What are specific actions that health professionals can take regardless of their practice area and site to promote population and community health?

• What advocacy actions might you take to improve health care through legislation at the state or federal level?

  Submission Instructions: 

• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points. 
• All replies must be constructive and use literature where possible.

Head-to-Toe Assessment

For this assignment, perform a complete head-to-toe assessment on someone of your choice or a hypothetical person who has at least two (2) systems issues. Use the head-to-toe template here to document your assessment (add more lines as needed). In a Microsoft Word document of 4-5 pages (in addition to the template) formatted in APA style, discuss the remaining criteria for the assignment. Please note that the title and reference pages should not be included in the total page count of your paper.

In your paper, address each of the following criteria:

• Use the template and include:
  • System being assessed.
  • Detailed review of each system with normal and abnormal findings.
  • For any system for which you do not have equipment, explain how you would do the assessment.
  • Normal laboratory findings for client age.
• An analysis of age-specific risk reduction health screening and immunizations.
• Two differential diagnoses (diseases) associated with possible abnormal findings.
• A plan of care (including two priority-nursing diagnoses, interventions, evaluation).
• Pharmacological treatments that can be used to address health issues for this client.
• Client and age appropriate evidenced-based practice strategies for health promotion.

On a separate references page, cite all sources using APA format. Helpful APA guides and resources are available in the South University Online Library. Below are guides that are located in the library and can be accessed and downloaded via the South University Online Citation Resources: APA Style page. The American Psychological Association website also provides detailed guidance on formatting, citations, and references at APA Style.
• APA Citation Helper
• APA Citations Quick Sheet
• APA-Style Formatting Guidelines for a Written Essay
• Basic Essay Template

Respond to the following post in two different replies. Your responses should be in a well-developed paragraph (300-350 words) to each peer. Integrating an evidence-based resource that is different than the one you used for the initial post.

Respectfully agree and disagree with your peers’ responses and explain your reasoning by including your rationales in your explanation.

APA format,  Cites three or more references, using at least one new scholarly resource . 

1st POST ( PLEASE RESPOND)

The purpose of this discussion post is to review ML’s new diagnosis and potential treatment options. For ML, her new diagnosis of stage A heart failure does not mean she has any structural abnormality with her heart. The pathophysiology of this condition includes the fact that ML has preexisting conditions that increase her risk of developing heart failure in the future, if left untreated. The conditions that would cause ML to be diagnosed with stage A heart failure and potentially lead to further heart failure staging if left untreated include hypertension, coronary artery disease, or diabetes mellitus (Woo & Robinson, 2020). The main goal with stage A heart failure includes managing comorbidities to prevent heart failure development (Tanaka, 2018). The main goal of this belongs with consistent blood pressure management. 

For ML, the main goal in her treatment therapy will include good blood pressure control. According to Woo and Robinson (2020), ACE inhibitors are typically the first line of treatment, as research has displayed these medications to improve patient symptoms, decrease mortality, and increase life expectancy. As these medications are typically shown to reduce the mechanisms that lead to heart failure, this would be the recommended drug of choice for ML to prevent her progression of stage A heart failure. Due to the fact that digoxin has not been shown to present a mortality benefit, although it may improve quality of life in patients with congestive heart failure, this would not be the first choice of treatment for ML. If, however, this was chosen for ML to treat her stage A heart failure and she was experiencing halos, this would be a sign of digoxin toxicity (Cummings & Swoboda, 2020). If ML has any renal impairment, she would be at increased risk for developing digoxin toxicity. To evaluate for toxicity, a random digoxin level should be checked as well as confirming when the last dose was taken by ML. Once an EKG and basic lab values are obtained, Digibind is an antidote that will assist with eliminating the toxicity, especially in life-threatening instances (Cummings & Swoboda, 2020). 

If digoxin is chosen to be the treatment for ML, special consideration should be taken if ML is an older adult or has renal impairment (Woo & Robinson, 2020). Along with this, digoxin was associated with increased risk of death and worsening heart failure in women compared to men (Jackson, 2015). Due to these risks and potential complications, ACE inhibitors will remain to be the drug class of choice for ML. Due to the risk of hypotension, a low-dose ACE inhibitor should be initiated, with a gradual increase in dose occurring to improve exercise tolerance and to relieve any potential symptoms. While doing this, BP and renal function should be closely monitored. Along with this, due to the risk of increased potassium levels, serum electrolyte levels should be regularly monitored. Lastly, one potential side effect that is typically the primary cause for discontinuation amongst patients is the risk of a persistent dry cough (Woo & Robinson, 2020). Ideally, with proper treatment and close monitoring, ML’s stage A heart failure will not progress to additional stages. 

