Nursing

Do according to the attachment 

REFERENCES: MINIMUM 2 CITATION

FOR ALL ASNWERS USE THESE

1

–

Grodner, M., Escott-Stump, S., & Dorner, S. (2020). Nutritional foundations and clinical applications: A nursing approach. St. Louis, MO: Elsevier.

(ONE MUST BE THAT ONE)

2 – Scholarly article within 5 years

PART 1 – EXAMPLE

Each time I teach a session of this class, I develop new ideas as to how to help my students answer the QUESTIONS of the assignments. I do know they are long and tedious at times, given the number of credits you are taking, in addition to a busy schedule.  So here are some pearls of wisdom I have gathered:

Let’s follow the path of a delicious ham and cheese sandwich with lettuce and pickles as it is eaten and digested! Start at the beginning and discuss the anatomical parts 
(1)
 as well as the biochemical roles
 (2) 
that contribute to this sandwich being turned into chemical energy. Be sure to include 
mechanical and chemical mechanisms 
(3),
 along with how they are metabolized in the body!
(4)

What happens if that part does not function?
 (5) For this portion of the question. Select any part of the GI system that may not function and discuss what may happen. It does not have to be the teeth. This is just an example.  For example, what happens to digestion if the person is missing many teeth but can’t afford dentures, or perhaps has a digestive disorder?

1. What stress factors may cause issues in the digestive tract for some people?

 
(5)

2. How can a regular exercise program aid in the development of a healthy digestive tract?

 
(6)

3. How might digestion and metabolism be different over the lifespan? 
(7)

Ask yourself: “What does my rubric say?” Look closely at the rubric criteria:

Postings apply concepts to professional practice, personal experience, or examples from healthcare delivery system. 
Using this criteria answer in detail (one or two sentences are not detailed) numbers 1 to 7 above. All of the questions should be answered in the initial post. The second post is to another student post that adds to that student post. “Good job”. “Excellent” is not acceptable. A second post should be about 4 or 5 detailed sentences with citations and references.

Postings integrate assigned readings, lessons, expert opinion, 
and outside professional resources (articles or websites). Sources are referenced.  
Be sure to include information from your textbook, lesson sections, and outside sources. Pay attention to APA format. Use citations and references. Appropriate citations and references in your discussion posts help when you have to submit your assignments especially the Unit 5 Team Assignment.

Actively responds to peers and engages in meaningful and respectful dialogue with them. 
This addresses responses to the instructor and peers. A good rule of thumb is to answer in detail in your first response all of the questions posted and respond to peers or instructor comments in your second post. If your post is late or you include only one post, points will be deducted because there cannot be meaningful interactions. 

Presents information using clear and logical language. Grammar, spelling, and punctuation are accurate. 
This addresses clear, logical information that is free of grammatical, spelling, and punctuation errors. A post that is not inclusive of all details or only one post will not receive full points.

Participation Requirement
: You are required to post a minimum of two substantive posts in each graded topic. These two posts must be on 2 separate days, and the first post in each graded topic must be completed by Wednesday, 11:59 p.m. mountain time (MT) in Weeks 1 to 7 and the second post must be completed by Sunday 11:59 MT. In Week 8, both discussions must be completed by Saturday at 5 p.m. 

A pearl of wisdom is to write the posts in your own words and use citations and references. Here is an example of answering part of the question above (you will answer all questions – this is just an example) using original words and citing and referencing from an article (website) and the textbook: (*Note – this example was borrowed from Dr. Prashad)

According to Grodner, Escott-Stump, & Dorner (2020), long before the mechanical and chemical processes involved with digestion begins, there are stimuli that will influence the selection, digestion, and absorption of nutrients. I will use my personal experiences as I only will eat a ham and cheese sandwich if it is part of a meal at a conference or meeting. I am at a nursing conference which started at 8am. I had a cup of coffee and half of a multigrain bagel. Based on my personal preference, the donuts and pastries do not appeal to me so I do not eat anything else for the rest of the morning. It is 1100 and I am watching the clock as I am starving and lunch is 1130. I walk up to the lunch table and see the ham and cheese sandwich and the smell makes me even hungrier. I look around for the mustard and start salivating. However, I forgot that I started using a new toothbrush two days ago and have an ulceration in my lower right cheeks, and cried out in pain as I bit into the sandwich. I had to put it aside and drink a cold beverage instead.

