according to the American Diabetes Association (2011), 25.8 million children and adults have been diagnosed with diabetes in the United States. Approximately 2 million more are diagnosed every year, with another 79 million people considered to be in a pre-diabetes state. These millions of people are at risk of several alterations, including heart disease, stroke, kidney failure, neuropathy, and blindness. Since diabetes has a major impact on the health of millions of people around the world, it is essential for nurses to understand the pathophysiology and associated alterations of this disorder. In this Discussion, you compare two types of diabetes—diabetes mellitus and diabetes insipidus.

                                            To Prepare

Review Chapter 19 in the Huether and McCance text and Chapter 18 in the  Hammer and McPhee text. 

Identify the pathophysiology of diabetes mellitus and diabetes insipidus. Consider the similarities and differences between resulting alterations of hormonal regulation.

Select two of the following patient factors: genetics, gender, ethnicity, age, or behavior. 

Think about how the factors you selected might impact the diagnosis and prescription of treatment for these two types of diabetes.

Post an explanation of the pathophysiology of diabetes mellitus and diabetes insipidus. 

Describe the differences and similarities between resulting alterations of hormonal regulation. 

Then explain how the factors you selected might impact the diagnosis and prescription of treatment for these two types of diabetes.

 

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Discussion: Diagnosing Neurological Disorders

As an advanced practice nurse, you will likely observe patients who experience neurological disorders. Challenging to the diagnosis of neurological disorders is the realization that many manifestations of disease may not be overt physically.

For this Discussion, consider the following three case studies of patients presenting with neurological disorders.

Case Study 1

80-year-old male Caucasian male brought to the clinic by his wife concerned about his “memory problems”. Per the wife, she has noticed his memory declining but has never interfered with his daily activities until now. He is unable to remember his appointments and heavily relies on written notes for reminder. Just last week, he got lost driving and was not found by his family until 8 hours later. He is unable to use his cell phone or recall his home address or phone number. He has become a “hermit” per his wife. He has withdrawn from participating with church activities and has become less attentive.

PMH: HTN, controlled Prostate cancer 20 years ago Dyslipidemia SH: no alcohol or tobacco use; needs assistance with medications PE: VS stable, physical exam unremarkable

Case Study 2

A 30-year-old Asian female presents to the clinic with headaches. History of headaches since her teen years. Headaches have become more debilitating recently. Describes the pain as sharp, worsens with light and accompanied by nausea and at times vomiting. Rates the pain as 7/10. Typically takes 2 tabs of OTC Motrin with ‘some help’. “Sleeping it off in a darkened room’ helps alleviate the headache. VS WNL, physical exam unremarkable.

Case Study 3

A 50-year-old African American male presents with complaints of dizziness left arm weakness and fatigue. PMH: poorly controlled diabetes, hypertension, hyperlipidemia PE: Upon exam, you noted a very mild dysarthria, he understands and follows commands very well. Mild weakness on the left side of the face is noted, and left sided homonymous hemianopsia but no ptosis or nystagmus or uvula deviation.

To Prepare:

· You will either select or be assigned one of the three case studies provided.

· Reflect on the provided patient information including history and physical exams.

· Think about a differential diagnosis. Consider the role the patient history and physical exam played in your diagnosis.

· Reflect on potential treatment options based on your diagnosis.

 

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Develop and Concept Map, using the form provided, on the following patient. Include Diagnostic data and medical orders that you expect to be ordered on the patient.

T.J., a 30-year-old African American client, is in his last year of law school and is clerking for a prestigious law firm. He and his fiancé plan to marry as soon as he graduates. During the last week he has had four dizzy spells and a headache at the base of his skull upon awakening for the last 2 days. His father has a history of hypertension, so T.J. is aware that his symptoms may indicate high blood pressure. On his way home from work, T.J. stops by the clinic and asks the nurse to check his blood pressure. The nursing assessment yields the following data.

