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write a discussion for the following prompt: 

J.C is an 82-year-old white man who was evaluated by GI specialist due to abdominal discomfort, loss of appetite, weight lost, weakness and occasional nausea.

Past Medical History (PMH):
Patient is Diabetic, controlled with Metformin 500 mg by mouth twice a day, Lantus 15 units SC bedtime. Hypertensive, controlled with Olmesartan 20 mg by mouth once a day. Atrial Fibrillation, controlled with Rivaroxaban 15 mg by mouth once a day and bisoprolol 10 mg by mouth once a day.

Labs:
Hb 12.7 g/dl; Hct 38.8% WBC 8.2; Glycemia 74mg/dl; Creatinine 0.8 mg/dl; BUN 9.8 mg/dl; AST 21 U/L ALT 17 U/L; Bil T 1.90 mg/dl; Ind 0.69 mg/dl; Dir 1.21 mg/dl.

Diagnostic test:
Endoscopic Ultrasound of the Pancreas. Solid mass in the head of pancreas 4 cms, infiltrating Wirsung duct. The solid mass impress to infiltrate the superior mesenteric vein. Perilesional node is detected, 1.5 cms, metastatic aspect. Fine needle aspiration (FNA) biopsy: Ductal adenocarcinoma.

Case study questions:

1. Please name the potential most common sites for metastasis on J.C and why?
2. What are tumor cell markers and why tumor cell markers are ordered for a patient with pancreatic cancer?
3. Based on the case study described, proceed to classify the tumor based on the TNM Stage classification. Why this classification important?
4. Discussed characteristic of malignant tumors regarding it cells, growth and ability to spread.
5. Describe the carcinogenesis phase when a tumor metastasizes.
6. Choose the tissue level that is affected on the patient discussed above: Epithelial, Connective, Muscle or Neural. Support your answer.

Submission Instructions:

• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
• You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.) 
• All replies must be constructive and use literature where possible.
• Please post your initial response by 11:59 PM ET Thursday, and comment on the posts of two classmates by 11:59 PM ET Sunday.
• You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date. 

Hematopoietic:
J.D. is a 37 years old white woman who presents to her gynecologist complaining of a 2-month history of intermenstrual bleeding, menorrhagia, increased urinary frequency, mild incontinence, extreme fatigue, and weakness. Her menstrual period occurs every 28 days and lately there have been 6 days of heavy flow and cramping. She denies abdominal distension, back-ache, and constipation. She has not had her usual energy levels since before her last pregnancy.

Past Medical History (PMH):
Upon reviewing her past medical history, the gynecologist notes that her patient is a G5P5with four pregnancies within four years, the last infant having been delivered vaginally four months ago. All five pregnancies were unremarkable and without delivery complications. All infants were born healthy. Patient history also reveals a 3-year history of osteoarthritis in the left knee, probably the result of sustaining significant trauma to her knee in an MVA when she was 9 years old. When asked what OTC medications she is currently taking for her pain and for how long she has been taking them, she reveals that she started taking ibuprofen, three tablets each day, about 2.5 years ago for her left knee. Due to a slowly progressive increase in pain and a loss of adequate relief with three tablets, she doubled the daily dose of ibuprofen. Upon the recommendation from her nurse practitioner and because long-term ibuprofen use can cause peptic ulcers, she began taking OTC omeprazole on a regular basis to prevent gastrointestinal bleeding. Patient history also reveals a 3-year history of HTN for which she is now being treated with a diuretic and a centrally acting antihypertensive drug. She has had no previous surgeries.

Case Study Questions

1. Name the contributing factors on J.D that might put her at risk to develop iron deficiency anemia.
2. Within the case study, describe the reasons why J.D. might be presenting constipation and or dehydration.
3. Why Vitamin B12 and folic acid are important on the erythropoiesis? What abnormalities their deficiency might cause on the red blood cells?
4. The gynecologist is suspecting that J.D. might be experiencing iron deficiency anemia.
   In order to support the diagnosis, list and describe the clinical symptoms that J.D. might have positive for Iron deficiency anemia.
5. If the patient is diagnosed with iron deficiency anemia, what do you expect to find as signs of this type of anemia? List and describe.
6. Labs results came back for the patient. Hb 10.2 g/dL; Hct 30.8%; Ferritin 9 ng/dL; red blood cells are smaller and paler in color than normal. Research list and describe for appropriate recommendations and treatments for J.D.

Cardiovascular
Mr. W.G. is a 53-year-old white man who began to experience chest discomfort while playing tennis with a friend. At first, he attributed his discomfort to the heat and having had a large breakfast. Gradually, however, discomfort intensified to a crushing sensation in the sternal area and the pain seemed to spread upward into his neck and lower jaw. The nature of the pain did not seem to change with deep breathing. When Mr. G. complained of feeling nauseated and began rubbing his chest, his tennis partner was concerned that his friend was having a heart attack and called 911 on his cell phone. The patient was transported to the ED of the nearest hospital and arrived within 30 minutes of the onset of chest pain. In route to the hospital, the patient was placed on nasal cannula and an IV D5W was started. Mr. G. received aspirin (325 mg po) and 2 mg/IV morphine. He is allergic to meperidine (rash). His pain has eased slightly in the last 15 minutes but is still significant; was 9/10 in severity; now7/10. In the ED, chest pain was not relieved by 3 SL NTG tablets. He denies chills.