The mechanical processes have not started yet. Some chemical processes already occurred as the smell and stimulus of being hungry stimulated the production of saliva. As you noted, even before I can start chewing a series of events were present to help me get the nutrients I need: personal preference, choice of food, smell, and other internal stimuli. Rose (2015) identified a number of factors that influences nutrition. These factors are validated in my personal story above and also in Unit 1 readings: finances, appetite, oral health, eating alone, and overall health.

References:

Grodner, M., Escott-Stump, S., & Dorner, S. (2020). Nutritional foundation and clinical applications: A nursing approach (6th ed.). St Louis, MO: Elsevier Mosby.

Rose, G. (2015). Ten factors that affect an older adult’s nutrition. Livestrong Foundation: Austin, TX. Retrieved from:

http://www.livestrong.com/article/557860-ten-factors-that-affect-an-older-adults-nutrition/ (Links to an external site.) (Links to an external site.)

 

Dr. Dykes

WHAT TO WRITE ABOUT 1 – Digestive System

Let’s follow the path of a delicious ham and cheese sandwich with lettuce and pickles as it is eaten and digested! Start at the beginning and discuss the anatomical parts as well as the biochemical roles that contribute to this sandwich being turned into chemical energy. Be sure to include mechanical and chemical mechanisms, along with how they are metabolized in the body!

What happens if one part does not function? For example, what happens to digestion if the person is missing many teeth but can’t afford dentures or perhaps has a digestive disorder?

1. What stress factors may cause issues in the digestive tract for some people?
2. How can a regular exercise program aid in the development of a healthy digestive tract?

3. How might digestion and metabolism be different over the life span?

THIS IS AN EXAMPLE OF WHAT MY FRIEND DID FOR THESE QUESTIONS TOPIC 1

Introduction

The chemical breakdown of food practice from the digestive organs are being used by various cells within the body to function properly. Digestion begins with the mouth. Chemical and mechanical digestion is the stimulation of the food in the mouth. Chemical digestion occurs through saliva and amylase, which initiates the starch digestive cycle. Mechanical digestion relies on the teeth and language that are also present in the mouth. Teeth help tear and spray food and tongue help food in chewing positions and send pulverized food to the esophagus (Grodner, Escott-Stump & Dorner, 2020). When the food is taken into the mouth, the teeth or mouth aid food breakdown with the aid of salivary amylase enzymes. Once the ham and cheese sandwich are taken, the amylase and mucous membrane change the sandwich chemically such that the food can be quickly passed into the esophagus.

What stress factors may cause issues in the digestive tract for some people? 

For example, the thought of food can cause the stomach to release digestive juices or the thought of making a major presentation can cause constipation or uncontrollable bowels. Our brain and stomach interact continuously. That direct relationship makes our gastrointestinal system sensitive to emotions and reactions like stress. When stressed, our brain sends signals to be released for chemicals like adrenaline, serotonin a hormone that influences mood and is in the digestive system as well as the cortisol stress hormone. It may cause adverse reactions to these hormones.

Stress has a many-way detrimental impact on our digestive system. It can cause lower the flow of oxygenated blood to the stomach, cramping, intestinal imbalance and inflammation. These symptoms may develop further into gastrointestinal (GI) disorders such as irritable bowel syndrome (IBS), irritable bowel disease (IBD), peptic ulcers or GERD.

How can a regular exercise program aid in the development of a healthy digestive tract? 

Exercising and digestion will be mutually exclusive. Regular exercise helps make the digestive tract stronger and keep the body healthy. Regular exercise has many advantages for the digestive system including increasing the microbiota found in the gut and that the risk of colon cancer. Physical exercise can also be helpful for our digestion. Exercising increases the flow of blood to the muscles and digestive tract which can help push food through the digestive tract.