2ND POST (PLEASE RESPOND)

 The purpose of this post is to discuss heart failure and the implications of using digoxin as a treatment option
Pathophysiology of Stage A heart failure. According to Cleveland Clinic (2021), Stage A heart failure is where though one is not having heart failure, the risks are high due to family history or other health medical conditions such as diabetes, hypertension, alcohol use, cardiomyopathy, drug use, coronary artery diseases, metabolic syndrome, rheumatic fever, and others. This means that the patient has a high risk for heart failure, but they do not have symptoms or structural heart diseases
Digoxin is the rational drug choice for treatment of this individual because it does not affect contractility. In addition to that is for maintenance as it does not cure heart failure. As stage A is just a risk and not fully heart failure, there is no need to alter the function of the heart. According to American Heart Association (2021) women need to get low dose digoxin, the advantage to this is, the low doses are beneficial hemodynamic, neurohormonal, and in clinical effect (Gheorghiade, 2017).
The patient’s concern about halos should digoxin be prescribed is a legit concern. When a patient has digoxin toxicity, there are a myriad of side effects and some are visual which include the haloes. If that happens, the patient should notify the provider immediately and get blood work to assess the serum level, tapering may be the first option that complete discontinuance of the medication (Pincus, 2016).
There are gender considerations related to medication treatment as women have increased mortality rates than men. One of the reasons is due to the hormone interaction and digoxin. Progestin increases the serum digoxin levels as it causes the reduction of digoxin excretion through the kidneys (Rathore, 2018).
Digoxin monitoring is very important as it has a very narrow safety range and to ensure therapeutic levels are met. Blood work is done as recommended especially after a few hours from last dose taken. The results will aid in adjusting medications or maintaining the regimen. In addition to that blood work is essential as it will monitor magnesium and potassium levels that can alter digoxin levels. Lastly if there is digoxin toxicity, there is an antidote that can be given to prevent adverse issues (Lab tests, 2020) 

RESPOND TO EACH POST WITH 300-350 WORDS. 

1. Answer the following questions below:
   1. How do public health policies and interventions affect your daily life?  Use examples.
   2. What are some examples of primary prevention, secondary prevention, and tertiary prevention for specific disease conditions?  
      • When would each type of prevention be appropriate?
2. Your paper should:
   • be typed in WORD, double spaced.
   • be three (3) or more pages.
   • include a Title page and a Reference page.
     • use one reference besides the textbook that is 5 years or newer (2013-2018). 
     • follow APA format according to the APA Style Guide
     • See NUR4667 – Library APA Citation Style web page for additional information.
   • use factual information from the textbook and/or appropriate articles and websites.
   • be original work, and will be checked for plagiarism.

Bacteriuria is defined as bacteria in the urine in a patient who is asymptomatic, whereas symptomatic bacteria in the urine is termed urinary tract infection.

