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Administrative Health Care Annotated Bibliography

Annotated Bibliography

[Author Name(s), First M. Last, Omit Titles and Degrees]

[Institutional Affiliation(s)]

Author Note

[Include any grant/funding information and a complete correspondence address.]

Chukhraev, N., Vladimirov, A., Zukow, W., Chukhraiyeva, O., & Levkovskaya, V. (2017). Combined physiotherapy of anxiety and depression disorders in dorsopathy patients. Journal of Physical Education and Sport, 17(1), 414.

The research evaluates the consequences of the management of dorsopathy patients founded on a multilevel method, united with the psychophysiological improvement of discomfort and anxiety syndromes. The objective of the research was to develop protocols and to collect statistical data for the effectiveness of anxiety and depression disorders. The researcher conducted his research in Road Clinical Hospital. He took 100 patients and divided into 5 groups to evaluate the effectiveness of different protocols in handling anxiety and depression disorders. By utilization of low-frequency sonographic treatment, magnetic laser treatment, endo-nasal breathing of singlet oxygen mixture, electro-neurostimulation and in a combination of clinical manifestation for the treatment of anxiety and depression. Results were astonishing as 50% of the cases were identified with reduced anxiety disorders. Besides, 45% to 65% pain relief management in participants was successfully achieved. After analyzing the results, it is evident that the combination of different rehabilitation therapies, psychophysiological procedures along with analgesics can decrease anxiety and depression disorders significantly among patients.

Martínez, V., Rojas, G., Martínez, P., Gaete, J., Zitko, P., Vohringer, P. A., & Araya, R. (2019). Computer-Assisted Cognitive-Behavioral Therapy to Treat Adolescents with Depression in Primary Health Care Centers in Santiago, Chile: A Randomized Controlled Trial. Frontiers in psychiatry, 10, 552.

Data from researches indicate the usefulness of computer-linked cognitive-behavioral treatment in analyzing youngsters with depression at home and in school surroundings. This paper presents the results of a randomized controlled trial of a brief therapist-guided cCBT interference for youngsters’ depression in resource-assisted primary health care (PHC) conditions. A center providing therapies for multiple diseases in two parallel-group, on 216 depressed youngsters age ranging from 15-19. This study was conducted in Santiago, Chile and participants were visiting every week. The participants were seeking enhanced usual care interference by qualified PHC psychologists. All the psychologists were qualified and skilled and most importantly they were present in primary health care centers. Statistical analysis revealed that the participants were significantly satisfied. As all the participants were having depression disorder, so the interventions were greatly enchased in reducing their depression symptoms. These symptoms were greatly reduced after visiting primary health care centers eight times and taking eight sessions as a whole. Further researches required to open a new venture analyzing how much this strategy was more effective in low-income cities of the country.

Atabek, M. E., Eklioglu, B. S., Akyürek, N., & Alp, H. (2014). Association between vitamin D level and cardiovascular risk in obese children and adolescents. Journal of Pediatric Endocrinology and Metabolism, 27(7-8), 661-666.

The study was conducted on U.S. obese children and adolescents to evaluate vitamin D level in relation with cardiovascular risks. The aim of the study was to see the connection between vitamin D deficiency and development of cardiovascular disorders in children. The participants were 8-16 years old obese children and adolescents. The participants were analyzed on the basis of their body mass index and blood pressure measurements. The study revealed that there is a high ratio of obese children in U.S. with vitamin D deficiency. This figure has an alarming situation for the children. These children and adolescents were having vitamin D deficiency of 46%. It has also been revealed that there was a low relationship between vitamin D level and cardiovascular disorders. The study suggested an association between vitamin D and metabolic syndrome. Overall study revealed a low association of vitamin D intake and atherosclerosis despite of the other factor that may affect the obese children and adolescents in acquiring cardiovascular disorders.

Subject: Healthcare and Nursing

Pages: 2 Words: 600

Admissions Essay

How humanism plays a part in your nursing practice?

[Author Name(s), First M. Last, Omit Titles and Degrees]

[Institutional Affiliation(s)]

Humanism plays a part in my nursing practice. In my nursing practice, it is perhaps the most humane profession. I have humanism in my nursing practice such spiritual qualities as kindness, patience, responsiveness, sensitivity, compassion, mercy. All times, different nations took care of the sick, mainly relatives, by women. In my profession, it should put compassion and respect for the patient's life above all else. The nurse is obliged to respect the patient's right to alleviate suffering, to the extent that the current level of medical knowledge allows. A nurse is not entitled to participate in torture, executions and other forms of cruel and inhuman treatment of people

Subject: Healthcare and Nursing

Pages: 1 Words: 300

Admissions To Health Science Program

[Name of the Writer]

[Name of Instructor]



Admissions to Health Science Program

The power and compassion that health care practitioners have in healing patients and bringing unlikely individuals together in a profound way inspired me to join this profession. I developed a profound love of helping out people and community from a very young age. My enthusiasm can be judged by my experience that shaped learning and enthusiasm to join this profession. I have volunteered in nursing and took care of a large number of people in their homes. The empathy and compassion that I had for the people helped me in volunteering human societies every summer since 2015.

I am a person who always accepts challenges and works hard to prove myself worthy. Despite challenges that I had to face in my education at ole miss, I always proved myself and passed with flying colors throughout my carrier. The community service that I did help me a lot to balance time between school and community service without compromising my academic performance. Along with academic excellence, I achieved a lot of experience in solving the problem of the people which ignited the fire to excel in this profession.

When you are driven by a passion of a carrier that you love, then you do not fear the challenges. I know that the difficulties will enhance my skills as a healthcare practitioner. I learned patience, compassion, and interaction with the attention that are key personality traits of a health practitioner through my experience. I know that to achieve excellence hard work is necessary and it takes years for a person to develop a carrier in such a field. A medical school requires commitment because it is challenging, lengthy and physically strenuous. However, my commitment to community services and passion for this filed will enable me to go through the course that I intend to join.

Subject: Healthcare and Nursing

Pages: 1 Words: 300





Adolescent development

Adolescent is the age of rapid physical, psychological, emotional, moral and social development (Offer, 1992). This is the age of transitional development from childhood to adolescence encapsulating multifaceted aspects of development (Spear, 2002). As far as my adolescent peer group is concerned, all of them followed rapid physical alterations during this significant transition. They reported abrupt physical changes characterized by puberty and hit them quite hard. For example, some of them accomplished the growth milestones with the utmost age appropriateness whereas some remained lackadaisical; it attempted to develop substantial anxiety on their part. Some of them reported emotional issues due to their separation from parents because of schooling or forced independence. Formerly, they were too dependent on their parents for emotional and instrumental support but when they reached adolescence, their support was withdrawn and they felt helpless with the lingering sense of separation anxiety. However, later on, their resiliency enabled them to establish such personality that was essentially person-centered and self-sufficiency oriented due to which they became adjusted in the society at their own. As we all are fully insightful, adolescence is the age of ambiguity because they are too small to be called as adults and too big to be called as children; sometimes they are considered as adults and directed to become independent whereas some instances demand them to remain naïve (Offer, 1992). This ambiguity remained a great matter of concern for them however they overcame this issue through social support from family members, teachers and mentors. Furthermore, they physical development ending at puberty caused them to experience an upsurge of sexual desires and feelings of intimacy as suggested by Sigmund Freud in the Genital stage of personality development in which the focus of libido is shifted to sexual organs and one feels attraction toward opposite gender (Offer, 1992). Similar thing happened to my peer group however social norms acted as a strong repressor of their desires and they learned to control them triumphantly. Erickson defined the individual belonging to this stage as the distracted, thoughtless, daring and rebellious because they lack personal experiences which may act as a reinforcement to direct their behaviors (Spear, 2002). Another rationale behind their recklessness is the rising hormonal level and lack of appropriate channel to vent the energy out. With the passing time, they learned to serve their energy to develop something productive in terms of career development and academic aspirations.

In my view, the biggest challenging aspect of adolescent development now-a-days is the separation anxiety that they encounter due to the sudden separation from parents (Spear, 2002). Suppose a child was previously growing up under helicopter parents; he was less concerned with his career development, fiscal remittance and other significant decision making because his parents did everything for him. After crossing childhood and reaching adolescence, his parents decided that he would be sent to a distant city for better schooling which is something unacceptable for him. A newer place with newer people offers newer challenges to him because his parents are not there to assist him and he himself is responsible for his further development. A sudden withdrawal of emotional support from parents takes a serious toll on his physical, mental and emotional development. Moreover, a peer group having bullies adds further insult to his injuries and hampers his adjustment gravely. Separation anxiety coupled with the adverse ramifications of bullying leaves the adolescent helpless and his mental health start deteriorating (Offer, 1992). Hence, parents and teachers must be knowledgeable about the potential adversities of adolescent profoundly and must address this stage of development with great care because the nature of experiences at this stage determines the appropriateness of development at the later stages of development.


Spear, A. B. (2002). Adolescent Growth and Development. Journal of the Academy of Nutrition and Dietetics, 102(3), 23-29. Doi: 10.1016/S0002-8223(02)90418-9

Offer, D., (1992). Debunking the myths of adolescence: findings from recent research. J Am Acad Child Adolesc Psychiatry. 31, 1003–1014.

Subject: Healthcare and Nursing

Pages: 2 Words: 600

Adolescence: Contemporary Issues And Resources

Adolescence: Contemporary Issues and Resources

[Name of the Writer]

[Name of the Institution]

Adolescence: Contemporary Issues and Resources


Adolescence is the stage of development changes between childhood and adulthood. It brings variations in personality through both physical and psychological changes. During this stage of development, teens often face various problems and decisions like self-esteem, peer pressure, depression, alcoholism, sexual problem, and suicide. Among these and many other issues, depression is the problem which brings other physical and psychological issues. Depression is a real part of the lives of teens ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"XZetygEw","properties":{"formattedCitation":"(beyondblue, n.d.)","plainCitation":"(beyondblue, n.d.)","noteIndex":0},"citationItems":[{"id":625,"uris":["http://zotero.org/users/local/rVaVAHaF/items/D65UJUHG"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/D65UJUHG"],"itemData":{"id":625,"type":"webpage","title":"Psychological treatments for depression","abstract":"There are several types of psychological treatments shown to be effective in the treatment of depression","URL":"https://www.beyondblue.org.au/the-facts/depression/treatments-for-depression/psychological-treatments-for-depression","language":"en","author":[{"family":"beyondblue","given":""}],"accessed":{"date-parts":[["2019",5,10]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (beyondblue, n.d.). This is the stage when parents and guardians should not criticize and judge the teens. If parents or guardian notice their child facing the problem of depression, they should arrange an appointment for a proper examination by the physician. Proper assessment should be made to inquire about the changes in physical and psychological behavior. The purpose of the study is to highlight the symptoms, external stressor of the depression in order to develop assessment strategies and intervention to encounter the external factors causing depression in adolescence.

There are various symptoms of depression including; changes in eating habit and sleeping pattern, a decrease in the interest for studies and physical activities, and they try to be isolated as much as possible. Various external factors cause depression-like loss of loved ones during this stage of life, family adversity, chronic medical conditions, and most importantly study difficulties. Due to these external factors, a sudden and negative change in behavior and thinking happens because of which teens lose their motivation.

Assessment Strategies:

The symptoms can be noticed by the teen as well as his/her parents. Whenever, symptoms of depression are identified a proper assessment is required to control the issue because depression is the problem which can lead to many other problems like self-esteem, alcoholism and sometimes suicide. Therefore, it is necessary to screen teens for depression. There are various tools which can be used for the assessment of the patient like Patient Health Questionnaire for Adolescents (PHQ-A). The basic strategies to make the assessment are to understand the situation of the teens and the role of parents. For instance, if the patient has a background from family adversity and loss of loved one then proper guideline should be provided to both patient and parents that how the patient can feel better or avoid loneliness with the help of different activities and sharing of thoughts. Questions like do you feel sad or lonely? Had you faced difficulty with sleeping and eating habits? Do you lose interest in things which pleased you before? If the patient appears severely depressed then it is necessary to share the result of assessment with the patient and his parents. In addition, they should be reassured that the issue is not a fault it is a biological-based problem ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"TDJ96Fyg","properties":{"formattedCitation":"(Melinda, 2018)","plainCitation":"(Melinda, 2018)","noteIndex":0},"citationItems":[{"id":624,"uris":["http://zotero.org/users/local/rVaVAHaF/items/UQAXLJ5D"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/UQAXLJ5D"],"itemData":{"id":624,"type":"post-weblog","title":"Depression Treatment - HelpGuide.org","container-title":"https://www.helpguide.org/","abstract":"Learn about the many effective ways of treating your depression and preventing it from coming back.","URL":"https://www.helpguide.org/articles/depression/depression-treatment.htm","language":"en_US","author":[{"literal":"Melinda"}],"issued":{"date-parts":[["2018",11,2]]},"accessed":{"date-parts":[["2019",5,10]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Melinda, 2018).

Support options to encounter external stressors:

Depression is not a problem which is difficult to handle however, if no significant steps are taken on time it may lead to other severe disorders like alcoholism and suicidal ideation. The first option to encounter external stressor of the depression is the medication. Through proper assessment and examination of the physical and psychological health of the patient, a proper medication should be taken according to the instructions given by the physicians. The most effective medication for depression is antidepressant medication. Antidepressant may create some issue or side effect like drowsiness and headaches however, after two weeks patient starts to feel better ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"h76LzXeD","properties":{"formattedCitation":"(\\uc0\\u8220{}Five tips to help manage stress,\\uc0\\u8221{} n.d.)","plainCitation":"(“Five tips to help manage stress,” n.d.)","noteIndex":0},"citationItems":[{"id":622,"uris":["http://zotero.org/users/local/rVaVAHaF/items/2RRCHRKB"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/2RRCHRKB"],"itemData":{"id":622,"type":"webpage","title":"Five tips to help manage stress","container-title":"https://www.apa.org","abstract":"Five healthy techniques that psychological research has shown to help reduce stress in the short- and long-term.","URL":"https://www.apa.org/helpcenter/manage-stress","language":"en","accessed":{"date-parts":[["2019",5,10]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (“Five tips to help manage stress,” n.d.). Regular checkup is important for the patient to avoid any serious issue faced due to medication. Another best option to reduce depression is therapy. Various types of psychological therapy are present that can be effective to encounter the external stressors like loss of loved ones, family adversity, and chronic medical conditions, social and study pressure. The most effective therapy for the patient of depression is cognitive behavioral therapy (CBT). It is the technique to reduce depression by changing thought patterns. CBT helps patients to reduce the stress of study and society, cope with the complicated relationships, and increasing the interest in different physical activities. There is various kind of CBT include; interpersonal therapy (IPT), Mindfulness-based cognitive therapy (MBCT), and behavior therapy. Then there is E-therapy. It is online therapy most suitable for the patient who cannot visit the doctor often or when there is no physician nearby. This is like a self-guide in which patient is the therapist for himself. He works according to the program with the help of the therapist. The patient can take help from people around him that are family and friends. The best guidance that a doctor can give to the patient is to take a break from the stressor. It can be done by involving different activities to step away from the stressor and keeping the mind busy. The best options to cope with the stressor are the exercise and getting social support ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"0UaYekPU","properties":{"formattedCitation":"(\\uc0\\u8220{}Promoting Healthy Mental Development: A Bright Futures Online Curriculum,\\uc0\\u8221{} n.d.)","plainCitation":"(“Promoting Healthy Mental Development: A Bright Futures Online Curriculum,” n.d.)","noteIndex":0},"citationItems":[{"id":621,"uris":["http://zotero.org/users/local/rVaVAHaF/items/3XVVHBK4"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/3XVVHBK4"],"itemData":{"id":621,"type":"webpage","title":"Promoting Healthy Mental Development: A Bright Futures Online Curriculum","URL":"https://www.brightfutures.org/development/adolescence/depression.html","accessed":{"date-parts":[["2019",5,10]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (“Promoting Healthy Mental Development: A Bright Futures Online Curriculum,” n.d.).


