.  Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2742160/

What is lupus? (2019).  Retrieved from https://www.lupus.org/resources/what-is-lupus

Bottom of Form

"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"

NURS 6501: Advanced Pathophysiology

Arthritis

Lorie Valentin RN, BSN

Arthritis

            Osteoarthritis (OA) and Rheumatoid Arthritis (RA) are both diseases of the joints. Each is characterized by pain, swelling and stiffening of joints throughout the body (Huether & McCance, 2017). The most common joints affected are the hands, knees, hips and spine (Huether & McCance, 2017). In OA the breakdown of cartilage within the joints causes causing damage to the underlying bone and tissue. This breakdown causes a disruption of the fluid distribution mechanism within the joints allowing to much fluid into the cartilage, which in turn causes swelling in the joint and a weakening of the cartilage. As the cartilage weakens, breakdown occurs and causes further damage to the underlying boney structures, which leads to pain, inflammation and deformity of the joints. The most common cause of OA is repeated compression of the joints due to repetitive motion or constant pressure such as weight on the knees. In RA the causative factors are related to the increase of the synovial membrane comprised of pro-inflammatory cytokines (Hammer & McPhee, 2019). Where this increased lining comes in contact with out tissues such as cartilage and bone, it causes breakdown of those tissues.

Influencing Factors

            Though the rates for developing the disease are relatively equal in all parts of the world women are 30 percent more likely to develop RA than men (Hammer & McPhee, 2019). However, though the incidence rates are relatively equal between men and women, as they age women are typically more profoundly affected by OA (Huether & McCance, 2017). Ethnicity does not appear to play a major role in either disorder as it strikes individuals equally in different areas of the world (Hammer & McPhee, 2019).

Diagnosis and Treatment

            The diagnosis for OA is best achieved through thorough examination, in depth history, and radiological imaging to look for joint deformities (Huether & McCance, 2017).  The treatment for OA is based on the severity of the deterioration of the adjacent bone tissue in the joint. For mild to moderate disease physical therapy and exercise along with anti-inflammatory medications can improve mobility and pain. By improving muscle tone and flexibility many of the symptoms can be relieved. Possible addition of supplements and changes in diet can help decrease the inflammation characteristic of OA. More aggressive treatment for progressive disease might include steroid injections or surgery to replace the joint.

            The diagnosis for RA is much more complicated and is reliant on physical assessment, history and presentation. The most significant finding during evaluation that would point to RA is the swelling of the joints. Treatment should be immediate and aggressive to reduce the deterioration of the joint and the potential for damage to other organs within the body (Hammer & McPhee, 2019). Initial treatment for RA should be started with disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, sulfasalazine, or leflunomide (Huether & McCance, 2017). Like OA, RA treatment should also include physical and occupational therapy to improve muscle tone and flexibility as well as anti-inflammatory medications such as NSAIDS and steroids.

References

Hammer, G. D., & McPhee, S. J. (2019). Pathophysiology of disease: An introduction to clinical

medicine (8th ed.). New York, NY: McGraw-Hill Education

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis,

MO: Mosby

Bottom of Form

"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"

This discussion looks at the life of Emma Gee and the relevance of implementing a Strengths-Based Nursing (SBN) plan in her healthcare as she struggled to recover from a stroke. Emma Gee was an energetic young therapist whose life was turned around after suffering a stroke. Due to the presence of an arteriovenous malformation (AVM), doctors scheduled a brain surgery for Emma. It was during the high-risk surgery procedure that Emma developed complications and suffered a stroke. Doctors immediately put Emma into an induced coma after the surgery. She later woke up unable to move or even speak. Through nursing and healthcare efforts from Dalcross Hospital, Royal Talbot Rehabilitation Centre and her family, Emma was able to recover and she is now a renowned motivational speaker and occupational theapist.The discussion looks at Emma’s healthcare experiences after she regained consciousness and during her rehabilitation. Based on her experiences, the discusion suggests how implementing a Strenths-Based Nursing and Healthcare approach could have made a difference in Emma’s recovery.

