This week, you will select Lewin’s change theory or the PDCA that would work best for your proposed quality improvement project. you will need to summarize the main theoretical notions and concepts of the selected theory. You will then need to discuss in detail the various stages of implementation of the proposed project based on the selected theory.
Nursing knowledge is classified in a variety of ways, one of which is Carper’s Patterns of Knowing (Carper, 1978). Carper’s framework offers a lens through which the nurse can reflect upon insights acquired through empirical, ethical, personal, and aesthetic knowledge (Carper, 1978). Through intentional reflection using Carper’s Patterns of Knowing, nurses can process experiential learning and knowledge acquired through practice. The purpose of this assignment is to reflect upon a specific practice situation and better understand the professional knowledge and insights obtained through that experience.
Criteria for Content
Week 4 ion channel —2 Peer Response 800w. due9-26-23
Instructions:
Please read and respond to the two peers' initial postings for week 2 below. Consider the following questions in your responses.
Compare and contrast your initial posting with those of your peers.
1. How are they similar or how are they different?
2. What information can you add that would help support the responses of your peers?
3. Ask your peers a question for clarification about their post.
4. What most interests you about their responses?
5. Summaries at least 1 evidence based article that supports there point.
Please be sure to validate your opinions and ideas with citations and references in APA format.
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Response 1 400 words mam
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Differentiate between the opening of a ligand-gated ion channel and a voltage-sensitive ion channel.
· In the nervous system, there are two important types of ion channels: voltage-gated ion channels and ligand-gated ion channels. Both of these ion channels play crucial roles in transmitting electrical signals, often referred to as messages, throughout the nervous system. Each type of channel has its own specific mechanism for opening and closing. These ion channel proteins are influenced by various stimuli or external factors, which can trigger their activation or deactivation within the cell's plasma membrane (Xiao-Yu, 2023).
· Ligand-gated ion channels, as their name suggests, require a ligand to open. Ligands are chemical messengers that can bind to protein receptors on the channel. In simpler terms, when a specific chemical, such as a neurotransmitter, binds to the channel's receptor, it triggers a conformational change in the protein channel. As a result, the channel gains the ability to open, allowing ions (usually Na+, K+, or Cl-) to flow through the channel pore (Stahl, 2021). Ligands can include neurotransmitters, hormones, medications, and other molecules. Each ligand-gated ion channel has a specific binding site for its particular ligand. Most ligand-gated ion channels are located at synapses. When neurotransmitters are released into the synaptic cleft, they can bind to their specific binding sites on ligand-gated ion channels found in the post-synaptic cell membrane. This binding facilitates the transfer of signals. Ligand-gated channels are known for their rapid response and are well-suited for fast synaptic transmissions (Stahl, 2021).
· Voltage-gated ion channels are distinct from ligand-gated channels in that they respond to changes in electrical charge, specifically the membrane potential, rather than chemical ligands. These ion channels are regulated by alterations in the voltage across the cell membrane. The distribution of positive and negative ions on either side of the cell membrane varies. Typically, during the resting state, the inside of the cell membrane carries a more negative charge compared to the outside. When a signal is potent enough to elevate the positive voltage within the cell membrane, reaching a critical threshold, the voltage-gated channels open (depolarization). During the depolarization period, voltage-gated ion channels allow the transfer of ions, which initiates an action potential. Various stimuli or external factors have the capability to trigger the activation or deactivation of voltage-gated channel proteins present within the cell's plasma membrane. Voltage-sensitive channels are distributed along the axons and dendrites of neurons throughout the nervous system. Additionally, they can be found in other excitable cell types, including muscle and cardiac cells (Stahl, 2021).
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References
· Stahl, S. M. (2021).
Stahl’s essential psychopharmacology: Neuroscientific basis and practical application (5th ed.).
· Xiao-Yu, D. (2023). Calcium ion channels in Saccharomyces cerevisiae.
Journal of Fungi, 9(5), 524. https://doi.org/10.3390/jof9050524
Response 2. 400 words mc
Compare and contrast the two different major classes of ion channels.