Case Study Questions

1. For patients at risk of developing coronary artery disease and patients diagnosed with acute myocardial infarct, describe the modifiable and non-modifiable risk factors.
2. What would you expect to see on Mr. W.G. EKG and which findings described on the case are compatible with the acute coronary event?
3. Having only the opportunity to choose one laboratory test to confirm the acute myocardial infarct, which would be the most specific laboratory test you would choose and why?
4. How do you explain that Mr. W.G temperature has increased after his Myocardial Infarct, when that can be observed and for how long? Base your answer on the pathophysiology of the event.
5. Explain to Mr. W.G. why he was experiencing pain during his Myocardial Infarct. Elaborate and support your answer.

Submission Instructions:

• Include both case studies in your post.
• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.

RESPON BACK TO THIS POST: you should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. 

All replies must be constructive and use literature where possible.

Barriers to Advanced Practice Nursing

There are many barriers that slow the progression of advanced practice nursing in healthcare. In this discussion, I will focus on the affects of the financial burden of affording higher education, restrictions on the scope of practice, and role conflict within interprofessional teams. It will address the impact that these barriers have on the growth of advanced practice nursing, as well as strategies that can be used to help advanced practice nurses (APRNs) navigate and overcome them.

Financial Burden of Affording Higher Education

While programs like The Affordable Healthcare Act’s Graduate Nurse Education Demonstration aim to offset the costs of clinical training for APRNs, many candidates still face difficulty financing their advanced degrees (Porat-Dahlerbruch et al., 2022). This slows the progress of advanced practice nursing by limiting access from nurses who are financially disadvantaged due to income, number of dependents, or established debt. Possible solutions to overcoming the lack of financial support for education include considering working full-time while completing the advanced degree, seeking scholarships and grants from honor societies and other organizations, applying for financial aid through federal student aid, and exploring military benefits (Khawly & Blore, 2025).

Restrictions on the Scope of Practice

The roles, responsibilities and autonomy for APRNs vary from state to state.  While 27 US states and territories allow full practice authority, others only allow reduced or restricted practice regulations (Boehning & Punsalan, 2023). This factor causes healthcare disparities within our nation by inhibiting access to high-quality, affordable, and preventative healthcare in many underserved areas (Boehning & Punsalan, 2023). This barrier can be overcome by advocating for state and federal-level policy changes allowing full practice authority for APRNs across the board.

Role Conflict within Interprofessional Teams

APRNs are trained to provide care by utilizing evidence-based practice and standardizing high-quality and affordable patient care for the American public (Boehning & Punsalan, 2023). The persistent misunderstanding of the APRN role has limited effective collaboration within the interprofessional team establishing role conflict. One distinguishing characteristic of APRNs is their proactivity in patient care. This feature is displayed within the advanced nursing practice via comprehensive patient education and lifestyle counseling, holistic patient care, and disease prevention (NPHub, 2024a). Establishing an advanced practice nursing leadership structure within healthcare organizations could help overcome this barrier within the interprofessional team by evaluating, maintaining, and promoting the APRN role. (Henderson et al., 2024).

Conclusion

           In conclusion, financial constraints, limitations on practice authority, and interprofessional role conflict hinder the progression and advancement of advanced practice nursing. Addressing these inhibitions would require policy reforms, financial support programs, and enhanced collaboration within the interprofessional network. APRNs can continue to evolve and improve patient outcomes with ongoing advocacy and systemic change. 

Using the “Mod 3 | Part 3” section of your Academic Success and Professional Development Plan Template presented in the Resources, conduct an analysis of the elements of the research article you identified. Be sure to include the following 

Please see attached for instructions

RESPON BACK TO THIS POST: you should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. 

All replies must be constructive and use literature where possible.

Barriers For Advanced Practice Nursing

Advanced practice nursing play an important role in the healthcare system in a vast variety of environments.  Several barriers are noted to hinder the growth and development of the advanced practice nurse.  For this discussion I would like to focus on these three barriers that affect advanced practice nursing, community resistance to advanced practice nursing roles, regulatory restrictions and the lack of full utilization in the advanced practice nursing skill set and scope of practice.  Advanced practice nursing has experienced great growth in their career development in the past years.  There has been acknowledgement nationwide for the need of more advanced practice nursing roles.  Personally, I was hesitant to step into this role and begin my education to further my career as I have seen these various barriers throughout the years in my community and the educational resources available to myself. 

We are all directly affected by our community.  Community resistance in certain areas have affected the growth and dynamics of the advanced practice nurse role.  Viewing advanced practice nursing roles as limited in scope of practice.  There are misconceptions on education required to achieve the role and this affects how the public views the advanced practice nursing role and the ability of individual to care for their community appropriately.  Educating our community and advocating for more of advanced practice nurse role presence can create a better dynamic of trust and acceptance.  This can be done as simply educating our community on one on one basis during visits, promoting healthcare fairs with advanced practice nurse roles present and putting information out that directly reflects the importance and capability of scope that an advanced practice nurse role implies. 