Adolescence is the stage when an individual moves from childhood to adulthood. At this stage teens often face both physical and psychological changes. These changes bring lots of issue like aggression, self-esteem, peer pressure, depression, alcoholism, sexual problem, and suicide. Depression is an issue which leads to other problems like self-esteem, alcoholism, and suicidal ideation. External stressors like loss of loved one, family adversity, chronic medical conditions, and most importantly study difficulties increase the chances of depression in teens. Various symptoms can detect depression which includes; changes in eating habit and sleeping pattern, a decrease in the interest in studies and physical activities, and they try to be isolated as much as possible. To diagnose the problem, patient should consult with the physician and physician should use assessment strategies and options like medication, therapy, and proper guidance to reduce the depression.


ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY beyondblue. (n.d.). Psychological treatments for depression. Retrieved May 10, 2019, from https://www.beyondblue.org.au/the-facts/depression/treatments-for-depression/psychological-treatments-for-depression

Five tips to help manage stress. (n.d.). Retrieved May 10, 2019, from https://www.apa.org website: https://www.apa.org/helpcenter/manage-stress

Melinda. (2018, November 2). Depression Treatment - HelpGuide.org. Retrieved May 10, 2019, from https://www.helpguide.org/ website: https://www.helpguide.org/articles/depression/depression-treatment.htm

Promoting Healthy Mental Development: A Bright Futures Online Curriculum. (n.d.). Retrieved May 10, 2019, from https://www.brightfutures.org/development/adolescence/depression.html

Subject: Healthcare and Nursing

Pages: 3 Words: 900

Adult Health 1

Adult Health 1

[Name of the Writer]

[Name of the Institution]

Adult Health 1


Asthma is a chronic airway disorder which consists of blockage of the airway while coughing and sneezing. The shortness of breath can also be classified in Astha disorder. The pathophysiology of Asthma would consist of its diagnostic and treatment plan that would help the nurse organize specific interventions (Sullivan et al, 2016). The blockage of airway due to inflammation can cause hyperresponsive impairment. These are some of the diagnostics and symptoms of this disorder while its treatment plan would be discussed below in the discussion. Similarly, Pneumonia is an infection in both lungs due to bacterias and viruses. Due to these causes, the airway can become congested and could make it hard for the patient to breathe properly. It can generally be found in an age group of either old people or young children over the age of 5. The discussion would evaluate the pharmacology, assessment, nursing care plan, and diagnostic of the given disorders.



The patient with a history of asthma and in the current state with pneumonia would require intensive care which would be assessed through the diagnostic information. The impact of pneumonia on the body consists of affecting the respiratory system, circulatory system, muscular system, and immune system (Simonsen et al. 2015). Asthma management by a nurse involves both long-term and acute treatment process. The medication plan or the pathophysiology of the disorder depends on the patients physical and health characteristics. Patients medical history would also be pertinent for the nurse in case immediate action is required. The psychological agent which is mostly used for patients suffering from pneumonia is Levofloxacin which treats CAP caused by the disorder. As for asthma, a B2 agonists inhaler can be used to stop an acute asthma attack. This agent includes corticosteroids which can stabilize cells within the body and help the airway expand while reducing blockage (Bai et al. 2019).

The nurse would require the aforementioned pharmacology along with an assessment plan. This can be initiated through a lab and diagnostic test of the patient. Patient education is critical to optimize environment control and recognize specific symptoms. The nurse would have to evaluate a care plan to treat the patient effectively. The nurse would have to obtain lab tests which include appropriate medications and therapies. A full respiratory assessment would involve checking to breathe, repositioning, suctioning, etc. Also promoting normothermia is another choice. Optimizing fluid balance and inducing cluster care is primitive and essential to conserve patients energy for tasks such as ambulation or eating. The nurse should continually encourage the patient to breathe deeply and exchange gas occasionally. Nutrition is also supplementary along with the chosen medication plan which would prevent further infection in the lungs.


The discharge plan for the patient would consist of taking the aforementioned medications promptly. Drinking at least eight glasses of water daily to help loosen up the throat and reduce coughing. Using a cool-mist humidifier in the patient's bedroom is also required. Moreover, using warm compressions or eating pads will also help the patient with experiencing relive from chest discomfort. Getting flu shorts annually and taking plenty of rest is considerably important. Follow up a care plan, and constant check-ups from the doctor are required. Medical care should be immediately sought when the pain in the chest starts to swell along with lips turning blue due to breathing trouble. In the case of blood coughing or mucus products, the patient should immediately call your doctor or get admitted. Patient education along with recognizing the symptoms is highly essential for the understanding of the assessment and pathophysiology of the disorders.


Bai, C., Xu, J., Ma, K., Huang, L., Liu, S., Jiang, X., ... & Gu, X. (2019). Yinlai decoction alleviates lipopolysaccharide-induced pneumonia by changing the immune status of juvenile rats: a study based on network pharmacology. Journal of Traditional Chinese Medical Sciences.

Simonsen, D. F., Søgaard, M., Bozi, I., Horsburgh, C. R., & Thomsen, R. W. (2015). Risk factors for postoperative pneumonia after lung cancer surgery and impact of pneumonia on survival. Respiratory medicine, 109(10), 1340-1346.

Sullivan, A., Hunt, E., MacSharry, J., & Murphy, D. M. (2016). The microbiome and the pathophysiology of asthma. Respiratory research, 17(1), 163.

Subject: Healthcare and Nursing

Pages: 2 Words: 600

Advance Care Planning

Advance Care Planning

[Author Name]

[Institutional Affiliation(s)]

Advance Care Planning


It is the legal right of every citizen to access quality health care. Also, decisions regarding health care preferences at any stage of life is the right of every citizen. However, as soon as a person grows old people around them try to take hold of their situation and make health care decision on their behalf without their consent. Advance care planning is a process that allows an individual to make plans regarding their future health care preferences and decisions. These plans will help people when they are not in a position to make health care decisions (Detering & Silvester, 2010). However, several ethical dilemmas arise when specifically, discussion about end of life process and demands for specific treatments by the patients. This paper will discuss the ACP process, its benefits and ethical dilemmas regarding decisions made by patients while also incorporating legislature regarding ACP.


Due to the increased life expectancy aging population is growing in Australia. According to the statistics over 1 in every 7 Australian is aged 65 or more. Despite increased life expectancy older people are more prone to several diseases. Typically, older people living with chronic illness can face an emergency at any time that can cause severe consequences. At the time of emergency healthcare professionals are required to make several decisions to safe patient’s life (Gómez & Quintana, 2018). However, to treat any patient it is important to know their preferences regarding their treatment. This cause an extreme ethical dilemma where a doctor has to save his patient’s life while also taking into account a patient’s preferred treatments.

Many countries such as Australia, Canada and USA, etc have given right to every citizen to refuse unwanted medical treatment. According to Australian law, every competent adult has the right to refuse certain medical treatment, now and in the future. ACP in Australia relies upon this act and allow citizens to choose their preferred treatment. Many health care professionals must be taught about the ACP process so that they can help their patients in understanding it. This will further help health care practitioners in discussing this process with their patients that are older and have a chronic illness. As older people who are unaware of the ACP process can face certain difficulties in case of emergency. Also, their families have to face ethical obstacles while making a difficult decision regarding the treatment of their family member.

In ACP process there are two methods by which a person health preferences can be known. The first method is a substitute decision-maker in which a surrogate can decide on behalf of the patient. This surrogate can be any person whom patients have authorized. The second method is to complete the advance care directive. This document contains details of a person’s health care preferences. ACP reduces the stress and anxiety of a person as by planning future health care decisions a person does not have to worry during an emergency where he would not be able to take decisions (Johnson & Tattersall, 2017). However, the most neglected part of ACP is the end of life decision. The EOL will let the person to choose natural death or to use medical technologies to increase life span. (Chan & Bowers, 2016).

Life is a gift of God and as a human, it is our responsibility to protect this gift. Although there are several benefits of ACP such as a person does have to depend upon others will to get treated. However, the end of life part of this process is against moral and religious values. Although natural death without any pain is every person’s dream yet still if a life can be saved using medical technologies then it is important to consider the treatment. As there are many cases in which after relying upon medical technologies people get better and increase their life expectancy. Specifically, several patient’s demand physician-assisted suicides, or ask illegal drugs that may help them getting relief from pain is another disadvantage of end of ACP and EOL process (Derse & Limehouse Jr, 2019). Another point of concern arises when a patient’s APC document or attendants refused to get the nutrition through feeding tubes PEG. Most people will not allow the physician to use these tubes while most of them demand to remove the tubes to safe patient from pain and prolonged death (Karnik & Kanekar, 2016, June). However, it is necessary to safe a person’s life as long as possible as miracles do happen and by removing feeding tubes or demanding PAS can finish the chances of patient’s betterment. It is, therefore, necessary to educate people regarding the APC process and legal implications of this process so that people can make better decisions regarding their future treatments.


ACP process is an important process that may help an individual in making the most important health decisions that may help him or her in future. Specifically, in elderly people this process is more efficient as with the increased life expectancy there is a very large elderly population. Also, most of the elderly people are living with chronic illness such as COPD, kidney and heart problems etc. Due to which they have to prepare themselves for emergencies. ACP will not only help them but will help their families, as well as the family members, do not have to make a difficult decision on their behalf. However, there are certain ethical issues with the ACP process (Detering & Silvester, 2010). The most important is EOL. Most of the patients' demands physician-assisted suicide and reject feeding tubes to end their life and free themselves from pain, which is ethically wrong (Cooper, 2017). This causes severe problems for the physicians as well because in most of the countries PAS are not allowed yet still they have to follow their patient’s will. Thus, people must first understand the legal implications of ACP while also incorporate physician’s recommendations as well so that better health decisions can be made.


Chan, R. J., Webster, J., & Bowers, A. (2016). End‐of‐life care pathways for improving outcomes in caring for the dying. Cochrane Database of Systematic Reviews, (2).


Cooper, J. (2017). End-of-life: An exercise in comprehension. In Ethics in Mental Health-Substance Use (pp. 315-332). CRC Press.

Detering, K. M., Hancock, A. D., Reade, M. C., & Silvester, W. (2010). The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. Bmj, 340, c1345.

Derse, A. R., Moskop, J. C., McGrath, N. A., Vearrier, L. E., Clayborne, E. P., Goett, R. R., & Limehouse Jr, W. E. (2019). Physician‐assisted Death: Ethical Implications for Emergency Physicians. Academic Emergency Medicine, 26(2), 250-255.

Gómez-Batiste, X., Blay, C., Broggi, M. A., Lasmarias, C., Vila, L., Amblàs, J., ... & Quintana, S. (2018). Ethical challenges of early identification of advanced chronic patients in need of palliative care: the Catalan experience. Journal of palliative care, 33(4), 247-251.

Johnson, S., Kerridge, I., Butow, P. N., & Tattersall, M. H. (2017). Advance Care Planning: is quality end of life care really that simple?. Internal medicine journal, 47(4), 390-394.

Karnik, S., & Kanekar, A. (2016, June). Ethical issues surrounding end-of-life care: a narrative review. In Healthcare(Vol. 4, No. 2, p. 24). Multidisciplinary Digital Publishing Institute.

Subject: Healthcare and Nursing

Pages: 3 Words: 900

Advance Directive & Physician Orders For Life-Sustaining Treatment

Advance Directive & Physician Orders for Life-Sustaining Treatment

Author Name

[Institutional Affiliation(s)]

Author Note

Advance Directive & Physician Orders for Life-Sustaining Treatment

An advance directive is also known as a living will or advance health care directive. It is a legal document in which an individual specify what action should be taken for their health if they are unable to decide for themselves due to incapacity and illness. The advance directive was created in response to the increasing prevalence and sophistication of medical technology. Many studies have demonstrated the main deficit in the medical care of dying. There are many formats of advance directives. Some follow forms that are outlined in state law while others are created by patients themselves and lawyers. Court and state law decides whether these documents are valid or not. The advance directive can be used to indicate health care treatment preferences such as dying process management and personal values about quality of life. The law allows but does not need other preferences to be documented such as the arrangement of autopsy and funeral, appointment of a guardian and tissue and organ donation. Under the California state law, a person has a legal right to express their health care wishes and to have them considered when they are not able to make decisions themselves ADDIN EN.CITE <EndNote><Cite><Author>Yadav</Author><Year>2017</Year><RecNum>1320</RecNum><DisplayText>(Yadav et al., 2017)</DisplayText><record><rec-number>1320</rec-number><foreign-keys><key app="EN" db-id="axzrwpxxqvwtw5evsf3xrer2arfwsa5f0e5d" timestamp="1575051056">1320</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Yadav, Kuldeep N</author><author>Gabler, Nicole B</author><author>Cooney, Elizabeth</author><author>Kent, Saida</author><author>Kim, Jennifer</author><author>Herbst, Nicole</author><author>Mante, Adjoa</author><author>Halpern, Scott D</author><author>Courtright, Katherine R</author></authors></contributors><titles><title>Approximately one in three US adults completes any type of advance directive for end-of-life care</title><secondary-title>Health Affairs</secondary-title></titles><periodical><full-title>Health Affairs</full-title></periodical><pages>1244-1251</pages><volume>36</volume><number>7</number><dates><year>2017</year></dates><isbn>0278-2715</isbn><urls></urls></record></Cite></EndNote>(Yadav et al., 2017). California consolidated different earliest forms of personal health care preferences into one advance care directives. California health care directive form can be valid in other states but it can confuse the person's wishes because the laws of other states can give different meanings to the terms which are used in this document. The Health Care Decision Act formulated an advance directive in California and is based on the uniform law commission act. This advance directive is in the California probate code under section 4670.

