Nephrolithiasis is the third most common problem of the genitourinary system. Identify and discuss risk factors for kidney stones including cultural considerations.

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Create  A DISCUSSION response to shemika NU623 APA STYLE. Pls use proper english and let it make sense.

Nephrolithiasis is the third most common problem of the genitourinary system.

Identify and discuss risk factors for kidney stones including cultural considerations.

Studies using the Nurse’s Health Study (NHS) I and NHS II data have established the significance of multiple factors in kidney stone accumulation and disclosed that higher dietary calcium was correlated with a lower risk of kidney stones in women. Patients with kidney stones are at increased risk of developing diabetes, hypertension, and cardiovascular disease.  According to several studies over the last two decades, findings revealed the importance of dietary and urinary factors, beverages, and body size in the evolution of kidney stones. Factors associated with increased risk for kidney stones include:

  • supplemental calcium,
  • Dietary oxalate
  • Sucrose, Fructose
  • Sugar-sweetened soda, Punch
  • Bmi, Diabetes mellitus (type 2)
  • Cholelithiasis
  • Urinary calcium excretion
  • Urinary oxalate excretion (Prochaska, Taylor, & Curhan, 2016)

 The frequency is higher in women who are in their 30s. Copious dietary factors may influence calcium oxalate stone formation, such as consuming calcium, oxalate, potassium, spinach, potatoes, and nuts. Animal protein could increase urinary calcium and decrease urinary citrate, but animal protein is not exclusively associated with a higher incident stone formation.  Men who have had a vasectomy and patients who take diuretics are also at increased risk of developing kidney stones. Kidney stones are more prevalent in the Midwest, Southeast, and the Western part of the United States (Dunphy, Winland-Brown, Porter, & Thomas, 2019). Non-Hispanic white individuals have the greatest prevalence between racial and ethnic groups (10.3%), superseded by Hispanics (6.4%) and non-Hispanic African Americans (4.3%) (Khan et al., 2016).

Patients should follow the dash (Dietary Approaches to Stop Hypertension) diet to minimize the chances of developing a kidney stone. The dash diet includes a lot of fruit and vegetables, minimal processed red meat, and moderated intake of low-fat dairy products. Patients should also abstain from caffeine, wine, and beer(Dunphy, Winland-Brown, Porter, & Thomas, 2019).

Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2019). Primary care: Art and science of advanced practice nursing – an interprofessional approach (5th ed.). [Bookshelf Ambassadored]. Retrieved from https://ambassadored.vitalsource.com/#/books/9780803694941/cfi/6/2!/4/2/2/2@0:0 (Links to an external site.)

Khan, S. R., Pearle, M. S., Robertson, G., Gambaro, G., Canales, K., Doizi, S., … Tiselius, (2016, February 25). Kidney stones. Nat Rev Dis Primers, 2(16008). http://dx.doi.org/10.1038/nrdp.2016.8

Prochaska, M. L., Taylor, E. N., & Curhan, G. C. (2016). Insights Into Nephrolithiasis From the Nurses’ Health Studies. Am J Public Health, 106(9), 1638-1643. http://dx.doi.org/10.2105/AJPH.2016.303319

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What are the clinical indicators of fetal well being (normal findings) and what steps would you take if findings are not reassuring? c

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Nu631: create a substantive initial post. APA style and minimum 2 references. Pls use very Good english i am using u guys again because you promised me a better writter.

Question : Review the essential elements of a fetal assessment during the last trimester of pregnancy. What are the clinical indicators of fetal well being (normal findings) and what steps would you take if findings are not reassuring? 

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What should be included in the physical examination at this visit?

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Nu623: Create a response to the above question. APA style and pls answer each question in paragrah and use good english 

A 35-y.o. woman is seen in the office with a chief complaint of a breast mass. She states she found the lump when she was in the shower, and she is quite visibly distressed. Her medical history is unremarkable, although she reports that she has not had a mammogram. She takes no prescription medications.

  • What additional questions should you ask the patient and why?
  • What should be included in the physical examination at this visit?
  • What are the possible differential diagnoses at this time?
  • What tests should you order and why?
  • How should this patient be managed?