The two major classes of ion channels according to Stahl (2021), are
ligand-gated ion channels, ionotropic receptors and ion-channel-linked receptors and
voltage-sensitive or voltage-gated ion channels. Ligand-gated ion channels are ion channels that are closed and opened by actions of neurotransmitter ligands at receptors acting as gatekeepers. The neurotransmitter binds to the gatekeeper receptor, which in turn causes a conformational change in the receptor, opening the ion channel. The receptors regulate the opening and closing of the ion channels and are therefore ligand-gated ion channels. On the other hand, the opening and closing of voltage-sensitive or voltage-gated ion channels is regulated by voltage potential or ionic charge across the membrane in which they reside (Stahl, 2021).
Explain the difference between full agonists, partial agonists, antagonists, inverse agonists.
The action of full agonists is to change the conformation of the receptor to open the ion channel the maximum amount and frequency allowed by the binding site (Stahl, 2021). Consequently, the maximum amount of downside signal transduction is triggered and medicated by the binding site. In contrast, partial agonists change the receptor conformation to open the ion channel to a greater extent and more frequently than its resting state (Stahl, 2021). As a result, the downstream signal transduction and ion flow produced in the absence of an agonist is greater than the resting state but less than that of full agonists.
Antagonists, on the other hand, stabilize the receptor in the resting state, which is similar to the state of the receptor in the absence of agonist (Stahl, 2021). Antagonists are said to be silent or neutral because the resting state is the same in the absence or presence of an antagonist. The resting state of an antagonist is not a fully closed ion channel and as a result, some degree of ion flow through the channel even in the absence of an agonist and in the presence of antagonist. Inverse agonists are neither neutral nor silent like the antagonists. They produce a conformational change in the receptors at ligand-gated ion channels causing the channel to close first, then stabilizing it in an inactive form. As a result of inactive conformation action of inverse agonists, ion flow and signal transduction are functionally reduced compared to the resting state. The action of inverse agonists is reversed by antagonists (Stahl, 2021).
References
Stahl, S. M. (2021).
Stahl's essential psychopharmacology: Neuroscientific basis and practical applications (5th ed.). Cambridge University Press.
1.
Evidenced-based practice in healthcare utilizes the current best and most relevant research, clinical experience, and patient/family valued preferences to deliver healthcare that not only improves patient experiences, but also provides better quality care for the patient and empowers clinicians, which leads to increased job satisfaction (Melnyk & Fineout-Overholt, 2023). While research clearly shows the benefits of evidence-based practice, there are a multitude of barriers that stand in the way of it becoming the standard of care such as: the lack of knowledge pertaining to evidence-based practice, lack of belief that this will result in more positive outcomes, overwhelming patient loads, and resistance to change just to name a few. Overcoming these barriers is necessary to move from practices based on outdated research in order to be able to provide better and safer healthcare.
Utilizing evidenced-based practice within the scope of my nursing license promotes lifelong learning and continuously improved nursing practice. My hospital has recently implemented bedside shift report for nurses, which has been shown to improve patient satisfaction and safety. Bedside shift report allows me to visualize both the patient and the surroundings in addition to communicating the plan of care to the patient. Initially, there was much resistance to changing the process of our shift report. Some nurses reported overwhelming patient loads (e.g. “I have to give report to 4 different nurses”) as a reason for which they struggled to do bedside report. After much encouragement from peers and leaders, the transition to bedside shift report has improved nursing accountability and teamwork. Visualizing all of my patients first thing in the morning allows me to ensure accuracy of the report and prioritize care.
References
Melnyk, B. M., & Fineout-Overhold, E. (2023).
Evidence-Based Practice in
Nursing & Healthcare (5th ed). Lippincott Williams & Wilkins.