nursing

Description

Bacteriuria vs Urinary Tract Infection

Bacteriuria is defined as bacteria in the urine in a patient who is asymptomatic, whereas symptomatic bacteria in the urine is termed urinary tract infection. Bacteriuria is not usually treated unless the patient is pregnant, immunocompromised or scheduled to undergo a genitourinary procedure, whereas urinary tract infections are treated with antibiotics.
History
Additional history that would be beneficial for the assessment would include last pelvic exam, and any history of change in color, consistency or volume of vaginal secretions. Medications that the patient is currently taking to assess if any of the medications are immunosuppressive medications in addition to the patient history of menstruation, menstrual frequency or menopause, “Postmenopausal women may be at higher risk for colonization due to a loss of an acidic vaginal pH.” (Crader, M. F. 2020). Past medical history of renal calculi as they can colonize with bacteria, history of frequency of daily urination to assess and history of tobacco use to assess for bladder cancer risk and process used for urine sample to verify clean catch. Additionally personal hygiene habits such as use and frequency of use of feminine napkins, use of feminine hygiene products such as douche that can change the pH of the vagina and inquiry about personal practices of use of sexual lubricants and https://iacademicessay.com/ urination after intercourse.
Diagnostic Studies
Verifying that the urine specimen has an order for culture would be the first diagnostic study; a culture of the bacteria detected will help guide potential treatment options, additional tests to add on to the urine sample would be urine cytology to screen for bladder cancer if there is a strong history of tobacco use. Vaginal exam with vaginal and urethral smears and culture given the reports of recent marriage and thus new sexual partner to test for STDs. Ultrasound can be useful to assess for abscess or suspected renal calculi in the bladder or urethra.
References
Crader, M. F. (2020, November 19). Bacteruria – StatPearls – NCBI Bookshelf. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK482276/
Merck Manuals. (2020c). Bacterial Urinary Tract Infections. Merck Manuals Professional Edition. https://www.merckmanuals.com/professional/genitourinary-disorders/urinary-tract-infections-utis/bacterial-urinary-tract-infections?query=Asymptomatic%20Bacteriuria
Case #2: 23-year-old woman
Differential Diagnosis
Possible inflammatory causes for 23-year-old woman reoccurring symptoms could be urethritis, sexually transmitted infections, and vaginitis. Urethritis is inflammation of the urethra that is commonly caused by bacterial or viral source, the most common bacteria for urethritis N. gonorrhoeae, C. trachomatis and Mycoplasma genitalium, and viral causes are commonly HPV, HSV and CMV. Sexually transmitted infections that cause the symptoms include Gonorrhea, Chlamydia, Trichomoniasis and https://getacademicessay.com/ Herpies simplex, given the information that the recurrent infections started after marriage there is possibility of STI due to introduction of a new sexual partner and previous treatment for acute cystitis may have helped with the infection but subsequent sexual encounters reintroduced the infectious agent. Vaginitis is a bacterial infection with symptoms of discharge, odor irritation and itching that can also cause dysuria. The most common causes of vaginosis include candidiasis, and trichomoniasis.
Possible non-inflammatory causes for 23 year old womans reoccurring symptoms include non-inflammatory causes could be urethral anatomic abnormalities, local trauma, and endometriosis. Urethral anatomical abnormalities such as strictures or diverticulum can cause reflux of urine and recurrent urinary infections, however most common anatomical abnormalities are present at birth and this is usually diagnosed in childhood in patients with a family history or urethral anatomical abnormalities. Local trauma such as “genitourinary instrumentation or surgery, pelvic irradiation, foreign body presence, horseback or bicycle riding” Michels, T., & Sands, J. (2015). Endometriosis of the bladder can cause acute flank pain, microscopic hematuria, dysuria, increased frequency, and urgency when the endometrial tissue grows within the bladder wall. Bladder endometriosis is extremely rate, with an occurrence rate of 1-2% of women who have endometriosis.
Diagnostic Tests
Urine culture and sensitivity could help determine if there is a bacterial cause of the recurrent dysuria if it is of a infectious nature. A pelvic exam with assessment for discharge, odor, and screening with vaginal and urethral smears and culture for possible vaginosis or sexually transmitted infections. For diagnosis of anatomical abnormalities or endometriosis of the bladder an cystoscopy would be required to visualize the causative nature of the symptoms.
Recurrent Lower UTIs
Common causes of recurrent UTIs in women include use of spermicides for contraception, new sexual partner, and voiding dysfunction. “Many other factors have been thought to predispose women to RUTIs, such as voiding patterns pre- and post-coitus, wiping technique, wearing tight undergarments, deferred voiding habits and vaginal douching; nevertheless, there has been no proven association” (Scholes D et all 2000).
Renal Failure
Acute kidney failure also known as acute renal injury (AKI) is an sudden decrease in renal function and is defined as one or more of the defining criteria of rise in serum creatinine of at least 0.3 mg/dL, serum creatinine >1.5 times the baseline value or urine volume of < 0.5mL/kg per hour for 6 hours. The cause of acute kidney injury can be subdivided into 3 causes, prerenal, intrarenal and post renal. Prerenal is associated with decreased renal profusion that is related to volume depletion or decreased arterial pressure that causes the glomular filtration rate to decrease.
Intrarenal AKI results from an ischemic or nephrotoxic cause such as prolonged hypotension or exposure to a nephrotoxic substance or medication that cause an acute inflammation of the glomeruli.
Postrenal AKI is due to a blockage or obstruction of urinary flow and is seem most often in prostate hypertrophy in men. “Patients with acute kidney injury are more likely to develop chronic kidney disease in the future. They are also at higher risk of end-stage renal disease and premature death”( Goldberg R, Dennen P 2008).