Advance directive form of California consist of 5 different parts. Part 1 is known as the power of attorney for health care. This part allows a person to name someone who can decide on his health care. The power of attorney becomes effective when a doctor determines that the patient is not able to understand the consequences and nature of his health care decision. Part two of this form includes instruction for individuals. In this part, choices are provided to the patient to express his wishes regarding withholding and provision of treatment. Part 3 allows the person to express his wishes regarding organ donation. Part four of the advance directive form allows the patient to designate his physician to have the main responsibility for his health care. The last part of this form includes the signature and provision of witnesses required to make the document effective. The physician orders for life-sustaining treatment (POLST) is an order for the physician that outlines a plan of end of life care reflecting both judgments of physicians based on medical evaluation and preferences of the patient concerning care at life ends. The main aim is to allow patients and physicians to establish default order concerning life end care which can be conveyed clearly to other health care and emergency personnel. The POLST form is completed by the physician in collaboration with the patient regarding the treatment preferences and current and future health conditions of the patient. POLST form must be signed by both physicians and patients. In a case where a patient is not able to make a medical decision then legally recognized decision makes of the patient can participate in signing and completion of a form. This form should specifically be considered for patients with metastatic disease or those having the metastatic diagnosis. This form is also appropriate for patients residing permanently in long term health care facilities. This form should be filled by a person who is seriously ill and towards the end of life. This form will give medical orders to emergency personnel based on the patient current medical situation. The form is completed by the health care provider after discussing with the patient what is important for him, his diagnosis and future prediction of disease. To make POLST form legal signatures of legal representatives, patient, witness, and authorized practitioner are necessary ADDIN EN.CITE <EndNote><Cite><Author>Shenk</Author><Year>2019</Year><RecNum>1319</RecNum><DisplayText>(Shenk, Vranas, Lin, Slatore, &amp; Sullivan, 2019)</DisplayText><record><rec-number>1319</rec-number><foreign-keys><key app="EN" db-id="axzrwpxxqvwtw5evsf3xrer2arfwsa5f0e5d" timestamp="1575050970">1319</key></foreign-keys><ref-type name="Book Section">5</ref-type><contributors><authors><author>Shenk, JL</author><author>Vranas, KC</author><author>Lin, AL</author><author>Slatore, CG</author><author>Sullivan, DR</author></authors></contributors><titles><title>POLST-Discordant Care Among Patients Presenting to the Hospital: A Qualitative Analysis</title><secondary-title>A22. FACILITATING PALLIATIVE AND END-OF-LIFE CARE</secondary-title></titles><pages>A1085-A1085</pages><dates><year>2019</year></dates><publisher>American Thoracic Society</publisher><isbn>1073-449X</isbn><urls></urls></record></Cite></EndNote>(Shenk, Vranas, Lin, Slatore, & Sullivan, 2019)

An advance directive is written on plain white paper whereas POLST is printed on brightly colored paper such as bright green or shocking pink. Although the white color is not mandatory it does promote recognition and visibility. Both of these are developed in a non-emergency situation. An advance directive is witnessed by two non-relatives or signed by a notary. To be legal, the POLST form must be signed by both the physician and the patient. An advance directive can be for anyone above age 18 and is developed at any stage of disease whereas POLST is developed for a person with serious illness at any age. An advance directive provides instruction for future treatment whereas POLST provides a medical plan for current treatment.

Patient autonomy means that a patient has a right to make his decision about medical care without the influence of health care providers. Patient autonomy allows health care professionals to educate patients but does not allow them to decide a treatment plan for them. Registered nurses seek to involve patients and help them understand different treatment options and collaborate with patients to achieve the goals of wellbeing. The nurse should respect the autonomy of the patient by giving them appropriate information and encourage them to participate in the decision-making process. Nurses play an important role in facilitating communication between patients and family members. Nurses should also demonstrate empathy for the patient and family members ADDIN EN.CITE <EndNote><Cite><Author>Sutton</Author><Year>2019</Year><RecNum>1321</RecNum><DisplayText>(Sutton, Brewster, &amp; Tarrant, 2019)</DisplayText><record><rec-number>1321</rec-number><foreign-keys><key app="EN" db-id="axzrwpxxqvwtw5evsf3xrer2arfwsa5f0e5d" timestamp="1575051162">1321</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sutton, Elizabeth</author><author>Brewster, Liz</author><author>Tarrant, Carolyn</author></authors></contributors><titles><title>Making infection prevention and control everyone&apos;s business? Hospital staff views on patient involvement</title><secondary-title>Health expectations</secondary-title></titles><periodical><full-title>Health expectations</full-title></periodical><dates><year>2019</year></dates><isbn>1369-6513</isbn><urls></urls></record></Cite></EndNote>(Sutton, Brewster, & Tarrant, 2019).


ADDIN EN.REFLIST Shenk, J., Vranas, K., Lin, A., Slatore, C., & Sullivan, D. (2019). POLST-Discordant Care Among Patients Presenting to the Hospital: A Qualitative Analysis A22. FACILITATING PALLIATIVE AND END-OF-LIFE CARE (pp. A1085-A1085): American Thoracic Society.

Sutton, E., Brewster, L., & Tarrant, C. (2019). Making infection prevention and control everyone's business? Hospital staff views on patient involvement. Health expectations.

Yadav, K. N., Gabler, N. B., Cooney, E., Kent, S., Kim, J., Herbst, N., . . . Courtright, K. R. (2017). Approximately one in three US adults completes any type of advance directive for end-of-life care. Health Affairs, 36(7), 1244-1251.

Subject: Healthcare and Nursing

Pages: 3 Words: 900

Advanced Care Planning & Directives

Advance Care Planning and Directives

[Name of the Writer]

[Name of the Institution]

Advance Care Planning and Directives


There is a lot of difference in communication, planning and end of life decisions. It should not be the place of intensive care unit where such type of choices is going to be taken as measures for the implementation long before the times comes for its application. Advance care planning and directives in the palliative care are significant and guide the healthcare professionals in Victoria to work under the legal framework provided over it. Various ethical principles are also attached to advance care planning (ACP), and it should be followed accordingly. The use of ACP/ACD is an essential aspect, and it is mostly referred to the nature of patients. If a person has the severity of issue which comes suddenly than it would not work because of the limited time.


Planning is always essential regarding health care issues and the chance to make decisions receive at a time when someone is unable to speak for itself. The objective is to increase the independence and health of individual faced at the end of its life. The process is compassionate, and with the support and education, it is easy to sustain with changes in health. For example, the knowledge of contingent heart defect will positively impact the health and complete the process adequately. Over time changes occurred in the health of a person includes the completion of advance directives after the documentation (Bryant et al., 2015). In general advance directives is the written statement which provides the medical information about the health of a person. Throughout the regions of the United States and especially victories, these are actively served for the best interests of the patient.

When someone fails to decide about his/her health, these documents provide the opportunities and way for others to read the case study and take appropriate decision. There is nothing right and wrong instead it is the health of person which itself shows what to do and how to move for the completion of the process (Waldron et al., 2016). Further, the communities have devised specific laws which are known as legal requirements, fact sheets and forms in Victoria. The law provided that during serious injury one cannot decide about its health because values, beliefs and expectation of patient are already ensured and considered. It allows the team to treat the person without waiting for its consent. Other steps for the advance care planning will incorporate the values of being open, ready and be heard.

These laws encourage the person to talk about preferences and beliefs along with the decision of appointing substitute decision maker. The sharing of documentation is allowed with the doctors, carers, friends and family. There would be significant benefits of sharing the information with other individuals, and everyone will be informed accordingly. The distribution of information is again essential because it shows the support of many people for the early recovery of the patient. Further, the speaker who deals all the matter would be appointed according to the Victorian Civil and Administrative Tribunal (VCAT) laws. The designated person must have a continuous relationship with a patient which signifies as the spouse or domestic partner, primary care, adult child, parent and the adult sibling.

There is a form given to the patient for the appointment of another decision maker for medical treatment in Victoria. It is vital that the chosen person must accept the responsibility of caring and overviewing the patient (Sudore et al., 2017). The legal limitations and conditions will be followed by the appointed individual who shows that one should carefully choose the person for the right job. Preferences for the care would follow the lines and directions issued according to the laws and rules of Victoria. Further, the ethical values are also included in those directions that are published on behalf of the Victoria laws and system for running the patient with severity. One of the significant challenges that occurred during the treatment is the conflict between family members and the health care professional (Lotz et al., 2015). It is because of the terminologies used by the health care personnel concerning the treatment of the patient. These confusing and tremendous terms create difficulty for an ordinary person.

It is mentioned in the laws that every difficulty or the hindrance on the part of the centre or particular unit would result in the action against the responsible person. Use of the right tools is always appreciated to minimise appropriate level intervention for the patient. There are specific questions in the mind of a patient which according to Victoria laws must be satisfied by the concerned authority for a smooth running of the business inside and outside the hospital. The effective advance care planning has the measurement to enhanced comfort for individual and removes all the concerns that are placed before them. Carelessness of any type would result in action against the employee and staff available on duty. One can empower itself by talking with the ACHD provider and take necessary decisions about end of life change and choices. There must be a plan in place to cater to such concerns and illness.

Regarding the personal opinion and assessment of advance care and planning, I would prefer these plans and especially those who are underlined by the Victoria laws and followed by certain ethics. These are very important because of the severity of health and anything that happened with a person in one or the other way (Murray et al., 2017). We need to appreciate such efforts and practices introduced by the concerned organisations so that everyone could have the facility of dealing with its health condition which can be disturbed at any time. A person is taken to hospital with a heart attack, and he or she is facing the severity of the situation will be affected if it is not given the due care. Even those who are already admitted in the care centres should follow certain ethics and organisational norms like the practice of advance care.

Events or happening related to the health will not wait for someone to come and rescue the person from a bad position.

Plans are always, and these should be considered for immediately responding to the critical condition. Presence of professional along with medication can only be possible when there is a plan of action. Without it, there would be no execution, and many examples are available on the record (Chan et al., 2016). The clinical papers and research are supported by the fact that these measures should be encouraged to allow the other facilities of health care in Australia for adjusting advance care planning. However, any direction that negates the values and ethics should not be allowed to operate because it will cause negativity for the already existing operations of health care and planning.


Concluding the assessment, it is notable to mention that advance care and planning is one of the significant tool used by the people across Australia and other regions. There must be support and encouraging elements that can enhance such practices for the betterment and well-being of patients. A sense of control is better than no knowledge of health care and what is going on in the future. Over time evaluation and reviewing is also a great source of learning and stability of the individual health.


Bryant‐Lukosius, D., Carter, N., Reid, K., Donald, F., Martin‐Misener, R., Kilpatrick, K., & DiCenso, A. (2015). The clinical effectiveness and cost‐effectiveness of clinical nurse specialist‐led hospital to home transitional care: a systematic review. Journal of evaluation in clinical practice, 21(5), 763-781.

Bryant‐Lukosius, D., Spichiger, E., Martin, J., Stoll, H., Kellerhals, S. D., Fliedner, M., & Schwendimann, R. (2016). Framework for evaluating the impact of advanced practice nursing roles. Journal of Nursing Scholarship, 48(2), 201-209.

Chan, R. J., Webster, J., & Bowers, A. (2016). End‐of‐life care pathways for improving outcomes in caring for the dying. Cochrane Database of Systematic Reviews, (2).

El-Jawahri, A., Paasche-Orlow, M. K., Matlock, D., Stevenson, L. W., Lewis, E. F., Stewart, G., ... & Temel, J. S. (2016). A randomised, controlled trial of an advance care planning video decision support tool for patients with advanced heart failure. Circulation, 134(1), 52-60.

Epstein, R. M., Duberstein, P. R., Fenton, J. J., Fiscella, K., Hoerger, M., Tancredi, D. J., ... & Kaesberg, P. (2017). Effect of a patient-centred communication intervention on oncologist-patient communication, quality of life, and health care utilisation in advanced cancer: the VOICE randomised clinical trial. JAMA oncology, 3(1), 92-100.

Farrelly, S., Lester, H., Rose, D., Birchwood, M., Marshall, M., Waheed, W., ... & Thornicroft, G. (2016). Barriers to shared decision making in mental health care: a qualitative study of the Joint Crisis Plan for psychosis. Health Expectations, 19(2), 448-458.

Lotz, J. D., Jox, R. J., Borasio, G. D., & Führer, M. (2015). Pediatric advance care planning from the perspective of health care professionals: a qualitative interview study. Palliative Medicine, 29(3), 212-222.

Lund, S., Richardson, A., & May, C. (2015). Barriers to advance care planning at the end of life: a systematic explanatory review of implementation studies. Plus One, 10(2), e0116629.

Murray, S. A., Kendall, M., Mitchell, G., Moine, S., Amblàs-Novellas, J., & Boyd, K. (2017). Palliative care from diagnosis to death. BMJ, 356, j878.

Radbruch, L., Leget, C., Bahr, P., Müller-Busch, C., Ellershaw, J., De Conno, F., ... & board members of the EAPC. (2016). Euthanasia and physician-assisted suicide: a white paper from the European Association for Palliative Care. Palliative Medicine, 30(2), 104-116.

Rietjens, J. A., Sudore, R. L., Connolly, M., van Delden, J. J., Drickamer, M. A., Droger, M., ... & Orsi, L. (2017). Definition and recommendations for advance care planning: an international consensus supported by the European Association for Palliative Care. The Lancet Oncology, 18(9), e543-e551.

Sudore, R. L., Lum, H. D., You, J. J., Hanson, L. C., Meier, D. E., Pantilat, S. Z., ... & Kutner, J. S. (2017). Defining advance care planning for adults: a consensus definition from a multidisciplinary Delphi panel. Journal of pain and symptom management, 53(5), 821-832.

Waldron, N., Johnson, C. E., Saul, P., Waldron, H., Chong, J. C., Hill, A. M., & Hayes, B. (2016). Development of a video-based education and process change intervention to improve advance cardiopulmonary resuscitation decision-making. BMC health services research, 16(1), 555.