Overview Of Strengths-Based Principles

Strength-based nursing and health care (SBNC) is an approach that aims to create conditions whereby patients experience healing in their lifespan through the promotion of health and optimisation of their wellbeing and functioning. SBNC is about discovering, uncovering, understanding, and releasing social, interpersonal, intrapersonal, and biological strengths to meet healthcare and personal goals while dealing with the challenges. SBN is based on the guiding principles of collaborative partnership, relational care, empowerment and movement, person and family-centered care, and holistic care (Gottlieb, Gottlieb and Shamian, 2012). These principles provide hope, self-efficacy, and empowerment. It means that there should be a collaboration between the healthcare team and the patient while empowering him/her and the family to find meaning and attain their objectives. It also requires the health care team to understand the individual in whole by facilitating personalized care, holistic care, and whole-person nursing care.The principles aim to ensure the affected individual is responsible and takes charge of his or her healing and recovery process. Gottlieb (2012) outlined eight values that underly SBN. These include self-determination, person and environment are integral, subject reality and created meaning, holism, and embodiment, uniqueness, health and healing, collaborative partnership, learning, timing, and readiness. According to Gottlieb (2012), practicing a SBN model of health care promotes the quality of life, health behaviors, and brings hope to stroke survivors such as Emma Gee. It is especially important in Australia’s healthcare system whereby there are over 440,000 Australians directly affected by the effects of stroke (Rosamond et al., 2008). The National Stroke Foundation which is among the leading stroke support group in Australia approximates that over $44 million is needed to tackle the effects of stroke over a four year period.

Implementation Of Strengths-Based Nursing In Emma’s Case

This discussion looks at a case study on Emma Gee and investigates on the most appropriate ways in which a SBNC approach could have been implemented to assist Emma during her journey after suffering a life-changing stroke. After suffering a stroke at such a young age, Emma faced a lot of challenges in her new way of life. Being an active girl as evidenced by her various outdoor activities such as running and netball, Emma was devastated after the stroke and she had to accept her new reality. While in the induced coma, after regaining consciousness, during her rehabilitation, and in her integration back to the community, Emma had various health care needs. Implementing a SBN approach during her recovery journey could have greatly impacted the healthcare outcome and facilitated her wholesome recovery. Most importantly, a SBNC approach would have empowered and ensured collaboration between Emma, her family, and her healtcare providers. There are various challenges Emma encountered in her journey that could have been better addressed using a SBN model. These challenges range from dysphagia, balance and mobility complications, loneliness, environmental irritation, dysarthria, double incontinence, societal issues, to dependency. Furthermore, it is important to empower patients and ensure that they participate in their well being by involving them in decisin making activities.

Relationships In Nursing Practice

SBNC provides a guidance framework for nurses and other healthcare professionals. It facilitates the expansion of a nurse’s imaginary horizon and the providence of innovative solutions that solve long-term health care problems. While delivering medical services, healthcare professionals should have put themselves in Emma’s shoes. It would have ensured they understand what she went through physically, mentally, emotionally, and even spiritually (Kobau et al., 2011). According to Lietz (2007), SBNC broadens healthcare focus to include the well being, quality of life, healing and health of the whole person. It encourages a shift from analyzing the outcomes of health care as assessed by health practitioners to focusing on client-based outcomes. It is all about patients and the health care system combining effort to get the most of what is both meaningful and important to them.Such an approach would ensure the suffering experienced by stroke victims is minimised. While in hospital, Emma experienced double incontinence meaning she had lost control of her bowels and therefore needed to use a catheter. The nurses showed little or no empathy for her as evidenced by how they treated and acted towards her care. Emma even often felt embarrassed by the situation. Involving her parents or sister in cleaning up Emma would have made her feel more comfortable. Collaboration between her family and the nurses would have ensured Emma recovered from this stage of her journey in a personalized manner. Generally, nurses should have taken a personalized approach aimed at empowering Emma while collaborating with her family.

Transition Points

When formulating a SBN care plan, it is crucial to involve the patients, their families, and carers to facilitate procedures, clear health care expectations, investigations, and discharge of the patients in a collaborative manner. This helps in empowering the patient and helping him/her take charge of their recovery. A strength-based nursing care plan must consider verbal communication with the patient and family, previous documentation on the patient, clinical handover, and an assessment of the patient.