DKA
Mrs. S is a 28-year-old patient, with a 12-year history of type I diabetes mellitus. Her husband states that she has had a “bad cold” for several days. Yesterday she stayed in bed and slept all day. She was “too ill” to check her blood sugar, and since she was not really eating, she did not take her insulin. This morning, she was not able to stand up and vomited twice. A Gram stain of Mrs. S’s blood contains gram-positive cocci in clusters. Her admission vital signs are: BP = 90/60; HR = 118 bpm (sinus tachycardia); RR = 32/min; T = 102.3° F; O2 sat via pulse oximetry = 96%. Her serum glucose is 398 mg/dl, and she is positive for serum ketones. She is admitted with a diagnosis of DKA.
Her baseline ABGs on 2 L of oxygen are: pH = 7.25; PCO2 = 28; HCO3 = 14; PaO2 = 92; O2 sat = 96%. Her respirations are deep, rapid, and labored. She has bronchial breath sounds in the right axillary area. There is bilateral chest expansion and no evidence of cyanosis.
A regular insulin bolus is given, and a regular insulin drip is initiated. Mrs. S’s IV fluids are infusing at 800 ml/hr. Her vital signs after 2 hours in the unit are: BP = 120/70; HR = 78 bpm (normal sinus rhythm); RR = 22/min; O2 sat = 100%. Her serum glucose is 250 mg/dl and serum potassium is 4.0 mEq/L. She is more alert and is feeling hungry.
MY NUMBER ASSIGNED WAS 1 WHICH IS: **What is the nurse’s responsibility with a perspective organ donation? What are some absolute contraindications for donation, and what is the difference between organ and tissue donation?
Each student will be assigned a number randomly. Whatever your number is, select the corresponding topic below, then post a minimum of 5 bullet points about the topic.
Your bullet points should address key components of the topic, such as what, how, who, & why. This information should not be basic things you learned in Med/Surg, but rather advanced critical care based.
Think about this as a group effort to create a study guide. Use ONLY your textbook, but do not cut & paste from the book.
Then create, find, or borrow a test style question about your topic & post at the bottom of your bullet points. The format needs to be multiple choice or select all that apply. Think NCLEX style.
PART 2:
Part 2:
Interview:You will take a few minutes and ask 2 people about their personal coping mechanisms for dealing with the stress of working in healthcare during this unique time of Covid. Stress can be physical, emotional, spiritual, or any combination of triggers. Ask a diverse variety of people, don’t forget those in other departments at different points of hierarchy. For example, ask your unit manager, environmental services, volunteers, patients, fellow nurses, etc. Write 2-3 paragraphs on your findings and impressions while respecting the person’s identity.
Resources
In your Case Study Analysis related to the scenario provided, explain the following:
Conc of Pathophys of NSg peers response
· respond to peers thoughtfully, add value to the discussion, and apply ideas, insights, or concepts from scholarly sources, such as: journal articles, assigned readings, textbook material, lectures, course materials, or authoritative websites. For specific details and criteria, refer to the discussion rubric in the Menu (⋮) or in the Course Overview Weekly Discussion Guidelines.
1st peer post
Samantha WootenSep 11, 2023 at 9:31 AM
Marshall (2022) reports “In anorexia nervosa’s cycle of self-starvation, the body is denied the essential nutrients it needs to function normally. Thus, the body is forced to slow down all of its processes to conserve energy, resulting in serious medical consequences” (P. 1). Marshall also surmises that lab work up on a patient may look normal, but this does not rule out impending death, death could happen quickly by cardiac arrest caused by electrolyte imbalances (2022. P. 1).
Cultural and environmental implications affect a large amount of people within all ethnicity, gender, and age however women are largely targeted, the University of East Anglia state “his quite obvious connection between eating disorders and cultural expectations surrounding femininity is woefully neglected in much treatment” (P. 1). With the technology boom in recent years this is ever more present for this population, a social media environment instills these behaviors in today's society.
Financial implications that cause anorexia include lack of income and homelessness. Underprivileged populations have no choice but to sacrifice food to prioritize other necessities. Chan (2023) reports 64.7 billion being spent on eating disorders per year, with 23,560 hospitalizations yearly (p. 1).