Weaver, M. S., Heinze, K. E., Kelly, K. P., Wiener, L., Casey, R. L., Bell, C. J., ... & Hinds, P. S. (2015). Palliative care as a standard of care in pediatric oncology: Pediatric blood & cancer, 62(S5), S829-S833.

You, J. J., Downar, J., Fowler, R. A., Lamontagne, F., Ma, I. W., Jayaraman, D., ... & Neary, J. (2015). Barriers to goals of care discussions with seriously ill hospitalised patients and their families: a multicenter survey of clinicians. JAMA internal medicine, 175(4), 549-556.

Subject: Healthcare and Nursing

Pages: 4 Words: 1200

Advanced Care Planning & Directives

Advanced Care Planning & Directives

[Name of the Writer]

[Name of the Institution]


Advance care planning refer to the advance discussions concerning patients healthcare with the healthcare staff. Advance care planning facilitates those who have the ability to take rational and benefitting decisions to reflect and recognise the significance and concern of their health status to develop goals, in order to prepare for the consequences in advance with the help of healthcare experts and family. Advance Care Planning (ACP) takes into account the psychological and social areas into consideration. ACP applies to everyone at any stage in life; however, it is specifically designed to target end-stage life and those terminally ill. It reassures planning amongst individuals to assign a representative to respond to their needs and preferences in a setting where they are unable to do it themselves appropriately CITATION Rob14 \l 1033 (Robert A. Pealrman, 2014). ACP aims to accommodate to the needs of the patients who do not have the ability to appoint their physicians and reflect upon their choice of treatment. Advance care planning in adults develops the consistency of care with patients. It can help in building the communication between the patient and healthcare providers, trust, avail better medical satisfaction, reduction in patient anxiety and an increase in quality of life. Advance Care planning has gained more interest as the number of research, campaigns, books, awareness initiatives and law keep on contributing to it. A significant number of papers and research journals persisting to eliminate the gap and add quality to the process. Such initiatives have shown prolific results and have been recognised by the state appreciatively.


The advance care planning revitalises the need to make rightful and well-informed decisions in a situation, unfortunately where one is unable and has lost the ability to undertake medical help. Advance care planning and directives work on the narrative of a substitute who takes the decision on the patient's behalf. Successful ACP initiatives do not only guarantee that the health care staff and patient communicate about their future medical considerations but also ensure that such records move along stages of care as they proceed along health care settings. CITATION Hic05 \l 1033 (Hickman SE, 2005). The process is inclusive of an advance narrative document known as Advance Directive which keeps a record of the preferences, beliefs and values for their well being. The individual assigned the document is known as the surrogate decision maker CITATION Adv19 \l 1033 (Advance Care Planning Australia). The document usually withholds the transfer of legal authority to take decisions on behalf of the patients' inability to make them, in a standardised format generally understood by healthcare staff. This also leads to more efficient and productive medical services. The goals of ACP are multi-dimensional mirroring upon autonomy exercised by the patient; to maximise the contribution to their health and to minimize the harm CITATION Rob14 \l 1033 (Robert A. Pealrman, 2014). Advance Care Planning has received a considerably immense amount of optimistic response amongst adults. It has resulted in an increased understanding of patients wishes and reduced end life hospitalisation CITATION Ten07 \l 1033 (Teno JM, 2007).

Legal Framework in Victoria

In Victoria, Advance Care Planning is a legally perceived notion of an individual's consensual record regarding their health care preferences. It is majorly categorised and provided to aged, life threatening situations, end-life/life- limiting conditions, in cognitive conditions and unforeseen occurrences. Victorian Parliament passed Medical Treatment Planning and Decisions Act in 2016 stating directives and making it an obligation for the individuals and healthcare providers CITATION adv19 \l 1033 (advance-care-planning, 2019). It further clarifies that the Advance Care is not a substitute for consent in regular treatment cases, a choice or a medium to attain reasonable and favourable healthcare with equitable resources amongst the public or an alternative for personal clinical services and engagements. The legislation on advance care planning is widely ensured around health care units and organisations through an efficient mode of strategy meeting the needs of local communities, their practices and learned informed empathetic health practitioners.

Ethical Principles

Ethical principles are the most central to advance care planning since they build and develop trustworthy ties with the adults to provide optimal health support to them. It brings individuals and those who are close to them and medical staff to discuss their future course of care. It should comprehensively include the needs and desires of the individual regarding health and medical care priorities. The individuals shall have access to understanding of the information they desire to know regarding their future course of care.Advance Care planning shall be updated as the over time as individuals life status and age change, in order to prepare for a particular strategy for medical treatments.

Moreover, significant decisions shall be in compliance with the Victorian law, healthcare expert and circumstances the individual is experiencing and lastly the most important ethical principle is to take into consideration and record the individual's values and beliefs when it comes to making decisions to healthcare providers. (Institute of Medicine. Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life, 2015)

Benefits and Barriers

Advance Care Planning provides the advantage of direction to the family and relative in accordance with taking informed healthcare decisions when it comes to the individual in reference. Moreover, it gives legitimate authority to the surrogate decision maker to uphold the individual's preferences. It lifts the burden of anxiety and moral misery from the substitute of not maintaining the desires of the individual CITATION Elp05 \l 1033 (Elpern EH, 2005 ). It also minimises the fear and concerns of taken care of in time of need and treated with effective healthcare, particularly in end life situations. It further gives the individuals the option to die in a place of their choice Advance Care Planning also increases mortality rate significantly and help those with incognitive issues to plan their care and treatments before their condition deteriorates. Not only does the process ease the individuals and their families it also helps the healthcare providers to shift from curative care to palliative care controlling the symptoms than curing the illness, hence improving the quality of life CITATION Bri14 \l 1033 (al, 2014). There are specific barriers to the advance care planning making it challenging to operate productively such as thinking and discussing the end stage of life by the individual or family members with the healthcare staff. Also, many people are not fully aware of the advance care planning and may not opt for it for better care in their end-life stages. And lastly, it is uncomprehendable by ACP to indulge in the unpredictability of the individual's situations is known CITATION Joh10 \l 1033 (Johnson MJ, 2010.)


The advance care planning recognises the very importance of the decisions by the individual's health care needs mainly when they are unable to undertake them, themselves. They are facilitated by the healthcare organisations and legislation to bring the best to near life-ending stages or a comfortable experience with chronic illness through advance care directives. These documents outline the individual's choices, values and beliefs which are then accomplished by their surrogate decision makers. Although positive and successful results have emerged by effectively proceeding with programme however still more to be done to come to an arrangement with better end life experiences through individuals own consent and choices. The initiatives shall mark more significant change in accepting the reality of deterioration t with care and smooth journey onwards.


BIBLIOGRAPHY Advance Care Planning Australia. (n.d.). Retrieved March 2019, from www.advancecareplanning.org.au.

advance-care-planning. (2019). Retrieved 2019, from www2.health.vic.gov.au: https://www2.health.vic.gov.au/hospitals-and-health-services/patient-care/end-of-life-care/advance-care-planning/acp-forms

al, B.-S. A. (2014). The effects of advance care planning on end-of-life care: a systematic review. Palliative Medicine , 28: 8, 1000-1025.

Elpern EH, C. B. (2005 ). Moral distress of staff nurses in a medical intensive care unit. Am J Crit Care. , 523-30. .

Hickman SE, H. B. (2005). Hope for the future: achieving the original intent of advance directives. Hastings Cent Rep , 26-30.

(2015). Institute of Medicine. Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. Washington, DC: The National Academies Press.

Johnson MJ, B. S. (2010.). ) Palliative and end-of-life care for patients with chronic heart failure and chronic lung disease. Clinical Medicine. Journal of the Royal College of Physicians of London , 10: 3, 286-289.

Manage, J. P. ( 2017 ). Defining Advance Care Planning for Adults: A Consensus Definition from a Multidisciplinary Delphi Panel. Author manuscript , 821–832.

Robert A. Pealrman, M. M. (2014). Advance Care Planning & Advance Directives. ETHICS IN MEDICINE University of Washington School of Medicine .

Teno JM, G. A. (2007). Association between advance directives and quality of end-of-life care: a national study. J Am Geriatr Society , 189.

Subject: Healthcare and Nursing

Pages: 4 Words: 1200

Advanced Care Planning & Directives

Victorian Legal Framework of ACP/ACD



With the advancements in almost every field of life, healthcare and nursing are also getting advanced and effective. Now, healthcare professionals are highly concerned to spread awareness among the people regarding chronic diseases, their interventions, and preventive measures. Due to such efforts of healthcare professionals and the use of advanced technology in healthcare, people are able to live longer with chronic disease and disability. Many of the people have an idea of how to medically manage chronic diseases and disabilities. However, still, a large size of the population is unaware of the preventive measures against chronic diseases and the importance of timely treatment. Thus, this study argues that legal implications of ACP/ACD and healthcare awareness are highly essential to prepare the population for their future medical care.

Victorian has recently formalized the law relating to ACP/ACD in order to address the health awareness issues. Advance Care Planning (ACP) supports adults at any stage of health in understanding their preferences, life goals, and personal values related to future medical care. The aim of the ACP is to ensure that people are aware of the preventive measures against chronic diseases and receive medical care, consistent with their preferences, goals, and values. However, the Advance Care Planning requires effective communication between the healthcare providers and patients, or between the family and patients. The communication helps the patients to take decisions regarding specific medical treatment. Simply, ACP is a continual process, where patients’ medical situation and prognosis are reviewed, his/her preferences are elicited, and medical dilemmas are discussed with the patient. This process requires detailed discussion between the patient and clinician, where the ethical issues and legal aspects need to be kept under consideration CITATION DJJ12 \l 1033 (Janssen, Engelberg, Wouters, & Curtis, 2012). In some situations, the patients are not mentally ready to take any decision regarding their medical treatment. In such a situation, the healthcare providers, friends, and family members prove to be the great support to prepare the patient regarding future medical treatment. This situation occurs to many parents at old age, when they lack their capacity to make the decision for them. Thus the surrogates, such as children, must communicate with the parents to prepare them for their medical treatment and help them in their better decision making. However, the ethical considerations and legal frameworks help the patients to choose their surrogate for decision making on behalf of the patient, and nothing can be done forcefully CITATION Det18 \l 1033 (Detering & Silveira, 2018).

To keep the ethical measures at priority, the legal frameworks support Advance Care Directives (ACD). ACDs are the documents a person completes in possession of decisional capacity regarding future medical care and right of decision making on his/her behalf when loses the capacity to make decisions regarding medical care. ACDs are used as a legal tool and do not necessarily require ACP. Similarly, ACPs do not always yield Ads. However, one thing needs to be clear to medical institution and surrogate that ACDs can only be used when the patient does not remain in the capacity to make decisions otherwise ACP is the best to prepare the patients for their future medical care CITATION SND06 \l 1033 (Davison & Simpson, 2006).

In Victoria, the legal framework also supports the legal documentation of the patient regarding future medical care. According to this framework, the patient must sign an Advance Care Directive before the medical treatment starts. According to this ACD, the patient authorizes the healthcare provider or the surrogate to take a decision when the patient does not remain in the capacity of taking decision for him/her. These ACDs prove to be a great help to the healthcare providers in case of emergency, when they have to take emergency decisions without getting patient involvement in the decision-making process CITATION Aus17 \l 1033 (Health, 2017).

The ethical principles related to ACP guide the healthcare providers and the surrogate regarding importance to the patients' will. Preparing someone for future medical care decisions is a sensitive process and legal restrictions. Victorian legal framework related to ACP provides proper documentation of how a healthcare provider or the surrogate must communicate with the patient regarding medical treatment. In this process, no one is allowed to force the patient in decision-making process instead the documentation supports the assistance to the patient regarding decision making for his/her future medical care in case he/she loses the capacity to make a decision and rest leave everything on patients' will. The ethical principals also restrict the healthcare professionals for taking medical care decision about the patient, in case of an emergency. The patients, via legal documentation, authorize an individual to take a decision on the behalf of the patient, and thus the professionals must consult to the authorized person in case of emergency and must follow his/her decisions even if healthcare providers do not agree with that. This is essential to keep the healthcare providers at the answerable position while keeping the patient's preferences at priority.

The use of ACP/ACD is beneficial for both; the patient and the healthcare providers. On behalf of the patient, keeping him/her satisfied before treatment is essential. When the patient completes the legal requirements of ACD, he/she remains satisfied regarding future medical care. It gives a thought to the patient that nothing wrong is going to happen even when he/she will not be in the capacity to make medical decisions for him/her. On the other hand, the healthcare providers use the proper conversation framework of ACP to prepare the patient regarding future medical care and complete process of ACD, via which they remain at the answerable position. However, according to ethical measures, the tool of ACP must be used properly to help the patient in their decision making, aware them regarding chronic diseases, and motivate them to remain prepared for fighting against the chronic diseases CITATION Ame181 \l 1033 (Physicians, 2018).

Detering & Silveira (2018) also supported the concept of ACP/ACD as it is the best way to communicate with the patients regarding future medical care while keeping all legal measures on priority CITATION Det18 \l 1033 (Detering & Silveira, 2018). Davison & Simpson (2006) conducted an interview-based qualitative study to evaluate what does the patient think about the use of ACP/ACD. The findings of the study also showed that ACP/ACD is the best way to motivate the patient in taking medical care decision. Especially, these legal tools are helpful to those, who are facing last stages of their chronic diseases and may lose their sense or capacity of decision making at any time CITATION SND06 \l 1033 (Davison & Simpson, 2006).

Conclusively, communication with the patient regarding chronic diseases also becomes the source of comfort to the patient, where he can discuss the medical issues with healthcare providers and can obtain the desired answers. Some patients are not physically and mentally strong enough to take serious decisions regarding their healthcare, thus ACP helps them to build their capacity of taking decision for their better and healthy future.


BIBLIOGRAPHY \l 1033 Davison, S., & Simpson, C. (2006). Hope and advance care planning in patients with end-stage renal disease: a qualitative interview study. BMJ, 333-886.

Detering, K., & Silveira, M. J. (2018). Advance care planning and advance directives. update.

Health, A. (2017). Advance care planning and the law: Victoria. Advance Care Planning Australia.

Janssen, D., Engelberg, R., Wouters, E., & Curtis, J. (2012). Advance care planning for patients with COPD: past, present and future. Patient Educ Couns, 86-19.

Physicians, A. C. (2018). ACP issues ethical guidelines for individuals participating in volunteer medical trips. Medical Press.