Subjective data: States he has had four dizzy spells and has awakened with a headache in the occipital lobe the last two mornings. T.J. has 1 glass of wine at lunch and 2-3 beers in the evening to relax from the tension of school and work. Most of his meals are at fast-food establishments and have a high fat content. T.J. does not smoke. He used to jog 4 mornings a week but quit when he started clerking. He has had nocturia for the last 3 weeks. He is not taking any medication. T.J. states he is concerned about having hypertension because he does not want to take medication.

Objective data: T 98.6°F(37°C), AP 78 beats/min, R 16 breaths/min, BP 142/92 mm Hg, Wt 190 lbs (optimum weight 160). No edema noted in hands, feet, or legs.

 

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Mr. Jones, who is 74 years of age, is being discharged home after having a right knee replacement. The discharge orders from the orthopedic surgeon include: continuous passive motion (CPM) at the current setting of 0-degrees extension worn when walking with crutches (nonweight-bearing postdischarge day 1, and may begin weight-bearing postdischarge day 2); and home nurse visits, as needed. Physical therapy should begin the day after discharge at an orthopedic center. The orders will be faxed to the center. The following medications with prescriptions attached include: Lovenox (enoxaparin) 70 mg subcutaneously once daily for 7 days, Vicodin (hydrocodone bitartrate) 10 mg every 4 hours PRN, and Colace (docusate sodium) 100 mg every day. The patient is to follow up with the orthopedic surgeon in 3 weeks. His daughter plans to stay with him for several weeks to assist him with meals and household chores, and take him to physical therapy and the orthopedic surgeon for follow-up. Mr. Jones has three other children who live in other states. He is a widower and attends a local church. 

1. What preparations should the nurse make in advance before attaining necessary community resources and referrals before the patient is discharged?
2. What necessary community resources and referrals will the patient need?

2. Mrs. Johnson, a 67-year-old female patient, has recently been discharged from the hospital following an admission for COPD. She has a past medical history of a colon resection related to acute diverticulitis. She developed a surgical wound infection that requires daily wet to dry wound packing and IV Zosyn. Mrs. Johnson was discharged with home oxygen. To manage her care at home, home care visits were ordered. (Learning Objective 5)

1. What would be involved in setting up the first home care visit?
2. Describe the nursing assessments and management that would oc

 

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Need ONE Response Per Each Discussion Total 6 Responses. Attached Are The Discussions And Rubric Please Follow Them. Posts Will Be A Minimum Of 100 Words, APA Format.One Reference Per Each Di

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Community Nursing Practice Model

T Plan prevention and population-focused interventions for vulnerable populations using professional clinical judgment and evidence-based practice . However, there is a shortage for physicians who can take up responsibilities in the community health sector. Among the efforts in place to strengthen the human resource is the growing interest to have nurses in advance practices participate inpatient care at the community health level. By applying the community, nursing practice model advanced practice nurses are better prepared to deliver care and outcomes to patients in poor communities.

The Community Nursing Practice Model

The community nursing model plays an essential role in ensuring that less privileged communities can access better healthcare by providing a framework for community nurses to focus on entire populations that have similar health concerns or characteristics. For example, a society where there are reproductive health issues, nurses applying this model in such a community will be able to know what the needs of the community are as far as reproductive health is concerned (Maclaine, 2014).

The model considers all levels of prevention, which include primary prevention whereby the advanced practice nurses promote health and protect against threats to health in the community. For example, carrying out awareness in the community on sexually transmitted diseases and distributing latex condoms in the community (Maclaine, 2014). Another level of prevention is secondary prevention, which involves the community nurses’ practitioners detecting and treating problems at the early stage of detection so that the health problem does not cause serious problems or affect others. The last level of prevention involves the community nurse practitioner preventing existing problems from getting worse.

The MSN Essential

Clinical prevention and population health are one of the MSN essential that is relevant to the community nursing practice. The underlying notion of this MSN essential is recognizing that masters prepared nurse applies and integrates a good organizational, patient-centered and culturally appropriate idea in planning to deliver and managing of clinical prevention and community care services to individuals and families (AACN, 2011). Under this essential, it is well elaborated that a master’s degree level nurse should be able to synthesize broad social determinants of health and data from epidemiology to design and deliver clinical interventions to the communities in need while using relevant strategies. 