How might digestion and metabolism be different over the life span 

Digestion is a complex combination of mechanical, chemical, and neurological interactions, and aging can alter the role of each of these activities. The gastrointestinal tract comprises the greatest number of immune cells and is therefore home to the enteric nervous system, the biggest and most complex neuron group outside of the central nervous system. As we age, each organ associated with digestion is undergoing changes that are a normal part of aging but that affect digestive function.

Aging may have dramatic effects on digestive system functions. Some of which is decreased appetite due to changes in hormone production and a change in odor and taste. Physiological changes in pharyngeal abilities and motility to the esophagus can lead to dysphagia and reflux, and many factors lead to changes in daily gut microbial fauna in the intestines, making older people more vulnerable to bloating, discomfort and bacterial infection (Brunet & Rando, 2017). There is also a dramatic age-related increase in the incidence of various gut pathologies like colon cancer.

References:
Grodner, M., Escott-Stump, S., & Dorner, S. (2020). Nutritional foundations and clinical applications: A nursing approach. St. Louis, MO: Elsevier.

Brunet, Anne, & Thomas A. Rando, (2017). “Interaction between Epigenetic and Metabolism in Aging Stem Cells.” Current Opinion in Cell Biology. Elsevier. Retrieved from: 

https://doi.org/10.1016/j.ceb.2016.12.009 (Links to an external site.)

PART 2 – EXAMPLE

As I read Hannah’s case study and the course outcomes:
1. Discuss carbohydrates and their relationship with health promotion and wellness (COs 1 and 2)
2. Discuss fluids and electrolytes and their relationship with health promotion and wellness (COs 1 and 2)
3. Explore the critical functions of water in health and wellness (COs 1 and 3),
It occurred to me to start at the beginning to gain an understanding of how Diabetes affects carbohydrate metabolism. Individuals who are living with Diabetes cannot produce sufficient insulin to allow carbohydrates to enter the cell where it is used to perform the metabolic activities we need to survive (Couch et al., 2018). In order to teach individuals such as Hannah and her mom we need to incorporate the information we read in Unit 1: educational level, access to health care, financial status, and lifestyle changes needed to name a few (Grodner, et al., 2020).  As you conduct your research to respond to this case study, take into consideration the disease process, family situation, and Hannah’s stage of growth and development.

Be sure to read the entire discussion introduction and answer all 6 of the questions listed.  It may help to list the question and then put the answer under it.

· When are carbohydrates good for us?

· What are “good” versus “bad” carbohydrates?

· When are they not good for us or our bodies?

· What chemistry is involved in their breakdown, usage, and storage?

·

What are the first steps you would take, as Hannah’s nurse, to assess her eating habits and understanding of diabetes mellitus?

·

What did Hannah and Rose tell you (subjective) and what did you see (objective)?

Remember to think like a nurse!

Couch et al. (2018). Diabetes education for children with Type 1 Diabetes Mellitus and their families. Agency for Healthcare Research and Quality: Rockville, MD. Retrieved from:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0007437/?report=printable (Links to an external site.) (Links to an external site.)

Grodner, M., Escott-Stump, S., & Dorner, S. (2020). Nutritional foundation and clinical applications: A nursing approach (6th ed.). St Louis, MO: Elsevier Mosby.

WHAT TO WRITE ABOUT 2: Carbs, Culture, and Diabetes

1

In this discussion, you will consider the following information prior to responding with your post.

In order to fully understand Hannah’s situation, please first answer the following:

· When are carbohydrates good for us?
· What are “good” versus “bad” carbohydrates?
· When are they not good for us or our bodies?
· What chemistry is involved in their breakdown, usage, and storage?

After you have discussed this, consider Hannah and Rose’s situations and think like a nurse!

Hannah is a 12-year-old who has had Type I diabetes for a few years. Her mother, Rose, is a strict vegetarian and believes this is also the best diet plan for her daughter. Hannah says, “I just want to eat like all my friends do!” As a result, she often cheats, and lately, there has been a steady increase in Hannah’s blood sugar.

What are the first steps you would take, as Hannah’s nurse, to assess her eating habits and understanding of diabetes mellitus?
What did Hannah and Rose tell you (subjective) and what did you see (objective)?

