Heparin-induced thrombocytopenia

Introduction

            Heparin induced thrombocytopenia is a complication that develops in heparin therapy and occurs in two types. The first type of Heparin induced thrombocytopenia is type 1 HIT which develops two days after the patient has been exposed to heparin. During this period, the platelet count reverts to normal as the patient continues with the heparin therapy. Type 1 HIT is therefore a disorder that is as a result of the effect that heparin causes to the body when the platelets are being activated. The second type of Heparin induced thrombocytopenia is type 2 HIT which is an immune mediated disorder that occurs between 4 to 10 days following exposure to heparin (Crowther et al, 2012). The second type of Heparin induced thrombocytopenia has far reaching consequences as can result in the patient losing their limbs or even dying.

            Heparin induced thrombocytopenia is one of the most important immune mediated type of thrombocytopenia and requires to be frequently administered to the body. If left unchecked or goes unrecognised, it often results to morbidity or death to the victims (Crowther et al, 2012). The drug Heparin is commonly used for thromboprophylaxis and other treatments such as acute coronary syndrome, atrial fibrillation, dialysis, venous thromboembolism, cardiovascular surgery, invasive procedures and during extracorporeal circulation. Despite its advantages however, there are serious side effects, some of which cause serious medical conditions and could even cause death, an example being Heparin induced thrombocytopenia (Francini, 2005). Patients are at further risks because there are various factors that could result to patients admitted in hospital getting thrombocytopenia which results to Heparin induced thrombocytopenia occurring but remaining unrecognised until adverse effects appear.

            It is estimated that about eight percent of heparinised patients also develop the antibodies that are associated with Heparin induced thrombocytopenia and that about five percent of those on heparin will also develop Heparin induced thrombocytopenia with thrombocytopenia. The patients are also likely to suffer from venous and arterial thrombosis

Description of the HIT currently used in the practice.

            Heparin induced thrombocytopenia is associated with a decrease in the number of platelets during the period when the patient is exposed to heparin or shortly after exposure. Although the mechanisms of the first type of Heparin induced thrombocytopenia (type 1 HIT) are still unknown, type 1 HIT affects the immune system as it has a pro-aggregating effect on the platelets (Arepally, 2017). Type 1 HIT affects about 10 percent of patients who receive heparin treatments and causes mild and transient asymptomatic thrombocytopenia. The effects occur within 2 days after heparin is first administered but disappear quickly after the heparin treatments stop. Type 2 HIT on the other hand is immune mediated and poses great risk to the thrombosis. Since type 2 HIT is more serious than type 1 HIT, proposals have been made to change the definition for type 1 HIT to non-immune heparin associated thrombocytopenia and type 2 HIT be recognised as HIT so as to resolve the confusion surrounding the two syndromes (Francini, 2005). The definitions are intended to help differentiate the two so as to easily identify which preventive measures to take according to the type of syndrome being resolved.

            Patients that are undergoing cardiovascular surgery have been identified as being more likely to develop more antibodies compared to those undergoing orthopaedic surgery. Post-surgical patients are also at a higher risk of developing antibodies compared to patients undergoing treatments that do not require surgery (Cucker, 2016). Patients that receive unfractionated heparin are also at a higher risk of developing antibodies compared to those that receive treatments containing low molecular weight heparin. It is however important to note that antibodies that develop in patients that get UFH often have a high likelihood of cross reacting with LMWH. According to a study involving 665 patients undergoing elective hip arthroplasty, it was discovered that LMWH has a higher chance of preventing the occurrence of Heparin induced thrombocytopenia (Francini, 2005). In the study, the patients had been randomly selected and given either LMWH or UFH. The results revealed that 9 out of the 332 patients who were given UFH developed Heparin induced thrombocytopenia while none of the patients who received LMWH developed Heparin induced thrombocytopenia (Francini, 2005). Patients who received UFH were also more likely to develop antibodies that depended on the presence of heparin compared to patients who received LMWH.

Description of HIT change for the practice.

            Danaparoid can be an ideal substitute for heparin when treating patients with Heparin induced thrombocytopenia. Danaparoid is an anticoagulant that is made up of three glycosaminoglycans and through antithrombin, help to prevent anti-FXa activity. The three glycosaminoglycans include dermatan sulfate, heparin sulfate and chondroitin sulfate (Weigelt, 2012). According to research conducted to assess the effectiveness of alternatives like danaparoid, results from the 460 patients involved in the study revealed that patients with Heparin induced thrombocytopenia associated thrombosis had a success rate of 90 percent when danaparoid was used as a substitute for heparin (Francini, 2005). The research further revealed that danaparoid is 70 times more successful than dextran in relation to the treatment of Heparin induced thrombocytopenia associated venous and arterial thrombosis.

Description of how it will improve the HIT of the practice

The treatment of Heparin induced thrombocytopenia involves stopping all formulations of heparin immediately after Heparin induced thrombocytopenia has been identified in the patient. Stopping the formulations of heparin however do little to prevent the severe consequences as thrombin continues to be generated which causes thrombotic events that take plays days, and even weeks after Heparin induced thrombocytopenia has been identified (Askari & Linkolf, 2010). Even in cases where heparin cessation is done early, the chances of reducing mortality and morbidity thus proving that caseation is not an ideal treatment method. This is especially because successful treatment is dependent on successful removal of the triggers and also full control of the thrombin storm of Heparin induced thrombocytopenia which can be achieved by the use of an alternative anticoagulation agent such as danaparoid (Kaushansky & Levi, 2018). Since Danaparoid does not cross-react with HIT antibodies, it acts as a suitable alternative and is immediately active and is able to stop the thrombin directly or inhibit its generation process.  

Description of the implementation process or roll-out and how the change would be evaluated.

            The treatment of Heparin induced thrombocytopenia will involve giving patients an intravenous bolus dose of 2500 that is followed by 400 U/hour for 4 hours. This is followed by another dose of 300 U/hour for 4 hours another subsequent 200 U/hour which is done until anticoagulation is no longer necessary (Abrams et al, 2013). The dose should be adjusted accordingly to ensure that the plasma anti-Xa levels are maintained between 0.5 to 0.8 U/mL. The use of danaparoid is likely to prevent the generation of thrombin and any reduction should be seen as a n indication that the approach is working.

Conclusion

The importance of Heparin induced thrombocytopenia as an immune mediated type of thrombocytopenia has made it difficult to manage the condition due to the health risks the patient is exposed to. Even when the condition has been identified, managing it is made difficult by the lack of appropriate substitutes for heparin. There are however other alternatives like danaparoid that have made it easier to manage the condition without exposing the patient to the adverse effects of Heparin induced thrombocytopenia.

References

Arepally M, (2017) “Heparin-induced thrombocytopenia” Blood, retrieved from,             https://ashpublications.org/blood/article/129/21/2864/36268/Heparin-induced-       thrombocytopenia

Askari, A. T., & Lincoff, A. M. (2010). Antithrombotic drug therapy in cardiovascular     disease. Dordrecht: Springer.