In summary,the model has transcended values of respect, care, and wellness, which are essential in primary health care. The CNP and MSN essential provide a framework for nurses who want to practice in the community health sector and especially for advanced care nurses. The model depicts community health nursing practitioners as an essential part of an interdisciplinary team that includes physicians and nutritionist. The team approach is vital to the success of community health practice.

References

Maclaine, K. (2014). Advanced Nursing Practice in the Community. Community Health Care Nursing, 234-252. doi:10.1002/9781444316247.ch15

The American Association of Colleges of Nursing (AACN) (2011). AACN Resources to Facilitate Integration of the Essentials of Master’s Education in Nursing. Nurse Educator, 36(5). doi:10.1097/nne.0b013e3182297b78

Wessel, L. A. (2005). Nurse Practitioners in Community Health Settings Today. Journal of Health Care for the Poor and Underserved, 16(1), 1-6. doi:10.1353/hpu.2005.0019

 Eduardo Soto Quinones

                                                                                       Florida National University

                                                                                               July 17. 2019

       Nurse Practitioners are the principal group of advanced-practice nurses delivering primary care in the United States and are the initial point of patient contact in many settings and deliver care consistent with their areas of expertise and the laws that govern nursing scope of practice. Nurse practitioners deliver primary care in small and large private and public practices, and in clinics, schools, and workplaces. Often taking the lead clinical, management, teaching, researching and accountability roles in innovative primary care models. Nurse practitioners care for a wide range of patients from babies to senior citizens. They can diagnose and treat patients for many common ailments, also prescribe medications, order lab tests as well as interpret the data to treat a patient. Family nurse practitioners have a long history of engaging patients in their care, helping them to understand their illness and practical measures they can take for improvements. With the growing complexity of health care and diminishing availability of primary care physicians, many patients are seeing family nurse practitioners for their primary needs.

       I think essential IX: Master’s Level Nursing Practice, is related to community nursing practice. Nurse practitioners must be prepare to implement safe, quality care in a variety of settings and roles. Also must advocate for patients, families, caregivers, communities and members of the health care team.

References.

American Association of Colleges of Nursing.(2011). The essentials of master’s education in nursing.

US Department of Health and Human Services. Bureau of Labor Statistic.( 2016). The Registered Nurse Population.

Marie Germain Discussion: 7

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          After reading this article, I came to the realization of the role and collaboration and need of the Family Nurse Practitioner throughout the community. The NP can use the Community Nursing Practice Model to facilitate the care needed for the undeserved population within our communities. The Association of Clinicians for the Underserved (ACU) defines transdisciplinary care as a holistic approach to patient assessment and treatment through a highly collaborative team of health care professional (Wessel 2005). According to Wessel (2005), the ACU advocates for improved healthcare for under deserved populations who receive irregular health care due to existing health disparities in the healthcare system across America. The nursing practice model helps in the provision of preventive care and maintenance as well as continued patient education for people suffering from chronic illnesses such as Diabetes, Hypertension, and HIV/AIDS.

          The community health nursing model provides the network through which community health nurses work with people, supports and practice that represents the standards of community health nursing. The standards of practice revolve around values, beliefs, which empowers the community health nursing to focus on improving the health of people in the community by facilitating change in health systems or society in support of health care outcome and provision for patient in need in both rural and urban community. As a FNP, we can work throughout the community in variety of different role and settings, as a care provider, educator, advocate, manager, collaborator leader, and researcher. Nursing Practice (NP) provides adequate care to the patients by developing a close relationship with them, building their strength as well as responding to their demands holistically, mind, body and spirit.  NP are equipped the with in-depth knowledge of care and prevention. With this, nurses will be in a better position of sensitizing patient in under deserved communities on causes of certain diseases, as well as initiating education and preventive measures that are patient-centered, to improve their overall quality of health. I came to understand that empowering patients is vital in improving the outcome of patient health in under deserved communities. With empowerment, patients will be able to take good care of themselves, change their lifestyle, and alleviate acute disease exacerbations. Moreover, NP working within the community curbs regular visits to the hospital; in this instance; which is cost effective for the patients, making it more beneficial to the minority populations (Wessel, 2005).

