Gastrointestinal Case Study

CF is a 48-year-old man who presents for evaluation of heartburn. He denies current tobacco use but has a history of one ppd for 15 years. He consumes a glass of wine nightly, more on the weekends. He has a sedentary job.

He reports a burning feeling in his chest after eating. It is worse when he eats spicy foods or tomato sauce. He is sometimes awakened at night with these symptoms. He has tried over-the-counter antacids and histamine H2 receptor antagonists (H2RAs) with partial relief. He is on no regular medications. His examination today is normal. An upper gastrointestinal (GI) X-ray series reveals gastroesophageal reflux.

1. What lifestyle modifications do you recommend for CF?
2. Describe a rational drug choice for this patient. Be specific regarding what factors you would consider. Include pharmacokinetic and dynamic considerations for the pharmacological choices made. Also consider interactions and side effects.
3. What counseling points about this medication do you give CF?

RUBRIC:

Discussion Question Rubric

Note: Scholarly resources are defined as evidence-based practice, peer-reviewed journals; textbook (do not rely solely on your textbook as a reference); and National Standard Guidelines. Review assignment instructions, as this will provide any additional requirements that are not specifically listed on the rubric.

Note: The value of each of the criterion on this rubric represents a point range. (example: 17-0 points)

Discussion Question Rubric – 100 PointsCriteriaExemplary
Exceeds ExpectationsAdvanced
Meets ExpectationsIntermediate
Needs ImprovementNovice
InadequateTotal PointsQuality of Initial PostProvides clear examples supported by course content and references.

Cites three or more references, using at least one new scholarly resource that was not provided in the course materials.

All instruction requirements noted.

40 pointsComponents are accurate and thoroughly represented, with explanations and application of knowledge to include evidence-based practice, ethics, theory, and/or role. Synthesizes course content using course materials and scholarly resources to support importantpoints.

Meets all requirements within the discussion instructions.

Cites two references.

35 pointsComponents are accurate and mostly represented primarily with definitions and summarization. Ideas may be overstated, with minimal contribution to the subject matter. Minimal application to evidence-based practice, theory, or role development. Synthesis of course content is present but missing depth and/or development.

Is missing one component/requirement of the discussion instructions.

Cites one reference, or references do not clearly support content.

Most instruction requirements are noted.

31 pointsAbsent application to evidence-based practice, theory, or role development. Synthesis of course content is superficial.

Demonstrates incomplete understanding of content and/or inadequate preparation.

No references cited.

Missing several instruction requirements.

Submits post late.

27 points40Peer Response PostOffers both supportive and alternative viewpoints to the discussion, using two or more scholarly references per peer post. Post provides additional value to the conversation.

All instruction requirements noted.

40 pointsEvidence of further synthesis of course content. Provides clarification and new information or insight related to the content of the peer’s post.

Response is supported by course content and a minimum of one scholarly reference per each peer post.

All instruction requirements noted.

35 pointsLacks clarification or new information. Scholarly reference supports the content in the peer post without adding new information or insight.

Missing reference from one peer post.

Partially followed instructions regarding number of reply posts.

Most instruction requirements are noted.

31 pointsPost is primarily a summation of peer’s post without further synthesis of course content.

Demonstrates incomplete understanding of content and/or inadequate preparation.

Did not follow instructions regarding number of reply posts.

Missing reference from peer posts.

Missing several instruction requirements.

Submits post late.

27 points40Frequency of DistributionInitial post and peer post(s) made on multiple separate days.

All instruction requirements noted.

10 pointsInitial post and peer post(s) made on multiple separate days.

8 pointsMinimum of two post options (initial and/or peer) made on separate days.

7 pointsAll posts made on same day.

Submission demonstrates inadequate preparation.

No post submitted.

6 points10OrganizationWell-organized content with a clear and complex purpose statement and content argument. Writing is concise with a logical flow of ideas

5 pointsOrganized content with an informative purpose statement, supportive content, and summary statement. Argument content is developed with minimal issues in content flow.

4 pointsPoor organization and flow of ideas distract from content. Narrative is difficult to follow and frequently causes reader to reread work.

Purpose statement is noted.

3 pointsIllogical flow of ideas. Prose rambles. Purpose statement is unclear or missing.

Demonstrates incomplete understanding of content and/or inadequate preparation.

No purpose statement.

Submits assignment late.

2 points5APA, Grammar, and SpellingCorrect APA formatting with no errors.

The writer correctly identifies reading audience, as demonstrated by appropriate language (avoids jargon and simplifies complex concepts appropriately).

Writing is concise, in active voice, and avoids awkward transitions and overuse of conjunctions.

There are no spelling, punctuation, or word-usage errors.

5 pointsCorrect and consistent APA formatting of references and cites all references used. No more than two unique APA errors.

The writer demonstrates correct usage of formal English language in sentence construction. Variation in sentence structure and word usage promotes readability.