Regaining Consciousness

This discussion presents a SBN care plan following Emma regaining consciousness and focuses on collaboration between Emma, her family and other healthcare professionals involved in Emma’s case. For clinical documentation of Emma’s case, the study will adopt a multidisciplinary team approach and a SOAP framework to provide collaborated health care and communicate information on Emma’s progress to everyone invested in her recovery (Donohoe, 2015).After Emma regained consciousness, she faced various deficits such as trouble swallowing, vertigo, double incontinence, diplopia, left-side paralysis, right-side facial paralysis, mobility and balance issues among others. To facilitate her recovery, it is crucial to implement a SBN care plan that propagates collaboration between Emma, her family and healthcare professionals. The first step in developing the SBN care plan is to assess existing medical and personal information on Emma. It includes her emotional, social, family, mental, and physical history. To help her successfully transition and recover after the coma, it is important to determine and understand the factors surrounding her current condition. The next step of the care plan would be to observe the real-time progress of Emma. It includes Emma’s current condition such as her inability to swallow food. Through collaboration between Emma, her family members and the multidisciplinary team consisting of nurses under the guidance of a speech therapist, Emma’s situation can be analyzed, and appropriate interventions applied. This care plan would encompass educating and involving Emma’s family in assisting her with her swallowing complications. The outcome of the procedure would then be analyzed, and appropriate changes implemented based on Emma’s response to the intervention. Aside from educating and sensitizing them on the importance of collaborative healthcare approach, Emma’s family would constantly be updated on her progress and response. The care plan would further ensure that Emma’s family are consulted before, and present during any landmark decisions and progress on Emma’s recovery journey in the hospital.

Rehabilitation

SBN practices during a patient’s  rehabilitation should be geared towards helping the patient bounce back from their unfortunate scenario. A SBN care plan for Emma while at the Royal Talbot Rehabilitation Centre should have been focussed on empowerng Emma to take active part in her rehabilitation process. It was the responsibility of the nurses and Emma’s parents to work together with Emma and give her the motivation she needed. Under a SBN care plan, Emma’s nurses such as Fran, should have used a person-centered approach while rehabilitating Emma. A SBN care plan would include a multidisciplinary team comprised of nurses and specialists to help in the therapy process of Emma. This team would focus on making Emma feel valued in order to motivate and empower her to perform. The care plan would follow a carefully formulated therapy scheduleas determined by the input of Emma, her parents and the therapists at Talbot. It is also important to ensure patients are rehabilitated in a condusive environment. Unlike the brisk and careless attitude experienced at Talbot, a warm and nurturing approach to give Emma a sense of belonging would have been better suited to Emma’s situation. Such an environment would foster a feeling of comfort synonymous with having a family. Emma often felt dependent and powerless as a result off the care plan practiced at Talbot. This only made Emma feel vulnerable instead of empowered. Emma’s family and friends clearly supported her as evidenced in their unannouced visits and even the ‘RUN to GEE’ fundraiser to support Talbot. This kind of support compliments a SBN care plan by fuelling the recovery of a patient.

Reflection Of Emma’s Experience

Although Emma had caring parents and an identical twin sister who understood her, she felt lonely and sad while in admitted in the hospital, during rehabilitation and even after being integrated back into the community. The best approach would have been to sensitize her family and friends on the importance of communal support in facilitating the recovery process of a stroke victim (Wells et al., 2014). Emma needed to be emotionally motivated and supported to ensure her quick recovery, health, and quality of life. It is important to have a sense of belonging and a hand to help you through such a difficult time (Havens, Wood and Leeman, 2006). It was of grave importance for her family and friends to be actively involved in her recovery by visiting her a frequent as possible and showing her that they cared and supported her along her journey. Knowing she had the support of her family and medical staff would have fostered resilience in Emma throughout her recovery journey.

Before the unfortunate incident, Emma had been fond of food and cuisines as seen in her association of family time and visitors with food and other gifts.It however, took a negative turn since she started showing symptoms that were later diagnosed as an Arteriovenous malformation (AVM). The situation only worsened when she suffered a stroke and upon gaining consciousness, experienced dysphagia. Due to the difficulties faced by Emma while trying to swallow food, tubes were shoved down her throat to help her. During her recovery process in the hospital, Emma’s speech therapist taught her feeders to encourage the food downwards by stroking her neck although Emma found the idea quite unpleasant. By facilitating a SBN approach focused on empowering Emma while ensuring family involvement, it would have been more prudent to involve Emma’s parents or sister in this particular process. By providing her with the understanding yet familiar touch of her family, Emma would have been more comfortable. This familiarity coupled with her evident determination to recover and return to normal eating habits would have benefitted both Emma’s well being and functioning.