          The MSN essential that is most significant and correlates with Community health is essential VII Interprofessional Collaboration for Improving Patient and Population Health Outcomes. It is patient-centered and integrates concepts that are culturally accepted in healthcare planning, delivering, managing, and evaluating diseases based on the evidence, prevention, care, as well as services to families, individuals, and identified communities. The MSN essential VII prepared Nurse Practitioner working within the community, to allocate the proper referral, consults, collaborate and educate individuals towards optimal health outcomes (American Association of Colleges of Nursing, 2017).

References

American Association of Colleges of Nursing. (2011). The essentials of master’s education in

           nursing. March 21, 2011.

Wessel, L. A. (2005). Nurse practitioners in community health settings today. Journal of

            health care for the poor and underserved, 16(1), 1-6.

Community Nursing Practice

Robert Alonso

                                                                                                             Community Nursing Practice

There are numerous fields where a registered medical attendant can practice. One area of these fields is known as Community Health Nursing. Community nursing integrate evidence-based research with the public health needs to give care dependent on science and facts. Public health medical attendants frequently hold jobs in the legislature or at freely financed facilities, yet besides work for private wellbeing offices. The Community health nursing model (CHNM) outlines the dynamic idea of public health nursing work on, grasping the present and anticipating into the future (American Nurses Association. 2013). The CHNM gives the vehicle through which public health medical attendants work with individuals and supports the training that epitomizes the principles of public health nursing. The standards of practice rotate around both the beliefs and values and the nursing process with the energies of public health nursing continually being centered on improving the health of individuals in the society and encouraging change in systems or society in help of wellbeing. Wessel contends that public wellbeing nursing practice does not happen in disengagement yet instead inside an ecological setting, for example, approaches inside their work environment and the service structure pertinent to their work (2005).

One MSN Essential that most corresponds to this discussion identified with public nursing practice is how the nurse practitioners can serve as an advocate. In their communities, medical caretakers advocate for the necessities of patients and their families by utilizing their aptitude to influence those in positions of power in regards to financial issues, just as issues in the educational and health care sectors (ANA. 2013). Medical attendants likewise, straightforwardly advocate for patients in specific cases where a need is evident.

 References

American Nurses Association,. (2013). Public health nursing: Scope and standards of practice.

Wessel, L. A. (2005). Nurse practitioners in community health settings today. Journal of health care for the poor and underserved, 16(1), 1-6.

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Gretell Alfonso 

Week 12 Discussion Gretell Alfonso

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While making the decision of where to take my career as a registered nurse to the next level, I was always in between Nurse Practitioner and CRNA. However,when I thought of the option of nurse practitioner I was confused and lacking the knowledge when thinking about where they are able to practice. For example, for sure I understood and knew that they can practice in a hospital or in a family primary care office but, I never really thought about any other settings therefore giving me a limited perspective as to where Nurse Practitioners could work. My decision was to go into Nurse Practitioner program because I knew that I would enjoy working at either one of these settings but mainly in a doctors office. As I go through the program I have learned that as a nurse practitioner I can work in many other settings and take on different roles, the ones I never really thought I could as well. As a nurse practitioner we have the ability to play many roles such as a primary care professional, teacher, researcher and management. After reading the article “Nurse Practitioners in Community Health Settings Today” I was able to make myself more aware of the places I can take my degree and roles to use them to the fullest potential possible. Although this article mainly focuses on the nurse practitioner working in a community setting, it explores great ideas in how to help the patients that cannot afford health insurance. As we are aware, many people in USA are experiencing health insurance issues and therefore not able to receive preventive health care or any care. As nurse practitioners we can be a part of changing that to a more positive thought. Helping the undeserved and low income people to receive care can be done just how the nurse practitioner in the article “Nurse Practitioners in Community Health Settings Today” explains how she has accomplished it such as by providing primary care to those uninsured immigrants on a community health van. Nurse practitioners are professionals who are able to provide health care to the community by using a combination of their skills and educating patients on their health due to their previous experience as a nurse. A nurse practitioner will concentrate more in the patients health care needs and assist them to achieve them while working along with an MD who will diagnose the patient and not spend as much time talking about other topics such as how can a patient afford their medication. The essential that I believe applies to the nurse practitioner role is VII-Interprofessional Collaboration for Improving Patient & Population Health Outcomes. I believe that interprofessional collaboration is exactly what we do when working with Medical doctors due to the fact that we cover the topics and go over them with the patients that the MD might not have time to talk about with them. Patients have many questions when it comes to their health and a lot of the noncompliance with their health comes through not being educated enough about their diagnoses or illness. AsNP’s we work closely with doctors to make sure our patients receive the best care possible while clarifying all the questions and concerns our patients have which will provide better health outcomes to our patients. 