Crowther M, Dans A, and Linkins L, (2012) “Treatment and prevention of Heparin-induced             thrombocytopenia” CHEST, retrieved from,             https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3278058/#

Cucker A, (2016) “HIT syndrome (heparin-induced thrombocytopenia with thrombosis)” Cancer Therapy, retrieved from,            https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/critical-            care-medicine/hit-syndrome-heparin-induced-thrombocytopenia-with-thrombosis/

Franchini, M. Heparin-induced thrombocytopenia: an update. Thrombosis J 3, 14 (2005).             https://doi.org/10.1186/1477-9560-3-14

Kaushanky K and Levi M, (2018) “Williams haematology haemostasis and thrombosis”   McGraw-Hill Education

Shaz, B., Hillyer, C. D., In Abrams, C. S., & Roshal, M. (2013). Transfusion medicine and           haemostasis: Clinical and laboratory aspects. London: Elseiver

Weigelt, J. A. (2012). Surgical Critical Care, An Issue of Surgical Clinics - E-Book. Saunders

 Nature and Nurture Contribution to Child Obesity

Introduction

Nature's contribution to childhood obesity is based on the genetic disposition meaning that it is developed from genes that are inherited from the parents. This means that the child has no control over it because it is biological. Nurture contribution to child obesity on the other hand is based on lifestyle and family characteristics. This includes the child’s diet, food intake, leisure time, eating patterns, social-economic status among other lifestyle habits. Both nature and nurture contribute majorly to child obesity because the lifestyle a child is raised with is as important as their genes.

According to Fleming, weight gain is influenced by genetic mechanisms. Research shows that an obese child is more likely to have obese parents and siblings and in this case, their weight is attributed to genes. Twin and adoption studies have been used to show the effect genetics has on obesity on children. The studies show that 40-70 of the disparity between children concerning their weight could be accredited to genes. These disparities are closely related to those of height that have already been proven to be genetic. Studies also show that 80% of children with obese parents are bound to become obese at one point in their lives due to the child’s genetic metabolism. The fat gene that causes obesity delays the ability of the body to feel satisfied because it blocks the Leptin hormone. This hormone tells the brain that the body is full and it has had enough but when it is blocked, a person continues to feel hungry and therefore takes in more food slowing down their metabolism rate. It is believed that there is a break in the leptin hormone that makes a person not to starve but does not stop him from overeating.

Various genetic syndromes are connected and contribute to obesity. These syndromes may cause behavioral and health concerns that lead to an increase in energy intake or a decrease in activities. They may also cause disruptions in the central control of appetite resulting in hyperphagia (Skelton, Grzywacz & Miller 2011).  Hyperphagia that results from a lack of melanocortin increases the intake of food and is related to obesity. Several genetic abnormalities that have been discussed by researchers include the deficiency of leptin, mutations in POMC that result in a lack of signal to the central appetite which leads to hyperphagia. Other abnormalities include melanocortin 3 and 4 receptors which are important in feeding behaviors.

Lifestyle changes in recent years have resulted in children taking part in very few physical activities which is a nurture contribution to child obesity. Children are most likely to use a school bus to school rather than use a bike or walk. Playing time has been occupied by watching television or playing video games. The environment that the children are growing up in with lots of calorie intake and less physical activity has contributed to child obesity (Thompson 2016). Most of the school time is spent on academics and no time for engaging in physical activity. With less physical activity, children are consuming a lot of calories and this includes even in schools where students buy chips, candy, and all the other junk food being sold. Some of the low-income areas lack quality healthy food to purchase and most of them get their food from fast-food chains.

Parents on the other hand have become more drawn to their jobs making it hard for them to prepare a healthy meal for their children. In most cases, it is easier to order out food or buy something that is easy to prepare and doesn’t consume a lot of time (Campbell 2016). The family’s attitude and behavior toward food can contribute to child obesity. If the family engages in unhealthy eating, the children too will develop these unhealthy habits. Also, overweight parents tend to serve their children large portions of food and this contributes to weight gain. Another contribution to obesity is the type of food that is consumed. Studies have shown that most obese children eat more fatty foods and fewer carbohydrates. Fatty foods are linked to obesity because of their increased energy intake and they are more likely to be stored in the body. We cannot change the genetic makeup but we can change and control our environment and this includes eating healthy and engaging in physical activities.

Conclusion

Nurture gives the strongest contribution to child obesity. This is because of its connection to poor eating habits, lifestyle changes, high-calorie intake, and lack of physical activity. I feel it is the strongest because, for nature contributions, there is not much that can be done about it. For the nurture contributions, it is more of engaging in unhealthy habits and luring the children into the habits as well. These are habits that could be altered by consuming healthy diets and changing their eating patterns. Parents should introduce and encourage their children to engage themselves in physical activity other than sit down and watch television.

References

Campbell, M. K. (2016). Biological, environmental, and social influences on childhood obesity.

Pediatric Research, 79(1), 205-211.

Fleming, G. CHILDHOOD OBESITY: NATURE OR NURTURE? Retrieved from

https://psychology.tcd.ie/spj/past_issues/issue02/Reviews/Grainne%20Fleming.pdf

Skelton, J. A., Irby, M. B., Grzywacz, J. G., & Miller, G. (2011). Etiologies of obesity in

children: nature and nurture. Pediatric clinics of North America, 58(6), 1333–ix. https://doi.org/10.1016/j.pcl.2011.09.006

Thompson, T. (2016). Childhood obesity. Farmington Hills, Mich. : Greenhaven Press, A part of

Gale, Cengage Learning, [2016]

Schizophrenia Case Study

Introduction

Schizophrenia is a mental disorder whereby individuals abnormally interpret reality. It affects how a person feels, thinks, and behaves. Schizophrenia’s diagnosis is made if a person starts to experience hallucinations, delusions, or disoriented speech for at least one month. Therapeutic communication is important for people with this condition because it contributes to the nurse-patient interaction and relationship. Schizophrenia is treated with a combination of medications and therapy.

Scenario 1

The assessments that should be conducted are the coping styles of the patient. This is because denial coping occurs when patients report the refusal to admit that a stressor exists. Schizophrenia patients have a limited range of coping styles hence the reason for the assessments (Holubova et al 2015). Patients who refuse to believe and admit that they are ill will not be motivated to learn more about the illness and therefore will not take the recommended precaution. Using the denial coping strategies, the patient will get awareness about the condition that they are ignoring. Getting more knowledge about recognition and acceptance of their condition will make them more informed and this will lead to better decisions concerning treatment.

Scenario 2

In therapeutic communication with a person with schizophrenia, I will use my high level of self-knowledge, be honest, authentic, and have empathy for the person. I will approach the person in a calm and caring manner to make them feel comfortable and feel they're in a safe environment (Pinho, Pereira & Chaves 2017). Active listening will enable me to focus on the person’s experiences and be honest to them by letting them know that what they are experiencing is real. Authenticity is important since the person will be able to distinguish between what is part of the disease and what is not. I will let the person understand the symptoms and difficulties they are having and their need to cooperate. Then I will let the person know all the possibilities available for recovery. To enhance cognitive deficits, I will develop interventions that target specific deficits. For example, for the person to be able to focus, I will encourage them to choose activities that improve attention such as computer games which will help in concentration. For memory issues, I will encourage the person to write down all the important information and this will help them to remember.

