The shift of roles from one which is already established to a new one can be considered to be stressful due to various factors that are associated with it. Some of these factors include unfamiliar settings, changes in the managerial style, heavy workload, infrequent breaks, long hours and shift, lack of motivation, and unnecessary routine tasks that may be experienced in the new setting. In the United States, it is estimated that 60% of the employees associate the source of stress to their jobs and their responsibilities (Hussung, 2015). This paper will discuss the about ways of identifying stress and how it can be prevented or reduced
Identification of Stress
Stress resulting from a change in roles in the work environment can easily be mistaken with challenges. However, it can easily be identified by the signs that accompany it, such as feeling overwhelmed, loss of confidence, being angry frequently, and social withdrawal. Others include problems with sleeping, loss of interest at work, and headaches (Hussung, 2015). It is noteworthy to consider that the signs above occur after the shift, and the individual did not have them before he/she took the new role.
Stress Reduction and Prevention
The most crucial and best initial way of dealing with stress at work is through sharing the experience with someone close such as a family member. Through face-to-face communication, people tend to understand and give support, which is useful in reducing it and regaining calmness (Segal et al., 2019). I consider this the “power of a good listener.” Furthermore, support from co-workers can be sought, leaning on friends and other family members who can understand the situation and building new satisfying friends can also be a good strategy of dealing with it initially.
Besides, support of health through exercise and nutrition also works very well. This is because of their ability to make an individual more resilient to stress. Furthermore, taking care of oneself does not need a total change in lifestyle but simple things that can lift mood, raise the energy levels, and let go things that one does not have control over (Segal et al., 2019). Fortunately, regular exercises give those advantages. It can also sharpen focus and relax both the mind and the body. Other rhythmic movements such as dancing, drumming, and working work best by soothing the nervous system, and thus, regular 30 minutes of activity can be the best way to relieve stress.
Additionally, food choices can play a significant role in stress reduction. This is because eating small and frequent meals maintains an even level of blood sugar, which then increases energy, maintains focus, and prevents issues such as mood swings. However, it is essential to consider reducing intake of sugar and refined carbs, reduction of food that adversely affects mood such as caffeine and trans fats, and eating more of Omega-3 fatty acids to boost mood (Segal et al., 2019). Others include avoidance of nicotine and drinking alcohol in moderation.
The quality of sleep also influences stress levels. This is because it affects creativity, ability to focus, productivity, and problem-solving skills of an individual. Therefore, improvement of the quality of sleep through adopting a good routine can promote the better side of life (Segal et al., 2019). Some of the activities that can be done are sleeping and getting up the same time each day, being keen on the diet to ensure it does not interfere with quality sleep, turning off screens at least one hour before bedtime, and avoidance of stressful situations in bed.
Conclusion
In conclusion, stress issues in the workplace are common, and they result from various sources, including changes in responsibilities. However, they can be identified through their symptoms, which occur after the stimuli. Fortunately, it can be easily managed through sharing with friends and family, regular exercise and nutrition, and engaging quality sleep patterns.
References
Hussung, T. (2015, September 4). Understanding Work Stress: Causes, Symptoms and Solutions. Retrieved October 12, 2019, from https://online.csp.edu/blog/business/understanding-work-stress.
Segal, J., Smith, M., Robinson, L., Segal, R. (2019). Stress in the Workplace. Retrieved 12 October 2019, from https://www.helpguide.org/articles/stress/stress-in-the-workplace.htm
Can a RN dispense self-administered hormonal contraceptive and contraceptive injections?
A Registered Nurse is authorized to dispense and administer hormonal contraceptives and contraceptives injections in public facilities including nonprofit community and student health center (Parker et al. 2017).
Can a nurse practitioner with schedule III-V furnishing privileges obtain schedule II furnishing privileges to meet the rescheduling Hydrocodone combination products (HCP) legislation?
A nurse practitioner can obtain schedule II furnishing privileges but the nurse should complete an online course and wait for approval from the Board of Registered Nurse on the verification system (BRN, 2004).
Can a nurse practitioner function in the emergency department?
A nurse practitioner can offer emergence treatment to patients with critical conditions.
Can nurse practitioners authorize durable medical equipment, certify disability and approve, sign, or modify care for home health services within the standardized procedure?
Nurse practitioners are authorized to prescribe medical equipment’s to patients, certify a disability, and approve home health services.
Can a nurse practitioner authorize disability benefits?
A nurse practitioner should provide evidence which entails all medical records such as the disabling condition, clinical findings, treatment history, and more so that patient can receive a disability benefit(BRN, 2004).
Can nurse practitioners obtain consent for blood transfusions?
Nurse practitioners should obtain a written consent before conducting any process such as blood transfusions. The NP should provide the patient with information regarding the risks and benefits (BRN, 2011).
Can nurse practitioners sign DMB physical exam for school bus drivers?
Nurse practitioners act as medical examiners. They perform physical exam for drivers to promote health. If they detect a chronic illness such diabetes and hypertension, they provide health care to improve their mental and physical health (BRN, 2011).
Can nurse practitioners certify disability for purpose of persons obtaining a disability placard or disability car license plate?
Nurse practitioners should certify that a person has a disability such as impairment so that the person can apply for a placard.
Do my patient charts need to be counter signed by a physician?
The law does not authorize the physician to counter sign the patient medical record.
Can a nurse practitioner dispense medications: If so, what laws should the nurse practitioner know about to perform this function?
A nurse practitioner can dispense medications under the B&P Code Section
Is a nurse practitioner practicing illegally when the physician supervisor is more than 50 miles away?
The nurse practitioner should provide quality of care and adhere to the standardized procedures even when the physician supervisor is 50 miles away.
Does the nurse practitioner need a physician supervision who is approved by the medical board?
The medical board does not approve the physician supervision. A physician can supervise from a distance.
I am a pediatric nurse practitioner and the physician wants me to start treating adults. I feel comfortable treating adults, so can we develop standardized procedures to cover this new population, diagnosis/treatments and furnishing?
In this case, the Nurse Practitioner should advance education to gain competence in the new area. The adult standardized procedure has the training requirement and the NP should adhere to the procedures to qualify (BRN, 1998).
. How often do my standardized procedure need updating?
Since patients require quality care every time, an update should be done regularly.
Can I adopt my nurse practitioner program’s standardized procedures as my own when I go out into practice?
A nurse practitioner can adopt the procedures if they are developed and approved by health care systems (BRN, 1998). The nurse should follow the specified conditions and should have the required education to utilize the policies and protocols.
I am a geriatric nurse practitioner and work with a physician who has patients in a number of long-term health care facilities. We have developed standardized procedure
For the medical care I will be providing in these facilities. Do the standardized procedures have to be approved by each facility?
The standardized procedures need to be approved by each facility. Note that the procedures are developed by nurses in healthcare system and they consider several activities (BRN, 1998). Each facility has its own policies and practices and therefore each facility should approves its own standards to meet the patients’ needs.
What are the requirements for the nurse practitioner in a long-term care facility?
In long-term care setting, NP are required to provide alternate care and visit, write admission orders, adhere to the standardization of procedures, conduct initial history, monitor patient condition, among other roles(BRN, 2004).
I am certified as a nurse practitioner by a national certifying body. Do I need to apply to the BRN for a nurse practitioner certificate?
As a NP, you should apply to the BRN to obtain a certificate and a license. Note that the BRN is responsible for categorizing the health nurses and a NP is issued with a furnishing number.
Can a Nurse Practitioner develop and use standardized procedures with a chiropractor? Can the Nurse practitioner furnish drugs and devices to these patients?
Focusing on the scope of practices, the NP and a chiropractor cannot develop standardized procedures. Note that these are two different fields which require different activities towards providing patient care. There should be no overlapping functions and therefore the clinicians from different field should not develop procedures (BRN, 1998). On the same note, the NP cannot furnish drugs to chiropractor patients since the standardized procedures are not well-matched. Note that it is illegal for a chiropractor and licenses healthcare professionals to makes medical decisions.
May I call myself a nurse practitioner once I have completed my nurse practitioner program?
Unless the Board of Registered Nursing gives the licenses and certification, one cannot be called a NP. Note that a NP is someone who qualify in accordance to the BRN.
I am a nurse practitioner and I do not have a nurse practitioner furnishing number. Can I still “furnish” medications for patients using a standardized procedure?
The only way a NP can furnish medications is through a furnishing number. The number is given to the NP who completes the requirements.
Does the NP need a furnishing number issued by the BRN to obtain a DEA number?
According to the guidelines, the NP should use the delegated authority to access the furnishing number and use the prescriptive authority to access DEA.
Does having a DEA number eliminate the need for a furnishing number?
It is important to understand that obtaining a DEA number and a furnishing number are two different step (BRN, 2004). Therefore, a NP should go for a DEA number in order to prescribe uncontrolled drugs and a furnishing number in order to furnish drugs.
On the DEA application, it asks “Administer, Dispense, and Prescribe”. Can an NP as a result SB 816 and now 1/2004 AB 1196 Montenez Chapter 748 prescribe?
NP can prescribe controlled substances with DEA registration and furnish number. They should adhere to the standardized procedures
Are NPs now considered “prescribers”?
NPs are now prescribers in that due to the prescriptive authority, they can prescribe medications in accordance to the standard of care.
Can the NP with a furnishing number use the physician’s DEA number?
The NP should have own furnishing number and DEA number
What is required to be printed on the prescription pad/transmittal order/drug order for schedule ll through V?
The prescription should contain the practitioner name, drug name, and furnishing and DEA numbers.
How long is a controlled substance prescription (Schedule ll -V) valid?
If a health professional prescribes a drug, the prescription is valid until 6 months.
Do nurse practitioners have prescriptive authority and can nurse practitioners get DEA numbers?
NR have a prescriptive privileges which allow them to obtain a DEA number
History of laws related to Furnishing schedule lll-V schedule ll controlled substances
The Controlled Substance Act has non-criminal regulatory which guide the regulation of substances from illegal use. Schedule 1 regulates unsafe drugs, Schedule II to V regulate less dangerous substances. Schedule 1 was initiated in 1984 for the purpose of restricting harmful chemicals from being accessed (BRN, 2004).