PART 3 – EXAMPLE

This week, we will be assessing how the intake of fats, fatty acids, and proteins provide nutrients for optimal health and wellness. We will continue to describe how utilization of fats, fatty acids, and proteins promote health and wellness across the lifespan and then we will discuss the psychological, sociological, economical, and cultural implications of food on nutritional status (COs 1, and 2). 

As we look at Mark and Jacob’s intake of nutrients and the factors influencing their health, let us examine the significance of the cholesterol, LDL, and HDL while thinking of an effective teaching plan for Mark and Jacob (Grodner et al., 2020). The National Institute of Health (NIH) and the American Heart Association (AHA) have many publications geared towards monitoring the three factors to consider:  total cholesterol level, low density lipoproteins (LDL) and  high density lipoproteins (HDL) (NIH, 2001; AHA, 2014).

I am looking forward to reading about your plan for Mark and Jacob.
References:
American Heart Association. (2014). Good vs bad cholesterol. Author: Dallas, TX. Retrieved from:

http://www.heart.org/HEARTORG/Conditions/Cholesterol/AboutCholesterol/Good-vs-Bad-Cholesterol_UCM_305561_Article.jsp#.Vmh-LbEo4dU (Links to an external site.) (Links to an external site.)

Grodner, M., Escott-Stump, S., & Dorner, S. (2020). Nutritional foundation and clinical applications: A nursing approach (6th ed.). St Louis, MO: Elsevier Mosby.
National Institute of Health. (2001). ATP guidelines at a glance: Quick desk reference. Author: Rockville, MD. Retrieved from:

http://www.nhlbi.nih.gov/files/docs/guidelines/atglance

WHAT TO WRITE ABOUT 3: Diet and Lab Values

Mark, a single father of a 2-year-old son, Jacob, stops every morning at a local fast food restaurant to pick up breakfast for himself and his son on their way to daycare. Mark says, “I don’t have time to cook in the mornings, and I can’t feed Jacob anything I make at home any cheaper than this. Besides, he really loves these sausage and egg sandwiches, and at least I can get him to eat them!”

Mark has a family history of diabetes, as well as hyperlipidemia, and has the following risk factors for cardiovascular disease: primary hypertension (treated with medication), cigarette smoking, inactive lifestyle, and occasionally eating foods high in sodium. Both of his parents died at young ages due to what Mark calls “heart troubles,” and his brother has high cholesterol. During his physical, Mark learns that his lipid panel is as follows: total cholesterol 245 mg/dl, LDL 180 mg/dl, and HDL 35 mg/dl.

As his nurse, you know that risk factors for cardiovascular disease are fixed or modifiable. Give at least two examples of each.

1. For modifiable risk factors, what can be done to reduce risk?

2. What is the significance of Mark’s blood work? What does a normal lipid profile look like?

3. Based on the information provided in the scenario, how would you educate him?

Be sure to include physical fitness and nutrition based on the USDA 2015 Dietary Guidelines and 

choosemyplate.gov (Links to an external site.)

 covered in Week 1.

PART 4 – EXAMPLE

This week we will be discussing vitamins, minerals, and antioxidants and their relationship with health promotion and wellness and choosing foods that contain particular nutritional components (CO 1, 2, and 4). To begin looking at Mrs. Law and to include information being studied, there are several factors from the previous Units that needs to be considered: stage of growth and development (In Unit 2 Hannah was an adolescent, in Unit 2 Mark was most likely a young adult and his son Jacob was a toddler), access to health care, nutritional state, and overall medical condition (Grodner et al., 2020). 

When answering this case study, take into consideration all the vitamins and minerals in your readings and compare that to the recommended daily allowances (RDA) for Mrs. Law. The RDA differs according to age group, gender, and general medical condition. An analysis of Mrs. Law food intake indicate that she is missing calcium. Calcium is important for bone health. The RDA for women ages 51 and older is 1200 milligrams/day (Jacobsen, 2014). Using the Virtual Shopping cart at the end of the Lesson section in Unit 4, I found the following foods she can consume to increase the calcium: low fat ice cream, low fat cheese, low fat milk and oranges (Jacobsen, 2014).