References:

Adkins, C. (2003). Agenda for change: Guidance for community practitioners and community nurses: The journal of the health 

     visitors’ association. Community Practitioner, 76(10), 390-392. Retrieved from 

https://search.proquest.com/docview/213297710?accountid=158399

The Essentials of Master’s Education in Nursing. (2011). American Association of Colleges of Nursing. Retrieved July 17, 2019, 

       from https://fnu.blackboard.com/bbcswebdav/pid-948066-dt-content-rid-11761660_1/courses/19SUMF-NGR5110-DL-

       MSN1A/AACN MastersEssentials 2011.pdf.

 The Journal for Nurse Practitioners Continuing EducationCredit Application. (2014). The Journal for Nurse Practitioners, 10(1),

          11-12. doi:10.1016/j.nurpra.2013.11.013

Discussion 7: Manuel M Cabrera

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Discussion 7

Family nurse practitioners (FNPs) are provided with opportunities to work in a variety of settings, including primary care hospitals, acute care facilities, and urgent-care centers. A trained nurse has to acknowledge the differences between these settings and modify their strategies depending on the environment and the needs of the patient. Similarly, FNPs may participate in research and assume management roles (Wessel, 2005, p. 1). In other words, FNPs are expected to prioritize flexibility. Nevertheless, it is also beneficial to focus on a specific setting to gain experience and become an expert. For example, many trained professionals recognize that community nursing requires unique skills and knowledge to provide high-quality care. The Community Nursing Practice Model focuses on the connection between different dimensions of healthcare that may influence a specific nursing situation. The advantage of this model is that it highlights the need to establish organizations with wide jurisdictions to address the needs of groups and communities. Wessel (2005) believes that this approach is necessary to provide disadvantaged communities with the necessary services (p. 5). Association of Clinicians for the Underserved (ACU) is one of such organizations, and its objective is to establish an organizational structure that would help communities in need such as undocumented immigrants to gain access to healthcare services. One may argue that the 8th Essential may be linked to the practices associated with community nursing because this Essential focuses on the application of nursing concepts in the context of population health (AACN, 2011, p. 24). Low-income communities and minority groups are disproportionately affected by health disparities. One has to recognize that core healthcare challenges cannot be addressed if the needs of disadvantaged groups are not taken into account (CDC, n.d.). Thus, community nursing practice should be viewed as a core element of nursing practice because it could help to address current challenges.

References

American Association of Colleges of Nursing (AACN). (2011). The Essentials of master’s education in nursing [PDF file]. Retrieved from http://www.aacnnursing.org/portals/42/publications/mastersessentials11.pdf

Centers for Disease Control and Prevention (CDC). (n.d.). CDC community health improvement navigator. Retrieved from https://www.cdc.gov/chinav/

Wessel, L. A. (2005). Nurse practitioners in community health settings today. Journal of Health Care for the Poor and Underserved, 16(1), 1-6. doi: 10.1353/hpu.2005.0019

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