Subject: Healthcare and Nursing

Pages: 5 Words: 1500

Advanced Pathophysiology

Advanced pathophysiology

[Author Name(s), First M. Last, Omit Titles and Degrees]

[Institutional Affiliation(s)]

Author Note

[Include any grant/funding information and a complete correspondence address.]


Soreness of the protective coating of the stomach resulted in gastritis. It may happen for a short duration and prolonged disorder, depending on the severity of the inflammation. Acute gastritis includes unexpected, acute inflammation ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"a2hhd1udokv","properties":{"formattedCitation":"(Baker & Blakely, 2017)","plainCitation":"(Baker & Blakely, 2017)"},"citationItems":[{"id":105,"uris":["http://zotero.org/users/local/p8kwKNoG/items/NFHCINHV"],"uri":["http://zotero.org/users/local/p8kwKNoG/items/NFHCINHV"],"itemData":{"id":105,"type":"article-journal","title":"Gastrointestinal disturbances in the elderly","container-title":"Nursing Clinics","page":"419-431","volume":"52","issue":"3","author":[{"family":"Baker","given":"Natalie R."},{"family":"Blakely","given":"Kala K."}],"issued":{"date-parts":[["2017"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Baker & Blakely, 2017). Chronic gastritis implicates continuing and prolonged inflammation as a result of non-treatment.

Diagnosis and Treatment

A physical exam is performed to check for the signs and indications such as abdominal pain, nausea, fever, or black or glittery black feces. Blood test diagnosis is performed using a blood count test, liver functions test, H pylori test, and kidney function test. Urinalysis is also performed to check for the urine detailed examination. Endoscopy is performed to view stomach lining using an endoscope ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"a28n6s1vtqu","properties":{"formattedCitation":"(de Bortoli et al., 2013)","plainCitation":"(de Bortoli et al., 2013)"},"citationItems":[{"id":101,"uris":["http://zotero.org/users/local/p8kwKNoG/items/YLM8HGPH"],"uri":["http://zotero.org/users/local/p8kwKNoG/items/YLM8HGPH"],"itemData":{"id":101,"type":"article-journal","title":"Overlap of functional heartburn and gastroesophageal reflux disease with irritable bowel syndrome","container-title":"World journal of gastroenterology: WJG","page":"5787","volume":"19","issue":"35","author":[{"family":"Bortoli","given":"Nicola","non-dropping-particle":"de"},{"family":"Martinucci","given":"Irene"},{"family":"Bellini","given":"Massimo"},{"family":"Savarino","given":"Edoardo"},{"family":"Savarino","given":"Vincenzo"},{"family":"Blandizzi","given":"Corrado"},{"family":"Marchi","given":"Santino"}],"issued":{"date-parts":[["2013"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (de Bortoli et al., 2013). Occasionally biopsy is suggested to check for gastritis and other gastrointestinal tract disorders. Treatment methodologies lie on the cause of gastritis. Depending upon the severity of the disease, different treatment prescriptions are utilized, such as antacids, proton pump inhibitors, acid-reducing medicines, and probiotics are used. Proton pump inhibitors are the drugs that block the cells which produce stomach acid. It includes omeprazole and esomeprazole drugs ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"a7hqe13e0n","properties":{"formattedCitation":"(de Bortoli et al., 2013)","plainCitation":"(de Bortoli et al., 2013)"},"citationItems":[{"id":101,"uris":["http://zotero.org/users/local/p8kwKNoG/items/YLM8HGPH"],"uri":["http://zotero.org/users/local/p8kwKNoG/items/YLM8HGPH"],"itemData":{"id":101,"type":"article-journal","title":"Overlap of functional heartburn and gastroesophageal reflux disease with irritable bowel syndrome","container-title":"World journal of gastroenterology: WJG","page":"5787","volume":"19","issue":"35","author":[{"family":"Bortoli","given":"Nicola","non-dropping-particle":"de"},{"family":"Martinucci","given":"Irene"},{"family":"Bellini","given":"Massimo"},{"family":"Savarino","given":"Edoardo"},{"family":"Savarino","given":"Vincenzo"},{"family":"Blandizzi","given":"Corrado"},{"family":"Marchi","given":"Santino"}],"issued":{"date-parts":[["2013"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (de Bortoli et al., 2013). However, prolonged use can cause dementia and other nutrient deficit disorders. Medications used for acid reduction are usually recommended for minor cases of gastritis because these drugs can aid in pain reduction as well as restores stomach lining ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"a11vn9m0sfq","properties":{"formattedCitation":"(Baker & Blakely, 2017)","plainCitation":"(Baker & Blakely, 2017)"},"citationItems":[{"id":105,"uris":["http://zotero.org/users/local/p8kwKNoG/items/NFHCINHV"],"uri":["http://zotero.org/users/local/p8kwKNoG/items/NFHCINHV"],"itemData":{"id":105,"type":"article-journal","title":"Gastrointestinal disturbances in the elderly","container-title":"Nursing Clinics","page":"419-431","volume":"52","issue":"3","author":[{"family":"Baker","given":"Natalie R."},{"family":"Blakely","given":"Kala K."}],"issued":{"date-parts":[["2017"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Baker & Blakely, 2017). These drugs are ranitidine and famotidine. Antacids are the drugs that help in relieving pain as it neutralizes the acid. The use of probiotics is essentially important as it helps in restoring and reproducing healthy and digestive flora.


The prevalence of gastritis and gastrointestinal tract related disorders in the United States is around more than 40%. In this number prevalence of Helicobacter pylori is the highest. Prevalence among 100,000 population is approximately 30,000 in children in South America. Whereas it is 43000 in Central America. In the adult, it is even higher that is 82,000 in South and 65,000 in Central America ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"a6k48sfep4","properties":{"formattedCitation":"(Baker & Blakely, 2017)","plainCitation":"(Baker & Blakely, 2017)"},"citationItems":[{"id":105,"uris":["http://zotero.org/users/local/p8kwKNoG/items/NFHCINHV"],"uri":["http://zotero.org/users/local/p8kwKNoG/items/NFHCINHV"],"itemData":{"id":105,"type":"article-journal","title":"Gastrointestinal disturbances in the elderly","container-title":"Nursing Clinics","page":"419-431","volume":"52","issue":"3","author":[{"family":"Baker","given":"Natalie R."},{"family":"Blakely","given":"Kala K."}],"issued":{"date-parts":[["2017"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Baker & Blakely, 2017). The prevalence of gastric disorders is higher in developed countries. All age groups may develop this condition, but the prevalence increases with the age of the individuals. It is more often observed in Native Americans (54%).

Clinical Presentation

Patients with a positive medical history of heartburn, acidity, and gastritis often develop this condition with time. Clinical signs and symptoms comprise of throwing out, abdominal burning, pain, indigestion, and incomplete digestion, nausea, and vomiting. The primary cause of the disorder is gram-negative bacteria that is Helicobacter pylori ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"a1mhpv6t0o2","properties":{"formattedCitation":"(de Bortoli et al., 2013)","plainCitation":"(de Bortoli et al., 2013)"},"citationItems":[{"id":101,"uris":["http://zotero.org/users/local/p8kwKNoG/items/YLM8HGPH"],"uri":["http://zotero.org/users/local/p8kwKNoG/items/YLM8HGPH"],"itemData":{"id":101,"type":"article-journal","title":"Overlap of functional heartburn and gastroesophageal reflux disease with irritable bowel syndrome","container-title":"World journal of gastroenterology: WJG","page":"5787","volume":"19","issue":"35","author":[{"family":"Bortoli","given":"Nicola","non-dropping-particle":"de"},{"family":"Martinucci","given":"Irene"},{"family":"Bellini","given":"Massimo"},{"family":"Savarino","given":"Edoardo"},{"family":"Savarino","given":"Vincenzo"},{"family":"Blandizzi","given":"Corrado"},{"family":"Marchi","given":"Santino"}],"issued":{"date-parts":[["2013"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (de Bortoli et al., 2013). Symptoms of clinically diagnosed patients with gastritis involve upper abdominal area ache, bloating, and feeling full. In chronic cases of gastritis, patients subsequently have vomiting with blood or dark-colored fluid.


Numerous researches specify a noteworthy grade of overlay among irritable bowel syndrome (IBS) and gastroesophageal reflux disease (GERD). Similarly, together with functional heartburn and IBS have been seen in some patients ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"a11c1raljbb","properties":{"formattedCitation":"(Dunlap & Patterson, 2019)","plainCitation":"(Dunlap & Patterson, 2019)"},"citationItems":[{"id":104,"uris":["http://zotero.org/users/local/p8kwKNoG/items/KVN9K9LH"],"uri":["http://zotero.org/users/local/p8kwKNoG/items/KVN9K9LH"],"itemData":{"id":104,"type":"article-journal","title":"PEPTIC ULCER DISEASE","container-title":"Gastroenterology Nursing","page":"451-454","volume":"42","issue":"5","author":[{"family":"Dunlap","given":"Jayne Jennings"},{"family":"Patterson","given":"Sheila"}],"issued":{"date-parts":[["2019"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Dunlap & Patterson, 2019).

Acute gastritis

Due to the impairment and inflammation of the stomach lining, erosive gastritis evolves. Use of painkiller usually block the production of cyclooxygenase-1; this is a vital enzyme that works in the biosynthesis of the stomach wall ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"a2qd61f91r9","properties":{"formattedCitation":"(de Bortoli et al., 2013)","plainCitation":"(de Bortoli et al., 2013)"},"citationItems":[{"id":101,"uris":["http://zotero.org/users/local/p8kwKNoG/items/YLM8HGPH"],"uri":["http://zotero.org/users/local/p8kwKNoG/items/YLM8HGPH"],"itemData":{"id":101,"type":"article-journal","title":"Overlap of functional heartburn and gastroesophageal reflux disease with irritable bowel syndrome","container-title":"World journal of gastroenterology: WJG","page":"5787","volume":"19","issue":"35","author":[{"family":"Bortoli","given":"Nicola","non-dropping-particle":"de"},{"family":"Martinucci","given":"Irene"},{"family":"Bellini","given":"Massimo"},{"family":"Savarino","given":"Edoardo"},{"family":"Savarino","given":"Vincenzo"},{"family":"Blandizzi","given":"Corrado"},{"family":"Marchi","given":"Santino"}],"issued":{"date-parts":[["2013"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (de Bortoli et al., 2013). It leads to the development of ulcers in the stomach lining. Painkillers, NSAIDs, and aspirin damage and decline the levels of prostaglandin. Prolonged use of these drugs causes permanent damage that leads to the constant declining in the stomach lining ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ai49g9uvqn","properties":{"formattedCitation":"(Baker & Blakely, 2017)","plainCitation":"(Baker & Blakely, 2017)"},"citationItems":[{"id":105,"uris":["http://zotero.org/users/local/p8kwKNoG/items/NFHCINHV"],"uri":["http://zotero.org/users/local/p8kwKNoG/items/NFHCINHV"],"itemData":{"id":105,"type":"article-journal","title":"Gastrointestinal disturbances in the elderly","container-title":"Nursing Clinics","page":"419-431","volume":"52","issue":"3","author":[{"family":"Baker","given":"Natalie R."},{"family":"Blakely","given":"Kala K."}],"issued":{"date-parts":[["2017"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Baker & Blakely, 2017). The use of alcohol also corrodes the inner stomach lining.

Chronic gastritis

Prolonged use of drugs that damage the inner stomach wall, immune system dysfunction, and certain disorders become the cause of chronic gastritis. Disorders such as HIV/AIDS, connective tissue disorders, and liver damage can lead to gastritis. The immune system works in the production of antibodies, and it maintains homeostasis. However, due to some disorders or surgery, antibodies produced by the immune system could not recognize the stomach cells as body cells and attack them ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"aue15bmspj","properties":{"formattedCitation":"(de Bortoli et al., 2013)","plainCitation":"(de Bortoli et al., 2013)"},"citationItems":[{"id":101,"uris":["http://zotero.org/users/local/p8kwKNoG/items/YLM8HGPH"],"uri":["http://zotero.org/users/local/p8kwKNoG/items/YLM8HGPH"],"itemData":{"id":101,"type":"article-journal","title":"Overlap of functional heartburn and gastroesophageal reflux disease with irritable bowel syndrome","container-title":"World journal of gastroenterology: WJG","page":"5787","volume":"19","issue":"35","author":[{"family":"Bortoli","given":"Nicola","non-dropping-particle":"de"},{"family":"Martinucci","given":"Irene"},{"family":"Bellini","given":"Massimo"},{"family":"Savarino","given":"Edoardo"},{"family":"Savarino","given":"Vincenzo"},{"family":"Blandizzi","given":"Corrado"},{"family":"Marchi","given":"Santino"}],"issued":{"date-parts":[["2013"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (de Bortoli et al., 2013). As a result, the stomach wall, intestine wall injuries ended up in gastritis. Age is an important factor in the development of chronic gastritis.


It is a result of consistent damage to the mucosal replacement mechanism of the stomach coating. This outcome as a result of constant damage to gastric glands. The stomach wall has a mechanism in which it progressively replaces damaged cells with a new active protective sheet of cells. The underlying causes of the mucosal glands impairment are unknown; however, it is a chronic inflammation of the mucous cells.


Gastroesophageal reflux illness arises when gastric acid recurrently streams back into the esophagus. This backwash exasperates the lining of the esophagus. This effect aggravated with increasing age ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"aputidk5m5","properties":{"formattedCitation":"(Buttaro, 2019)","plainCitation":"(Buttaro, 2019)"},"citationItems":[{"id":103,"uris":["http://zotero.org/users/local/p8kwKNoG/items/9N63PJE8"],"uri":["http://zotero.org/users/local/p8kwKNoG/items/9N63PJE8"],"itemData":{"id":103,"type":"article-journal","title":"The Physiology and Psychology of Aging","container-title":"Case Studies in Geriatric Primary Care & Multimorbidity Management-E-Book","author":[{"family":"Buttaro","given":"Terry Mahan"}],"issued":{"date-parts":[["2019"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Buttaro, 2019). The continuous flow of gastric acids results in complications that may include mucosal damage. Patients suffering from gastritis often develop other gastrointestinal tracts related disorders such as gastroesophageal reflux disorder and peptic ulcer disease. The constant flow of gastric acid in the lining results in hoarseness of the throat. It may outcome in laryngitis and chronic dry coughing. Bad breath and sometimes difficulty breathing. The damage that outcome because of the immune system dysfunction, can aggravate the condition ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"aru47keprg","properties":{"formattedCitation":"(de Bortoli et al., 2013)","plainCitation":"(de Bortoli et al., 2013)"},"citationItems":[{"id":101,"uris":["http://zotero.org/users/local/p8kwKNoG/items/YLM8HGPH"],"uri":["http://zotero.org/users/local/p8kwKNoG/items/YLM8HGPH"],"itemData":{"id":101,"type":"article-journal","title":"Overlap of functional heartburn and gastroesophageal reflux disease with irritable bowel syndrome","container-title":"World journal of gastroenterology: WJG","page":"5787","volume":"19","issue":"35","author":[{"family":"Bortoli","given":"Nicola","non-dropping-particle":"de"},{"family":"Martinucci","given":"Irene"},{"family":"Bellini","given":"Massimo"},{"family":"Savarino","given":"Edoardo"},{"family":"Savarino","given":"Vincenzo"},{"family":"Blandizzi","given":"Corrado"},{"family":"Marchi","given":"Santino"}],"issued":{"date-parts":[["2013"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (de Bortoli et al., 2013). Peptic ulcer disorder and gastritis, if left untreated or due to constant gastric acid flow, can result in stomach bleeding, permanent loss to esophageal lining, and stomach cancers.