References:
Grodner, M., Escott-Stump, S., & Dorner, S. (2020). Nutritional foundation and clinical applications: A nursing approach (6th ed.). St Louis, MO: Elsevier Mosby.
Jacobsen, M. T. (2014). Food sources for vitamins and minerals. WebMD: NY, NY. Retrieved from:

http://www.webmd.com/food-recipes/guide/vitamins-and-minerals-good-food-sources (Links to an external site.)

WHAT TO WRITE ABOUT 4: Bone Health

Mrs. Law, a 77-year-old female, is at home recovering from a surgery that she had after falling and breaking her hip 5 days ago. She lives with her husband, Dean, who helps to care for her. Mrs. Law is a former smoker and has a past medical history of hypertension and hyperlipidemia.

You are the visiting nurse, assigned to check on her postoperative progress. You ask the client how she is feeling, do an assessment, and inquire as to what she has eaten over the past 24 hours. Mrs. Law states that she has “no pep,” no appetite, has been taking her pain medication as prescribed (every 4 hours—but not real helpful!), cannot sleep well, doesn’t feel much like walking except to the bathroom, and has been unable to move her bowels for several days.

· Breakfast: Two glazed doughnuts, coffee (black)

· Lunch: Tossed salad with oil and vinegar, diet soda

· Dinner: Tomato soup, 1 cup; four soda crackers; and red homemade wine

· Snack: Pretzels, diet soda

What nutrients that contribute to bone health are missing in Mrs. Law’s diet?

What other dietary concerns do you have?

Is Mrs. Law getting the appropriate amount of vitamins and minerals for her age and current condition? Why or why not? 

PART 5 – EXAMPLE

This week we are looking at nutrition through the life span.  Remember, nurses are in an excellent position to help individuals throughout all stages of life – including in the elderly years.  Often, the elderly live alone due to the loss of a spouse.  Mr. Basset is in that situation.  In addition, his children do not live nearby, which means he may lack the support needed to maintain a healthy nutritional status.  The elderly also often have chronic illnesses and polypharmacy that affect nutritional status.  

This week you will take a moment to look at the “big picture” related to Mr. Basset and his nutritional status.  Consider what physiological factors may be contributing to his nutritional status and subsequent weight loss. Be sure to explain each factor as it relates to Mr. Basset.

Then let’s look at and explain the psychosocial factors are affecting his nutritional status and subsequent weight loss. Can you think of an explanation of why Mr. Basset’s dentures don’t fit?

If you were the nurse assigned to Mr. Basset, what nursing actions would you need to include in the plan of care to improve his nutritional status?  Why? (Hint: be sure to give interventions that are feasible, considering his physiological and psychosocial factors).   

WHAT TO WRITE ABOUT 5: Elderly Case Study

You are asked to see Mr. Basset, who is 80 years old, currently living alone, and has recently lost his wife. His children do not live nearby, but Mr. Basset sees them on holidays. Mr. Basset was recently diagnosed with lung cancer and has had an unexplained weight loss of 20 pounds in 3 months. He is getting chemotherapy as well as taking oral medication for hypertension and arthritis, and is showing signs of dehydration.

Mr. Basset reports that his wife did most of the cooking and he has limited cooking skills. He usually has cereal with milk and coffee for breakfast and soup for a second meal later in the day. He eats crackers throughout the day if he is hungry, but admits that he doesn’t have much of an appetite. In addition, Mr. Basset has ill-fitting dentures and claims that food just does not taste the same. He is also on a limited budget.