In the ED with 16-year-old Jonathan Collins coming into the facility for anorexia nursing interventions would include evaluating the patients diet/exercise regimen and educate on proper diet and exercise with adequate fluid intake. Identify coping strategies and emotions related to weight, allowing the patient time to think and express how they're feeling. This will allow underlying causes to surface for treatment. Lastly, addressing body images issues. Targeting these fears will allow the patient to accept a healthy body weight to maintain health and stay out of the hospital (Belleza, August 9, 2023. P. 1).
According to Miller, Grinspoon, and Ciampa (2020) vital signs with anorexia tend to include a slower than normal heart rate, hypotension, and hypothermia. Lab values tend to include anemia and in some cases thrombocytopenia. Sodium levels average around 122, with normal levels being 135-145. Average potassium in patients with anorexia being 1.9 with normal values being 3.4-4.8. All of these values contribute to cardiac arrest via electrolyte imbalance. In some anorexia patients there are dysrhythmias due to electrolyte imbalances and hypovolemia. Also of note with women populations are menstrual dysfunction and osteoporosis (P. 1).
Treatment includes a combination of psychotherapy, family therapy, and medicine according to St. Lukes Hospital (2015), they also state “A combination of treatments can give the person the medical, psychological, and practical support they need. Cognitive behavioral therapy, along with antidepressants, can be an effective treatment for eating disorders. Complementary and alternative (CAM) therapies may help with nutritional deficiencies” (P. 1).
references
Belleza, M. August 9, 2023. Eating disorders: Anorexia & Bulimia Nervosa. Nurse Labs.
Eating Disorders: Anorexia & Bulimia Nervosa – Nurseslabs
Chan, T. H. 2023. Report: Economic Costs of Eating Disorders. Harvard School of Public Health.
Report: Economic Costs of Eating Disorders | STRIPED | Harvard T.H. Chan School of Public Health
Marshall, D. 2022. Anorexia Nervosa. National eating disorders association.
Anorexia Nervosa | National Eating Disorders Association
Miller, K. Grinspoon, S. Ciampa, J. (Marh 14, 2020). Medicla Findings in Outpatients with Anorexia Nervosa. JAMA internal medicine. Doi:10.1001/archinte.165.5.561.
St. Lukes Hospital. April 23, 2015. Complementary and Alternative Medicine of Anorexia Nervosa. A Division of Ebix.
Anorexia nervosa | Complementary and Alternative Medicine | St. Luke's Hospital (stlukes-stl.com)
University of East Anglia. November 13, 2017. Eating disorder treatments need to consider social, cultural implications of the illness. Science Daily.
Eating disorder treatments need to consider social, cultural implications of the illness | ScienceDaily
2nd peer post
Kira DespinsSep 11, 2023 at 3:20 PM
1. Thoroughly explain the pathophysiology of anorexia. Use a scholarly or authoritative source to support your answer.
Anorexia is a medical condition summarized by an inadequate intake of nutrients to regulate an individual’s weight to reduce their BMI and be ‘thin’. It causes physiological imbalances such as amenorrhea and psychological imbalances such as an obsessive-compulsive need to exercise or an all-encompassing fear of gaining weight. This population exhibits body dysmorphia. Once begun, this disease is persistent in select populations (Klein, 2004).
1. Examine each of the following three factors related to this disease process. Support all three with a scholarly source.
Cultural: Western culture perpetuates a standard of beauty based on being thin. This standard is propagated through social media outlets. Klein (2004) summarizes that popular media not only emphasizes the need to be a thing but perpetuates it through advertisements such as marketing diet fads and fitness trends.
Financial: Relating to the treatment of anorexia, a study by Gatt et al. (2014) found significant household financial stress for those seeking treatment for their eating disorder. They compared treatment costs to being the second highest after cardiac artery bypass surgery. As the disease is notoriously difficult to manage by oneself, it would be prudent to establish funding for this patient population so all individuals can access treatment without causing significant burdens on themselves and their families.
Environmental implications: Nature vs. nature has been heavily debated in pursuing the best understanding of anorexia. Klinger (2012) highlights that from an environmental perspective, children who have been neglected and/or abused are more prone to develop anorexia.