Another barrier that affects this role is regulatory restrictions.  Florida advanced practice nurses have limited scope of practice and are often met with opposition from state and medical groups (Hain et al,).  A total of 21 states allows for full scope practice for the advanced nursing role (Hain et al,).  That leaves greater than half of the states restricting how this role is allowed to practice and affecting how it is seen by the public as well as affecting the rate at which individuals will pursue this role.  Payer policies limit the scope of practice allowed and some policies do not view advanced practice nursing as a primary care role and this affects insurance payments, who is hired to certain facilities and of course limits scope of practice (Flaubert et al,.). Promoting policies that would allow the advanced practice nurse to practice in full scope would decrease this barrier.  Advocating for laws and policies and creating evidence-based practice could help achieve a better role. 

The inability to practice within their full scope is a barrier for the advanced nursing role.  In Florida there are various restrictions to include not being allowed to prescribed controlled substance, the having to practice under the supervision of a physician limits and sometimes this creates an environment that the advanced practice nurse does not want to partake in.  Not only do some payer policies not view the advanced nursing role as a primary care role that can be utilized and billed to insurance studies have shown though a valuable role and positive outcomes physician and patients have shown preference to care directly from a medical doctor (Hain et al,.).  Allowing a full scope of practice while promoting a positive view and work environment can decrease the barrier of stigma against the advanced nursing role and allow it to be viewed similar to physician role in medical practice. 

The Need for Institutional Review Boards (IRBs) and Their Impact on Research Studies

     Institutional Review Boards (IRBs) play a vital role in the modern research landscape, particularly in healthcare settings where studies involve human participants. These ethics committees serve as essential gatekeepers, ensuring that research maintains high ethical standards while protecting participants from potential harm. My clinical experience working alongside nurse researchers has shown me firsthand how crucial these oversight bodies are to maintaining public trust in the research enterprise. The primary function of IRBs stems from historical ethical failures in research. The infamous Tuskegee Syphilis Study, where researchers withheld treatment from African American men with syphilis without their knowledge, and the horrific Nazi medical experiments during World War II demonstrated the dire consequences of unchecked research. These events led to the development of ethical frameworks like the Nuremberg Code and the Declaration of Helsinki, which eventually evolved into our current IRB system ‌(Barrow et al., 2022). Today, IRBs ensure that researchers obtain proper informed consent, maintain participant privacy, minimize risks, and equitably distribute research benefits.

      IRBs can significantly impact research studies in various ways. One example involves modifying participant recruitment methods. In a study by White et al. (2021), researchers examining pregnancy and birth experiences initially proposed recruiting vulnerable postpartum women through direct solicitation in hospital settings. The IRB identified potential constraint issues and required revisions to the recruitment protocol, mandating that initial contact occur through healthcare providers who had no stake in the research. This modification protected vulnerable participants from feeling pressured to participate but extended the recruitment timeline by several months. Another example of IRB impact relates to risk mitigation strategies. Stokes et al. (2017) conducted a study examining trauma-informed nursing interventions for patients with severe mental illness. The original protocol included detailed questioning about traumatic experiences without adequate psychological support mechanisms. The IRB required substantial revisions, including the addition of on-site mental health professionals during interviews, development of distress protocols, and follow-up mental health resources. While these changes enhanced participant protection, they increased study costs and necessitated additional personnel training.

     IRBs can also shape data collection procedures to protect participant privacy. In my own clinical setting, I observed a nursing quality improvement project examining medication errors that initially proposed collecting identifiable information about staff members involved in errors. The IRB required removing all staff data and implementing stronger data security measures to prevent potential professional repercussions for staff. This modification protected participants but limited some analytical opportunities regarding individual-level factors contributing to errors. The structure and function of IRBs continue to evolve alongside emerging research methodologies and technologies. Modern IRBs must navigate complex issues like genetic data privacy, social media-based recruitment, and international collaborative research (Somia Abdul Same’e & Antony Sheela Anmary, 2024). While sometimes perceived as administrative hurdles, IRBs ultimately strengthen research quality and protect both participants and researchers by ensuring ethical compliance.

References

Barrow, J. M., Khandhar, P. B., & Brannan, G. D. (2022). Research Ethics. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459281/

Somia Abdul Same’e, & Antony Sheela Anmary. (2024). Navigating the Ethical Complexities. Advances in Information Quality and Management, 139–158. https://doi.org/10.4018/978-1-6684-8526-2.ch009

Stokes, Y., Jacob, J.-D., Gifford, W., Squires, J., & Vandyk, A. (2017). Exploring nurses’ knowledge and experiences related to trauma-informed care. Global Qualitative Nursing Research, 4(4). https://doi.org/10.1177/2333393617734510

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White, A., Grady, C., Little, M., Sullivan, K., Clark, K., Ngwu, M., & Lyerly, A. D. (2021). IRB Decision‐Making about Minimal Risk Research with Pregnant Participants. Ethics & Human Research, 43(5), 2–17. https://doi.org/10.1002/eahr.500100