Scenario 3

The fastest weight gain with olanzapine medication occurs within the first six months but this differs from person to person. It can continue after the six months but at a slower rate. This is because the drugs increase sugar and fat levels in the blood. Weight gain is more likely experienced by people during the earlier stages of their treatment. The olanzapine causes weight gain by stimulating appetite making a person feel hungry leading to more calorie intake. The medication also causes some people to crave for sweet or fatty food. These drugs may add a person’s weight but they are effective when it comes to treating the schizophrenia symptoms (Dayabandara et al.2017). Instead of discontinuing the effective medication, we could use the lifestyle approaches to manage the weight gain. This will include changing the diet, eating behaviors, and exercising. 

Conclusion

Schizophrenia has a great impact on how a person feels, thinks, and behaves. For a person who denies that they are suffering from the condition, their coping styles should be assessed and coping strategies should be used to enable the person to be aware of the condition. Knowing how to handle a person with schizophrenia through therapeutic communication is important because it helps with the interaction process. People who are being treated using schizophrenia drugs tend to experience weight gain and decide to discontinue the medication. Because the drugs are effective, lifestyle changes could be used to control weight gain.

References

Dayabandara, M., Hanwella, R., Ratnatunga, S., Seneviratne, S., Suraweera, C., & de Silva, V.

2241. (2017). Antipsychotic-associated weight gain: management strategies and impact on treatment adherence. Neuropsychiatric disease and treatment, 13, 2231–2241. https://doi.org/10.2147/NDT.S113099

Holubova, M., Prasko, J., Hruby, R., Kamaradova, D., Ociskova, M., Latalova, K., & Grambal,

3048. (2015). Coping strategies and quality of life in schizophrenia: cross-sectional study. Neuropsychiatric disease and treatment, 11, 3041–3048. https://doi.org/10.2147/NDT.S96559

Pinho, L. G. D., Pereira, A., & Chaves, C. (2017). Nursing interventions in Schizophrenia: the

importance of therapeutic relationship. Nurse Care Open Acces J, 3(6), 00090. Retrieved from https://medcraveonline.com/NCOAJ/nursing-interventions-in-schizophrenia-the-importance-of-therapeutic-relationship.html

Changes in Gait Pattern

Human composure contains of a sequence of muscle contractions and relaxations, which allows for movement. The lower limbs have been adapted to withstand the weight and allow for a change of position in order to carry out the day to day activities. In conditions of extreme subjection to limbs, a change in gait occurs, which has a subsequent effect on the muscles withholding power. Two significant forms of gait exist; the normal gait and the abnormal gait. In reasonable gait conditions, a person maintains a healthy walking posture unlike in the abnormal gait condition where an individual cannot walk in the usual way. This essay looks into the changes that occur in the gait and why they would occur in response to painful corn under the 5th metatarsal-phalangeal joint.  

In relation to the 5^th metatarsal-phalangeal joint painful corn, a patient often develops antalgic gait pattern. The outcomes of this pattern are that the patient tries evade pain when walking by not using various ways of movements. The patient experiencing pain in the foot has limited joint movement as the joint cannot withstand body weight and the effect caused by the corn on the sole. The resulting outcomes is that the patient makes short steps, slow movement, limps and has loss in heel-to-toe motion. According to Harrington (2005), when a patient is experiencing gait in forefoot, a move to curb the pain and toe-off is exercised

 Antalgic gait pattern affects the style and posture of the patient. Antalgic gait mostly originates from a sudden incidence caused by a particular disease or the gradual damage caused by a musculoskeletal system (Harrington, 2005). The gain cycle comprises two primary phases, which include the swing phase as well as the stance phase. This stance stage is further made of five sub-phases: early flatfoot, heel rise, heel strike, toe-off, and heel strike. Antalgic pattern experience by specific patience usually affects individuals' stance phrases located in the gait cycle and shortened significantly from the heel weight experienced by the patient as they suffer from pain in their forefoot.  Though the gait cycle is generally divided into two regular phrases, a patient experience extreme pain in their foot as a result of the corn from sole is expected to spend less time of about 20-30% of their gait cycle instead of 50% (Cowley, 2016).

 Besides, their reasonable stride length also reduces as a result of this particular condition, which further results in patients are having an elongation of their one stride as compared to the other one.  The extreme pain being experienced by the patient usually disrupts their normal locomotion significantly, resulting in soft and fast footsteps to avoid the pain and the load from affecting the affected foot (Harrington, 2005).   The patients automatically increase the magnitude of the swing phrase due to the impact of this condition and cause them to lack a forceful activation in some cases.

Conclusively, it is significant to note that no vibrant evidence recommends that damage in the lower extremity may have profound effects on the opposite undamaged limb except if the injury causes major muscle or complete paralysis on individuals' damaged leg.  The complete paralysis affects the other foot since it may cause a length discrepancy equal to 5 centimetres making the gait pattern to be altered. However, this abnormality has to exist for an extended period, but it may not affect the other foot if it is only for a short while. Moreover, crutches or casts may not have any significant impact on the borne of the uninjured leg. It is crucial to note, Antalgic gait pattern affects the style and posture of the patient.

References

Cowley, E., Maher, A., Prior, T., & Rome, K. (2016). Roundtable discussion: plantar heel pain. Podiatry Now, 19(3), 18-23.

Harrington, I. J. (2005). Symptoms in the opposite or uninjured leg. In Workplace Safety Insurance Appeals Tribunal (pp. 1-21).

Mental Health

Mental illness is rapidly spreading across the world. So it is highly important for everyone to comprehend the underlying factors causing mental illness. However, mental health is one of the most neglected fundamental need in human society despite it being an essential element of the human body. First of all, mental illness is normally stigmatized due to the simple assumption that human beings suffering from mental illness are not upright people (Abuse, 2013). Whereas a person suffering from an observable sickness is separated from the disease, mental illness is never separated from its patient and the individual's identity gradually becomes synonymous with mental illness. Since mental illness affects the mind, it is inseparable from actions, thoughts, and even the personality of the victim.

 Most of the time, mental health is assumed to be a secondary need. For instance, if one is depressed, it may not be considered an urgent matter as compared to a person suffering from a visible illness. Thus, the wrong assumption created around mental health has fostered an air of falsehood which in turn impedes sincere progress in the mental health sector (Petersen et al., 2011). Subsequently, mental health tussles to attract donations due to promotional issues and inability to gain traction especially among medics and other shareholders (Davydov et al., 2010). In the end, it is difficult for a depressed person to gain access to quality medication and counseling. This partly explains the high suicide rates which occur among men and women all over the world.