Emma was greatly disturbed by sound and visual irritations. Her communication and mobility challenges made it hard for her to do anything about these irritations. It is important for health facilities to incorporate a holistic approach to their health care services. Such an approach would ensure the outcome of the health services focus on the patient and his family by considering all their needs. By proving a conducive environment, hospitals and rehabilitation facilities enhance a patient’s quality of life. In Emma’s case, the hospital admitting her should have ensured the hospital facility and the rooms of sensitive patients such as Emma are located in a secure location with minimum irritants. 

 Due to dysarthria developed as a result of the stroke, Emma had difficulties in communicating and the people around could not understand her. This challenge plagued her both in the medical facilities and in the community. While in hospital, it would have been pivotal if all concerned parties collectively participated in Emma’s speech and mobility therapy.It would have encouraged self-dependency in Emma by motivating her. Their collaboration would make it easier and faster to understand Emma’s communication attempts. While back in the community, Emma found it difficult to relay information to others effectively and she was even occasionally misunderstood. Such scenarios could have been mitigated by the use of a SBNC approach that sensitized the community on how to take care of stroke patients. Additionally, Emma’s family would be able to accompany her at times and help her around. The outcome of this approach will be a community that is united in the health and general well being of stroke victims.

Promotion of self-efficacy is among the main principles underlying SBNC. Individuals under SBNC need to be self-dependent and in control certain aspects of their health and healing process Family and health care professionals play a great part in eliciting positivity and self-efficacy in a patient. This was however not the case in Emma’s journey. Emma frequently felt dependent on the medical staff for her day to day routine activities to a point she felt helpless and that the health professionals dominated her life. This feeling of dependence manifested itself even after she was released from hospital whereby she felt useless in her parents’ house. Her twin sister further reminded Emma of the life she had before she suffered the stroke. The society must also be involved in supporting stroke patients. Incidences such as people directing piercing looks or avoiding Emma in the pool should be mitigated to cultivate self-confidence. An effective SBNC approach would ensure that those around Emma such as the nurses, her family, and other people in the community elicit positivity. This positive attitude would, in turn, reflect on Emma and give her an inner drive to take charge and responsibility of her health and healing journey (Resnick, 2011).

Conclusion

In conclusion, it is important to ensure the individuals have a sense of purpose and are adequately empowered to make their own decisions.SBN can help achieve patient and family empowerment, health promotion, and partnerships in Australian healthcare by facilitating a healthcare system in which the community is actively involved and sensitive to patients and their needs. SBN considers the resources and strengths possessed by the individual and his family and uses these strengths to alleviate the existing deficits and problems. Organizations such as the Borrondara Stroke Support Group (BSSG) and the National Stroke Foundation enhance strength-based care in Australia through their various events and activities. These interventions collectively work to promote the well being of stroke patients, enhancing their resilience, and softening their suffering. SBN’s guiding principles of collaborative partnership, relational care, empowerment and movement, person and family-centered care, and holistic care provide hope, partnership, self-efficacy and empowerment to stroke victims in Australia

"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"

Respond on to  two different days who selected different immune disorders and/or factors than you, in the following ways:

Share insights on how the factor you selected impacts the pathophysiology of the immune disorder your colleague selected.

Expand on your colleague’s posting by providing additional insights or contrasting perspectives based on readings and evidence.

                                                    Main Post

                            Irritable Bowel Syndrome (IBS):

Irritable bowel syndrome is a problem of a bowel function of the gastrointestinal tract.  IBS is one of the most common reasons for gastroenterologist consultation (Hammer & McPhee, 2019).  Irritable bowel syndrome symptoms are persistent abdominal pain, gas, bloating and with bowel disturbance; there are four subtypes of IBS: constipation (IBS-C), diarrhea (IBS-D), mixed (IBS-M), or unsubtyped IBS (IBS-U) (Kosako et al., 2018).  The incidence of IBS is higher in women; it is 1.5 to 3 times higher than men; with greater incidence in youth and middle age (Huether & McCance, 2017).

