QUESTION 1: Discuss how professional nursing organizations support the field of nursing and how they advocate for nursing practice. Explain the value professional nursing organizations have in advocacy and activism related to patient care.

QUESTION 2: (A) Discuss the importance of advocacy as it pertains to patient care. (B).What is the nurse’s role in patient advocacy? (C).Describe a situation in which you were involved with patient advocacy. (D).Explain what the advocacy accomplished for the patient, and what the repercussions would have been if the patient would not have had an advocate.

1. Explain the relationship of reflexology complementary therapy to natural body systems and their functions.
   1. Describe how reflexology can be used in: health restoration, health promotion and illness prevention. 
2. Find evidenced-based research articles that report reflexology’s history and evidence for or against its effectiveness.
3. Cite your sources and attach the article(s) to this post. 
4. Post must be 150-200 words. 

Respond to a minimum of two peers on two separate days. 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:

Response 1

Heart failure affects approximately 6 million Americans and over 26 million people worldwide (Gupta et. al, 2018). Technological advances and improved medications have decreased mortality and led to increased prevalence of this public health concern. The incidence of heart failure increases with age, with a mortality rate of 50% within 5 years of diagnosis (Woo & Robinson, 2017). The objective assessment of heart failure is classified in four stages A-D, with stage A being the least severe and stage D being the most severe (American Heart Association, 2017). The functional capacity assessment of heart failure is classified stages I-IV; with stage I not causing any physical limitations and stage IV describing the most severe physical limitations (American Heart Association, 2017). Managing the symptomology of heart failure can be complex and requires consideration of the patient’s allergies, medical history, and treatment goals. The purpose of this discussion is to integrate two evidenced-based resources in addition to course textbook in the review of the recommended clinical practice guidelines pertaining to heart failure.

            Stage A objective assessment of heart failure is also known as pre-heart failure or asymptomatic cardiac dysfunction (Morbach et. al, 2020). The American Heart Association (AHA) denotes Stage A heart failure as having no objective evidence of cardiovascular disease or physical activity limitation (2017). Therefore, stage A classification describes a patient possessing common cardiovascular risk factors that lead to the development of coronary artery disease, reduced left ventricular function, and heart failure (Morbach et. al, 2020). Risk factors that contribute to the development of heart disease include but are limited to: hypertension, diabetes, coronary artery disease (CAD), chronic obstructive pulmonary disease, and rheumatic heart disease (Gupta et. al, 2018).  The rational drug choice for this individual given limited health history, would be not to prescribe any medication at this time. Primordial prevention of heart failure would include eliminating ML’s underlying pathologies and inducing relevant lifestyle modifications (Woo & Robinson, 2017).

            Digoxin was once the only successful drug in the treatment of heart failure however, evidenced-based data has suggested it no longer be considered as the primary treatment of heart failure (Woo & Robinson, 2017). ML’s concern of seeing yellow vision or green halos is justified, as it is a sign of digoxin toxicity (Woo & Robinson, 2017). Gender-specific pharmacokinetic differences of digoxin were not found. However, gender related pharmacokinetic characteristics can exist secondary to factors such as body composition, lean muscle mass, and cardiac drugs that bind to plasma protein (Stolarz & Rusch, 2015). Digoxin is still used for patients with systolic dysfunction on optimal doses of beta-blockers, ACE inhibitors, who do not show improvement (Woo & Robinson, 2017). If digoxin is prescribed, therapeutic levels of the drug should be monitored in each patient to prevent toxic effects. The patient’s heart rate, rhythm, renal function and potassium level should also be assessed (Woo & Robinson, 2017). Prescribing digoxin should be considered thoroughly to assure the benefits outweigh the risks.