 Presently, the growing world populace, diversifies every single person's personality, identity, hobbies, and even physical attributes (Reinke et al., 2011). The unique human characteristics complicate mental health matters further as each person will have his or her unique mental issues. Mental health is not uniform across the board as tolerance levels toward life issues vary from one person to another. According to scientists the higher the tolerance levels the greater the ability to contain. sOn the other hand an increased population sometimes reduces tolerance levels or may sometimes expose people to sensitive aspects of mental illness. Undeniably, mental health is highly important because it directs personal thought patterns, emotions, and sometimes the manner in which people conduct themselves. The fact most people ignore their mental health has unveiled numerous negative consequences (Zeanah, 2018). The importance of safeguarding mental health is something that has come to the public limelight recently. However, it has not received the much attention it needs. Consequently, this made mental health issues fall behind in terms of measures and intervention needed to preserve or sustain the mental health of people from all walks of life.

  One primary factor impeding people from seeking therapy is finance. Most people consider therapy an expensive activity. Nevertheless, even if therapy is expensive, there are cheaper alternatives. If someone has medical insurance, he or she can search for mental health benefits by consulting the insurance company offering the services (Abuse, 2013). An insurance company not only connects one to a professional therapist but also explains details that are covered under their medical insurance policies hence giving a person the ability to judge and then evaluate the situation and if seeing a therapist is an option worth going for. At the end of the day, prioritizing mental health should be considered one of the primary issues within a health system.

 Another factor that derails mental health is lack of time. Most people are busy and cannot seem to find time to cater to their mental health needs. Overwhelming obligation take most of the time and hinder people from seeking mental health advice (Davydov et al., 2010). For example, careers, family, and college. Therapy is a form of commitment which most people are not willing to make or even consider for long term purposes. If one can find a therapist who lives within the same residential area, then it would be considered prudent for one to take his or her time off and make time for the therapist. Making an appointment with a therapist may be the first step to stable mental health.

 Sometimes people forget that anxiety, depression, and other mental illness are remediable. The remedial process begins when one admits that he or she is suffering from a mental illness. Some individuals may experience significant relief and improvement once they have sought the services of a certified specialist (Davydov et al., 2010). Even though a treatment outcome may vary, the majority of individuals may start showing symptoms of recovery after a few months into the treatment. Self- drive and personal initiative from time to time may influence the recovery journey to stabilized mental health.

 In summary, the stigmatization of mental health among humans has impeded accessibility to mental health treatment. Mental health influences thoughts, actions, and attitude towards people. Mental health balances emotion and actions while ensuring that people get a chance to live out their lives without depression or extreme emotions running their lives. Thus, someone's mental health status defines how he or she handles stress, makes vital life choices all through his life, and eventually affects a person’s entire life.

References

Abuse, S. (2013). Mental Health Services Administration. Results from the, 2, 013.

Davydov, D. M., Stewart, R., Ritchie, K., & Chaudieu, I. (2010). Resilience and mental health. Clinical psychology review, 30(5), 479-495.

Petersen, I., Lund, C., & Stein, D. J. (2011). Optimizing mental health services in low-income and middle-income countries. Current opinion in psychiatry, 24(4), 318-323.

Reinke, W. M., Stormont, M., Herman, K. C., Puri, R., & Goel, N. (2011). Supporting children's mental health in schools: Teacher perceptions of needs, roles, and barriers. School Psychology Quarterly, 26(1), 1.

Zeanah, C. H. (Ed.). (2018). Handbook of infant mental health. Guilford Publications.

Reflection paper on OT program coursework & capstone project

Introduction

Autism spectrum disorder is a disability that impacts an individual's behavior, communication, and interests in activities. Young adults with USD report negative experiences during the transition from high school to college. An issue to put into consideration is that if transition is a challenging experiencing for everyone, what about individuals who struggle with a disorder that limits their social and communication ability? This indicates that the transition becomes more complex to people with ASD in that they have a difficult task in adjusting to life and managing their life. Therefore, these students need support and guidance to help them manage their emotions, solve their problems, and make decisions by analyzing different situations. The proposed transition curriculum will help achieve the OT program-level outcomes and hence support ASD students during post-secondary transition. The purpose of the transition curriculum is to provide academic curricula to educators, counselors, occupational therapists, school district representatives, behavioral specialists, special education teachers, and other transitional teams. The curriculum transition will help achieve the goals of OT program in that the transition team will gain knowledge about the needs of transition, they will gain evidence-based information, critical reasoning skills, and develop collaboration in addressing challenges experienced by students with ASD. 

How OT program-level outcomes (PLOs) are met

 The Capstone project focus on developing a transitional education program where occupational therapists, educators, and another transition team will support students with  ASD  enroll in postsecondary education (AOTA, 2020). A point to note is that to prepare the students with disabilities gain a positive high school transition, occupational therapists and educators need professional knowledge. Occupational therapists and educators play a significant role in connecting the students with social support, ensure that students with disabilities are included in all educational aspects, and provide students with reasonable accommodations, and adaptive equipment to ensure full participation in education (AOTA, 2020). They also address the students' personal needs and protects their rights. The capstone project recognizes the important role of the occupational therapist and other community members and concludes that it is important to create a curriculum for service providers. The curriculum will provide evidence-based practices to support students and help them go through a positive transition. The capstone projects state that the project aims at achieving positive outcomes such as ensuring effective transition and creating a positive environment for higher education (AOTA, 2020). The paper will explain how the OT program-level outcome will be met concerning the Capstone project and Program Learning Outcomes.

 The transition curriculum will advance the profession and the occupational therapists will understand the potential barriers to a successful transition. The purpose of the transition curriculum is to aid the occupational therapy create transition planning and goals. An important point to note is that one goal of the occupational therapy program is being competent in the field of occupational therapy (Coffelt & Gabriel, 2017). Lifelong learning allow occupational therapists to develop professional growth and meet social need. Thus, the transitional curriculum will allow occupational therapy to grow personally and professionally and address the needs of students with ASD. Note that students with ASD are unable to communicate, and they cannot comprehend information.  In higher education, these students meet the new physical challenge and they lack the skills to adapt to the new environment (Coffelt & Gabriel, 2017). They develop anxiety and depression due to lack of socialization, and lack of support system. At this point, occupational therapists play a significant role in supporting the student, teaching them social skills, management skills, connects them with social groups, among other roles. Education curriculum designed for the service providers will help occupational therapists advance the profession, build competence, and the knowledge will aid in understanding the students' needs. 

 Students with ASD experience myriad issues that not only act as a barrier to learning but also hinder life success.  In higher education, students with disabilities lack reasonable accommodation since fellow students and staff do not appreciate their condition. The capstone projects address these challenges by proposing a transition curriculum where occupational therapists will develop knowledge on the importance of supporting students by helping them set realistic goals, develop a healthy living, among other skills that are important in life (Case-Smith & Arbesman, 2008). However, it is important to note that in addressing the need for students with disabilities, occupational therapists should use evidence-based knowledge.  Also, occupational therapists should integrate evidence-based practice to provide the students with the best intervention and support which address their needed.  Since the occupational therapists may lack the knowledge or an evidence knowledge which will make a positive change, the transition curriculum will create programs that are effective and have also evidence (Case-Smith & Arbesman, 2008). This means that occupational therapists will apply a science-based exercise to improve quality. 