There are minimal to no grammar, punctuation, or word-usage errors.

4 pointsThree to four unique APA formatting errors.

The writer occasionally uses awkward sentence construction or overuses/inappropriately uses complex sentence structure. Problems with word usage (evidence of incorrect use of thesaurus) and punctuation persist, often causing some difficulties with grammar. Some words, transitional phrases, and conjunctions are overused.

Multiple grammar, punctuation, or word usage errors.

3 pointsFive or more unique formatting errors or no attempt to format in APA.

The writer demonstrates limited understanding of formal written language use; writing is colloquial (conforms to spoken language).

The writer struggles with limited vocabulary and has difficulty conveying meaning such that only the broadest, most general messages are presented.

Grammar and punctuation are consistently incorrect. Spelling errors are numerous.

Submits assignment late.

2 points5Total Points100 

Please read the following post and add information or comment on the post . One page with 2 reference and citation 

The problem that I talked about during last week’s discussion was nurses experiencing burn out during a pandemic. The research design that I believe would best fit this problem would be qualitative. According to this week’s lesson, “qualitative designs are chosen in order to understand the meaning of phenomena and may form the basis of theories.” (Chamberlain University, 2020). More specifically, I believe the study is focused on phenomenology. “Phenomenology develops understanding of experiences through the perception of those living them.” (Chamberlain University, 2020). The study should focus on interventions to reduce burn out in nurses and how nurses are responding to them. The research method should include participants who understand the study and are willing to express feelings and experiences. The findings will be described from the participants point-of-view (“Qualitative Research Designs”, n.d.). This will give us the best idea of how the nurses are feeling based on the interventions we study.

References:

Chamberlain University. (2020). Week 3: The Research Design. https://chamberlain.instructure.com/courses/69443/pages/week-3-the-research-design?module_item_id=9595709

Qualitative Research Designs. (n.d.). http://www.umsl.edu/~lindquists/qualdsgn.html

While the US healthcare system represents around $3.5 trillion in annual spending and is the largest single sector of the overall economy, it also sits inside larger “macro trends” that help define the landscape of jobs. 

Factors to consider: globalization, the state of the general economy, the rapid pace of innovation, digitalization of medicine and genomic technology, and demographics of the U.S. population (e,g, aging population, and higher healthcare utilization) and changing values and beliefs. Also consider the role of Artificial Intelligence in “replacing” some jobs. For example IBM’s Watson can now make some diagnosis as well as or better than a third year medical resident including making wrong diagnoses that kill patients.

So what difference do all these big changes mean to us?

The answer is both obvious and complicated. I will answer the obvious part and leave the complicated part to you to explore. 

The obvious answer is that these big changes are changing the way we live our lives. Just think; it was not that long ago that classes on the internet were considered unusual or suspect. And now, such classes are the norm. 

The obvious part is that such factors as globalization, the economy, technology, an aging society, and changing cultural values are all working together to change pretty well everything that used to be — into something else. 

The hard part — and the part you need to think about — is what do all the changes really mean for healthcare? Not only what skills will you require in the future, but who will you be hiring and what role will they fulfill?

If we think that healthcare professionals will continue to do exactly what they are doing now over the next ten years then we are not paying attention to how much the work world has already changed from the way it was ten years ago (does anyone remember when you couldn’t text?).

So…

How will healthcare systems evolve to best leverage a global job market for their services? 

What will a growing share of healthcare dollars mean to the healthcare workforce in a stagnant or slow-growing general economy?

How will smartphones or other technologies create new jobs in healthcare? 

Will genomic research eliminate certain diseases by modifying a person’s DNA? What ethical issues might this raise? How this change will affect the workforce skill and volume demand? 

How will the massive chronic care needs of older people create new career opportunities? 

What new jobs may be created to best meet new consumer demands for more patient-focused care? Less institutionalization of the elderly? And better access to culturally appropriate caregivers? 

So what do you think? What human resources needs are you likely to be encountering – and managing — in ten or so years? Consider the questions above but develop your answer based on your own ideas and supporting evidence to present. 

  Respond  by providing at least two contributions for improving or including  in their Parent Guide and at least two things that you like about their  guide. 

NOTE: Positive Comment

                                                    Main Discussion

Rett Syndrome is a neurodevelopmental disorder that almost exclusively affects girls (National Institute of Neurological Disorders and Stroke [NINDS], 2020). Rett syndrome is characterized by normal early growth and development, followed by a slowing of development, loss of purposeful use of the hands, distinctive hand movements, slowed brain and head growth, problems with walking, seizures, and intellectual disability (NINDS, 2020). Rett Syndrome is a rare disease, affecting 1 in every 10,000 to 15,000 newborn females worldwide.   