Mind Map

-647701358140Foreign protein (pathogen)

0Foreign protein (pathogen)

4705350243840 503872524765Antibiotics









495300070485Proton pump blockers

00Proton pump blockers

200024363855Bile, liver and kidney failure

0Bile, liver and kidney failure






4676775217170Clinical Manifestation

00Clinical Manifestation


left12065Connective tissue disorders

0Connective tissue disorders


4886325333375Abdominal bloating

00Abdominal bloating






12382529210040% population observed with H-pyloric in the US

0040% population observed with H-pyloric in the US






center172085Blood test

Blood test

4876800137795Loss of appetite

0Loss of appetite


left13970054% in Native Americans

0054% in Native Americans

666750139705295900290195center13970Stool test

Stool test

482917555880Severe Abdominal pain

00Severe Abdominal pain



ADDIN ZOTERO_BIBL {"custom":[]} CSL_BIBLIOGRAPHY Baker, N. R., & Blakely, K. K. (2017). Gastrointestinal disturbances in the elderly. Nursing Clinics, 52(3), 419–431.

Buttaro, T. M. (2019). The Physiology and Psychology of Aging. Case Studies in Geriatric Primary Care & Multimorbidity Management-E-Book.

de Bortoli, N., Martinucci, I., Bellini, M., Savarino, E., Savarino, V., Blandizzi, C., & Marchi, S. (2013). Overlap of functional heartburn and gastroesophageal reflux disease with irritable bowel syndrome. World Journal of Gastroenterology: WJG, 19(35), 5787.

Dunlap, J. J., & Patterson, S. (2019). PEPTIC ULCER DISEASE. Gastroenterology Nursing, 42(5), 451–454.

Subject: Healthcare and Nursing

Pages: 3 Words: 900

Advanced Pharmacology

Advanced Pharmacology


Affiliations with Institutes

Advanced Pharmacology


The patient is presented with symptoms of nausea, vomiting and diarrhea. HR appears to have some kind of chronic infection based on her medical history and current medication (Nifedipine 30mg daily, Synthroid 100mg daily and prednisone 10mg daily). The patient has also a history of hepatitis C and drug abuse.

Rationale for Diagnosis

Hepatitis C is an infection of the liver that is caused by the hepatitis C virus. It is usually transferred from infected person to person contact of bodily fluids and blood, sexual intercourse, and sharing of infected needles that are associated with illicit drug abuse ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"FnPqq7tp","properties":{"formattedCitation":"(Sullivan et al., 2018)","plainCitation":"(Sullivan et al., 2018)","noteIndex":0},"citationItems":[{"id":350,"uris":["http://zotero.org/users/local/qnvKw9vm/items/F97EESHQ"],"uri":["http://zotero.org/users/local/qnvKw9vm/items/F97EESHQ"],"itemData":{"id":350,"type":"article-journal","container-title":"JAMA psychiatry","issue":"5","page":"474-483","title":"The role of aging, drug dependence, and hepatitis C comorbidity in alcoholism cortical compromise","volume":"75","author":[{"family":"Sullivan","given":"Edith V."},{"family":"Zahr","given":"Natalie M."},{"family":"Sassoon","given":"Stephanie A."},{"family":"Thompson","given":"Wesley K."},{"family":"Kwon","given":"Dongjin"},{"family":"Pohl","given":"Kilian M."},{"family":"Pfefferbaum","given":"Adolf"}],"issued":{"date-parts":[["2018"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Sullivan et al., 2018). Synthroid 100 mcg is administered to the patient daily. This medicine has side effects if not taken properly or misused. The side effects associated with this drug include diarrhea, nausea, and vomiting. The patient is also taking prednisone which suppresses the immune system of individual. Therefore, the medical history and current medication shows that the patient is most likely to suffer from gastroenteritis.

Drug Therapy

Following the guidelines of the American Association for the Study of Liver Diseases, spontaneous and regular checkups and laboratory monitoring of infectious hepatitis C virus is recommended ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"pg3KaEfV","properties":{"formattedCitation":"(Sullivan et al., 2018)","plainCitation":"(Sullivan et al., 2018)","noteIndex":0},"citationItems":[{"id":350,"uris":["http://zotero.org/users/local/qnvKw9vm/items/F97EESHQ"],"uri":["http://zotero.org/users/local/qnvKw9vm/items/F97EESHQ"],"itemData":{"id":350,"type":"article-journal","container-title":"JAMA psychiatry","issue":"5","page":"474-483","title":"The role of aging, drug dependence, and hepatitis C comorbidity in alcoholism cortical compromise","volume":"75","author":[{"family":"Sullivan","given":"Edith V."},{"family":"Zahr","given":"Natalie M."},{"family":"Sassoon","given":"Stephanie A."},{"family":"Thompson","given":"Wesley K."},{"family":"Kwon","given":"Dongjin"},{"family":"Pohl","given":"Kilian M."},{"family":"Pfefferbaum","given":"Adolf"}],"issued":{"date-parts":[["2018"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Sullivan et al., 2018). It is important to clear persistent infection. Following the history and infection details, the drug therapy that is suggested to patient include a combination of Grazoprevir 100 IU/mL and Elbasvir 50 mg and a combination of Ritonavir (100mg) and Dasabuvir (600mg) daily. Counselling is also recommended for the patient on hydration, nutrition, and the use of hepatotoxic drugs.

Justification for Drug Therapy

Hepatitis C is significantly important to be treated at initial stages to stop infection. Initiate treatment as early as possible. Complete regular monitoring is essentially important for acute infection of hepatitis C ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"WmohmBPO","properties":{"formattedCitation":"(Martin, Gonzalez, Vassileva, & Bechara, 2015)","plainCitation":"(Martin, Gonzalez, Vassileva, & Bechara, 2015)","noteIndex":0},"citationItems":[{"id":351,"uris":["http://zotero.org/users/local/qnvKw9vm/items/BDRMUIQ6"],"uri":["http://zotero.org/users/local/qnvKw9vm/items/BDRMUIQ6"],"itemData":{"id":351,"type":"article-journal","container-title":"Neuropsychology","issue":"6","page":"926","title":"Delay discounting is greater among drug users seropositive for hepatitis C but not HIV.","volume":"29","author":[{"family":"Martin","given":"Eileen"},{"family":"Gonzalez","given":"Raul"},{"family":"Vassileva","given":"Jasmin"},{"family":"Bechara","given":"Antoine"}],"issued":{"date-parts":[["2015"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Martin, Gonzalez, Vassileva, & Bechara, 2015). Spontaneous clearance of infection of hepatitis is not suggested in this case, therefore, these drugs are recommended ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Wcq6Uisa","properties":{"formattedCitation":"(Talal, Thomas, Reynolds, & Khalsa, 2017)","plainCitation":"(Talal, Thomas, Reynolds, & Khalsa, 2017)","noteIndex":0},"citationItems":[{"id":349,"uris":["http://zotero.org/users/local/qnvKw9vm/items/TIE7KDPN"],"uri":["http://zotero.org/users/local/qnvKw9vm/items/TIE7KDPN"],"itemData":{"id":349,"type":"article-journal","container-title":"Annals of internal medicine","issue":"12","page":"897-898","title":"Toward optimal control of hepatitis C virus infection in persons with substance use disorders","volume":"166","author":[{"family":"Talal","given":"Andrew H."},{"family":"Thomas","given":"Dave L."},{"family":"Reynolds","given":"Jessica L."},{"family":"Khalsa","given":"Jag H."}],"issued":{"date-parts":[["2017"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Talal, Thomas, Reynolds, & Khalsa, 2017). Synthroid would be suggested as it is a hormone replacement therapy. The acute gastroenteritis would be treated by administering dimenhydrinate or cyclizine ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"KtTQIQxc","properties":{"formattedCitation":"(Alexandraki, Smetana, & Aronson, 2017)","plainCitation":"(Alexandraki, Smetana, & Aronson, 2017)","noteIndex":0},"citationItems":[{"id":348,"uris":["http://zotero.org/users/local/qnvKw9vm/items/NPNA7VDE"],"uri":["http://zotero.org/users/local/qnvKw9vm/items/NPNA7VDE"],"itemData":{"id":348,"type":"article-journal","container-title":"UpToDate. Retrieved from https: www. uptodate. com/contents/acute-viral-gastroenteritis-in-adults","title":"Acute viral gastroenteritis in adults","author":[{"family":"Alexandraki","given":"Irene"},{"family":"Smetana","given":"Gerald W."},{"family":"Aronson","given":"M. D."}],"issued":{"date-parts":[["2017"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Alexandraki, Smetana, & Aronson, 2017). An appropriate diet along with plenty of fluid intake would be recommended to treat acute gastroenteritis within 48 hours as this is caused by using drugs ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"uDQD3GzG","properties":{"formattedCitation":"(Szajewska et al., 2019)","plainCitation":"(Szajewska et al., 2019)","noteIndex":0},"citationItems":[{"id":347,"uris":["http://zotero.org/users/local/qnvKw9vm/items/QQTKX9PL"],"uri":["http://zotero.org/users/local/qnvKw9vm/items/QQTKX9PL"],"itemData":{"id":347,"type":"article-journal","container-title":"Alimentary pharmacology & therapeutics","issue":"11","page":"1376-1384","title":"Systematic review with meta‐analysis: Lactobacillus rhamnosus GG for treating acute gastroenteritis in children–a 2019 update","volume":"49","author":[{"family":"Szajewska","given":"Hania"},{"family":"Kołodziej","given":"Maciej"},{"family":"Gieruszczak‐Białek","given":"Dorota"},{"family":"Skórka","given":"Agata"},{"family":"Ruszczyński","given":"Marek"},{"family":"Shamir","given":"Raanan"}],"issued":{"date-parts":[["2019"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Szajewska et al., 2019). Utilizing these drugs would help the patient to recover from gastroenteritis and hepatitis C.


ADDIN ZOTERO_BIBL {"custom":[]} CSL_BIBLIOGRAPHY Alexandraki, I., Smetana, G. W., & Aronson, M. D. (2017). Acute viral gastroenteritis in adults. UpToDate. Retrieved from Https: Www. Update. Com/Contents/Acute-Viral-Gastroenteritis-in-Adults.

Martin, E., Gonzalez, R., Vassileva, J., & Bechara, A. (2015). Delay discounting is greater among drug users seropositive for hepatitis C but not HIV. Neuropsychology, 29(6), 926.

Sullivan, E. V., Zahr, N. M., Sassoon, S. A., Thompson, W. K., Kwon, D., Pohl, K. M., & Pfefferbaum, A. (2018). The role of aging, drug dependence, and hepatitis C comorbidity in alcoholism cortical compromise. JAMA Psychiatry, 75(5), 474–483.

Szajewska, H., Kołodziej, M., Gieruszczak‐Białek, D., Skórka, A., Ruszczyński, M., & Shamir, R. (2019). Systematic review with meta‐analysis: Lactobacillus rhamnosus GG for treating acute gastroenteritis in children–a 2019 update. Alimentary Pharmacology & Therapeutics, 49(11), 1376–1384.

Talal, A. H., Thomas, D. L., Reynolds, J. L., & Khalsa, J. H. (2017). Toward optimal control of hepatitis C virus infection in persons with substance use disorders. Annals of Internal Medicine, 166(12), 897–898.

Subject: Healthcare and Nursing

Pages: 1 Words: 300

Advanced Pharmacology

Advanced Pharmacology

[Author Name(s), First M. Last, Omit Titles and Degrees]

[Institutional Affiliation(s)]

Author Note

[Include any grant/funding information and a complete correspondence address.]

Advanced Pharmacology

Attention deficit hyperactivity disorder is a condition that makes it difficult for a person to control impulsive behaviors and to pay attention to. The person with ADHD is often restless and he feels constantly active. It is a childhood disorder that begins its symptoms in childhood. It initiates in childhood and develops with age. Persons with ADHD feel restless and have behavioral problems different from normal people. They are unable to control their aggression and impulsive behaviors.

The patient Katie is 8 years old and is active, clear and logical when visited hospital. She has properly dressed therefore, the behavior of the patient is improving with time ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"qCCmUUFK","properties":{"formattedCitation":"(Wiklund et al., 2019)","plainCitation":"(Wiklund et al., 2019)","noteIndex":0},"citationItems":[{"id":440,"uris":["http://zotero.org/users/local/qnvKw9vm/items/K8LMWDTW"],"uri":["http://zotero.org/users/local/qnvKw9vm/items/K8LMWDTW"],"itemData":{"id":440,"type":"paper-conference","container-title":"Academy of Management Proceedings","ISBN":"0065-0668","page":"17481","publisher":"Academy of Management Briarcliff Manor, NY 10510","title":"When ADHD helps and harms in entrepreneurship: An epidemiological approach","volume":"2019","author":[{"family":"Wiklund","given":"Johan"},{"family":"Lomberg","given":"Carina"},{"family":"Alkærsig","given":"Lars"},{"family":"Miller","given":"Danny"}],"issued":{"date-parts":[["2019"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Wiklund et al., 2019). She often felt lost in thoughts due to this disorder. The decision one would be prescribed by the physicians that she would be taking Wellbutrin medicine XL 150 mg daily and 1 mg orally intuniv ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"BYCLogkE","properties":{"formattedCitation":"(Bergey et al., 2018)","plainCitation":"(Bergey et al., 2018)","noteIndex":0},"citationItems":[{"id":439,"uris":["http://zotero.org/users/local/qnvKw9vm/items/2K2ZC6CM"],"uri":["http://zotero.org/users/local/qnvKw9vm/items/2K2ZC6CM"],"itemData":{"id":439,"type":"book","ISBN":"1-4214-2379-0","publisher":"JHU Press","title":"Global perspectives on ADHD: social dimensions of diagnosis and treatment in sixteen countries","author":[{"family":"Bergey","given":"Meredith R."},{"family":"Filipe","given":"Angela M."},{"family":"Conrad","given":"Peter"},{"family":"Singh","given":"Ilina"}],"issued":{"date-parts":[["2018"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Bergey et al., 2018). Along with that, she would be taking methylphenidate tablets that are chewable 10 mg orally.