Another thing about the proposal of transition curriculum in the Capstone project is that the  curriculum will provide an opportunity to interact with the inter-Professional team and determine effective interventions. To understand the unique needs of the students with ASD, it is important to use different perspectives or encourage community participation where different service providers should work together to make decisions and help the students gain a positive transition and adapt to the new environment. For example, families would play a significant role in developing an individual plan to support the student gain a positive experience during transition.  In general, the transition curriculum will allow occupational therapists to work with the local community to identify the gap and barrier to a positive transition. In this particular case, the communities, families, and occupational therapists will play a role in environmental and behavior modification.

 The transition curriculum embraces the goals of occupational therapy. Occupational therapists are required to adhere to the code of honesty while addressing students' issues. In the educational setting, occupational therapies may help the students solve problems related to anxiety, loneliness, self-awareness, and more (Loy et al. 2015).  In addressing these issues, the occupational therapist should show professional behaviors and as a result, the students will develop a positive relationship with the therapist and develop a positive attitude toward learning. Thus, the transition curriculum will promote professional behaviors which in turn will help the student’s understand themselves better (Loy et al. 2015).Thus, the proposal of transition curriculum to support students with disability is related to the OT program outcomes in that the curriculum will help the occupational therapist acknowledge the role of occupational therapy in promoting health and wellness. Also, occupational therapists will be aware that it is important to follow the principles and concepts and abide by the standard of practice.  Finally, occupational therapists are required to have leadership skills and engage in leadership behavior. Note that while addressing the issues or in this case the students' needs, the occupational therapists have power and influence. They should create a cooperative relationship with the clients, act as a mentorship, among other roles (Fleming-Castaldy & Patro, 2012). The transition curriculum will provide occupational therapists with leadership competencies that would enable solve the client's problem.

Conclusion

 The capstone topic and project demonstrate the OTD program outcomes.  An important point to note is that the capstone may take different forms but its overall aim is to develop professionalism, promote critical reasoning, and ensure that the occupational therapists integrate evidence-based knowledge in diverse settings. Overall, students with ASD experience challenges while joining institutions. These challenges act as a barrier in their personal and academic life.  Students are not prepared during high school transition and they do not find support programs in college where they can develop a sense of belonging and feel part of the environment. The capstone project has proposed a transition program where occupational therapists and educators will access resources and programs that will guide on how to address the issue faced by students especially those with ASD.  Intimately, the transition curriculum helps occupational therapists address the need for ASD students. The practices are aligned with the OT program and therefore the ultimate objective is to fulfill the OT goals. The last point to note is that occupational therapists use reasoning, value collaboration with family and communities, and focus on promoting health and well-being.

References

American Occupational Therapy Association. (AOTA). (2020). Students with disabilities in

postsecondary education Settings: How Occupational Therapy Can Help.  https://www.aota.org/about-occupational-therapy/professionals/rdp/postsecondary-education.aspx

Johnson Coffelt, K., & Gabriel, L. S. (2017). Continuing competence trends of occupational

therapy practitioners. The Open Journal of Occupational Therapy, 5(1), 4.

Case-Smith, J., & Arbesman, M. (2008). Evidence-based review of interventions for autism used

in or of relevance to occupational therapy. American Journal of Occupational

Therapy, 62(4), 416-429.

Fleming-Castaldy, R. P., & Patro, J. (2012). Leadership in occupational therapy: Self-perceptions

of occupational therapy managers. Occupational Therapy in Health Care, 26(2-3), 187-

202.

Loy, B., Micheff, H., Nguyen, K., & O'Brien, V. (2015). Interprofessional collaboration between

occupational therapists and nurses in an acute care setting: an exploratory study.

Part 1

Why is touch important?

Studies show that touch contributes to mental and physical health to both children and adults. During childhood, touch in importance as it develops a healthy relationship between a mother and her baby. When the child gets tough, he or she becomes stimulate and the stimulation helps in development. A psychologist known as Harry Harlow proves the importance of touch by conducting experiments. The results of his experiments show that intimate body contact or in other words 'mother-child bonding' is important than feeding. The nurturing touch makes the child feel safe and secure, hence physical and emotional security. Harlow's work sheds light on the importance of love and reveals that the skin-to-skin contact between a mother and the baby increases the mother's relaxation and supports a child's development.

 Touch is not only important during childhood but there is evidence that during adulthood, women need a supportive touch. Touch by a stranger is seen as a negative touch and act of invading one's privacy. However, a touch between people in intimate relationships has beneficial effects. For example, women enjoy touch and develop a feeling of security, affection, and comfort. Individuals in an intimate relationship improve relationships in that both develops a feeling of connectedness. Non-intimate individuals also enjoy non-aggressive touching such as a hug, the waist embrace, the shoulder embrace, the body support, and more. Note that this type of touch symbolizes solidarity and touch strengths the bonds of friendship. Another important point to note is that touch is important because it acts as a type of nonverbal combination between different people. For example, touch in a professional setting allows people to exchange messages. Touch in a social setting is seen as societal norms and people whether in same-sex interaction or not feel comfortable.

Finally, touch is important in the elderly. First, it is important to note that the elderly develop postural sway as a result of a deficit in visual information. As people grow old, their sensory system deteriorate resulting in a lack of postural control. However, light touch provides sensory information and increases postural stability.

Part 2

How are unattractive, insecure, or obese people treated unfairly in this culture?

 Societies such as North America perceive obese people as lazy, unintelligent, unsuccessful, and other forms of stigma and prejudice. Obese people are not socially acceptable in society. They are discriminated in all settings including education setting, in the courtroom, in the workplace, and other settings. For example, society relies on the perception that people are overweight as a result of unhealthy lifestyle behaviors. They are blamed for their appearance simply because everyone has a personal responsibility to take care of own health.

 Studies have shown that unattractive people are treated cruelly and unfairly. For example, in the courtroom, unattractive defendants are more likely to be found guilty. This means that society looks at physical appearance and this reveals a potential flaw in society as well as in the judicial process. In the workplace, attractive employees receive positive comments from their employers since the organization focus on attractiveness rather than job performance and ability. In school, unattractive children are discriminated in that teachers interact with attractive children. Thus, unattractive children are likely to develop mental issues and later they may develop behavioral issues. Overall, physical appearance determines how one will be treated. If you have a pretty face, the society will treats you fairly and if you have an ugly face, you will experience all types of biases and cruel treatment. For example, the reward theory states that in an interpersonal relationship, people are likely to associate themselves with attractive people since they believe that such people are honest, successful, and have other desirable characteristics.

Part 3

What does this spoof tell us about our expectations of Ted Talk speakers?