Where can a nurse practitioner find information on controlled substances such as the Drug Enforcement Administration (DEA) and pharmacy laws? Phone numbers subject to change.
Check online
A NP can derive information related to the manufacture and distribution of drug from sources such as Drug Enforcement Administration.
References
Parker, E. C., Kong, K., Watts, L. A., Schwarz, E. B., Darney, P. D., & De Bocanegra, H. T.
(2017). Visits to registered nurses: An opportunity to increase contraceptive access in
California. Nursing research, 66(4), 286.
BOARD OF REGISTERED NURSING. (BRN). (2004) CRITERIA FOR FURNISHING NUMBER
UTILIZATION BY NURSE PRACTITIONERS. DEPARTMENT OF CONUSMER AFFAIRS
BOARD OF REGISTERED NURSING. (2011). STANDARDIZED PROCEDURE GUIDELINES.
DEPARTMENT OF CONSUMER AFFAIRS
BOARD OF REGISTERED NURSING. (1998). AN EXPLANATION OF STANDARDIZED PROCEDURE
REQUIRMENTS FOR NURSE PRACTITIONER PRACTICE. DEPARTMENT OF CONSUMER
Post-Traumatic Stress Disorder in ‘A gesture Life’ by Chang-rae Lee
Post-traumatic stress disorder which is commonly referred to as PTSD is a condition that affects persons that have been experienced traumatic happenings in their past. For an individual to be diagnosed with PTSD, he or she must have been exposed to an event that involved intense fear, helplessness and horror (Workman, 251). This individual at the present is a result of the extreme trauma experiences, persistent memories of the traumatic event, and persistently avoids any stimulus that is associated with the trauma. PTSD is a theme that Chang-rae Lee explores in his work ‘A Gesture Life’ through the protagonist Franklin Hata.
Trauma is a theme that defies the element of stories being told in a chronological order. The characters that are used to help explore the concept of trauma are not able to address the nature of their trauma and so their autobiographical accounts are always disjointed as they try to subconsciously avoid their past experiences (Workman, 254). Hata in ‘A Gesture Life’ represses various traumatic events in his life including his responsibility to the death of K and also his lack of clarity on his origins, to present a narrative of a successful assimilation that through the voices of other people around him turns out to be a lie. Hata’s evasive voice is an attempt to narrate himself into a reputable identity that he wishes to have, but the memories of his trauma and the voices of Sunny and K create a conflicting concept that force him to realize the fictitious nature of his assimilation.
Hata is presented a self-proclaimed Japanese immigrant who now lives a seemingly fulfilling American life. Through his evasive voice and his involuntary intrusion of his past, his narrative is brought out as a structural representation of both adoption and trauma. One of Hata’s most traumatizing memory is the death of a comfort woman he during the war known as K. His lack of clear origins also greatly traumatizes him even before the chronological beginning of the novel. All throughout the novel, Hata perceives himself to be Japanese, but when he is asked for his Korean name by K, he explains that he had one during birth but no one ever used it, even his real parents because they wanted him to become wholly Japanese (Lee, 235). He later goes ahead to illustrate that his Korean birth name was used by the administrator when he was joining the war, he says on page (236) ‘the last time I heard their….birth name for me’. This is an indication that his Korean name was used despite his claims and it is an illustration that the story he told K about his birth parents not wanting him to have Korean origins was just a story that he had created to try and distance himself from his Korean Origins ((Workman, 260). This concept opens up the character of Hata as being an unreliable narrator through creation of self-deceiving stories to forget his traumas.
Hata as a ‘hidden’ Korean in the Japanese army makes him an oppressed object and this can also be considered to be a traumatic element for him. Hata felt lost in the Japanese army as a Korean, it is for this reason that he wanted to be close to K who was a Korean. His hope was that being close to a Korean would help him find a sense of belonging. K in Hata’s narrative is not only a link to his Korean roots, but also a device to help ensure the future of his identity narrative (Caroll, 592). Hata requires a family to help him to become fully produced Japanese and he sees K as his link to help him achieve that. Hata renders K mute to favour his narrative, her story is too heinous for him to address and he thus renders her mute through his fictional narrative. Hata greatly dissociate himself of the past events in his narrative as an attempt to try and distance himself from his trauma.
Hata constantly has memories of K in his present life, though the K of his imagination is very different from the one in his flashbacks. The K in his imagination is one crafted to fit in his self-deceiving narrative; he creates K as his perfect wife, submissive and one that is only concerned with his wellbeing (Cheng, 558). This is a K that is very different from the woman that in his past demanded that he kill her. By creating a different K in his memories, Hata tries to force her memory to solidify the fictional narrative that he has created. This is a clear indication that the trauma of K’s death is still very relevant, and Hata cannot really escape from his traumatized past as long as he is still holding onto his fictional narrative.
While Hata wishes to let go of K’s memory, letting it go is impossible because it would require him to address his traumatic responsibility for her death and this would unravel his fictional narrative. Hata is no able to give psychic meaning to the K’s memory because he is caught between two opposing narratives (Cheng, 572). There is the narrative that he presents in the text and the other one of his traumatic past that keeps intruding. Hata in this story is brought out as an individual that is too traumatized to even recognize his own trauma ‘he “could not smell or hear … could not … sense that other, tiny, elfin form … and [he] could not know what [he] was doing, or remember any part” (Lee, 305). The use of the word ‘Could’ instead of ‘did’ greatly helps to illustrate the concept of trauma for Hata. He admits his inability to properly understand his memories that he is not even able to access. His experiences become almost dormant in his mind, which leaves it to b ever present but beyond his control and the result is his entrapment.
Hata’s entrapment with his failed narrative with K is made evident by his interactions with his adopted daughter Sunny, whom he tries to narrate into the role that was to be filled by K. Hata used K in his narrative to help him to obtain his Japanese identity through family. Hata hence uses Sunny to try and rewrite his failed past and he uses Sunny to replace the traumatic end of K. Sunny is perceived as Hata’s chance to begin a fresh and to right the wrongs in his past (Caroll, 600). Hata refuses to accept his responsibility in K’s death and it only comes out subconsciously through how he reacts with Sunny. He feels that doing what Sunny asks her to do is the best, because if he had done the same with K it would have prevented her from being gang raped and killed. Hata is subconsciously haunted and traumatized by the fact that he did not agree to kill K as he requested and that is what led to her being gang raped and her death. Even though he does not admit it openly, Sunny was his chance to make up for not having ‘surrendered just once when it mattered’ (Lee, 321). Hata’s thinking was wrong because this only led him to become more entrapped in his trauma. All this is evidenced in his failed relationship with Sunny that helps to show his inability to move on from his traumatic past.
There is a shift in Hata as the novel is coming to an end in regard to showing remorse and taking responsibility. Unlike the inaccessible guilt of K’s death, Sunny realizes the consequneces of his actions with Sunny and shows some signs of remorse and actually admits his lack of understanding. This is a contrast to his normal evasive voice; he directly states his mistake with the adult Sunny that is no longer a part of his narrative. It this growing realization of responsibility that ends this novel, Hata now acknowledges his trauma and his responsibility towards it. This is seen in his decision to ‘fly a flag’ (356), which is a symbol of contamination.
A gesture Life is a testament to the issue of trauma and traumatic events in one’s life can affect their life decisions. Hata is brought out as a respectable, well assimilated Japanese citizen in America and it is only after understanding the narrative that a reader realizes the underlying trauma in his life. This story offers an insight into the life of a traumatized individual and it challenges the accounts of trauma pose to the victims.
Works cited
Caroll, Hamilton. “Traumatic Patriarchy: Reading Gendered Nationalisms in Chang-rae
Advantages and disadvantages of Electronic health records (EHR) systems
Electronic health records (EHR) systems
In the last one decade, every industry has adopted and invested heavily on technology, most especially computerization. Electronic health records (EHR) systems have become very common in hospitals as an effort to adopt the computerization trend. EHR is capable of transforming the health care system to an effective patient centred system. EHR can be defined as the longitudinal automated health registers of the data of the patients that is produced by the visits in any health care delivery setting (Alpert, 2016). Some of the elements that are included in this information include patient demographics, improvement records, treatment, past therapeutic account, vaccination, and laboratory records.
Benefits of EHR
Clinical outcomes greatly improve with EHR. The intention of health providers is always to ensure that there is patient safety, effectiveness and efficiency of health care. There is however, instances where patient encounters may not abide to the best health care practice guides. The causes for this can be as a result of clinicians not understanding the procedures, minimal time during patient appointment and clinicians not understanding that instructions relate to a specific patient. EHR greatly help to overcome all these issues, with computerized physician reminders help the physicians to remember the special are needed for each patient and this helps in reducing mix ups.
EHR helps in prevention of wasting health resources that include; provisions, apparatus, concepts and energy (Alpert, 2016). This also includes performance of redundant tests that central to incorrect positive outcomes that lead to increased expenses. Computerized reminders of previous tests such as blood tests help in reducing repetition of tests, which help improve quality of care (Alpert, 2016).
EHR greatly helps in reducing medication errors because the medication for every patient is properly recorded and reminders are set to help the nurses administer the correct medication at the correct time (Robinson, 2016). EHR also greatly aids to reduce billing inaccuracies and erroneous coding, and this helps to increase currency flow and improve profits. The EHR notices to both the workers and the patients about the tedious health appointments aid in increasing patient appointments and thus increase income (Robinson, 2016). Most of the avoided charges with EHR systems are as an end result of proficiencies, which are generated by having patient records automatically handy. Some of these comprise; amplified exploitation of tests, condensed staff assets devoted to patients administration, condensed charges of provisions that are essential to uphold paper records and reduced record charges.