There is no known pathophysiology of irritable bowel syndrome and no specific biomarker for the disease (Huether & McCance, 2017).  Increasing evidence showed due to the different types of symptoms presentation of IBS that there are possibilities of correlation to altered gut microflora, gut immune responses, neuroendocrine cell function, the brain-gut axis, genetic predisposition and epigenetic factor (Huether & McCance, 2017). Despite the global frequency and disease burden of IBS, its underlying pathophysiology remains unclear (Ng QX et al., 2018).  Inflammation may provide a pathogenic role in IBS; research has shown the occurrence of mucosal irritation at the microscopic and molecular degree in IBS (Ng QX et al., 2018).  It also been reported that considerable overlaps between IBS and inflammatory bowel disease (Ng QX, et al., 2018). 

Psoriasis:

Psoriasis is one of the common issues of chronic skin inflammation. The prevalence of psoriasis affects both sexes and in most ethnic groups (Huether & McCance, 2017).  Most common occurrences are in people in their 30s, but it can also happen soon after birth (Hammer & McPhee, 2019).  Familial history of psoriasis is common, and the genetic process is complicated (Huether & McCance, 2017). 

The inflammatory dynamic of psoriasis involves the multifaceted interaction between macrophages, fibroblasts, dendritic cells, natural killer cells, T helper cells, and regulatory T cells. The influence of these immune cells can signal the secretion of multiple inflammatory mediators such as interferon, tumor necrosis factor-alpha, and various cytokines including interleukin 12, 23 and 17 (Huether & McCance, 2017).  

Maladaptive consequences of IBS and psoriasis:

Skin diseases, including psoriasis, appeared to impact a substantial adverse effect on patients’ health-related quality of life (Jung et al., 2018).  Individuals with psoriasis report that the illness has various physical and mental implications, such as social isolation and stress, depression, shame, and anxiety (Jung et al., 2018).

Patients with irritable bowel syndrome (IBS) have been found to have a significant reduction in quality of life (Arluwaili, et al., 2018). People with IBS report that the disease broth substantial psychosocial consequences such as social lifestyle and activities, emotional, food, and diet interest (Arluwaili, et al., 2018).

Refences

Alruwaili, A. M. M., Albalawi, K. S. A., Alfuhigi, F. R. D., Alruwaili, A. F., Altaleb, B. A. A., & Aljarid, J. S. (2018). Effects of Irritable Bowel Syndrome (IBS) on the health-related quality of Life among Saudi Males at Al-Jouf, Kingdom of Saudi Arabia. Egyptian Journal of Hospital Medicine, 73(4), 6581–6585. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=a9h&AN=132302964&site=eds-live&scope=site

Hammer, G. D., & McPhee, S. J. (2019). Pathophysiology of disease: An introduction to clinical medicine (8th ed.). New York, NY: McGraw-Hill Education.

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

Jung, S., Lee, S.-M., Suh, D., Shin, H. T., & Suh, D.-C. (2018). The association of socioeconomic and clinical characteristics with health-related quality of life in patients with psoriasis: a cross-sectional study. Health And Quality Of Life Outcomes, 16(1), 180. https://doi-org.ezp.waldenulibrary.org/10.1186/s12955-018-1007-7

Kosako, M., Akiho, H., Miwa, H., Kanazawa, M., & Fukudo, S. (2018). Impact of symptoms by gender and age in Japanese subjects with irritable bowel syndrome with constipation (IBS-C): A large population-based internet survey. BioPsychoSocial Medicine, 12. https://doi-org.ezp.waldenulibrary.org/10.1186/s13030-018-0131-2

Ng QX, Soh AYS, Loke W, Lim DY, & Yeo WS. (2018). The role of inflammation in irritable bowel syndrome

"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"

Develop a 4 to 5 page paper, written to your organization’s leadership team, addressing your selected national healthcare issue/stressor and how it is impacting your work setting. Be sure to address the following:

· Identify and review two scholarly resources that focus on change strategies implemented by healthcare organizations to address the national issue of Full Practice Authority Restrictions for Nurse Practitioners

· Describe this national healthcare issue and its impact on your organization. Use organizational data to quantify the impact

· Provide a brief summary of the two articles you reviewed from outside resources on the national healthcare issue. Explain how the healthcare issue is being addressed in other organizations. 

· Summarize the strategies used to address the organizational impact of national healthcare issues presented in the scholarly resources you selected. Explain how they may impact your organization both positively and negatively. Be specific and provide examples.

"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"