This spoof tells us that public speaking is all about impressing the audiences. Audiences are interested in your look and sounded. Talk speakers are expected to give a standing ovation. However, it is important to note that as a speaker, you must make the audiences keen and attracted to you.  From the TED TALK by Pat Kelly, one can notice that the speaker is confident. He makes eye contact and gestures (counting the number of items using fingers). These two elements build trust and help the audiences get the main points. To get a standing ovation, TED TALK speakers are expected to engage the audiences. Pat Kelly engages audiences and makes their mind active through sharing personal experiences. The speaker also controls the mind of the audiences by using images. This strategy makes audiences became interested in listening. Pat Kelly also reminds Ted Talk speakers that they should be simple or in other words, they should avoid delivering complex things. Ted Talk speaker should be clear and provide interesting ideas. Note that audiences want to enjoy the talk and thus, the speaker should present clear and memorable information. Finally, audiences lose attention and therefore the speaker should maintain the attention by using humor. In general, a thought leader is someone who connects with the audiences in a meaningful way.

References

 Attached source

Ted Talk https://youtu.be/_ZBKX-6Gz6A

Case Summary

Marvin is a 32-year-old married white man. He was brought up in a decent family and later in life, used his family’s privileges to climb up the ladder of life. Just like any other normal human being, he made both good and bad decisions. Despite his normal family life, since he was 18 years old, Marvin has been attending Psychotherapy sessions. Marvin is shameful of this fact because his underlying psychological reasons forced him to become a house husband. The psychopathology impedes his capabilities hence has never held onto a job. Sometimes he develops extreme anxiety, especially whenever he steps on a carelessly disposed of chewing gum or even when his hands come into contact with sticky materials. Additionally, this has further impeded his social life. Throughout the day, his curtains are drawn hence preventing any light from coming into his room.

Clinical Impressions

Marvin’s condition is categorized under anxiety. Only certain things make Marvin anxious or even distressed to the point he cannot function properly. His attempts to stop or reduce his anxiety levels led to obsessive-compulsive disorders such as panic and schizophreniform. For example, viewing a child's toy from his kitchen widow made him feel dirty (Rowa, & Antony, 2008). This kind of hypertensive reaction points to serious anxiety levels. He is remorseful of the impact his condition has had on his children because they cannot bring in their friends into the house. Moreover, the fear of uncertainty clouds his mind as he thinks that his wife will leave him even though there is no indication of it ever happening.

Recommendations

 Anxiety can be experienced from time to time but in this particular case, Marvin experiences high levels of anxiety (Ruscio et al., 2010). From his case study, one of the best recommendations is exercising. Exercise relieves one of stress and diverts one's attention hence or she ends up putting more energy on accomplishing the specified exercise rather than concentrating hence decreasing the anxiety levels. The second option is through hypnosis. Hypnosis keeps the patient in a constant state of relaxation and regulates thoughts and even actions.

Questions

 The Impact of Hypochondriasis and Anxiety

 The hypochondriasis only amplifies the fear resulting from anxiety. This is seen through Marvin's worry for his wife and children (Milad, & Rauch, 2012). He is afraid that his wife will leave him and he seems to be worried about the plight of his children. His children cannot bring their friends over to the house because of his condition.

Understanding and Distinguishing Between Hypochondriasis and Anxiety

 The two conditions can be distinguished from the situational point of view. For instance, anxiety can be induced by stepping on chewing gums or touching anything sticky. But one can understand hypochondriasis through the patient regretful thoughts (Milad, & Rauch, 2012). For instance how he affects his children and wife. Thus both conditions can be understood from the patient’s perspective or testimonial rather than direct diagnosis.

Diagnosis of obsessive-compulsive behavior

 The diagnosis of obsessive-compulsive behavior should remain (Rowa, & Antony, 2008).  According to the diagnosis and behavior of the patient is consistent with obsessive-compulsive behavior. The inconsistent thoughts, feelings, and symptoms and actions point to a strong obsessive-compulsive behavior. For example, Marvin is sometimes is easily agitated and compulsive.

Obsessive-compulsive disorder

 Is centered on age while if a person shows a constant circle of obsessiveness and compulsions (Milad, & Rauch, 2012). In Marvin’s situation, he has anxiety convulsions which tend to break his obsessions and compulsions.

Obsessive-compulsive personality disorder can only be identified through observable routines (Milad, & Rauch, 2012). For instance his ability to keep a job or the degree to which the symptoms impede his productive opposed to directly checking for the actual symptoms.

Reference

Milad, M. R., & Rauch, S. L. (2012). Obsessive-compulsive disorder: beyond segregated cortico-striatal pathways. Trends in cognitive sciences, 16(1), 43-51.

Rowa, K., & Antony, M. M. (2008). Generalized anxiety disorder.

Ruscio, A. M., Stein, D. J., Chiu, W. T., & Kessler, R. C. (2010). The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Molecular psychiatry, 15(1), 53-63.

Preventing cardiovascular disease

Introduction

 In the 21st century, cardiovascular disease is causing high mortality rates in both low and middle-income countries. Various prevention strategies have been implemented in the health care settings by researchers and clinicians yet the disease remains a health issue. To address this health issue, the World Health Organization has updated the recommendations for preventing CDV.  Also, the journals of public health have updated their prevention recommendations. The sources provide a set of guidelines that the primary care providers as well the individuals should follow to prevent the cardiovascular risks. In general, lifestyle modification and risk assessment could promote a healthy lifestyle and reduce cardiovascular diseases.

 According to the World Health Organization, cardiovascular disease is a fatal disease given that in 2005, there were 30% million deaths as a result of CVD. Both low and middle-income countries experience a heavy burden yet these countries lack resources to manage the disease. Thus, it is high time the policy makers collaborate with the health care providers to employ an evidence-based preventive approach to reduce cardiovascular risks (WHO, 2007).  The WHO states that CVD can be prevented through the modification of behaviors. Various clinical trials have shown that behavioral modifications lower risks of cardiovascular events.  The following are ways to prevent cardiovascular disease.

 Tobacco

 There is an evidence from a cohort study that smoke cessation reduces the risk of CVD. A recent interheart study report that tobacco use- either higher consumption of low consumption- is associated with adverse effects (WHO, 2007). Thus, health professionals such as health counselors and physicians should encourage smoking cessation. The WHO recommends smoking cessation as a lifestyle modifications for preventing cardiovascular diseases. Primary prevention programs include bans on advertising and ban on tobacco sales.

Diet

  Trans-fatty acids increase bad cholesterol and hence the risk of CDV. A healthy diet should have a total calorie of less than 30% (WHO, 2007). In a systematic review, participants who reduced the intake of dietary cholesterol and consumed unsaturated fat reduced the risk of cardiovascular disease by 16%.  The article also states that omega-3 fatty acids have a cardio protective role. Population studies have shown that high sodium intake increases CDV. Note that high blood pressure contributes to CDV. Since a high sodium intake increases blood pressure, WHO recommends reducing sodium intake in processed food (WHO, 2007).  People should maintain good blood pressure and hence prevent cardiovascular disease. Another important point about diet is that fruits and vegetables have protective effects. Thus, people should prevent cardiovascular disease by consuming fruits and vegetables since these plant-based food have low calories.

 Physical activity

 Several meta-analyses have reported that sedentary lifestyles increase the risk of cardiovascular diseases. Others report that physical activity reduces the risk of cardiovascular diseases through improving blood pressure, and insulin control (WHO, 2007). WHO recommends the implementation of physical activity programs in health care settings. There should be individual counseling to promote self-directed physical activity and cardiorespiratory fitness. Other interventions include home-based physical activity, self-monitoring, and group counseling. 