EHR also helps to facilitate enhanced legitimate and supervisory passivity in regard to improved safekeeping of records and improved patient discretion over well-ordered and auditable worker right of entry. Ohno (2017), in their study illustrate that 6.1% health care facilities with EHR systems have an account of paid misconduct entitlements as equated to 10.8 of the physicians that do not have EHR systems. This decrease is as an outcome of augmented communication among the care providers, improved legibility and wholeness of patient accounts and improved devotion to medical guiding principles.
EHR systems also greatly help and improve the capacity to conduct studies. Having electronically kept patient data can clue to more measurable analyses to recognize evidence based best performances much more effortlessly (Vitari & Ologeanu, 2018).
Disadvantages of EHR
Financial issue is one of the drawbacks of EHR systems. The monetary concerns include; approval and execution charges, continuing upkeep charges, and loss of income that is related with provisional loss of output, and regressions in incomes (Khosrowpour, 2017). All these issues bring about a hindrance for health facilities and health care providers to accept and device EHR systems. Implementation and maintenance of an EHR system can be very costly adding up to about $14,000 per general practitioner in the first year of operation (Khosrowpour, 2017). The hardware and the software of an EHR system require be frequently replacing and upgrading and the providers also require to have on-going training to ensure that the system is effective.
Another drawback of EHR is the interruption of work flows for the staff and medical suppliers, which could clue to temporary losses in output (Vitari & Ologeanu, 2018). The loss of profits comes about from the end operators understanding how to operate this new system, which can possibly lead to losses in profits.
EHR systems also bring about the risks of violation of patient privacy. This is a major worry for patients since there is a cumulative amount of health data swapped by electronic means. This is an issue that many hospitals are trying to deal with by executing severe, no lenience punishments for staffs who access patient records inappropriately (Ohno, 2017).
EHR can also cause medical faults, adverse feelings and overreliance on technology. Systems that are not properly designed or lack of suitable end user training can central to augmented medical faults (Robinson, 2016). The end operators can also be faced with strong emotive reactions as they fight to familiarize themselves with the new technology and this can disturb the work flow.
Although there are many unintentional concerns of EHR systems, the benefits ensue to the patients and the society at large. Execution of EHR systems is essential in facilitating the transformation of the health care system for the better. EHR implementation is one of the many tactics that can help expand the attention on quality advancement and costs decrease.
References
Alpert JS. (2016). The electronic medical record in 2016: Advantages and disadvantages.
Vitari, C., & Ologeanu-Taddei2, R. (2018, March 21). The intention to use an electronic
health record and its antecedents among three different categories of clinical staff. Retrieved from https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-018-3022-0
What are the provisions for the content of a health record?
The health record provisions in are;
Confidentiality provisions- this states the patients privacy rights as well as disclosure rules
Patient access- this states that the disclose authorization
Procedure for disclosure- this states the procedures that the healthcare providers should use before disclosing the information to the third party.
Evidentiary disclosure- this states the evidence that will be needed by the court
Insurance disclosures- this states the procedure that the healthcare provider should follow in disclosing insured's medical records
Retention policies- this states the condition in which the patient's medical record should be retained (Stanley, n.d).
What are the rules regarding the timeliness of completion of a record?
The rules state that:
The healthcare provider should complete all patient medical records within 24 hour
Healthcare providers should include the date and time of medical records.
The care provider should also place the signature in the record (Maryland Department of Health, n.d).
Locate any state laws regarding health information or medical records for your state
The medical records laws in Maryland are federal and taste laws. These laws safeguard the health of the people. The laws expect the healthcare providers to report epidemics so that the government can aid in studying the disease and provide the best treatment as well as prevention (Maryland Department of Health, n.d).
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Are there retention statues
There are retention statues in Maryland. The Health Insurance Portability and Accountability Act (HIPAA) states that medical records should be kept for six years. The major information that should be retained includes X-ray reports, laboratory reports, drug records, and other relevant information (Maryland Department of Health, n.d). In case the patient dies, or the owner of the license decides to cancel the license, the healthcare provider should not destroy the medical records until he or she notifies the responsible authority.
Are references to the costs of providing copies of medical records?
The healthcare provider should reference the costs for preparing and producing the records before turning them to the authorized individual. The charges may be adjusted by examining the Consumer Price Index.
Share your thoughts on whether you feel these are quite liberal or too strict.
In my opinion, I feel that these regulations are quite liberal. They are very clear, and the healthcare provider can avoid errors. They are not strict but instead, they allow the care providers to maintain confidentiality and practice professionally (Maryland Department of Health, n.d). Providers and patients enjoy autonomy, and more importantly, they promote quality health
Focusing on ways of knowing in nursing, the pattern that I am most comfortable using is the empirical pattern. In nursing, I like empirical knowledge because it allows one to conduct research, gain evidence, and provide quality care (Averill & Clements, 2007). In other words, one must search for knowledge, apply the general law, and find factual evidence. I am also comfortable with this pattern since it involves the use of professional practice which is influenced by developing proposals. I understand that nursing is a field that needs empirical research or the act of conducting experiments and test to come up with a true and a justifiable conclusion about a specific issue.
Another reason why I like the empirical pattern as the way of knowing is that in nursing, I have learned that clinicians must engage in evidence-based research (Averill & Clements, 2007). The purpose of using evidence-based research is to provide effective and efficient care. To gain this evidence-based knowledge, one must employ the empirical pattern. Note that empirical pattern will enable one to engage in observation, and determine the outcome measures (Averill & Clements, 2007). Therefore, I like this pattern as it gives the chance to observe, employ both inductive and deductive patterns, and address a situation by moving beyond the traditional scientific paradigm.
On the different patterns of knowing, ethical knowing is not my area of strength. This is because, in nursing, nurses encounter ethical dilemmas, and they find it challenging to figure out what to do. They end up suffering from moral distress and carry a moral burden. I have weaknesses in making an ethical decision, and therefore in providing care, I prefer empirical knowing since it is associated with evidence but not ethical knowledge which entails the best course of action to take in certain situations (Averill & Clements, 2007). My point is in nursing; I apply the acceptable behaviors through conducting empirical research. I have weaknesses in making a moral judgment and apply justness and rightness. Instead, I have strengths in focusing on credibility, which does not crash with differing human responses, but it relies on dynamic interactions. Even if the empirical knowledge comes from a different objective view, nurses make a conclusion by selecting the correct answer.
In my worldview, the different ways of knowing and their uses reflect that nursing practice can be understood through multidimensional perspectives (Averill & Clements, 2007). This means that students can develop knowledge using diverse methods as long other the knowledge gained will bring innovative applications, and reduce health disparities. I also believe that all patterns of knowing can be applied in the nursing practice. This is because, for nurses to provide effective and efficient services, they need scientific research, moral knowledge, personal knowledge, and aesthetics (Averill & Clements, 2007). Another thing is nursing is a field where students come from diverse backgrounds. Therefore, all students should be allowed to seek skills and truth, apply their own way of thinking, solve complex problems using their own experiences, and own perceptions. In general, the different ways of knowing in the field of nursing indicates that students can derive knowledge from different sources, but it is important to concentrate on a single pattern (Averill & Clements, 2007). In the end, all pattern will be applied in the nursing learning, and as a result, there will be holistic learning where it will be easier to solve the problems that arise in health and social environment. I believe that these patterns provide knowledge which is used to improve social wellbeing. Note that the different patterns reflect the philosophy of life or the act of solving social problems. When students choose a specific pattern of knowing and studies human health and ways to improve health using a different perspective, the changing world will not bring confusion (Averill & Clements, 2007). This is because problem solvers are well informed since they have multiple ways of knowing.
Reference
Averill, J. B., & Clements, P. T. (2007). Patterns of knowing as a foundation for action-sensitive
pedagogy. Qualitative Health Research, 17(3), 386-399.
The mass media has a crucial role in public health due to its comprehensive coverage and with the rising number of people watching television, reading newspapers and magazines and surfing the internet. However, it has been found that there are significant differences between the use of evidence in the media and that which is provided by the medical community. This paper will discuss media stories on health and wellness, the influence of the social policy and media reporting on clinical practice and decision making, and finally, it will provide recommendations and its implication to the target population.
The majority of the information provided in the media does not focus on the policies rather genetic, behavioral, and individual explanations. Besides, the logic of news is giving reports on contemporary events, debates, developments, and conflicts in society. It is more concerned with what affects the public, and if the social institutions have taken the necessary steps to address them (Picard & Yeo, 2011). Furthermore, when feature content is involved rather than news, they shift their focus towards issues of lifestyle, human interest, individual improvement, and other general information.
I believe that media reporting and social policies have a positive impact on clinical practice and healthcare decision making. This is because, media works most towards serving the public interest, and on the other hand, social policies focus on improving the welfare of the population. Therefore, they are likely to provide valuable information which can be incorporated with the evidence-based practice to promote better outcomes of the health issue (Maksimainen & Michaelmas, 2017). Besides, it will give way for making informed decisions in the health facilities.
Some of the things that need to be considered by the media, its provision of quality, truthful and trusted information to minimize issues of confusion that may arise, and possibly fear. On the other hand, social policies need to be improved to ensure that the members of the public live better (Maksimainen & Michaelmas, 2017). This can be done through conduction studies and making necessary changes to promote better health of the target group.
In conclusion, the media serves as a better platform for providing information to the public. Though, the information provided by the media differs from what is offered by the health community in the manner in which it is delivered to the public. However, it plays a crucial role in influencing decision-making and the improvement of clinical practice.
References
Maksimainen, H., & Michaelmas, H. (2017). Improving the Quality of Health Journalism: When Reliability meets Engagement. Reuters Institute Fellowship Paper, 2017-09.
Picard, R. G., & Yeo, M. (2011). Medical and health news and information in the UK media: The current state of knowledge. A report of the Reuters Institute for the study of Journalism.
Nursing is a profession found within the health care sector that focuses on the care of families, individuals and the community so that they reach, maintain, recover well, and maintain a good quality of life. Various developments have occurred in the profession with emphasis delivering high quality, safe, and with much consideration of the evidence-based practice. The unique practice of a nurse is as defined by Virginia Henderson which focuses on providing spiritual, physiological, psychological and social needs to a person seeking health services whether sick or not, and this should be provided in a manner that promotes rapid independence (Gonzalo, 2014). This paper will discuss the four fundamental concepts of metaparadigm, which are considered to define the nature of nursing.