Response 2

 The American Heart Association (AHA) classifies heart failure (HF) into stages labeled A through D based on severity. Stage A HF patients are asymptomatic but are high risk for becoming HF patients due to other medical conditions such as obesity and hypertension (Tanaka, 2018). Early diagnosis of Stage A HF allows the patient and providers to form a plan to prevent high risk complications and a consequential Stage B through D HF. There are numerous causes for HF. Symptomatic HF are typically caused from improper mechanisms from the left ventricle (King, 2020).
The rational drug choice for treatment for ML is possibly none. ML’s diagnosis of a Stage A HF should be explained to her means that she is at risk but does not have any defect of her heart or symptoms that comprise actual HF. ML will need to be assessed for hypertension, smoking, exercise regimen, diet, and labs should also be ordered such as a lipid panel (Woo & Robinson, 2020). If any of these assessments are positive for a health condition medication may be started but often lifestyle changes are first attempted. If indicated, ML may be started on a diuretic if fluid overload is present or an angiotensin-converting enzyme (ACE) inhibitor as an initial treatment. Digoxin are recommended to be used if diuretics and ACE inhibitors are not successful (Woo & Robinson, 2020). Although digoxin would not be prescribed at this time, ML’s concerns regarding halos can be clarified for her own education as well as in case she needs this medication in the future. A hallucination of green halos around lights is a rare sign of digoxin toxicity (Woo & Robinson, 2020). More commonly patients will experience gastrointestinal sickness, a fast pulse, shortness of breath, and fainting episodes with digoxin toxicity (Cummings, 2020).
There are numerous differences in the use of cardiac medications regarding gender. Females have a higher rate of adverse drug reactions with this class of medication (Kalibala et al., 2020). Body weight as well as fat composition are some factors believed to have an impact in the difference of the pharmacokinetics of medications for females. This leads to more cases of toxicity as well which would result in the need for dose adjustments for females (Kalibala et al., 2020). ACE inhibitors are typically contradicted for women who are pregnant or planning on becoming so due to teratogenic effects (Jackson, 2015). Digoxin has a higher rate of complications and HF mortality despite therapy in women compared to men (Jackson, 2015). Close monitoring of medications for all patients is important but even more so with cardiac medications and with the female population. Monitoring of these possible medications would include functional capacity, fluid status, cardiac rhythm, and labs (Woo & Robinson, 2020). The functional capacity would assess things such as activity of daily living and exercise regimens. Fluids should be checked with all cardiac assessments with weights, listening to the lungs, blood pressures, and edema most commonly. Electrocardiograms regularly with a patient’s cardiologist should also be included with follow-up appointments for any patient on a cardiac medication. Lastly, labs for electrolytes as well as drug levels should be closely monitored. There may be specific tests/monitoring dependent on the medication prescribed as well but these four assessments are recommended by the National Institute for Health and Care Excellence (NICE) as a general rule for patients on cardiac medications for HF (Woo & Robinson, 2020). 

1. Which cancers originate from connective tissue?
2. Carcinoma refers to abnormal cell proliferation originating from which tissue origin?
3. What are characteristics of cancer in situ?
4. Cells from a muscle tumor show a reduced ability to form new muscle and appear highly disorganized. This is an example of what abnormal physiology?
5. What are tumor cell markers? What is the purpose of tumor cell markers?
6. What is apoptosis?
7. What are oncogenes?
8. Why are two “hits” required to inactivate tumor-suppressor genes?
9. How do cancer cells use the enzyme telomerase?
10. What are characteristics of benign tumors?
11. What is the major virus involved in cervical cancer?
12. Which of the viruses are oncogenic DNA viruses?
13. Which cancers are associated with chronic inflammation? How does chronic inflammation cause cancer?
14. A pathology report stages a tumor as T2, N1, M0. What is the meaning of this finding?
15. Why do nausea and vomiting occur after cancer therapy?
16. Which cytokine is involved in producing cachexia syndrome?
17. Normally, which cells, are considered immortal (never die)?
18. What are the common routes for distant metastasis?