  According to Omura et al (2019), physical inactivity is a contributing factor to cardiovascular disease. Thus, individuals are encouraged to increase physical activity to reduce the risk of developing cardiovascular disease and other conditions. However, 1 in 5 Americans do not adhere to the physical activity guidelines (Omura et al. 2019). To help these adults who do not engage in physical activities, the article recommends 'walking' as a simple physical activity that can promote cardiovascular health. The article states that walking as a form of physical activity is less prevalent. However, the Nationals Health Interview Survey report that active transportation lowered BMI, hypertension, and diabetes (Omura et al. 2019). This shows that even though walking is less common, there should be clinical interventions to promote aerobic physical activity. To promote physical activities, health care providers should encourage adults to incorporate walking since its safe and easy.

            Santos (2020) asserts that cardiovascular disease prevention can only be achieved by addressing the risk factors. For example, adults between 40-69 years suffer from blood pressure. These adults are likely to develop heart diseases. For example, the Framingham study found that risk factors for cardiovascular disease include obesity, high blood pressure, menopause, and more. The article states that it is important to understand these risks; both high risks and low risks (Santos, 2020). These risks should be considered in clinical practices and prevention/screening should be done and treat the risk factors. Also, primary health care should entail the provision of comprehensive care to individuals with severe health problems to lower the risks of cardiovascular disease. Note that comprehensive care will benefit both younger and adults and the risks will not be potentially harmful (Santos, 2020). Thus, risks assessment is an effective method for cardiovascular disease prevention and the individuals as well the health care setting will not face the burden of cardiovascular disease. 

Conclusion

 Cardiovascular disease is a threat to the world in terms of causing premature deaths and increase the burden of health care costs. Countries are struggling with health and financial needs. However, countries as well as individuals can prevent cardiovascular diseases. The main take-home message is that prevention intervention should start with physical activity and dietary advice. Individuals need lifestyle modifications such as quit smoking, consume a healthy diet such as fruits and vegetables and do away with sugars and saturated fats, and do physical exercises. Finally, a comprehensive assessment should be done to assess the risk factors and solve the existing health issues.

References

 Omura, J. D., Ussery, E. N., Loustalot, F., Fulton, J. E., & Carlson, S. A. (2019). Peer Reviewed:

Walking as an Opportunity for Cardiovascular Disease Prevention. Preventing Chronic

Disease, 16.

 Santos, P. (2020). The Role of Cardiovascular Risk Assessment in Preventive Medicine: A

Perspective from Portugal Primary Health-Care Cardiovascular Risk

Assessment. Journal of Environmental and Public Health, 2020.

World Health Organization. (2007). Prevention of Cardiovascular Disease: Guidelines for

Assessment and Management of Cardiovascular Risk. https://ish-world.com/downloads/activities/71665_71665_OMS_INT-RETIRATION.pdf

                                    AN EPIDEMIC OF THYROTOXICOSIS

Question 1: Place yourself in the role of the EIS Officer. Can you say that an epidemic exists?  Why or Why not?

            Considering the information that was provided by the EIS office, it is evident that thyrotoxicosis exits. In case this case, if I was the EIS personnel, one of the key factors that I could have taken into consideration is scrutinizing the data provided so as to determine whether this was not truly an epidemic or not. Despite that, it will be vital to take into account the main concern of the EIS officer or endocrinologist. For such a town with a total population of 801 people, it is logical to say that this is an alarming problem that should be studied chronologically. The reason for that is because out 801 people, 8 patients had already been diagnosed with thyrotoxicosis. From what we had previously learned, once a disease has been considered to be an epidemic, it means that it is spreading rapidly and quickly within a short time.

Question 2: a) What additional information might you try to collect on the phone call?

            As one of the EIS officers, one of my primary objectives will entail gathering sufficient information regarding the spread of the epidemic. The reason for that is because I will be able to assist the CDC (center for disease control and prevention) to make adequate adjustments regarding the mechanisms to be used in handling such an outbreak. As a result of that, I will dedicate my time to ask the endocrinologist whether the patients acknowledge each other. Next, I will as inquire from the endocrinologist about the mechanism that patients use to connect patients with each other. Information regarding the activities that the patients do for survival is also paramount to be included in this research.

            Information that is also vital to collected will entail understanding some of the factors that has the propensity of increasing the spread of such an epidemic. Such factors will be based on individual lifestyle, for instance, nutrition, physical exercises, and so on. The reason for that is that information regarding how patients change their diet is important because it plays a crucial role in boosting individual immunity (Luster et al., 2019). Last but not least, it will be to analyze some of the clinical strategies that could have been implemented in preventing the spread of this disorder.

Question 3: Which of the following three tasks are appropriate next steps to take?  Why?

1. Contact the state epidemiologist in South Dakota

            Contacting the state epidemiologist will be important because it will provide an opportunity to learn about the main signs and symptoms the epidemiologist gathered from the patient examined.  It will also be easier to learn on how the epidemiologist analyzed the information they could have gathered from patients. Interacting with the epidemiologist will assist in understanding the preventive strategies he or she could have recommended in combating the spread of this disorder.

2. Book an airline flight to Sioux Falls.

            Booking a flight to Sioux Falls will be important because it will offer an opportunity for interacting with the endocrinologist of the University of South Dakota. Taking into consideration the article the endocrinologist had read, it will be easier to understand his views regarding such an epidemic. Since some of the views regarding this epidemic is that is caused by a virus, it could be vital to understand some of the symptoms he or she considered to be common with each patient. Such an understanding will have to be based on the fact that the endocrinologist had noticed that some patients exhibited relatively low radioiodine intake. As a result of consulting the endocrinologist, there will be an opportunity of understanding the feedbacks he or she could have received from the EIS officer concerning their perspectives about the existence of such an epidemic.

3. Contact physicians in communities affected by the outbreak to identify more cases.

            By contacting physicians in communities that are affected by this outbreak will provide an opportunity for gathering information from them regarding the lifestyle of the people within that region. The knowledge to be provided by the local communities is relevant because they are always in close contact with their patients. Scrutinizing the clinical information they could have collected regarding such patients will also be easier in understanding the primary causes of this disorder. By interacting with the local physicians, it will be easier to have the contact information of the patients so that one can reach and interact with them. In so doing, it will be easier to implement effective strategies that can be used to prevent further spread.

Question 4: State and define the two major types of thyrotoxicosis.

            Thyrotoxicosis is one of the medical syndromes that develop as a result of the exposition of individual tissues to excessive circulating thyroid hormones. Usually, this condition develops as a result of the overproduction of the thyroid hormones by the thyroid follicular epithelial cells (Buck, 2017). The two types of thyrotoxicosis are hypothyroidism and hyperthyroidism. Hypothyroidism or underactive thyroid disease is a health condition in which individual thyroid glands fail to produce sufficient thyroid hormones. The primary objective of thyroid hormones entails regulating body metabolism. Therefore, individuals with underactive thyroid or hyperthyroidism have various symptoms that clinically show that he or she has low metabolism (White & Harvard Medical School, 2010).