With the advancement in research, nursing has focused more on evidence-based practice in the delivery of quality care to the patients. Nursing care must also adhere to the nursing principles, which include justice, beneficence, veracity, autonomy, fidelity, and accountability (Burke, 2019). Other principles include beneficence and non-maleficence. They indicate that the care provided to individuals needs to be fair and should involve patients in making a decision concerning their health (Burke, 2019). It should not cause harm, benefits the client, and must include keeping one’s promises. Besides, nurses should take responsibility for the decisions they make or their actions while offering services to the patient.
The concepts of the metaparadigm broadly define the nature of nursing. These concepts include the person, health, environment, and nurse/nursing. The person part aims at the individual receiving care though it too consists of the family members and other people who are essential to the client. Besides, the care structure considers addressing the person’s social, spiritual, and health needs (Branch et al., 2016). The resulting outcomes of the patient are attributed to how he/she interact with the social and physical connection with the main aim of empowering the patient to direct their health and well-being
The other component is the environment which involves the surrounding of the patient. I consist of both internal and external factors. It states how an individual interacts continuously with their environment influences their health and well-being. Additionally, interaction with other people and members of the family can be considered to be part of the environment, similar to other factors, for example, culture, social connection, and economic conditions (Branch et al., 2016). This theorizes that individuals can alter their environment to improve their well-being.
Health is another concept of the metaparadigms that shows the extent of health care availability and well-being of the client. It is considered to be described by several aspects in a constant state of motion. Also, it includes the genetic structure and person’s existence, and how emotional, physical, social, spiritual well-being and intellectuality can be integrated to attain optimum health benefits (Branch et al., 2016). The factors influence individual health status.
Furthermore, nursing is the last component of the metaparadigm which involves maximum health outcomes through the provision of care in a safe environment. It applies the principles of skills, collaborations, knowledge, professional judgment, technology, and communication to allow proper provision services (Branch et al., 2016). This promotes a reasonable scenario that facilitates better patient outcomes. The component integrates with other metaparadigm components and values a high degree of service for better patient well-being.
Conclusively, nursing has significantly advanced with new evidence being incorporated into the practice. Besides, care should be provided in such a way that it adheres to the nursing principles. Additionally, metaparadigm concepts such as health, patient, environment, and nursing are considered to define the nature of nursing.
References
Branch, C., Deak, H., Hiner, C., & Holzwart, T. (2016). Four Nursing Metaparadigms. IU South Bend Undergraduate Research Journal, 16, 123-132.
Gonzalo, A. (2014). Virginia Henderson: Need Theory Study Guide. Retrieved 1 October 2019, from https://nurseslabs.com/virginia-hendersons-need-theory/
Setting is a very important aspect in dementia care; people living with dementia are greatly affected by the designs of the spaces in which they live in. This comparative paper tries to understand the differences between special care homes for dementia patients and dementia care for prisoners living with dementia in the prisons. The paper discusses some of the design similarities that include; group settings, locked down boundaries, shared communal spaces. And also the design differences in the facilities including; interior and exterior environments, way finding assistance, private quarters, safety fixtures and fittings, and lastly modern 1950 themed dementia care villages. Special care homes as compared to prisons are more suited for dementia patients as compared to prions. Their designs have greatly improved over the years with the needs of these patients in mind a good illustration being with dementia care villages. The facilities have trained staffs that understand how to deal and cope with people living with dementia and they hence provide much better care as compared to the untrained prison staffs.
A dementia care village (Sagan, 2015) a prison (Hall, 2016)
Dementia Special Care Homes versus Dementia Care in Prison
Dementia is a syndrome that is characterized by physical changes in the brain that cause damage in reasoning most especially thinking, recall, conduct and capacity to perform their everyday tasks (Cooke & Chaudhury, 2013). It is a disorder that is progressive in nature and it mostly affects people as they age, though it is not a normal part of aging. People with dementia require critical care; this is an area of much debate now and in the future. The issues of debates include the best designs for the care homes to ensure that the aged are provided quality care (Cooke & Chaudhury, 2013). Dementia is becoming a growing problem in prisons as the age group of prisoners over 60 years is growing fast (Fazel et al., 2002). A prison is not a place where special care is offered to people with dementia, there are no enough resources to allow people with dementia to get the required special care for their conditions. This paper will analyse and compare care given to dementia patients in specialized care homes and in prisons. The designs of these two facilities will be looked into to understand how design and environment affects dementia care.
Similarities
Group settings
Group living is one of the things that special care homes and prisons have in common. People living with dementia in both types of facilities get to live together with other people, they have to share facilities like the dining area, the outdoor spaces and in some cases even the sleeping areas. This is beneficial for dementia patients because it allows for healthy social interactions (Cooke & Chaudhury, 2013). Both prisons and special care homes create an environment where persons living with dementia have an opportunity to socially interact with other people which help improve their conditions. Large social circles have a shielding effect on the intellectual capacity and cognitive aptitude of persons living with dementia. Basic conversation for persons living with dementia is a form of exercise that motivates the brain cells and the development of brain synapses, thus stimulating the conception of new nerve cells (Cooke & Chaudhury, 2013). Group living inspires and supports senior citizen to construct a social system by partaking in social service undertakings and cognitive rehabilitation programs.
Locked down boundaries
Prisons and special care homes are environments which are always on a lock down, to ensure that residents stay indoors. Anytime an individual have to conduct activities outside of the facilities, they have to be monitored by the staff members. A prison is a place where, there are very secure measures that have been put in place to ensure that the inmates stay within the premises (Macmadu & Rich, 2015). Special care homes also have very secure measures that ensure that the residents do not roam out of the facility to prevent getting lost issues that are common for persons living with dementia. Persons living with dementia have cognitive impairments which affects their ability to remember things (Cooke & Chaudhury, 2013). This basically means that they are at high risks of wandering of and not being able to find their way back. The lock down in both prisons and the special care facility is very important as it helps to ensure that persons living with dementia within these facilities are safe.
Shared communal spaces
Another similarity in both prisons and the special care homes is the concept of sharing communal spaces. Prisons and special care homes have communal dining areas, TV and games rooms, shared outdoor areas and in some facilities shared bathrooms. Communal spaces in both facilities greatly help to ensure that the residents get a time to socially interact with one another whether it is during eating hours or during play time (Fazel et al., 2002).. The shared communal spaces help in easing management of the residents for the staffs because they are all in one roof.
Differences
Interior and exterior environment
There are differences in the way that prisons and special care homes are designed. Nursing care homes are specially designed to accommodate seniors living with dementia. This means that a lot of consideration has been put to ensure that these persons are comfortable and also safe within the facility. Special care homes have nurses stationed in every area within the facility during the day and at night to ensure that residents well taken care of in case of any medical emergencies. This is not the same case with prisons which are designed to hold prisoners and not aged dementia prisoners. The few prison staffs that are there are expected to understand various health conditions and forms of disability and respond appropriately under massive pressure that is caused by the budget and staffing cuts (Fazel et al., 2002). This basically means that people with dementia can go undiagnosed and this leaves them without support in a hostile environment.
Special care homes for individuals living with dementia are designed to guarantee that there is security and safety for the patients. Most of these facilities have special staffs that understand the effects that dementia has on cognition and they are hence properly trained to ensure that the residents are properly taken care of (Tester et al., 2004). The staffs within the homes ensure that the residents’ belongings including clothes are well organized and their property well labelled such that they help motivate independence.
This is however, not the same in prisons, an environment designed for wrong doers and not dementia patients. The regimented and routine nature of prison life can be very problematic for people living with dementia (Fazel et al., 2002). This is an environment that can take away the ability of an individual thinking self-sufficiently which can de-skill them to even basic tasks and activities. There are no special facilities or treatments to guarantee that prisoners living with dementia are properly taken care of. In prison, the patients have no experts to label or to organize their belongings in a way that makes it easier for them to find them to avoid confusion (Fazel et al., 2002). Many of the prisoners living with dementia can struggle with the standardised regimes and time tables that they are expected to adhere to which cause them to miss out on important activities can for instance exercise if they are not able to reach the gym in time (Fazel et al., 2002).
Way finding assistance
Persons with dementia require special care in regard to safety measures and navigation through their environment which can be accomplished by ensuring that areas within their environments are clearly labelled and there is proper lighting both during the day and at night. Special care homes are secure in that they ensure that are all the residents are well taken care of by experts and this includes ensuring that they are independently able to find their way around the facility (Moyle et al., 2002). Every area within the nursing care homes facilities including various rooms and equipment are all properly labelled help the residents find their way within the compound with any need for support (Tester et al., 2004). Lighting is also greatly considered in the designs of the nursing care homes, because it is understood that persons living with dementia have problems with their eyesight and this can cause them to have accidents if there is no proper lighting. The facilities ensure that they have proper lighting both during the day and at night all around the compound to help the residents find their way around.
This is not the same case with prisons which are designed to hold criminals and so no special attention is paid on matters of safety for prisoners living with dementia. various rooms and areas are not properly labelled to help prisoners living with dementia to independently navigate their way around the prison. Most of these patients have to depend on their fellow prisoners to help navigate their way around the compound which can be really stressful and impactful to their conditions (Macmadu & Rich, 2015). Without proper labelling, the right kind of support and understanding of how dementia can affect an individual’s behaviour, prisoners with dementia can end up spending more time in prison than is necessary because they are not able to follow the rules and the time lines that are set for them in the prions (Macmadu & Rich, 2015).