Chapter 13: Cancer Epidemiology

1. Which characteristic among women correlates with a high morbidity of cancer of the colon, liver, gallbladder, pancreas, breast, uterus, and kidney?
2. What substance has been shown to increase the risk of cancer when used in combination with tobacco smoking?
3. Which diagnostic tests provide the greatest exposure to ionizing radiation?
4. Tobacco smoking is associated with which cancers?
5. What are the most important risk factors associated with the development of skin melanoma?
6. Which environmental factors has been shown to have the greatest effect on the frequency of genetic mutations in humans?
7. Research data support the relationship between ultraviolet sunlight exposure and the development of which cancers?
8. Alcohol consumption has been proven to be a consistent risk factor in the development of which of the major cancers?

Chapter 14: Cancer in Children

1. What congenital malformation is commonly linked to acute leukemia in children?
2. When are childhood cancers most often diagnosed?
3. Prenatal exposure to diethylstilbestrol (DES) can result in which cancer?
4. What percentage of children with cancer can be cured?
5. Most childhood cancers arise from which tissue?
6. Chronic myelogenous leukemia, retinoblastoma, and osteosarcoma are associated with which genetic factors in childhood cancers?
7. Childhood exposure to which risk factors increases susceptibility to cancer?
8. There are research data to support a carcinogenic relationship in children resulting from exposure to which virus?

Organizational Policies and Practices to Support Healthcare Issues

     Being a leader in the healthcare industry is very taxing, as many difficult decisions must be made, and numerous competing needs must be met. Healthcare is a business, and the bottom line must be met so the business can continue to run. However, healthcare is so much more than just a business; it is where people turn when they need healing. More often than not, the bottom line and the healing of patients do not run the same course. This means that leaders are left with a choice to make, knowing that at least one need will not be met. These differing needs often affect policy, and when needs are unmet, it can lead to problems such as nurse burnout.

The Effect of Competing Needs on Policy

     The effect of competing needs on policy can be seen clearly in many standardized clinical pathways, where patient care is often jeopardized with a standardized approach to care (Kelly & Porr, 2018). These standardized clinical pathways are often inflexible and do not allow for personalized care that will best meet the patient’s needs (Kelly & Porr, 2018). Administrator’s priorities when constructing new policies are often different than those implementing the policies and coming into direct contact with patients. As there are so many needs in healthcare that must be met, it is next to impossible for leaders to make decisions and construct policies that will meet all needs. With that being said, leaders must clearly communicate and explain the reasoning behind decision-making to help those whose needs have not been met understand the choices made (Laureate Education, 2009). If these choices are not clearly communicated, then the repercussions of not meeting all needs can be much more consequential.

The Effect of Competing Needs on Nurse Burnout

     Unmet needs in the healthcare industry can have many negative consequences. One of these consequences is nurse burnout. Leaders in healthcare typically prioritize the needs of the organization’s budget and patient outcomes. These priorities often overshadow the needs of the workforce. When nurses’ needs are not being prioritized and addressed, it can contribute to nurse burnout. Inadequate staffing is often a result of financial restrictions that have been prioritized over maintaining adequate staffing ratios. This leads to nurses being overworked, which is a component of nurse burnout (Brown et al., 2018). There are currently fourteen states that have laws and regulations in place that address nurse staffing (American Nurses Association [ANA], 2019). Healthcare organizations should have specific nurse staffing policies in place and ensure that they are strictly followed. This is not just important to prevent nurse burnout, but adequate staffing helps improve patient outcomes. Safe staffing ratios should be prioritized as it will help meet more than one of the competing needs that are seen in the healthcare industry.  

References

American Nurses Association. (2019). Nurse staffing advocacy. https://www.nursingworld.org/practice-policy/nurse-staffing/nurse-staffing-advocacy/

Brown, S., Whichello, R., & Price, S. (2018). The impact of resiliency on nurse burnout: An integrative literature review. Medsurg Nursing, 27(6). https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=11&sid=ef9c2b5f-a5cc-4dfe-8116-de60692fca86%40pdc-v-sessmgr01

Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance rn practice. The Online Journal of Issues in Nursing, 23(1). https://doi.org/10.3912/OJIN.Vol23No01Man06

Laureate Education. (2009). Working with individuals [Video]. Baltimore, MD: Author.