1. Identify 3-5 priority nursing interventions for the client in the emergency department.
-Cardiac monitoring due to electrolyte imbalance
-Fall risk prevention related to weakness
-Blood glucose monitoring related to low nutrient intake
1. Describe labs and diagnostic testing you would want to include in client’s plan of care and why. What are critical indicators? Support with a scholarly source.
Metevir, a nutrition counselor, highlights the importance of the following lab and diagnostic tests in anorexic patients (2022):
1. Vital sign monitoring, such as bradycardia, can signify a weak heart-conserving energy.
2. EKG to detect abnormal heart rhythm due to weakened heart muscles.
3. Complete metabolic panel to look for electrolyte imbalances in kidney and liver health. Hypokalemia would be a critical indicator.
4. Blood glucose tests as low food intake results in less glucose, which our brains depend upon
5. Hematology detects if our blood carries enough oxygen to perfuse our organs adequately.
6. Bone density test as low food intact can result in reduced hormone output, leading to weak and brittle bones.
1. What members of the interdisciplinary team need to be included for holistic patient-centered care? Provide a rationale and support with a scholarly source.
I believe that family members and friends are included in any team to support and care for those treated with anorexia. Knowing the care plan, these individuals can best provide care and support to the patient while out of the hospital, setting them up for success. Joy et al. (2003) believe that a physician, mental health professional, and nutritionist are also integral components of the care team as it affect an individual physically and mentally, and each has an overlapping specialty to assist the patient best. In an emergency department setting, involving a social worker or case management is integral to establishing resources for patients seeking help in an outpatient or in-patient setting.
References
Gatt, L., Jan, S., Mondraty, N., Horsfield, S., Hart, S., Russell, J., Laba, T. L., & Essue, B. (2014). The household economic burden of eating disorders and adherence to treatment in Australia. BMC Psychiatry, 14.
https://doi.org/10.1186/s12888-014-0338-0
Joy, E., & Wilson, C., & Varechok, S. (2004). The multidisciplinary team approach to the outpatient treatment of disordered eating. Curr Sports Med Rep, 331(6), 6. https://pubmed.ncbi.nlm.nih.gov/14583163/#:~:text=Team%20members%20include%20a%20physician,of%20individuals%20with%20disordered%20eating.
Klein, D. A., & Walsh, B. T. (2004). Eating disorders: clinical features and pathophysiology. Physiology & Behavior, 81(2), 359–374.
https://doi.org/10.1016/j.physbeh.2004.02.009
Klinger, D. (2012). Genes or environment: What causes eating disorders? GoodTherapy.
https://www.goodtherapy.org/blog/genes-environment-what-causes-eating-disorders
Metevier, J. (2022). The eating disorder medical test and nutrition lab guide. Integrated Care Clinic. https://integratedcareclinic.com/blog/the-eating-disorder-medical-test-and-nutrition-lab-guide/#:~:text=Metabolic%2FElectrolyte%20Labs,your%20sugar%20and%20protein%20levels
1.Post a brief description of the situation you experienced and explain how incorporating or not incorporating patient preferences, social determinants of healthLinks to an external site., and values impacted the outcome of their treatment plan. Be specific and provide examples. Then, explain how including patient preferences, social determinants of health, and values might impact the trajectory of the situation and how these were reflected in the treatment plan. Finally, explain the value of the patient decision aid you selected and how it might contribute to effective decision making, both in general and in the experience you described. Describe how you might use this decision aid inventory in your professional practice or personal life.
Use 3 sources
2. Post an explanation of how you anticipate enacting personal and professional commitment for advocacy to positively impact your patients, communities, and the profession. Be specific. Then, explain how your role as a DNP-prepared nurse contributes to advocacy for positive social change.
Use 3 sources
Centers for Disease Control and Prevention. (2021). Social determinants of health: Know what affects health.Links to an external site.https://www.cdc.gov/socialdeterminants/index.htm
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