Elements of domestic kitchen for instance a fridge, microwave and coffee maker among others have become a must have commodity in modern special care homes because they help facilitate independence and social interaction (Cooke & Chaudhury, 2013). The dining spaces in the modern special care homes are designed in such a way that they are of smaller sizes which help ensure that there are reduced incidences of aggression and agitation for the residents. Traditional special care homes which had more than twenty residents had much larger dining rooms which contributed to increased aggression agitation for the residents and this discouraged eating (Cooke & Chaudhury, 2013). This is different from the dining areas in prisons which are designed to hold more than 100 prisoners. This causes aggression on prisoners living with dementia who do much better in dining areas that have a small number of people and it affects their eating.
The furniture and the home decorations which are homely help the residents to adjust to their new environments with any alarms (Calkins, 2018). Homely residential environments are associated with improved emotional and intellectual functioning for persons living with dementia. The prison furniture on the other hand is old and it designed in such a way that it lasts for long not to provide a homely feeling for the prisoners. This leads the prisoners living with dementia to be constantly agitated and depressed which worse their health conditions (Macmadu & Rich, 2015).
Private quarters
Privacy is something that is normally disregarded for persons living with dementia because most of them need special care that is offered by their family members or nurses. However, persons living with dementia always require some privacy and they desire is accomplished with them having their personal bedrooms (Cooke & Chaudhury, 2013). Most of the special care home designs today allow residents to have their own bedroom and bathrooms, all furnished and decorated to their liking. This gives the residents a chance to have some privacy most especially those times when they prefer to just spend time on their own either watching a program or reading.
An image showing an enhanced-shared bedroom in a special care home for people living with dementia (Calkins, 2018)
The toilet areas in the special care homes are designed in such a way that they readily accessible and identifiable to help maintain independence (Calkins, 2018). The image of a toilet or signs such as ‘toilet’ written on the wall greatly helps individuals with dementia to find the restrooms much easier. Amber LED lighting is properly installed all around the facility most especially around the bathroom areas to help reduce falling accidents at night (Calkins, 2018).
Prisons on the other hand are designed in such a way that they can hold as many prisoners as possible. In prisons, most of the activities are constructed communally which means that residents have to share sleeping areas, dining rooms and even the bathrooms. There are no special labels or signs put in place to help people living with dementia to navigate their way around the facility (Macmadu & Rich, 2015). These prisoners have to sleep in a unit with more than twenty other prisoners which lead to increased agitation and very little privacy and this greatly affects their conditions.
An image showing a simple prison plan, where dementia patients have to share various facilities within the prison (Kain, 2011)
Safety fittings and fixtures
Safety is important for people living with dementia; these are people who in the course of the disease tend to lose the capacity to identify dangers. A secure living area can be defined is a society where programs set and employees available help individuals living with dementia to be comfortable and safe (Moyle et al., 2002). Special care homes for persons living with dementia have good designs that ensure residents are able to identify and use the fixtures and fittings in the homes that allow them to be more independent. Handrails and grab rails are normally well fixed near stair cases, in the bathrooms and in the toilets to help the residents navigate their way easily (Moyle et al., 2002). Most of the nursing homes understand the importance of colour contrast in and contrasting coloured fittings are normally used to help highlight the switches, the grab railings and the sockets in the special care homes.
This is however, not the same case with prisons. There are no grab railings or any highlighted switches or sockets for the prisoners living with dementia. The prisoners have no control of the lighting within the prisons because this is the work of the prison staffs. Lights in prisons are normally switched on and off at specific times, which means that the prisoners living with dementia have problems finding their way to the bathrooms at night which can accrue to accidents most especially because there are no grab rails.
Dementia Villages
Today, there are dementia villages which are designed in the 1950s theme, the facilities look like a normal village with a movie theatre, restaurants, a court yard and beautiful parks among many other features (Powell & Pawlowiski, 2018). These are modern dementia care facilities that have been designed to help patients living with dementia to have a normal active life and to give a sense of purpose. These villages always have trained nurses and caregivers who live among these residents in the restaurants and all other regions of the village, helping take care of them (Powell & Pawlowiski, 2018). These facilities are important and therapeutic for the dementia patients as it helps to elicit memories and to encourage conversation, improves their moods and their sleep quality. Memories for human beings re normally made between the ages of 10 to 30, therefore creating villages themed on 1950s helps the current generation of seniors to go back to their youth ages (Powell & Pawlowiski, 2018). This is a concept that is not available in prisons and so prisoners living with dementia have lower chances of living a purposeful active life.
A well-designed physical environment fosters positive performances such as reduced anxiety, augmented social interaction and less reliance in conducting day-to-day undertakings. In the past, not much was understood about dementia and so most people living with dementia were put in prisons because their conditions were not well understood. Special care homes designs or people living with dementia have greatly changed over time where they greatly consider the wellbeing of the residents. Modern care homes for persons living with dementia are designed in such a way that they hold less than ten persons per unit for easier management. Traditionally, nursing homes for people living with dementia were large facilities holding more than twenty individuals in one unit. Small units help the residents to experience privacy, dignity, meaningful activity and to have better relationships. Residents living in groups of less than ten have better social relationships, greater positive effects, helps them feel more at home and have a higher quality of life scores (Calkins, 2018). Prison designs have not really changed over time to accommodate prisoners living with dementia like the special care homes, prisons are unsuitable for people living with dementia, the staff knowledge is severely lacking to deal with people living with dementia.
References
Calkins P. M. (2018, January 18). From Research to Application: Supportive and
Fazel S, McMillan J, O'Donnell I (2002). Dementia in prison: ethical and legal implications
Journal of Medical Ethics;28:156-159.
Macmadu, A., & Rich, J. D. (2015). Correctional Health Is Community Health. Issues in
Science & Technology, 32(1), 64–70. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=tfh&AN=110096499&site=ehost-live
Moyle, D. Fetherstonhaugh, M. Greben, E. Beattie, AusQoL Group. (2015). Influencers on
quality of life as reported by people living with dementia in long-term care: a descriptive exploratory approach BMC Geriatrics, 15, p. 50
Powell, R., & Pawlowiski, A. (2018, April 10). Dementia day care looks like 1950s town to
stimulate patients' memories. Retrieved from https://www.today.com/health/dementia-day-care-looks-1950s-stimulate-patients-brains-t126727
Tester, G. Hubbard, M. Downs, C. MacDonald, J. Murphy. (2004). What does quality of life
mean for frail residents? Nursing & Residential Care, 6 , pp. 89-92
Williams, B. A., Stern, M. F., Mellow, J., Safer, M., & Greifinger, R. B. (2012). Aging in
Correctional Custody: Setting a Policy Agenda for Older Prisoner Health Care. American Journal of Public Health, 102(8), 1475–1481. https://doi.org/10.2105/AJPH.2012.300704
Additional resources
Hall, S. (2016, November 9). What Are the Duties of a Correctional Administrator?
Retrieved from https://work.chron.com/duties-correctional-administrator-17333.html
Kain, E. D. (2011, August 19). Florida Teenager Dies in Jail After Being Arrested for
Nursing is a field that has always been my best career, and I strongly believe in care delivery to the patient and other individuals seeking health services. As a professional nurse, I am seeking to get a Doctor of Nursing Practice (DNP) because of the opportunities it has in enhancing my skills and knowledge as a nurse. A DNP aids professionals make significant decisions in the continually changing health care environment, which then helps in the establishment of strategies that shape the sector and promote quality care delivery to the patients.
The main reasons why I want to pursue the Doctor of Nursing Practice is to get advanced skills. This will help me in developing the expertise that I have always wanted to deliver quality services as expected of me by my clients. It will improve my understanding of the health care environment and other organizational competencies that can place me in a better position of attracting executive opportunities that can connect corporate guidance and the compassion of nursing
Furthermore, the DNP program will also help in assuming high-end leadership roles that create the responsibilities that I am supposed to offer for the care process in the clinics' health care. The leadership responsibilities that the DNP can accord me may include overseeing other nurses who provide care services to the patients and therefore, it will be an excellent opportunity for me to advocate, promote and provide direction for quality care using evidence-based practice.
Besides, DNP will also provide me with the opportunity to offer educational services to other nurses on the importance of effective leadership. This is because of the skills and knowledge I can get from studying it. Additionally, it will also equip me with the expertise in breaking complicated health situation, which will then facilitate informed and smart decisions making for both long-term and short-term benefits. The knowledge and skills from the study can also give a chance to carry out research projects that have the potential to improve care delivery.
Over time, my professional goals have been increasing as I engaged with patients and other healthcare workers. Provision of high-quality care to my clients has always been my priority. Others include improving my skills and knowledge together with having the necessary expertise to understand difficult health issues. Besides, the aim of seeing quality care provided to patients to improve their outcomes and wellbeing has also pushed my wish to lead other nurses and offering mentorship skills to them.
I believe that earning Doctor of Nursing Practice can be able to offer me with the substantive, analytical skills and the crucial knowledge which is required for the provision of compassionate nursing care that maintains high-quality standards at the advanced practice level. I also firmly believe that I will get the knowledge that will enable me to participate, promote studies and development of expertise to facilitate the effectiveness of nursing practice, programs, and policies. I have completely satisfied with my pursuit of a nursing career, since, it provides me with the chance of living a life that is fulfilling and directed to aiding others.
My strength is the belief of the bright future of nursing in changing the healthcare sector for a better one. However, this can be done only through equipping nurses with the necessary skills they need in the changing health sector. On the other hand, I have challenges with inflexible academic studies.
Design of A Nanoparticle Of A DNA Plasmid For Intracellular Delivery
Cover letter
According to modern research, cell penetrating peptides (CPP) entirely consists of fundamental amino acids resides that has the potential of crossing cytoplasmic membranes for the purpose of delivering important biological molecules into cells. Despite that, the CPP or the cargo entrapment contained in the endosome has the capability of limiting biomedical utility once the cargos are being destroyed in the prevailing acidic environment. On the other hand, the protein transduction of the novel cell penetrating peptides (CPP) consists of the nona-arginine (IR9) and the INF7 fusion peptide that is used for the purpose of enhancing delivery of the vital molecules in cells. What this implies is the fact that the IR9 has the ability of interacting with DNAs and the quantum dots (QDs) for the purpose of forming stable IR9/QD as well as the IR9/DNA complexes. These complexes are vital because they have the propensity of entering human A549 cells.