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What additional questions should you ask the patient and why?

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NU623 create a response to this post by Krisnamor using APA style and minimum 2 refrences. Pls use proper english

A 35-y.o. a woman is seen in the office with a chief complaint of a breast mass. She states she found the lump when she was in the shower, and she is quite visibly distressed. Her medical history is unremarkable, although she reports that she has not had a mammogram. She takes no prescription medications.

          Breast cancer is a progressive and invasive disease that results from “damaged DNA and genetic mutations that can be influenced by exposure to estrogen (Alkabban & Ferguson, 2019). Breast cancer risk factors include age; family history; and reproductive factors such as early menarche, late menopause, late age at first pregnancy, and low parity (Sun et al., 2017). Both exogenous and endogenous estrogen, as well as lifestyle factors such as alcohol consumption and too much dietary fat, also increase the risk of breast cancer (Sun et al., 2017).

What additional questions should you ask the patient and why?

          Although the patient’s history is unremarkable, information regarding patient’sage at menarche, the number of pregnancies, if any,  as well as any family history of breast cancer and lifestyle factors precursors of breast cancer,  should be obtained.

What should be included in the physical examination at this visit?

          The American Cancer Society discourages regular breast palpation for screening (American Cancer Society, n.d.), but in this case, since the patient has already identified a mass on her breast, in my opinion, breast examination is granted. The practitioner should document all findings related to the mass, including texture, consistency, mobility, and whether there is tenderness (Alkabban & Ferguson, 2019).

What are the possible differential diagnoses at this time?

Possible diagnosis includes:

  • Fibrocystic disease or cyst
  • Fibroadenoma
  • Breast cancer
  • Intraductal papilloma
  • Lipoma
  • Breast abscess (mastitis)
  • Fat necrosis
  • Phyllodes tumor

What tests should you order and why?

          According to (Alkabban & Ferguson, 2019), the “evaluation of patients with breast cancer needs triple assessment using clinical evaluation, imaging, and tissue biopsy”. Because of the patient’s age, mammograms may not be sensitive enough, therefore, an ultrasound or an MRI would be better options. Ultrasounds are effective to determine characteristics of the mass such as “consistency and size” whereas MRIs are effective in “in describing abnormalities” and are indicated in “occult lesions or if there is a suspicion of multifocal or bilateral malignancy especially ILC” (Alkabban & Ferguson, 2019).

How should this patient be managed?

          Treatment will depend on the diagnosis. Although at this point the is no definitive diagnosis, the patient should be made aware that in the event the mass turns to be cancer “the 2 basic principles of treatment are to reduce the chance of local recurrence and the risk of metastatic spread (Alkabban & Ferguson, 2019).”

References

Alkabban FM, Ferguson T. Cancer, Breast. [Updated 2019 Jun 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482286/

American Cancer Society (n.d.). American cancer society recommendations for the early detection of breast cancer. Retrieved from https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html

Sun, Y. S., Zhao, Z., Yang, Z. N., Xu, F., Lu, H. J., Zhu, Z. Y., … Zhu, H. P. (2017). Risk Factors and Preventions of Breast Cancer. International journal of biological sciences, 13(11), 1387–1397. doi:10.7150/ijbs.21635

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As Lockwood and Magriples (2018) point out, the goal of prenatal care is to ensure the birth of a healthy baby with minimal risk for the mother.

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As Lockwood and Magriples (2018) point out, the goal of prenatal care is to ensure the birth of a healthy baby with minimal risk for the mother.  Prenatal care is not a single intervention but rather a series of assessments, discussions, education and interventions over time (Lockwood & Magriples, 2018).  Antepartum testing is based on the premise that the fetus responds to slowly progressive (chronic) hypoxemia with a detectable sequence of biophysical changes that begin with signs of physiological adaptation and potentially ending with signs of physiological decompensation (Signore & Spong, 2018).  Fetal biophysical activities, such as heart rate, movement, breathing, and tone, are sensitive to fetal oxygenation and pH levels.  Changes in fetal biophysical activities occur in response to, or in association with, hypoxemia and acidemia (Signore & Spong, 2018). There are other factors that can affect fetal biophysical parameters that include gestational age, maternal medication, maternal smoking, fetal sleep-wake cycles, and fetal disease or anomalies (Signore & Spong, 2018).

