DUE 1/22/21 BEFORE 6PM EASTERN TIME

Recently there has been an extensive amount of research into something called telomere, which is a short sequence of base pairs (DNA’s) that are found at the end of chromosomes. This short sequence repeats itself approximately 50-70 times and can be found at the end of the chromosomes found in human cells. There has been a push to isolate them on a person’s leukocytes because they are easy to isolate and locate within the body of these research subjects, but these can be found in other cells. 

The proposal as to the function of telomeres is that they were a timepiece for each person; which means that a telomere would drop off at predetermined intervals (maybe 1-2 yrs) and eventually when the telomeres ran out, the cell would either die or undergo the apoptosis process.  The telomeres would fall off when the cell produced an enzyme called telomerase.  Thus, researchers became fascinated by what appeared to be a biochemical process in direct control of cellular life and death, and that could potentially be in control of death of an organism such as a human.

If you can imagine that these scientists were science fiction writers, they would be dreaming about laboratories throughout the world that could assist their patients to live up to 150 years of age or even longer.  The potential for some kind of mediation allowing a person to live longer does appear to be a reality, but possibly not to the extent that many imagine. 

Stochastic Theories

• Free Radical Theory
• Orgel/Error Theory
• Wear and Tear Theory
• Connective Tissue Theory

Non-Stochastic Theories

• Programmed Theory
• Gene/Biological Clock Theory
• Neuroendocrine Theory
• Immunologic/Autoimmune Theory

Instructions:

1. Read the paragraphs above.
2. Answer the following questions as thoroughly and concisely as possible: 2 or more Pages Essay APA
   1. From the list of aging theories above (Stochastic & Non-Stochastic Theories), where would you categorize the “telomere aging theory”? Would it be a Stochastic or Non-Stochastic theory?
   2. Please provide a rationale as to your selection. Include references

Explain the positive and negative aspects of the living arrangements for the elderly listed below. Be sure to thoroughly evaluate each option.

1. Living in own home
2. Living with their children
3. Assisted living facility
4. Nursing home with intermediate care 
5. Nursing home with skilled nursing care and make recommendations for healthy and disabled elderly

To prepare for this Discussion:

• By Day 5 of Week 9, your Instructor will have assigned you a sleep/wake disorder,
• (Hypersomnia ) which will be the focus of your original post for this Discussion.
• Review the Learning Resources.

Assigned Disorder:   Hypersomnia 

Post:

• Explain the diagnostic criteria for your assigned sleep/wake disorder.

• Explain the evidenced-based psychotherapy and psychopharmacologic treatment for your assigned sleep/wake disorder.

• Describe at what point you would refer the client to their primary care physician for an additional referral to a neurologist, pulmonologist, or physician specializing in sleep disorders and explain why.

Note: Support your rationale with a minimum of three academic resources less than five years In APA Format and proper citation Including Introduction and Conclusion   

Analyze and discuss the following:

Risk factors for heart disease.

Risk factors for breast cancer.

Enumerate the step for a cardiovascular system physical exam.

6 pages APA

Participation Requirement: You are required to post a minimum of three (3) times in each discussion. These three (3) posts must be on a minimum of two (2) separate days. You must respond to the initial discussion question by 11:59 p.m. on Wednesday.  On additional days, respond to your peers’ posts as well as additional faculty posts. Responses to peers must be posted by 11:59 p.m. on Sunday each week a discussion is due.

Step 1: Read attached article entitled, Advance Directives and Health Care Planning-Are all the pieces in place.pdf 

Step 2: Read the following article: Effect of Living wills on End of Life Care.pdf.   

An Advanced Directive is a document in which a client who is competent is able to express wishes regarding future acceptable health care. The document may include decisions including the desire for extraordinary lifesaving measures, such as resuscitation, intubation, and artificial hydration, and nutrition. The advanced directive may also be used to designate another person to make decisions when the client becomes physically or mentally unable to do so. The Patient-Determination Act requires all clients admitted to a health care facility be asked if they have advanced directives.

Planning guides for seriously ill clients includes:

1. Living will: Legal document that instructs health care providers and family members about what, if any, life-sustaining treatment an individual wants if at some time the individual is unable to make decisions.
2. Durable power of attorney for health care: Legal document that designates another person to make health care decisions for the client when the client becomes unable to make decisions independently.

Nursing intervention in these types of situations is to ensure to communicate to the interdisciplinary health care team that the client has provided and advanced directive and that it has been placed in the client’s medical record. Clients who do not have advanced directives must be given written information outlining rights related to health care decisions.

Initial Discussion scenario:

Mr. Gomez is a 73-year-old man who is estranged from his wife. Since he prefers that she doesn’t make any medical decisions for him should the need arise, he has filled out an advance directive naming his daughter Elena as his health care proxy. He has suffered from diabetes for many years and is adamant that he does not want dialysis, even if it would sustain his life. He does, however, wish to have tube feeding for however long it will sustain him.

One evening while at home with his daughter, Mr. Suarez has a seizure. He is taken to the hospital immediately, but never regains consciousness and doctors do not expect him to do so. Elena contacts her mother Mr. Gomez’s estranged wife and she quickly joins her daughter at the hospital. They want to put him on dialysis (as his diabetes is worsening) and a feeding tube (as there is no other way for him to receive nutrients). His daughter informs the doctors of her father’s end-of-life wishes. The doctors warn her that without dialysis her father will pass away more quickly, even with the feeding tube. Mr. Gomez’s estranged wife informs Elena that she needs to follow the advice received from the doctors in order to save her father’s life. Elena says that although she is aware of the consequences, she wants them to carry out her father’s wishes.

The clients estranged wife immediately has her attorney file an order to stop Elena from following her father’s wishes that are in his advanced directive. She feels that even though they are estranged, she still should have the right to make decisions regarding Mr. Gomez’s care. This action delays Elena’s ability to honor her father’s wishes and the doctors feel that it is necessary to inform the hospital’s ethics committee about the ongoing issue.

Assignment: Discuss the following questions

1. What is the role of the doctors in deciding whether or not to respect Mr. Gomez’s advanced directive?
2. Does Mr. Gomez’s estranged wife have the authority to step in and ignore Mr. Gomez’s advanced directive. Explain your reasoning while providing evidence-based solutions in your conclusion.
3. Gomez’s estranged wife has filed temporary order to ignore the advanced directive. If you were Elena, how would you handle this dilemma? What rights does Elena have that allow her to honor her father’s wishes?
4. What is the role of the ethics committee and how can they best support the client and his family?

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