In connection with that, zeta-potentials are ultimately the best means of predicting transduction efficiency as compared to gel shifting analysis. What this implies is the general significance of the electrostatic interaction of the cell penetrating peptides (CPP) or the cargo complexes with the human plasma membranes. According to the mechanistic research, IR9/DNA and IR9/QD complexes have the capability of entering human cells through the process termed as endocytosis. Furthermore, the IR9/DNA and IR9/QD cannot be cytotoxic when their concentration falls. This implies that IR9 is the ultimate component that can be used for the purpose of carrying genes as well as drugs for various biomedical applications.
Specific aim
The aim of this research will entail determining whether the cell penetrating peptides has the potential of enhancing molecular activities when various molecules are tarnsfred in and out of the cells.
Introduction
The cell penetrating peptides (CPPs) can be categorized into various classes namely; chimeric, synthetic, and protein-derived. For example, penetratin and Tat, the first two categories of CPPs are considered to be protein-derived. Amphipathic peptide and nona-arginine (R9) do not possess natural proteins hence making them to one of the synthetic molecules. On the other hand, the members of the chimeric family have the possibility of incorporating the main functions of the natural proteins, for instance, that of transportan and Pep-1 respectively. The division of each CPPs family is based on their sequence or original characteristics (Langel, 2019).
Since CPPs has the potential of delivering important biological material into the cell membrane, it is perceived to an important tool in therapeutics. Some of the modern clinical experiments that have been conducted have been aimed at using CPPs in delivering macromolecular medicinal conjugates into patients suffering from multiple ailments (Li et al., 2017). The reason for that is because it has the capability of carrying with it multiple spectrums of cargo molecules, for instance, nucleic acids, cytotoxic drugs, proteins, liposomes, peptide nucleic acids, and so on. Accordingly, research indicates that the general internalization of the kinetics of CPPs is something that is rapid. Since the CPPs have been found to non-toxic to the majority of the cell, its safety can ultimately be analyzed using metabolic analysis (Yuan, 2011).
As stated above, quantum dots (QDs) are some of the inorganic semiconductor nanocrystals that have various excitation molecules taking into account their size and emission properties. Despite that, it should be understood that they do not possess the capacity of penetrating cells. The aggregation mainly occurs during internalization. To have the potential of overcoming these limitations, the modification of their surfaces using noncovalent or covalent linkages with the CPPs is essential. The facilitation of QDs using CPPs is the one that has the potential of reducing the nonspecific absorption as well as other associated side effects (Betty et al., 2013). Regardless of that, research indicates that QDs are venerable to sequestration and entrapment by lysosomes or endosomes in cells (Lin et al., 2009).
Accordingly, endosomoltic agents and transduction enhancers can also be used for the purpose of improving the transduction efficiency of CPP as well as to aid in overcoming lysosomal or endosomal entrapment. The majority of the enhancers used have the potential of increasing the general hydrophobicity of the CPPs as well as increasing cell membrane permeability. On the other hand, chloroquine, for instance, is one of the lysosomotrpic agents that aid in preventing lysosomal trapping. It should be understood that endocytosis is the ultimate mechanisms that are used for the purpose of enhancing the cellular intake of CPPs. Moreover, the quick discharge from the endocytic vesicles to the cytosol is fundamental in preserving all the biological activities of the molecules or cargos. Some of the endosome-desruptive peptides also termed as lysosomotrophic peptides can also be obtained from bacterial or viral toxins. The importance of these peptides is that they aid in triggering the acidification of endosomal which in return enables the cargos to move and enter the cytosol.
Overall aim
The essence of this research will entail creating a chimeric IR9 CPP that contains both designated IR9 and INF7 fusion peptide. The next step will entail assessing the main IR9 transduction process through the transportation of DNAs and QDs by the cell mebrane. The research will further investigate the mechanisms used by CPP to transport DNAs and QDs into cell membrane. In order to achieve these objectives, IR9 will be synthesized before examining IR9or DNA, IR9 or QD, and IR9 by the cell membrane suing flow cytometry and live cell imaging. Zeta-potential analyzer will also be used to aid in illustrating the relationship the characterization that exists between electrostatic interactions, charging state, and the transduction efficiency of IR9. Furthermore, to be in the position of elucidating the IR9/cargo complexes and IR9 uptake mechanisms, pharmacological and physical inhibitors will be taken into consideration to aid in blocking certain endoctytic pathways. The results obtained are the ones that will be used for the purpose of analyzing the prevailing cytotoxicity mechanisms of IR9/cargo complexes and IR9 uptake (Lin et al., 2009).
Governing hypothesis: The cell penetrating peptides (CPPs) has the potential of penetrating the cell membrane as well as transporting various biological molecules
Specific aim 1: The cell penetrating peptides will be investigated to aid in determining the manner in which it assists in the transportation of cellular molecules taking into account its molecular properties.
Background
A cell membrane is perceived to be a barrier that aid protecting cells from the entry of external materials through monitoring the inflow and outflow of such molecules. The presence of the cytoplasmic membranes also aid in mediating various essential processes, for instance, nutrient intake, cell wall biogenesis, secretion, cellular morphogenesis, and environmental sensing. What this implies is the fact that the significance of the plasma membrane ultimately takes into account the manner in which the majority of the pharmaceutical components end up targeting its components. Ideally, the transportation of various exogenous molecules across the plasma membrane is a mechanism that is ultimately influenced by protein, glycolipid, phospholipid, and cholesterol components (Li et al., 2017). The permeability of the plasma membrane ultimately depends on certain material transporters as well as the polarity and the size of the material being transported. When certain material transporters are not present, small hydrophobic molecules will only be permitted to pass into the cell by the membrane. It should be understood that large biological macromolecules and hydrophilic drugs, including RNAs, DNAs, and proteins cannot be allowed to pass through the cell membrane freely (Betty et al., 2013).
Nevertheless, the aim of this research will entail illustrating how the composition of the protein transduction domains or the cell penetrating peptides (CPP) consisting of small peptides that has the potential to traverse the cell membrane and in return deliver various materials into the cell. Normally, the truncated Tat proteins enable the movement of the peptides into the cell membrane as it penetrates it before they accumulate the cell nuclei. This implies that one of the main features of the CPPs entail its capability of transporting various essential molecules into the cell. Cationic, hydrophobic, and ampipathic peptides are the main constitutes of the CPPs (Liu et al., 2013).
Planned research
This research will take into account the investigation of the properties of the cell penetrating peptides in conjunction with the manner in which quantum dots end up enhancing its cellular activities. The same mechanism will take into consideration some of the difficulties that are encountered during the delivery of biological molecules into the cells.
Specific aim 2
The aim of this research will entail determining whether the cell penetrating peptides has the capacity of enhancing the transportation of various biological components into living cells.
Background
The CPPs (cell penetrating peptides) has the potential of penetrating cells without the production of proteins from prokaryotes. Due to the fact that IR9 is one of the chimeric molecules that were obtained as a result of the fusion of the fusogenic peptide INF7 and synthetic nona-arginine, it was possible to understand its penetration mechanisms. It was found out that IR9 has the potential of noncovalently interacting with DNAs and QDs to form stable complexes aid in delivering them into human A549 cell membrane.
Moreover, a high correlation was obtained between the transduction efficiency of protein and zeta-potential of the APCs/DNA complexes. On the other hand, the electrostatic interactions of the cargo or the IR9 complexes with the plasma membrane have been realized to play a crucial role in regulating cellular internalization. As a result of that, it is evident that endocytosis is the ultimate means that can be used for the purpose of enhancing the uptake of IR9 complexes (Ohshima & Makino, 2014). These characteristic indicates that IR9 can be used as the ultimate tool for studying various biological processes, for instance delivery vectors and gene expression in numerous biomedical applications
Planned research
In order to understand the biological applications of CPPs, human bronchoalveolar carcinoma A549 cells supplemented with 10 percent bovin serum. Living cells were examined using propidium iodine stain. Phosphate buffered saline was used to wash the living cells. The culture was transferred to RPMI 1640 that before adding a controlled percent of serum during the incubation process. Quantum Dots (QDs) and CPPs were measured so as to determine their emission peak wavelengths.
IR9 peptide was mixed with quantum dots (QDs) so as to prepare QD/IR9 complexes at different molecular ratios. Electrophoresis was used for the purpose of analyzing QD/1R9 on agarose gel. In order to prepare DNA/IR9 complexes, an equal amount of IR9 was mixed with pEGFP-N1plasmid to encode the enhanced green fluorescent protein (EGFP) reporter gene. After duration of two hour incubation, the DNA/IR9 mixtures were also analyzed using the electrophoresis process. Images were captured and analyzed
The noncovalent quntum dots transduction was carried out using different amount of IR9-FITC (fluorescein isothiocyanate) peptide. The mixture was incubated with the A549 cells before being analyzed using the flow cytometry mechanism. The cells that were initially treated using FITC, PBS, or non-CPP were used as the negative controls. During the kinetic study of transductions, different amount of IR9-FITC was added to the cells at different time but maintained at the same temperature. So as to be in the position of determining the colocalization of the sub-cellular mixture of the IR9-FITC, organelle fluorescents was used to aid in visualizing lysosomes and the cell nuclei respectively.
In order to foster the transduction of the noncovalent IR9/cargo complexes, quantum dots (QDs) was mixed with IR9 peptide at different molecular ratio. After that, the QD/IR9 complexes which were initially prepared were incubated for one hour at 37o C. So as to study the cells’ transduction kinetics, all the materials were prepared using IR9/QD complexes that were initially prepared at different molecular ratios. During the same experiment, the cells with high reactivity ratios were analyzed using a flow cytometer or a confocal microscope. To analyze the dissociation of the quantum dots (QDs) from the cell penetrating peptides (CPPs), IR9-FITC was used for the purpose of incubating the cells for at least 24 hours. After incubation, the complexes was removed and then stained before observing them using the confocal microscope. Chloroquine was added to the mixture so as to determine the cells’ lysosomal escape.