The results of decision one have shown that the patient after four weeks has been reported to be more attentive in the morning classes as compared to in afternoon classes. Heart rate was recorded to be 130 beats per minute.

Decision two would be the same dose of Ritalin and has to revisit in 4 weeks. Ritalin LA 20 mg orally in the morning and have to discontinue Ritalin and start Adderall XR 15 mg orally. The results of decision two has suggested that the client is recovering and performing well in academics. Her heart rate was funny beats per minute in this visit.

Decision three would be the current dose of Ritalin LA and increase Ritalin LA 30 mg in the morning orally. Also, has to obtain EKG based on heart rate (Conners et al., 1998). The third decision was appropriate and was interactive in its results. The associated pharmacotherapeutics has the potential to effectively improve the condition of the patient ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"gZXoxn4E","properties":{"formattedCitation":"(Health (UK, 2018)","plainCitation":"(Health (UK, 2018)","noteIndex":0},"citationItems":[{"id":441,"uris":["http://zotero.org/users/local/qnvKw9vm/items/TR2AZRHN"],"uri":["http://zotero.org/users/local/qnvKw9vm/items/TR2AZRHN"],"itemData":{"id":441,"type":"paper-conference","ISBN":"1-85433-471-9","publisher":"British Psychological Society","title":"Attention deficit hyperactivity disorder: diagnosis and management of ADHD in children, young people and adults","author":[{"family":"Health (UK","given":"National Collaborating Centre for Mental"}],"issued":{"date-parts":[["2018"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Health (UK, 2018). Therefore, it was suggested to the patient that she is performing well in academics and attention has been sustained. She needs to continue this prescription along with proper care.


ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Bergey, M. R., Filipe, A. M., Conrad, P., & Singh, I. (2018). Global perspectives on ADHD: social dimensions of diagnosis and treatment in sixteen countries. JHU Press.

Conners, C. K., Sitarenios, G., Parker, J. D. A., & Epstein, J. N. (1998). Revision and standardization of the Conners' Teacher Rating Scale (CTRS-R): Factors, structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26, 279-291.

Health (UK, N. C. C. for M. (2018). Attention deficit hyperactivity disorder: Diagnosis and management of ADHD in children, young people, and adults.

Wiklund, J., Lomberg, C., Alkærsig, L., & Miller, D. (2019). When ADHD helps and harms in entrepreneurship: An epidemiological approach. Academy of Management Proceedings, 2019, 17481.

Subject: Healthcare and Nursing

Pages: 1 Words: 300

Advanced Pharmacology

Advanced Pharmacology

[Author Name(s), First M. Last, Omit Titles and Degrees]

[Institutional Affiliation(s)]

Author Note

[Include any grant/funding information and a complete correspondence address.]

Advanced Pharmacology

Mr. Akkad’s Case

The assigned case study reveals the story of an Iranian old man 76 years of age who was brought to the clinic by his family due to strange behavior. His family complained that Akkad’s attitude towards life changed dramatically for the previous two years. He started enjoying the things he used to criticize in the past and started depreciating religious practices. Moreover, he was suffering from dementia. He started forgetting things and names and started showing difficulty to find the right words while communication. The symptoms told by his family shows that he is suffering from Alzheimer’s disease (Landreth, Jiang, Mandrekar, & Heneka, 2008). It is a kind of dementia that causes problems with memory, think and behave. Cynthia Steele writes in her book Psychiatric Symptoms and Nursing Home Placement of Patients with Alzheimer's disease than Alzheimer's patients are generally affected after 65 years of age. Akkad is at the typical age when this disease affects people. The clinical interview of the client reveals that he appears to be a kind of frank but confused old man. His behavior is friendly, but an impulsive kind of person (Regland, Lehmann, Abedini, Blennow, Jonsson, Karlsson, & Gottfries, 2001). Mini-Mental State Exam of the patient also reveals normality as he scored 18 out of 30 with primary deficits in orientation, attention, registration, and recall. His son although insisted that the kind of less-serious attitude in talking about things he was showing was not typical to him a few years ago.

Decisions to Treat Patients

All the symptoms described in the case study show that Mr. Akkad is suffering from Alzheimer’s disease which is an incurable disease yet, but some important steps taken by a healthcare professional can minimize the level of suffering of the patient and his relatives/friends, and it might also add some years to the age of the patient. Following decisions are important to treat such patients:

Exercise and healthful diet

Conversation Sessions

Routine Check-up and Tours

Mr. Akkad’s case reveals that he has not reached a serious stage of the disease although he is near to that. He has lived a major part of his life, but the case study does not reveal any other health issue with the old man. He might suffer from loneliness and thoughts of the past which makes his mind tired and he turns silly (Mayeux, & Sano, 1999).

The first decision is to engage Mr. Akkad in some productive mental, oral, and physical exercise. Richard Mayeux argues in his journal Treatment of Alzheimer's disease. New England Journal of Medicine that Alzheimer's disease damages the human brain, but medical scientists do not know what causes this damage and how this can be stopped. Therefore, they suggest drugs that lessen the pain, but no medicine is available to rebuild the broken brain cells. What we can do is strengthening the immune system of Mr. Akkad rather than any other method (Steele, Rovner, Chase, & Folstein, 1990). Light exercise and conversation sessions with Mr. Akkad can help his mind to become comparatively stronger and brain healthier. I would also ask his family to tolerate his behavior and keep him engaged in productive discussion, mostly which interests him. A healthful diet can also help Mr. Akkad to have a stronger immune system. Although medical scientists have not yet invented a medicine for the disease, natural foods like almonds, nuts, milk, and vegetables in a reasonable amount can empower his body to build a competent defense against the disease (Schelterns, & Feldman, 2003). Mr. Akkad is at the stage where medical check-up becomes necessary for people, and I suggest proper medical and psychological check-ups of Mr. Akkad to prolong the severity of the disease. Finally, I would decide to refer some tours to the patient. Authors of the book Treatment of Alzheimer’s disease with clioquinol. Dementia and geriatric cognitive disorders argue that identification of Alzheimer’s disease is the obvious declaration of a person’s death. We might lessen the patient’s pain, but we cannot cure this disease. My decision to suggest the patient tours is intentioned to keep him active and curious about new and charming objects of the world so plaques and tangles would slowdown growing and dentate gyrus would enhance its growth. Plaques and tangles are presumably responsible for Alzheimer’s disease and dentate gyrus enhances curiosity.


Steele, C., Rovner, B., Chase, G. A., & Folstein, M. (1990). Psychiatric symptoms and nursing home placement of patients with Alzheimer's disease. The American journal of psychiatry.

Mayeux, R., & Sano, M. (1999). Treatment of Alzheimer's disease. New England Journal of Medicine, 341(22), 1670-1679.

Regland, B., Lehmann, W., Abedini, I., Blennow, K., Jonsson, M., Karlsson, I., ... & Gottfries, C. G. (2001). Treatment of Alzheimer’s disease with clioquinol. Dementia and geriatric cognitive disorders, 12(6), 408-414.

Landreth, G., Jiang, Q., Mandrekar, S., & Heneka, M. (2008). PPARγ agonists as therapeutics for the treatment of Alzheimer's disease. Neurotherapeutics, 5(3), 481-489.

Doody, R. S., Raman, R., Farlow, M., Iwatsubo, T., Vellas, B., Joffe, S., ... & Aisen, P. S. (2013). A phase 3 trial of semagacestat for treatment of Alzheimer's disease. New England Journal of Medicine, 369(4), 341-350.

Schelterns, P., & Feldman, H. (2003). Treatment of Alzheimer's disease; current status and new perspectives. The Lancet Neurology, 2(9), 539-547.

Subject: Healthcare and Nursing

Pages: 2 Words: 600

Advanced Pharmacology



Institutional Affiliation


How a behavioral aspect, such as smoking Affect pharmacokinetic and pharmacodynamic processes for patients with cardiovascular diseases

Stroke has led to many deaths in the USA. When stroke disease is related to other diseases such as diabetes and hyperlipidemia and hypertension, it kills faster. However, hypertension and diabetes can be modified based on the risk factor of stroke, Smoking, diabetes, and hypertension, which can be classified as risk factors of stroke (Burnier, 2018).

Hypertension and stroke

Hypertension can be considered as a major risk factor of ischemic stroke. Elevated systolic pressures can be considered as a major risk factor for stroke. However, isolated systolic hypertension is another risk factor for stroke in older people who might also be having type 2 diabetes (Burnier, 2018). Controlling blood pressure has been proved to reduce the risk of stroke. About 130/80 mm Hg is recommended for hypertensive diabetic patients (Askari& Lincoff,2010). However, there is no information about a drug that can help in preventing stroke to those patients who have hypertensive diabetes (Burnier, 2018). However, good control of Blood pressure is recommended. Thus, this calls for a multi-drug policy. Clinicians have recommended a combination of some drugs such as calcium channel blockers, angiotensin‐converting enzyme (ACE) inhibitors, and angiotensin receptor blockers.

Diabetes and stroke

Many patients have diabetes combined with stroke. Patients having glucose intolerance are likely to suffer from brain infractions (Burnier, 2018). This risk is usually greater in women than in men. Hyperglycemia has been proved to affect the outcome of stroke disease to nondiabetic and diabetic patients. Hyperglycemic increases the production of lactate in the brain, thus promoting the conversion of hyperperfused tissues to areas of infarctions. On the other hand, insulin resistance happens to be a risk factor for those that have type 2 diabetes (Maleki,., Alizadehasl, & Haghjoo, 2018).

Hypertension and diabetes

Various studies have shown that BP control in patients improves the risk of various cardiovascular diseases such as stroke (Maleki,., Alizadehasl, & Haghjoo, 2018). However, the role in which angiotensin receptors paly in patients that have diabetes is not clearly explained (Askari& Lincoff,2010). The losartan intervention is also known to reduce hypertension effectively as compared to B- blocker therapy. On the other hand, patients are advised to quit smoking by all means.

Hyperlipidemia and lipid-lowering therapy

Most of the information that relates to cholesterol-lowering in patients with diabetes has been obtained from information on patients with coronary heart disease (GOSWAMI, 2019). This study has shown that lowering lipids using statins reduces the probability of stroke incidences. Reduce stroke using lipid-lowering therapy has been demonstrated by the use of gemfibrozil and statins.

Smoking and its effects

Smoking greatly affects hyperlipemia, stroke, hypertension, and diabetes management. Drugs may not work effectively when a patient who is trying to manage this disease continues to smoke. Smoking is a significant cause of death in patients who have cardiovascular diseases. It also causes cardiovascular events (GOSWAMI, 2019). Smoking is a significant cause of cardiovascular diseases. Thus, for a patient who wants to manage cardiovascular diseases effectively, they need to take the recommended drugs as well as quitting smoking. If a patient continues to smoke, he is likely to continue suffering significant attacks of cardiovascular diseases, which could lead to death (Watson& Zibadi, 2018). It has been estimated that one out for four of people suffering from cardiovascular diseases, die out of smoking. Chemicals associated with smoke make a cell in blood vessels to become inflamed and swollen. This makes the blood vessels inflexible and can lead to many cardiovascular conditions. Atherosclerosis is a situation where arteries narrow, becoming less flexible. It occurs when substances in the blood form a plague in the walls of the blood arteries. On the other hand, stroke is caused when the blood that flows through the brain is interrupted. Stroke is likely to cause significant damage to the brain, which can lead to death. On the other hand, smoking can lead to high blood sugars and insulin resistance. Diabetic patients are likely to lose their lives if they continue smoking since the intake of tobacco may cause drugs to be ineffective (Watson& Zibadi, 2018). People that smoke many cigarettes in a day have a high chance of losing their lives compared to other people. On the other hand, hyperlipidemia means that there is too much cholesterol in the blood. Smoking is known to lower HDL, which is a protective effect against multiple heart diseases. HDL is very crucial for women that have high cholesterols. For drugs to work adequately, patients must be advised to quit smoking by all means.

How changes in the processes might impact the patient's recommended drug therapy

However, when a patient smoke while still suffering from stroke, hypertension, diabetes, and hyperlipemia, he still can be put on medication after being advised to stop taking cigarette (Watson& Zibadi, 2018). The pharmacist can use polypharmacy to administer drugs to the patient. Polypharmacy is a situation where a patient is advised to take multiple drugs for treatment. A patient is expected to take 5 to 12 drugs. However, these drugs should be prescribed by a medical PR actioner. This kind of medication is mostly prescribed to older people as compared to young people. This is because there are always suffering from multiple medical conditions.

How you might improve the patient's drug therapy plan

However, the first step to treating a patient who smokes is outlining various ways in which he can quit smoking (Askari& Lincoff,2010). He can decide to stop smoking, This may not happen abruptly, but he can choose to reduce a cigar a day (GOSWAMI, 2019). Smokers that are unable to quit on their own can be put under nicotine replacement therapy. The patient should start taking the drugs a few days before the day they have set to quit smoking. A Patient can also be put under varenicline medication, which helps people to stop smoking by affecting the nicotine receptors which are located in the brain. It works by making a person get less pleasure in smoking while it also reduces symptoms that are associated with nicotine withdrawal.


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

Burnier, M. (2018). Drug adherence to hypertension and cardiovascular protection.


Maleki, M., Alizadehasl, A., & Haghjoo, M. (2018). Practical cardiology.

Watson, R. R., & Zibadi, S. (2018). Lifestyle in Heart Health and Disease.

Subject: Healthcare and Nursing

Pages: 3 Words: 900

Adverse Event Reporting

gifC Xbjbj,(,( NBNBP 8,( ,QL_)d9C)d)d)d)d)d)d@5)bJU0t)dT)d( )d0

Title of Paper

Your name

HCA375 Continuous Quality Monitoring and Accreditation

Type Instructor Name Here

Type Date



Refer to the instructions in the Week 4 Assignment of your online course to understand what is expected in each row. This completed template should be between eight to ten pages in length. Include APA citations within the description row where appropriate. List your references in APA format according to the HYPERLINK https//awc.ashford.edu/Index.html Ashford Writing Center guidelines on the last page of this template.