Essential elements of a fetal assessment during the last trimester of pregnancy include measurements and procedures done on the mother.  At each prenatal visit measurement of blood pressure should be obtained.  Measurement of blood pressure is necessary for diagnosis of hypertension and to help assess development of preeclampsia or gestational hypertension. Preeclampsia affects the arteries carrying blood to the placenta. If the placenta doesn’t get enough blood, the fetus receives inadequate blood and oxygen and fewer nutrients. This can lead to slow growth known as fetal growth restriction, low birth weight or preterm birth. (Signore & Spong, 2018)If left untreated, preeclampsia can lead to serious, sometimes fatal, complications for both mother and fetus.

During the second and third trimesters, fetal growth is assessed through measurement of fundal height or by ultrasound evaluation for women with risk factors for intrauterine growth restriction (Lockwood & Magriples, 2018).  Carroll and White (1988) indicate that this measurement in centimeters should correspond with the number of weeks gestation.  The closest correlation occurs between 18 and 30 weeks.  Serial measurements should be plotted to allow comparison and to allow for detection of abnormal growth patterns as seen in intrauterine growth restriction (IUGR). Significant deviation from the range of normal requires ultrasound investigation (Carroll & White, 1988).

Fetal heart rate along with assessment of maternal perception of fetal activity should also be assessed at each visit in the third trimester (Lockwood & Magriples, 2018). Signore and Song (2018) state that there is evidence that fetal movement decreases in response to hypoxia. Decreased or absent fetal movements are associated with increased risk of stillbirth or poor neonatal outcome (Carroll & White, 1988).  Normal fetuses move for periods of 20-60 minutes every 90 minutes on average. At term, they may not move for up to 75 minutes (Carroll & White, 1988).  For women who report decreased fetal movement a nonstress test may be performed (Signore & Spong, 2018). Carroll and White (1998) point out that the NST is only indicative of fetal health at the time of the test.

Other assessments should include asking about significant event since the last visit, such as recent travel, illness, stressors, or exposure to infection (Zika virus) (Lockwood & Magriples, 2018). Between the 24th and 28th weeks of gestation, women should be screened for gestational diabetes. If the woman is Rh negative, she should receive anti-D immune globulin (Rhogam) (Lockwood & Magriples, 2018).  Other screening tests include hemoglobin or hematocrit to check for anemia and screening for sexually transmitted infections and group B beta-hemolytic streptococcus.

References

Carroll, J. C., & White, D. G. (1988, September). Fetal assessment in the third trimester. Canadian Family Physician, 34, 2005-2009, 2049. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2219138/

Lockwood, C. J., & Magriples, U. (2018, October 25). Prenatal care: Second and third trimesters. UpToDate. Retrieved from https://www.uptodate.com/contents/prenatal-care-second-and-third-trimesters

Signore, C., & Spong, C. (2018, December 3). Overview of antepartum fetal surveillance. UpToDate. Retrieved from https://www.uptodate.com/contents/overview-of-antepartum-fetal-surveillance?search=prenatal%20screening&source=search_result&selectedTitle=4~150&usage_type=default&display_rank=4#H17

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For this assignment you will write a paper in which you explore a common transition faced by older adults.

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Transition from home to assisted living in old age

Assignment 3: Transitions and Aging | Value 30%


This assignment should be completed sometime between Units 5 and 9.


For this assignment you will write a paper in which you explore a common transition faced by older adults. This transition may relate to a health transition (e.g. illness), a transition in living environment (e.g., a move to an assisted living facility or a long-term care facility), or dying or death. The emphasis in this assignment is to examine how older adults face into a transition, including the psychosocial, existential, and family ramifications. For instance, you might choose to focus on grief and loss as a response to moving into a long-term care facility. Within this paper, you will examine how older adults experience this grief and loss, how family members respond, as well as existential issues that may arise from this transition (e.g., Who am I now that I am institutionalized?)