Pharmacological and physical endocytic modulators were used for the purpose of evaluating the effect of endocytosis in intricate transduction. IR9/DNA, IR9/QD, or IR9-FITC was incubated together with the human cells at 5o C. In order to be in the position of analyzing the significance of macropinocytosis in complex cell transductions, all the cells were mixed with cytochalasin D before uptake was determined (Dietz et al., 2009).
Expected outcomes
A graph showing the percentage relative shift of IR9/QD against IR9/QD ratio
Y-axis
120
100
Percentage 80
Relative shift 60
40
20
20 40 60 80 100 120 X-axis
IR9/QD ratio
From the graph above, the poor intracellular tracking trafficking as well as the release of endosomal molecules is the main factors that have the potential of reducing the transduction efficiency of CPP proteins that is mediated by the existing endocytic pathways. From the information gathered, it is evident that endosomal entrapment has the potential of inducing enzymatic degradation of the cell penetrating peptides (CPPs) as well as their cargoes. The incorporation of INF7 and HA2 peptides into the (cell penetrating peptides cell penetrating peptides is the one that can aid in overcoming macropisomes or endosomes entrapments. The reason for that is because they have the potential of inducing perturbation of the vesicle membranes (Langel, 2019).
The significance of the endosomolytic HA2 tag is that has the potential of increasing cellular uptake, accelerating endosomal escape, as well as promoting the cytosolic distribution of the andocytosed cell penetrating peptides (CPPs) that contain RFPs in the human A549 cell membranes. Ideally, it is evident that the comparative IR9-FITC with R9-HA2 was the potential of determining the one that has the ability of increasing transduction efficiency. Despite that it is evident that both of them have the ability of reducing cell viability taking into account their concentrations (Huang et al., 2005).
On the other hand, the potential of the membrane is the one that assists in the internalization of the arginine-rich cell penetrating peptides towards the cell membrane. What this implies is the fact that the change of state of the cargo or the IR9 complexes is the one that has the capacity of influencing the efficiency of the cellular internalization mechanisms of CPP. Ideally, the transduction of the proteins that are mediated by the cell penetrating peptides can be illustrated using three steps (Düzgüneş, 2012). The first one entail binding the cell membrane, the second one is its capability of penetrating cell, and the third one entail the release of specific or cytoplasmic organelles.
A graph showing the cell transduction efficiency against time
Y-axis
120
100
Transduction 80
Efficiency 60
40
20
1 2 3 4 5 6 7 8 9 10 X-axis
Time (minutes)
Cellular uptake is a mechanism that is ultimately enhanced through the electrostatic interaction between negatively charged plasma cell membrane and CPP or cargo complexes. For example, surface charge has been realized as being the main determinant when it comes to the flow of nanoparticles end up impacting the whole cellular processes. Some of the cellular processes that are impacted include mitochondrial functions, cell morphology, cytotoxicity, and the level of intracellular calcium. Since both the negatively and positively charged particles are ultimately cytotoxic, it implies that the negative one are always more toxic as compared to the positive ones. Zeta-potential always varies greatly taking into consideration the mechanism of producing and treating them, their nanoparticle size, the structure of their surface, as well as other associated properties (Baharvand & Aghdami, 2014). On the other hand, electrostatic properties of the cell membrane are used for the purpose governing the general interactions of the cargo complexes or the cell penetrating peptides (CPPs) or APCs. In connection with that, plasma membranes that are negatively charged have been realized to aid in determining transduction efficiency.
A graph showing the percentage cell viability of IR9/QD against IR9/QD cytotoxicity
Y-axis
120
A
100
C
Percentage 80
Cell viability 60
B
40
20
1 3 6 9 12 X-axis
N/P and IR9/QD cytotoxicity
KEY
A =Positive control
B= Negative control
C= Deoxyribonucleic acid (DNA) only
The understanding that was obtained through the cellular internalization of the use of the cell penetrating peptides illuminates the fact that it has the potential of utilizing several pathways when it comes to cellular entry. The two major pathways that are used for the cellular intake of the cell penetrating peptides are mainly the nonendocytic and endocytic pathways. Classical endocytosis is ultimately an energy-depended pathway of the CD8+ T cells (Donnelly et al., 2005). On the other hand, the nonendocytic route also termed as the pore-opening, direct penetration, or direct membrane translocation, is perceived to one of the rapid as well as the energy independent pathways. Accordingly, Tat, R9, and antennapedia have been realized to have the capacity of using at least main endocytic pathways. These pathways include, lipid/caveolae-raft mediated endocytosis, clathrin-mediated endocytosis, and macropinocytosis. From the information collected, it was evident that endocytosis is the ultimate means that is used for the purpose of enhancing cellular intake of the IR9 as well as the IR9 cargo complexes. In connection with that, the main pathways that are used for the purpose of enhancing the internalization of QDs mainly rely on the conjugated molecular carriers or peptides (Devarajan et al., 2015). What has the potential of influencing the pathways and the cellular uptake of the cell penetrating peptides include the cargo characteristics, APCs/CPP complexing methods, CPP concentration, CPP properties, composition of cell membrane, serum concentration, and transduction period.
In accordance with that, it is evident that surface charge is one of the factors that can aid in determining the manner in which gold nanoparticles end up impacting cellular processes, for instance cytotoxicity, levels of intracellular calcium, mitochondrial functions, and cell morphology. Regardless of the fact that both the negatively and positively charged nanoparticles are cytotoxic, the negatively charged gold particles have been found to be more toxic as compared to the positive ones. What was realized from the data collected is the fact that the electropositive zeta-potential of the cargo/IR9 complexes has the potential of improving its transduction efficiency. Electropositivity values obtained used as the limit for separating high-charged surface from the low-charged surface is the one that determines molecular suspension stability (Dietz et al., 2009). Conversely, the electrostatic properties that govern APCs/CPP complex correlation with the negatively charged cell membranes are the main factors that aid in determining the transduction efficiency of the transported molecules.
Although research indicates that cellular internalization of the cell penetrating peptides is a complex mechanism, it is evident that CPP utilizes more than two pathways when it comes to cellular entry. Moreover, the QDs internalization pathways that are involved mainly rely on their carriers or conjugated peptides. Some of the factors that have the potential of influencing cellular intake efficiency and the pathways for CPPs include its complexing method, serum concentration, CPP concentration and properties, transduction duration, cargo characteristics, sand so on (Lin et al., 2009).
Perspectives
From the information collected above, what this implies is the fact that cell penetrating peptides (CPP) and IR9 interacts noncovalently with DNAs or QDs for the purpose of forming stable complexes that has the capability of delivering them into the cells. Accordingly, the electrostatic properties of the cargo/IR9 components with the cells have been found to play key role cell internalization. IR9 and IR9/cargo complexes have the potential of entering the cell membrane though the process termed as endocytosis. In connection with that, IR9 consists of INF7 fusogenic domains that assist in promoting the general release of cargo or IR9 complexes from endosomes. Since IR9 is somehow nontoxic, it means that it can be utilized as the main carrier of medical cargoes in various biomedical applications.
In connection with that, it is evident that membrane potential plays a crucial role when it comes to the internalization of arginine-rich cell penetrating peptides (CPP) into the cell membrane. The charge state of the cargo/IR9 complexes is the one that has the potential of influencing the efficiency of the cell penetrating peptides during cell internalization. The protein transduction of the cell penetrating peptides (CPP) or APCs mediated cargo transportation takes three stapes. The first one takes into account the binding of the cell membranes, the second one entail its general penetration into the cell membrane, and the last one involves their release into the cytoplasm or certain organelles. Cellular uptake, as the first step of the properties of the cell penetrating peptides is something that that is enhanced by the electrostatic interactions that exist between the negatively charged plasma membranes and the cargo or CPP complexes.
Weekly work plan (grant chart)
TASK
PREDECESSORS
TIMELINE
1
CPPs materials acquisition
1 (CPPs material preparation)
1 day
2
Reacting material with required supplements
2 (investigating the chemical properties of the cells that were initially prepared
2 days
3
Leaving the mixture to react
3 (conforming the chemical nature of the material prepared after reacting)
1 day
4
Analyzing the cytoxocity properties of the material prepared
3 (determining the penetration properties of cellular molecules)
1 day
Research and economic impact
Some of the factors stated above have the potential of influencing cellular intake efficiency and the pathways for CPPs include its complexing method, serum concentration, CPPs or APCs concentration and properties, transduction duration, cargo characteristics, sand so on. The electrostatic properties that govern cargo/CPP complex correlation with the negatively charged cell membranes are the main factors that aid in determining the transduction efficiency of the transported molecules. With the negatively and the positively charged nanoparticles, research indicates that the negatively charged gold particles have been found to be more toxic as compared to the positive ones.
In accordance with that, it should be understood that protein transduction of the cell penetrating peptides (CPPs) or APCs mediated cargo transportation takes three stapes. The first one involves the binding of the cell membranes. The second one deals with the general penetration into the cell membrane. The last one involves the release of molecules into the cytoplasm or certain organelles. Therefore, what this implies is the fact that the cellular uptake, as the first step of the properties of the cell penetrating peptides is something that that is fostered by the electrostatic interactions that exist between the negatively and the positively charged plasma membranes and the cargo or CPPs or APCs complexes. Conversely, the understanding obtained through the cellular internalization highlights the fact that it has the possibility to utilize various pathways when it comes to cellular entry.
Suitability of application
The electrostatic interaction of the cargo or the IR9/DNA components was found to have the potential of enhancing cell internalization. This, therefore, suggests that endocytosis is the ultimate means that can be used for the purpose of enhancing the uptake of IR9 complexes. These characteristic indicates that IR9/DNA complexes can be used as the basic tool for studying various biological processes, for instance the expression of genes and delivery vectors. Accordingly, what this implies is the fact that endocytosis is the ultimate mechanisms that are used for the purpose of enhancing the cellular intake of CPPs.