DESCRIPTIONADVERSE EVENT The inappropriate prescribing of medication by the nurse to the patient of extreme depression. The overdose of psychiatric drug resulted on seizure. The event reflects the overdose of norepinephrine-serotonin reuptake inhibitors (SNRIs). The scenario reflects that the nurse failed to adopt adequate healthcare standards or to maintain quality that could assure patients welfare. HISTORICAL BACKGROUNDIn total 9 adverse event of medication error occurred during the last week with 20 interruptions. The mean time of interruption is recorded. The failure in medication events is recorded. Statistical software is used for analysis of data. The background provide practical implications of a delay in medicine administration due to interruption. In the nine medical events, 20 interruptions were recorded. The central cause of interruptions was a delay in medications preparation by nurses. The average delay in time is recorded as 2.5 minutes. It also reveal that 3.6 of the interruptions were due to clinical errors. The disruptions result in the delayed medical administration that undermines the patients right to quality service.LEGAL ACCREDITING AGENCY REQUIREMENTSInstitute of Medicine (IOM) stresses selecting the best practices that minimize the chances of errors in hospitals. The Medical Errors Reduction Act (2000) is applicable that identifies policies providing directives for appropriate medication handling. These healthcare policies restrict hospitals for avoiding the excessive and wrong use of medications. They provide the legal and regulatory framework for the hospitals. In the article, the authors explain medical errors indicates the failure of hospitals to adhere to the healthcare policies. Interruptions are due to the procedural errors caused by the negligence of the staff.

The principles of safe medication highlighted by Medication Error Prevention Act 2000 focuses on procurement, storage, supply, dispensing and prescribing guidelines. The hospitals are required to follow these principles. It stresses maintaining records of scheduled and non-scheduled medications. It explain that the purpose of medical administration is to promote quality and safety. The article explains that the event of errors undermines patients safety that is against the principles of Poisons and overdose.

Patient Safety and Error Reduction Act stresses on the need for advocating adequate medication systems and procedures. CQI TEAM COMMUNICATIONAn important step in the process of recognizing errors is to establish link between the leader/ manager and the nurses. The nurse leader will explain the principles of Patient Safety and Error Reduction Act states that every individual has the right to safe and high-quality care. The issues highlighted by the team related to the medicine

administration errors have relevance with the policies on quality healthcare of America.

The CQI team is responsible for the ongoing improvements of the healthcare services and the elimination of errors from the hospital settings. Necessary communication is established among team members so they could coordinate the issues on immediate basis. The team identify gaps and issues in the healthcare services and suggest solution for the problem.

This requires good interpersonal skills of the team leader for giving instructions and taking notice of the situation. Effective communication is crucial for maintaining continuous interaction with the team and staff. OPERATIONAL OR SAFETY PROCESSES The Patient Safety and Error Reduction Act is adopted that raise concerns about the promotion of safe health by uncovering the failures of hospitals to adopt procedural principles for efficient management of medications. The outcomes of the study reveal that the delay in nurses response causes interruptions that undermines the accuracy in medicinal administration.IMPACT OF THIS EVENT Patients right is violated in the hospital as the patient fails to receive quality service due to an interruption in medicinal administration. The event provides practical observations on the negligence of the patients right to safe treatment. The event had negative impact on the health of the patient as he experienced seizures due to overdose. This also increased the duration of his stay at the hospital. The nurse failed to offer required quality of care and left the patient unsatisfied.



You are tasked with graphing the data in Excel for your chosen event. The data is located in the classroom under the Week 4 Assignment Directions. Make sure to use only the data for your chosen event. The directions identify which columns of information to use depending on the chosen adverse event. Once you complete the graph in Excel, copy/paste your graph below.

Include an analysis of the data in paragraph format.

Discuss the frequency of the adverse event as compared to the increase or decrease of patient discharges. EMBED Excel.Chart.8 s What is the data telling youThe data depicts that 50 of the medication errors were due to negligence from the nurse. It also states that 10 of the errors were due to lack of coordination among nurse leader and the junior nurse and 20 errors were due to slow response. The remaining 20 errors were due to lack of nurse experience. The data reveals implications of medical errors caused by interruptions in hospital. The data followed a well-established goal for identifying the role of nurses in interruptions. It suggests that interruptions are the significant cause of medical errors. The preventing of the medical administration errors is an essential criterion for hospitals defined by the healthcare policies of Medication Error Prevention Act 2000. What possible factors in your opinion could be attributed to the changeThe possible factors that could have caused errors in medication include failure of the nurse to follow the guidelines presented on Patient Safety, incompetency of nurses, lack of experience, delayed response and inadequate coordination between leader and nurse (Siriwardena, 2009).

A Nursing care plan needs a revision because the patients health is extremely important and any error in judgment can produce detrimental effects. Revision for birth identifies all complexities that the patient has at that time. The rationale for revision at 1-2 months is to identify the changes in the physical and medical conditions of the patient. Similar criteria are used for 2-3 months and 2-3 years (Aronson, 2009).

The most appropriate action is to call the physician for the dose because administration of morphine involves serious legal concerns. The consultation of the physician will provide a better idea of choosing an appropriate course of action.



Choose one of the CQI Tools listed below to illustrate the use of the tool with your chosen Adverse Event.

Fish bone diagram

Limited infrastructure Training

Space in the hospital Skills buildings

Communication techniques Practicing

The CQI tool selected for the adverse event because it calrly identify the causes of medication errors. The fish bone diagrem is used for detemining the challenges faced by the nurse in proper administration of medicines. This is an effective tool used for adressing the causes of change outcome. By aadopting adequate stratgies and interventions it is possible to overcome the challenges for attaining high quality in the provision of healthcare services. In the current scenario the fish bone diagram is used for presenting solutions for building a professionaly competent nurrse who is capable of prescribing and administrating medications in appropriate manner. This suggests overcoming challenges such as lack of infrastructure, inadequate training and awareness. By provision of adequate training aand knowledge the nurse would be able to take responbsibility of providing right dosage.

Skills building and evaluation are part of plan that will familiarize nurses with the aaccurate procedures of medications. The evaluation involves determination of the skills and level of care delivery under the instructions of the nurse leader. It include observations of how student nurse responds to the instructions of the supervisor. It further involves assessment of the junior nurses knowledge associated with the emotional needs of the patients. The evaluation is also dependent on the determination of nurse awareness related to the physiological needs of the patients. Their competency depends on their performance skills and care delivery. Their ability to prioritize the tasks also reveals their level of competency and knowledge. The assessment also involves observation on how nurse responds to the supervisor and his awareness on the non-complex cases. The second level involve the evaluation of the initiation and management skills of the nurse. It uncovers the ability to deliver care to the patients according to their needs. It depends on nurse knowledge about medicines and safe administration of the practice. His ability to perform skills and deliver care in complex situations is also part of it. it further involve observations on the ability to manage workloads and priorities. The training also focuses on the ability to lead, plan and deliver appropriate care to the patients. It involve assessment of personal skills and knowledge, without the dependence on supervisors instruction. nurse dedication towards patient, families and community is an effective tool for evaluating performance level. An appropriate tool to measure the competency is to determine the responsibility of the nurse.






Team members


Data collected

Pilot phaseThe adverse event caused seizures to the patient and delayed his process of recovery.

The objective is to adopt effective care plan that will eliminate the possibilities of medication errors.

The team members of the plan include nurse leader, nurses, staff and the administration.

The leader is responsible for establishing efficient communication procedures. The tools adopted for communication include projectors, sms, video conference and internet. Ability to work in a cooperative environment. Expressing motivation and concerns about the patient care. Expression of enthusiasm for work. Friendly behavior and positive attitude. Avoiding aggression or expression of displeasure with patients.

Data will be collected through COPE system that will record the errors each day. The number of medication errors performed by the nurses will be recorded automatically. Online medication administration records will be maintained. Entries are processed electronically that will save time and provide immediate access to the data.

Pilot testing is developed that will require setting of infrastructure for COPE. The applications will be modified and the systems will be used for storing data. The nurses will be provided guidance for referring the COPE in case of confusion. Every time they prescribe a medicine they will enter data.

Potential settings for pilot testing include a unit that directly admits the patients. One medicine unit will instruct nurse about drug doses. DOThree possible solutions

One solution to implement

Result of pilot (create own scenario

Methods of communicationAdoption of stewardship program involves a set of strategies employed for improving the administration of medications. Nurses have a crucial role in appropriately giving the medications to the patients that lead to their health enhancement and wellness. The stewardship programs have significant roles in transforming the practice of medications, making them more influential and error free. It suggests the initiation of the antibiotics for treating infections that are focused on reducing morbidity. I find that the purpose of the antibiotic stewardship in clinical settings is to avoid the risks of wrong and inappropriate administration of the medication. The hospitals are not paying much attention to improve the antibiotic use that will lead to further complications (Olans, Olans, DeMaria, 2016). Antibiotic stewardship is an effective approach for making the best use of the antibiotics. Providing awareness to nurses who directly interact with the patient, so they need to possess good understanding and awareness on the right directions of prescribing medications. There is a need for bridging the gap between nurses perceptions of the program and the actual use of medicines. The hospitals are unable to carry the successful implementation of the awareness program until they involve the nurses. The clinics and hospitals have unrecognized the role of nurse that exists in the guidelines.

The incorporation of the Computerized Provider Order Entry (CPOE) system for medical analysis on daily activities increases the possibilities of maximizing patients wellbeing. Although nurses are integral to the practice, there is a need for recognizing their roles. Their roles are crucial in the optimization of the medications use in in-patient and out-patient settings.

Standardizing height and wright measurements will also eliminate likelihood of medication errors. They are the healthcare providers who spent the most time with the patients, giving them the opportunity to observe the patients and assess their needs. There are many activities that the nurses are capable of performing on a daily basis such as prescribing the right dose and the time of taking medicine. The nursing knowledge on hygiene will help them in guiding the patients about washing hands, using equipments properly and avoiding contact with unhygienic tools. They tell them the need for taking more fluids and what can be done for avoiding the side effects. The common roles of nurses associated in the administration of the medications include the adoption of the right techniques.

Stewardship program.

Identification of the training requirements. Feedbacks suggested revising the process because nurses wanted to understand in simple language.

The tools adopted for communication include projectors, sms, video conference and internet.STUDYSummarize data

Observations and problems

Comparison of pilot plan to pilot results

Revisions needed to meet objectiveThe nurses need to adopt adequate models for administrating the right use of medications. Collaboration with colleagues and the staff assist them in creating mechanisms for evaluating assessing the patients need.

Consulting senior nurse or physician for prescribing right dose is another strategy for controlling errors. Nurses have significant roles in encouraging the transition from the intravenous drugs to oral antibiotics. Nurses identify the conditions of the patients and decide the right dosage.

The non-pilot results reflected that all methods are effective for the removal of medication errors and the enhancement of healthcare. Pilot results suggested revising the process by considering feedbacks of young nurses who need more training. It suggest considering patients needs on planning care management, managing activities in time, putting all efforts to enhance the quality of health and application of clinical rules, procedures and adhering to the policies of the hospital. The question determined the professional skills by assessing ability to determine the patients problems, administrating of the acquired professional skills and capability of using the equipment and keeping them in good condition.

Assigning challenging roles to young nurses because it is not adequate to rely on nurse leader. Better methods of training were suggested that assure utilization of funds in appropriate manner.

It stresses more on the knowledge and skills of the nurse. The concept of medical administration states the determination of the appropriate steps for listed according to the priority. The proper administration of the medications, injections and care are part of the process. The concept of the medical administration allow nurse to take efficient decisions regarding medications, treatments and tests. The assessment also involves observation on how nurse responds to the supervisor and his awareness on the non-complex cases.

Conducting evaluations at the end of week or month is more advisable for minimizing the prevalence of medication errors from the healthcare settings.

ACTRevised improvement plan

How to Implement the plan hospital wide

Plan for monitoring the improvement plan

Checks and balanceStaff nurses have critical roles in the stewardship functions whose role is unrecognized. In the practical clinical environment, nurses act as first responders to the antibiotics because they are acting as communicators and coordinators of care. They are monitoring the conditions of the patient for 24 hours and are the immediate responders to the patients. Through formal education and adequate skills set the nurses manages to administer medications in required doses that lead to the maximum health enhancement of the patient. The education and awareness of the health care provider regarding the program play a significant role in its effective use. The healthcare sector has established the formal stewardship program for the last fifteen years, focused on infection prevention and disease prevention.

The plan will be implemented by developing infrastructure and installing the COPE systems. This will require funds and resources from the stakeholders and investors. The hospital will explain interest of stakeholders for convicting them. A training program on medications and use of COPE system will be conducted. This will provide opportunities to the staff nurse to familiarize themselves with the techniques of avoiding errors in medications.

The nurse leader will be responsible for reviewing the COPE entries for assuring that the nurses are complying with the medication standards that fulfill the conditions of Patient Safety Act. Leader will also be responsible for determining the errors caused due to overdose, wrong prescription or other issues. The nurses engaged on errors will be called and asked to justify their act. In case of severe adversity such as patients death the standards of the Medication Error Act will be followed. Training is provided for

Considering patients needs on planning care management.

Managing activities in time.

Putting all efforts to enhance the quality of health.

Application of clinical rules, procedures and adhering to the policies of the hospital.

Application of the critical skills for identification of the problems faced by the patient.

Determination of the immediate changes in patients condition.

Solving problems of the patient in a friendly manner.

Relying on personal knowledge and skills.

Ability to motivate other colleagues.

Providing guidance and assisting them.

Helping beginner nurses.

Ability to work with team members in a collaborative manner.

Accepting feedbacks and suggestions and avoiding conflicts.


Aronson, J. (2009). Medication errors what they are, how they happen, and how to avoid them. An International Journal of Medicine, 102 (8), 513521.

Olans, R. N., Olans, R. D., DeMaria, A. (2016). The Critical Role of the Staff Nurse in Antimicrobial StewardshipUnrecognized, but Already There. CLINICAL PRACTICE.

Siriwardena, A. N. (2009). Using quality improvement methods for evaluating health care. Quality in Primary Care, 17, 1559.

C Competent



Guidance and standards

Providing awareness

Instructing to follow standards

Removing overwork

Eliminating stress

Nurse capacity

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Teresa ThomasAB CT

Subject: Healthcare and Nursing

Pages: 10 Words: 3000

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