Assignment 3 must:


  • be seven to eight pages in length; not to exceed eight, excluding title page, references, and appendices;
  • be typed, double–spaced, single-sided, with margins of 2.5 cm on all sides;
  • follow the style guidelines found in the 6th edition of the APA Publication Manual; and
  • include references to provide evidence of application of theory.


Assignment 3 will be marked according to the following grading criteria:


Criteria

Marks
Describes a transition faced by older adults and includes psychosocial, existential, and familial responses to this transition. You may include a short case example to illustrate the topic. /10
Describes significance of this topic to the experience of the older adult (physical and mental health), how the transition is understood in the literature and in nursing research. /40
Analyzes how nurses can respond (assessment and intervention) to aid older adults and family members experiencing transitions. Also addresses two proposed changes to the health care system and a potential research study that could address how transitions impact older adults, family members or the health care system. /30

Scholarly writing style:

  • clarity, logical development, cohesion and tone
  • APA format, grammar, punctuation, spelling, and page length
 /20
Total /100

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PLs writer let your work make sense when its read. Dont write in your native language and translate. It doesnt come out readable. You must follow each instruction to the question.

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NU623 :Answer the questions below using APA style and Minimum 2 references not more than 4 yrs old.

NB: PLs writer let your work make sense when its read. Dont write in your native language and translate. It doesnt come out readable. You must follow each instruction to the question.

  • Discuss the differences in the various types of ankle pain.
  • Include a description of the classification, treatment and differential diagnoses.

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Identify two pregnancy-related conditions which necessitate a referral to higher level obstetrical management. What resources are available to you as an advanced practice nurse in your area which would guide and support you in decision-making regarding re

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NU631 : APA style and minumum 2 references less than 4 yrs old. 

PLs use english that makes sense.: If you do a job that doesnt make sense, i will reject it and request admin not to pay you.


Question : Identify two pregnancy-related conditions which necessitate a referral to higher level obstetrical management. What resources are available to you as an advanced practice nurse in your area which would guide and support you in decision-making regarding referral for further management?

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Describe your preferred learning strategies. Compare your current preferred learning strategies to the identified strategies for your preferred learning style.

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Learning styles represent the different approaches to learning based on preferences, weaknesses, and strengths. For learners to best achieve the desired educational outcome, learning styles must be considered when creating a plan. Complete “The VARK Questionnaire,” located on the VARK website, and then complete the following:

  1. Click “OK” to receive your questionnaire scores.
  2. Once you have determined your preferred learning style, review the corresponding link to view your learning preference.
  3. Review the other learning styles: visual, aural, read/write, kinesthetic, and multimodal (listed on the VARK Questionnaire Results page).
  4. Compare your current preferred learning strategies to the identified strategies for your preferred learning style.
  5. Examine how awareness of learning styles has influenced your perceptions of teaching and learning.

In a paper (750‐1,000 words), summarize your analysis of this exercise and discuss the overall value of learning styles. Include the following:

  1. Provide a summary of your learning style according the VARK questionnaire.
  2. Describe your preferred learning strategies. Compare your current preferred learning strategies to the identified strategies for your preferred learning style.
  3. Describe how individual learning styles affect the degree to which a learner can understand or perform educational activities. Discuss the importance of an educator identifying individual learning styles and preferences when working with learners.
  4. Discuss why understanding the learning styles of individuals participating in health promotion is important to achieving the desired outcome. How do learning styles ultimately affect the possibility for a behavioral change? How would different learning styles be accommodated in health promotion?

Cite to at least three peer‐reviewed or scholarly sources to complete this assignment. Sources should be published within the last 5 years and appropriate for the assignment criteria.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. 

You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.

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Describe a health promotion model used to initiate behavioral changes. How does this model help in teaching behavioral changes?

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Describe a health promotion model used to initiate behavioral changes. How does this model help in teaching behavioral changes? What are some of the barriers that affect a patient’s ability to learn? How does a patient’s readiness to learn, or readiness to change, affect learning outcomes?

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