Although CPPs does not have the capability of penetrating cells, such an aggregation ultimately occurs during cell internalization. So as to overcome these limitations, noncovalent or covalent linkages with the cell penetrating peptides (CPPs) is used. Therefore, what this implies is the fact that CPPs are capable of transporting vital biological materials into the cell membrane for medicinal purposes. From the research conducted, it is possible to deliver macromolecular substances into the cells of the patients suffering from various diseases. It is the capability of CPPs to carry with it multiple spectrums of cargo molecules that makes that possible.
References
Betty R. Liu, Yue-Wern Huang, & Han-Jung Lee. (2013). Mechanistic studies of intracellular delivery of proteins by cell-penetrating peptides in cyanobacteria. BMC Microbiology, 13(1), 1–9. https://doi.org/10.1186/1471-2180-13-57
Dietz, H., Douglas, S., & Shih, W. (2009). Folding DNA into Twisted and Curved Nanoscale Shapes. Science, 325(5941), 725-730. doi: 10.1126/science.1174251
Donnelly, J., Wahren, B., & Liu, M. (2005). DNA Vaccines: Progress and Challenges. The Journal Of Immunology, 175(2), 633-639. doi: 10.4049/jimmunol.175.2.633
Düzgüneş, N. (2012). Nanomedicine: Cancer, diabetes, and cardiovascular, central nervous system, pulmonary and inflammatory diseases. Amsterdam: Elsevier/Academic Press.
Huang, L., Hung, M., & Wagner, E. (2005). Non-viral vectors for gene therapy. San Diego: Elsevier Academic Press.
Baharvand, H., & Aghdami, N. (2014). Stem cell nanoengineering. Hoboken, New Jersey : Wiley Blackwell
Devarajan, P. V., & Jain, S. (2015). Targeted drug delivery: Concepts and design. Cham : Springer ; [St Paul, MN] : Controlled Release Society
Langel, U. (2019). CPP, cell-penetrating peptides. Singapore : Springer Press
Li, Z., Zhang, Y., Zhu, D., Li, S., Yu, X., Zhao, Y., … Li, L. (2017). Transporting carriers for intracellular targeting delivery via non-endocytic uptake pathways. Drug Delivery, 24(2), 45–55. https://doi.org/10.1080/10717544.2017.1391889
Lin, C., Liu, Y., & Yan, H. (2009). Designer DNA Nanoarchitectures†. Biochemistry, 48(8), 1663-1674. doi: 10.1021/bi802324w
Liu, B. R., Liou, J.-S., Huang, Y.-W., Aronstam, R. S., & Lee, H.-J. (2013). Intracellular Delivery of Nanoparticles and DNAs by IR9 Cell-penetrating Peptides. PLoS ONE, 8(5), 1–13. https://doi.org/10.1371/journal.pone.0064205
Ohshima, H., & Makino, K. (2014). Colloid and interface science in pharmaceutical research and development. Amsterdam: Elsevier.
Yuan, J. X.-J. (2011). Textbook of pulmonary vascular disease. New York: Springer.
Ethics in nursing has been in existence for decades, and it describes what is considered as right, and correct and wrong, and incorrect in behavior. There are two major categories of ethical principles and thoughts which include the deontology and utilitarianism. The former claims that the end-goal and the means must be ethical and moral, and on the other hand, utilitarianism states that the end goal justifies the method regardless of whether it is moral or not (Burke, 2019). However, there are some cases in which some ethical principles conflict which then results in dilemmas. For instance, in the case of the 39-year-old male homeless client who stopped taking his medication due to the side effects, and later was arrested for hitting someone without provocation. The issue, in this case, runs within the ethical principles of nursing, for example, the autonomy which gives the patient the chance to make decisions concerning their health and conversely, the principle of beneficence which promotes doing good and the right thing for the patient (Epstein & Turner, 2015). The two are conflicting because it is the right of the client to decide whether to take medication or not and on the other hand, the nurse is expected to do what is right for the patient; hence, it becomes problematic.
As a nurse, sticking to the principle of beneficence and understanding the end consequence of the situation is crucial. From the case, the result of not taking medication was causing injury to other members of the public and arrest. This is things that could have been avoided in case the client took his medication. Besides, the nurse needs to understand that the situation is one that requires an ethical decision-making process (Epstein & Turner, 2015). For example, he/she must have a clear description of the problem and all the issues surrounding it, collect information from published evidence-based practices and ethical codes and then perform data analysis for better understanding of the case (Burke, 2019). The nurse will also be involved in the identification, exploration, and establishment of potential solutions for the dilemma and implication of each problem. Additionally, the nurse will explore all the alternative solution to address the challenge and evaluating all of them. He/she will then choose one of the best and more ethical solution from the options and then apply in addressing the problem and finally, evaluate the results of the method used to determine whether it was effective in solving the issue (Burke, 2019). It is crucial for the nurse to understand the case before intervening.
From the case, I believe that the best option of addressing the challenge is to offer patient education where possible for the client to understand the importance of drug adherence. This is due to the fact that he hit someone after failing to take his prescription. I will stick to the principle of autonomy but with significant consideration that the client is fully aware of the advantages of taking the drugs. It must also be considered that all individual must be provided with high-quality care which is fair, respectful and of dignity regardless of their status and thus, the client deserves the best (Epstein & Turner, 2015). In the case where the patient still refuses to take the medication, then the safety of the public will come first while ensuring that the principle of non-maleficence is adhered to.
Epstein, B. & Turner, M., (May 31, 2015) "The Nursing Code of Ethics: Its Value, Its History" OJIN: The Online Journal of Issues in Nursing Vol. 20, No. 2, Manuscript 4.
Asthma is a human ailment that is associated with airflow obstructions and other episodic symptoms that evolve as a result of the exposure to environmental triggers. Since this disorder is sudden and deadly, it is important to highlight all associated risk complications and other health results when it is not managed properly. Moreover, according to modern research, there is not test or tests that have been proven to aid physicians to detect signs and symptoms associated with asthma (Asthma and Allergy Foundation of America, 2012). For instance, in case the conditions that induce acute asthma are not managed appropriately once they evolve, they develop into chronic asthma.
Describe the pathophysiological mechanisms of chronic asthma and acute asthma exacerbation
Clinically, the exaggeration of the human lower airway responses as a result of environmental exposure is what is termed as asthma exacerbation. One of the most commonly known environmental exposures is the respiratory virus infection that causes severe asthma exacerbation. Usually, airway inflammation evolves together with the obstruction of airflow as well as the increase in airway responsiveness. Its inflammation patterns greatly differ taking into considerations the asthma exacerbation triggering factors (Dondi et al., 2017).
Both these exacerbations have the potential of affecting bronchioles, bronchi, and finally the whole trachea. Nevertheless, the pathophysiological mechanisms that are currently used for exacerbating both chronic and acute asthma entail determining how shortness of breath, wheezing, coughing, and chest tightness induces periods or episodes of airflow obstructions (Huether & McCance, K2017). Understanding these pathopysiological mechanisms can enable patients and their families to understand to diagnose and treat these conditions.
How gender impacts the pathophysiology of both disorders
According to modern research, gender differences provide the best means of explaining the pathophysiology of these two disorders. For instance, childhood asthma has been found to be more prevalent in boys as compared to girls. Modern studies indicate that since the airway size of young male is relatively smaller as compared to that of young female, it has the likelihood of increasing wheezing risks after viral infection or cold. At the age of twenty, the number of male and female suffering from asthma is relatively the same. At the age of forty and above, there is an increase in the number of female suffering from asthma than men (Huether & McCance, K2017). Therefore, as compared to men, female are more susceptible to contracting this disorder.
Diagnosis and treatment
The diagnosis of asthma will have to take into account their gender and age differences. In younger generation, asthma diagnosis is easier as compared to aged individuals. For older people, asthma diagnosis may be omitted because the majority of their other health conditions are similar to that of asthma. Regardless of gender and age differences, clinical diagnoses will physical examination to examine factors, such as wheezing, chest tightness, coughing, and so on (Schreck & Williams, 2006). Moreover, asthma diagnosis will take into account things like chest imaging, pulmonary function testing, and sputum testing. On the other hand, the treatment of these disorders will consist of both long-term and acute therapies. Understanding the clinical history of the patient will also aid in determining the drugs to administer. For instance, the patient will be provided with drugs such as oral corticosteroids or engage him or her to physical exercises (Asthma and Allergy Foundation of America, 2012).
MIND MAPS
Acute asthma exacerbation
Pathophysiology
Clinical presentation
· Swollen and sensitive airways
· Muscle contraction
· Inflamed airways
· Narrowed bronchial tubes
ACUTE ASTHMA EXACERBATION
Treatment
Diagnosis
· Oral corticosteroids
· Physical exercises
· 0xygen
· Physical assessment
· Imaging
· Carrying out pulmonary function testing
· Sputum testing
Chronic asthma exacerbation
CHRONIC ASTHMA EXACERBATION
Clinical presentation
pathophysiology
· increasing permeability of the vasculature
· activation of the inflammatory mediators
Diagnosis
· Gender differences
Treatment
· Oral corticosteroids
· Physical exercises
· Administering oxygen
Breathlessness
Coughing
Chest pressure
Wheezing
References
Asthma and Allergy Foundation of America. (2012). Retrieved from http://www.aafa.org
Dondi, A., Calamelli, E., Piccinno, V., Ricci, G., Corsini, I., Biagi, C., & Lanari, M. (2017). Acute Asthma in the Pediatric Emergency Department: Infections Are the Main Triggers of Exacerbations. BioMed Research International, 2017, 1–7. https://doi.org/10.1155/2017/9687061
Huether, S. E., & McCance, K. L. (2017). Understanding Pathophysiology - E-Book. (6th ed.). St. Louis, MO: Mosby
Schreck, D. M., & Williams, D. M. (2006). Case studies illustrating the implementation of treatment strategies for acute and chronic asthma. American Journal of Health-System Pharmacy, 63(10), S22–S26. https://doi.org/10.2146/ajhp060129
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