Rett   Syndrome is a rare genetic neurological and developmental disorder that   affects how the brain develops, resulting in the progressive loss of   developmental milestones, intellectual disability, breathing abnormality,   motor skills, and speech (Yang et al., 2019). Mutations in the X-linked gene   methyl-cytosine-binding protein 2 (MECP2) occur among individuals with Rett   Syndrome (Kyle et al., 2018). MECP2 is located on the X-chromosome and controls   the functions of several other genes (NINDS, 2020). MECP2 is necessary for   brain development and acts as a biochemical switch that can either increase   gene expression or direct other genes to turn off and end the production of   their unique proteins (NINDS, 2020). Since the gene encoding of MECP2 occurs   on the X-chromosome, the disease occurs predominately among females   heterozygous for MECP2 mutations (Yang et al., 2019). Among individuals with   Rett Syndrome, the inefficient functioning of the MECP2 gene results in the   abnormal expression of other genes (Ehinger et al., 2018; NINDS, 2020). 

  Signs and Symptoms

In Rett Syndrome, common signs and symptoms that reflect the main diagnostic criteria include:

· Partial or complete loss of acquired purposeful hand skills (NINDS, 2020).

· Partial or complete loss of acquired spoken language (NINDS, 2020).

· Repetitive hand movements include hand wringing or squeezing, clapping, or rubbing (NINDS, 2020).

· Gait abnormalities, including toe walking, and an unsteady, wide-based, stiff-legged walk (NINDS, 2020).

Other signs and symptoms of Rett Syndrome may include (NINDS, 2020):

· Scoliosis 

· Teeth-grinding

· Small, cold hands and feet in relation to height

· Abnormal sleep patterns 

· Abnormal muscle tone

· Inappropriate laughing or screaming 

· Intense eye communication 

Diminished response to pain  

The clinical diagnosis of Rett Syndrome occurs by observing signs and symptoms congruent with this syndrome during the child’s early growth and development, and while conducting ongoing evaluations of the child’s physical and neurological status (Kyle et al., 2018; NINDS, 2020). Characteristic symptoms include loss of acquired speech and motor skills, repetitive hand movements, breathing irregularities, and seizures (Kyle et al., 2018). Sporadic episodes of gastrointestinal problems, hypoplasia, early-onset osteoporosis, bruxism, and screaming spells may also present among individuals with Rett Syndrome (Kyle et al., 2018). 

A genetic test that searches for the MECP2 mutation on the child’s X-chromosome can complement the clinical diagnosis (NINDS, 2020). The use of a highly specific test set of guidelines takes place to identify three types of clinical criteria: main, supportive, and exclusion (Bhandari et al., 2019; NINDS, 2020). Exclusion criteria for a Rett Syndrome diagnosis include a brain injury secondary to trauma, neuro-metabolic disease, severe infection contributing to neurobiological problems, and grossly abnormal psychomotor development in the first 6-months of life (NINDS, 2020). 

References

Djukic, A., Holtzer, R., Shinnar, S., Muzumdar, H., Rose, S. A., Mowrey, W., Galanopoulou, A. S., Shinnar, R., Jankowski, J. J., Feldman, J. F., Pillai, S., & Moshé, S. L. (2016). Pharmacologic treatment of Rett Syndrome with glatiramer acetate. Pediatric Neurology, 61, 51–57. https://doi-org.ezp.waldenulibrary.org/10.1016/j.pediatrneurol.2016.05.010

Ehinger, Y., Matagne, V., Villard, L., & Roux, J. C. (2018). Rett syndrome from bench to bedside: Recent advances. F1000Research, 7(398), 1-9. https://doi.org/10.12688/f1000research.14056.1

Glaze, D. G., Neul, J. L., Percy, A., Feyma, T., Beisang, A., Yaroshinsky, A., Stoms, G., Zuchero, D., Horrigan, J., Glass, L., & Jones, N. E. (2017). A double-blind, randomized, placebo-controlled clinical study of trofinetide in the treatment of Rett Syndrome. Pediatric Neurology, 76, 37–46. https://doi.org/10.1016/j.pediatrneurol.2017.07.002

Kyle, S. M., Vashi, N., & Justice, M. J. (2018). Rett syndrome: A neurological disorder with metabolic components. Open Biology, 8(2), 1-17. https://doi.org/10.1098/rsob.170216

National Institute of Child Health and Human Development (2016, December 1). What are the treatments for Rett syndrome? National Institute of Health. https://www.nichd.nih.gov/health/topics/rett/conditioninfo/treatments

National Institute of Neurological Disorders and Stroke (2020, March 17). National Institute of Health. Rett syndrome fact sheet. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Rett-Syndrome-Fact-Sheet 

Please review the rubric and follow as directed, including the A MUST SOURCES OF DATA COLLECTION to answer the questions. If you can’t deliver on time please DO NOT ACCEPT this ASSIGNMENT. Use scholar papers within 5 years, write in APA 6th ed. from USA (I have received so many papers with the reference part incorrect, etc!).