1. What physiological factors might contribute to Mr. Basset’s weight loss?

2. What psychosocial factors might contribute to Mr. Basset’s weight loss?

3. Give one likely explanation why Mr. Basset’s dentures do not fit.

4. What nursing actions need to be included in the plan of care to improve Mr. Basset’s nutritional status?

PART 6 – EXAMPLE

Last week we looked at a case study involving Mr. Basset, an elderly patient with multiple psychosocial and physiologic factors contributing to his nutritional status.  This week we will focus on Jordan, a 14 year old who also has a chronic illness – gallbladder disease.  As teen obesity in increasing in the United States, we are seeing increases in chronic health conditions such as diabetes and heart disease on the rise at earlier ages than ever before.  Let’s take a thorough look at Jordan – consider all of the factors listed in the case study above.  Based on what you see, what would you include in your initial assessment data?  Since there are so many resources available for teaching nutrition, let’s take choosemyplate.gov and develop a teaching plan for Jordan based on this resource.  What would you teach Jordan about diet as well as about gallbladder disease and nutrition? 
Accurate nursing diagnoses will be needed as we plan care for Jordan.  What might two high priority nursing diagnoses be for Jordan?  Why? 

WHAT TO WRITE ABOUT 6: Teen Case Study

Jordan is a 14-year-old middle school student who weighs 275 pounds and is 5’6” tall. Over the past 2 years, he has gained 60 pounds, has begun to withdraw from social activities, and has avoided other students due to bullying from others his age about his weight/appearance. Lately, Jordan has been missing a great deal of school too, particularly on the days he has gym. Jordan’s parents are both average in height and weight. Jordan’s mother says that he just takes after his grandfather William, who “was a husky man, and died of a sudden heart attack at the age of 44.” She says, “We just have fat genes in the family; you can’t do anything about that!” 

He has been told he has “…no willpower, or is weak, and that he needs to change his lifestyle, eat less, and exercise more.” Jordan says “I go for a couple days without eating, but then I get so hungry that I could eat the couch!”

Jordan has recently been diagnosed with gallbladder disease and has symptoms that typically occur after eating that include mild pain in the midepigastric region, radiating to the right upper quadrant of the abdomen and right subscapular area of the body.

You are the nurse assigned to Jordan.

1. What would you include in your initial assessment data based on the scenario provided?

2. What would you teach Jordan based on the Recommended Daily Allowance from choosemyplate.gov (Links to an external site.)
 discussed in Week 1 and the information provided about gallbladder disease provided in Week 6?

3. Based on your assessment data and the information from the scenario, what might be two high-priority nursing diagnoses to guide Jordan’s plan of care?

PART 7 – EXAMPLE

The National Institute of Health (2015) stated that Kava is a plant from the pepper family that is used in ceremonies or to treat tiredness, insomnia and issues involving the kidneys and the bladder. The Food and Drug Administration (FDA) has issued many warnings about this alternative treatment, claiming that it may be linked to liver damage, neurological disorders such as Parkinson’s Disease, and skin irritations. If ingested, there must be caution with operating heavy machinery or participating in activities that require an individual to concentrate or focus for a long period of time. Based on the information I read in the article, Kava presents dangers that may not be evident until after prolonged usage. Additionally, when used with prescription medications and other complementary and alternative medicines, it is critical that individuals are educated on possible dangers and side effects.  I did not see any interactions or contraindications related to liver or kidney disease.

National Institute of Health. (2015). Kava. Author: Washington, DC. Retrieved from: https://nccih.nih.gov/sites/nccam.nih.gov/files/Herbs_At_A_Glance_Kava_06-15-2012_0

WHAT TO WRITE ABOUT 7: Supplementing Your Diet

It has become common practice for people to supplement their diets with pills, smoothies, teas, herbals, and other complementary practices. Select two from the list below and locate an evidence-based article for each. Summarize the intended use, recommended dosage, side effects, and known interactions with over-the-counter and prescription medications. What if contraindications are identified for a patient with liver and/or kidney disease?
•    Probiotics
•    Acai
•    Apple cider vinegar
•    Garlic
•    Green tea
•    Turmeric
•    Cinnamon
•    Omega-3 fish oil
•    DHA
•    Glucosamine
•    Melatonin
•    St. John’s wort
•    Capsacin
•    Black cohosh
•    Aloe vera
•    Echinacea
•    Zinc oxide
•    Saw palmetto
•    Valerian root
•    Feverfew
•    Maca
•    Niacin
•    Red yeast rice
•    DHEA
•    Kava