            Hyperthyroidism is a clinical condition in which the thyroid glands produce excessive thyroid hormones; triiodothyronine (T3) and thyroxine (T4) hence making them be overactive. It mainly develops in three ways; production of excess T4 hormone by the thyroid nodule, thyroiditis (a condition which is associated with the increase in the size of the thyroid glands), or as a result of Grave’s disease (a condition which makes an individual’s thyroid glands to produce excess thyroid hormones) (Luster et al., 2019).

Question 5:

1. Thyrotoxicosis typically is an antecedent for which major form of arthritis? What is the relative frequency for this form of arthritis?

             Thyrotoxicosis has been realized to be an antecedent for osteoarthritis. Osteoarthritis is a type of arthritis that develops when the protective cartilage that protects individual bone joints wears or tears with time. Despite that it damages bones; it commonly affects any joint that is found on the knees, hips, hands, and spine. According to the information collected and published by CDC, out of 1000 people, 1 to 2 people are likely to develop this disorder (Wardle et al., 2010). Females have a relatively high frequency of developing osteoarthritis (OA) as compared to males. 

1. For each of the three prevention stages, identify strategies for prevention of osteoarthritis.

            As a means of preventing the development of osteoarthritis, it is important to select the strategies that suit the needs of each patient. That will take into account selecting appropriate clinical interventions that can attenuate or correct risk factors of osteoarthritis. Ideally, such interventions should be considered whether they are acceptable by each patient so as to maximize persistence with and adherence to the regimes (Ferri & Ferri, 2019). One of the primary prevention strategies that can be recommended is educating patients and the general public about osteoarthritis. Education is vital because it has been clinically proven to enhance self-management. With it, it becomes easier for individuals to understand how to use and prevent the overuse of joints in the appropriate way.

            Nevertheless, active prevention strategies should target individual lifestyle risk factors that have the propensity of increasing the development of osteoarthritis or joint damage. Some of the lifestyle risk factors include poor nutrition that causes malnutrition or obesity, lack of physical exercise, excessive joint strain and stress, and dehydration. Once these factors have been taken into consideration, educating individuals on how to change their lifestyle will be fundamental in preventing the development of osteoarthritis. Encouraging sufficient consumption of foods that are reach in vitamin D, calcium, and other related nutrients are vital in fostering the development of healthy bones. Avoiding alcohol intake and exposure to sunlight for at least 30 minutes each day is also important because it is the source of vitamin D (Reginster, 2012). The use of drugs such as acetaminophen or ibuprofen, or aspirin can be recommended as the strategy for preventing osteoarthritis. Intake of chemo-preventive supplements including a combination of vitamin D and calcium can also be administered for patients who are clinically ill.

References

Buck, C. J. (2017). 2018 ICD-10-CM for hospitals. Saunders Press

Ferri, F. F., & Ferri, F. F. (2019). Ferri's clinical advisor 2019: 5 books in 1. Philadelphia, PA : Elsevie Press

In Luster, M., In Duntas, L. H., & In Wartofsky, L. (2019). The thyroid and its diseases: A comprehensive guide for the clinician. Cham, Swizterland : Springer Press

Reginster, J.-Y. (2012). Osteoarthritis: Clinical and experimental aspects. Berlin: Springer.

Wardle, J., Sarris, J., & In Sarris, J. (2010). Clinical Naturopathy: An evidence-based guide to practice. Churchill Livingstone Australia Press

White, S. S., & Harvard Medical School. (2010). Thyroid disease: Understanding hypothyroidism and hyperthyroidism. Boston, MA: Harvard Health Publications.

Practice Setting & Theories

 The Roper Theory in nursing best fits my current clinical work setting which is the urgent care and COVID area department. This is because the theory is used to assess a patient throughout their care which works best for the current clinical settings I am in. After all, in both areas, a patient’s independence needs to be supported (Roper, Logan & Tierney 2000). The theory is suitable because in urgent care, assessing the changes that a patient is making since admission is very crucial and brings to attention if the patient is making improvements or not. If no improvements are noted, then it becomes easy to know that there is a need to change the type of patient care being used. In the COVID department too, the theory is significant because it enables one to evaluate the changes that the patient is making until they can be independent. The complete assessments enable one to know the interventions that will work towards the independence of the patient. The theory allows the assessment of a patient’s possible independence in their daily living activities.

This makes it well-suited in both my clinical work settings because it helps to establish the interventions that will assist a patient in increasing their independence and also the support that is required to offset any dependence that might still be in existence. By using the theory, the patient assessment is done upon admission and throughout the patient’s care plan, his dependence and independence are reviewed and evaluated (Roper, Logan & Tierney 2000). Through the changes in the dependence and interdependence, one can tell if the patient is making any improvements and if there is any need for making changes in the type of patient care being provided.

References

Roper, N., Logan, W., & Tierney, A. J. (2000). The Roper-Logan-Tierney method of nursing:

Based on activities of living. Harlow: Churchill Livingstone.

Cardiovascular System Discussion

What manages the repolarization and depolarization of the heart and what is the health condition develops when this function works improperly

The electrical activity of the heart takes place at the cellular level. Inside the cells, electrons have a negative charge and they have a resting potential of -80 to -90 Mv (Conover, M. B. (2003). The concentrations of potassium maintains the membrane potential. However, when the cardiac muscle contracts as a result of sodium ions entering the cells, depolarization occurs.   Depolarization means that the negatively charged electrons inside the cells become positively charged (Conover, M. B. (2003. Then, calcium ions enter into the cells and cause repolarization.  In other words, the calcium ions allows the electrical charge to achieve its membrane potential and become negatively charged again. During the recovery period (refractory period), the electrical charge resists electrical stimulation and this means that depolarization cannot happen again (Conover, M. B. (2003). Thus, both repolarization and depolarization are managed by the electrical activity where the cells are stimulated and relaxed. 

Atrial fibrillation

            When the electrical activities are not working well, a health condition known as atrial fibrillation occurs. This condition occur as a result of depolarization (Crowley, 2014).  Note that the depolarization causes muscle contraction. The depolarization should be a normal conduction system throughout the parts of the heart. However, in some cases, abnormal patterns occur   which causes abnormal cardiac rhythms. Note that coordination on the conduction system is needed for normal contraction. However, the lack of coordination results in irregular heartbeats (Crowley, 2014). Atrial Fibrillation is treated through slowing the heart rate and maintaining a normal heart impulse through the use of electrical shock or drugs. The aging population is prone to arrhythmia. The majority of patients with atrial fibrillation are 65 years and above and  these patients develop other morbidities such as heart failure (Khan, 2006).Young people, especially those with congenital heart diseases and  mitral stenosis also develop atrial fibrillation.

References

Conover, M. B. (2003). Understanding electrocardiography. St. Louis, Mo: Mosby.

Crowley, L. V., (2014). Essentials of human disease. Burlington, MA: Jones & Bartlett

Learning.

Khan, M. I. G. (2006). Encyclopedia of heart diseases. Burlington, MA: Elsevier Academic.