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After reviewing the course textbook (attached), summarize the history of nursing research. Discuss the importance of nursing research as it relates to applying evidence in practice (evidence-based practice).

Initial discussion question posts should be a minimum of 200 words and include at least two references cited using APA format.

Please, use at least y citation from the attached book, as a proof I already reviewed it.

• Describe and discuss the nurse’s role in health promotion and disease prevention in older adults. Share an example from your personal experience as an RN.
• Name and elaborate on at least three screening/preventive procedure that must be done in older adults.
• Define and discuss three common End-of-life documents that you as a nurse must be familiar with to be able to educate older adults.

initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.

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** Need turn it in report; NO AI, No plagiarism ***

Macrocytic Anemia

Selected Condition: Macrocytic Anemia

Macrocytic anemia is characterized by large red blood cells (macrocytic) and poor oxygen-carrying capacity. The term macrocytic is used to describe the size of red blood cells, and this can be ascertained from a blood test that computes the mean corpuscular volume (MCV). If the MCV exceeds 100 fL, the anemia is described as macrocytic. Low levels of vitamin B12 or folate, alcoholism, liver diseases, and some medications can cause this condition. Macrocytic anemia has general signs and symptoms and a detailed investigation is needed before diagnosing the cause.

Rationale for Selecting Macrocytic Anemia

I chose macrocytic anemia because it is a relevant and common problem in clinical practice. Anemia is prevalent among hospitalized patients, whereas macrocytic anemia is a subtype that may be associated with various diseases. Anemia can be a sign of a lack of necessary nutrients like vitamin B12 and folate or an indication of liver problems or medication that affects red blood cell formation (Moore, 2022). Knowledge of macrocytic anemia is crucial since it is at the core of patient care, including diagnosis, management, and patient counseling. Also, macrocytic anemia is another important differential in patients with chronic alcohol use or gastrointestinal pathology, which is significant to my practice as a nurse working in outpatient healthcare.

Prevalence and Incidence of Macrocytic Anemia in the United States

Macrocytic anemia is relatively high in the United States; it affects elderly patients and those with certain risk factors. A cross-sectional study by the National Center for Biotechnology Information (NCBI) reveals that macrocytosis, the major characteristic of macrocytic anemia, affects 2-4% of the population (Moore, 2022). The condition is more likely to be noticed in patients who are of advanced age. Specifically in elder care, the prevalence may increase to 10% due to factors like low nutritional intake, diseases, and medication hindering nutrient absorption (Moore, 2022).

The prevalence of macrocytic anemia also depends on the diseases that may lead to vitamin deficiency, including malabsorption disorders, autoimmune diseases, and chronic alcoholism. According to a survey by the American Society of Hematology, researchers found that vitamin B12 deficiency is the leading cause of macrocytic anemia in the United States, and the most affected group is the elderly (Soliman et al., 2024). Folate deficiency is another common cause, though it is less prevalent than the former. Furthermore, patients with alcohol use disorder require special consideration because alcohol interferes with folate metabolism and red blood cell formation, making patients with alcohol use disorder more prone to macrocytic anemia.

It is also important to note that macrocytic anemia is common in hospitalized patients and those with gastrointestinal or hematologic diseases. In a cross-sectional study that focused on adult inpatients, they identified that nearly 10% of the patients had macrocytic anemia, indicating this condition’s importance in the clinical setting (Rogers, 2023).

Summary of Scholarly Article on Macrocytic Anemias

The article “Macroytic Anemia” gives detailed information about the pathophysiologic mechanisms, etiologies, and clinical signs of macrocytic anemia (Koury & Hausrath, 2024). The article highlights that the underlying causes of macrocytic anemia include:

• Vitamin B12 deficiency: Vitamin B12 is very important for developing red blood cells in the human body. B12 deficiency causes a decrease in DNA replication in the bone marrow, which leads to the creation of oversized red blood cells.
• Folate deficiency: Folate is another vitamin required for DNA synthesis in the body, similar to vitamin B12. Folate deficiency fails to produce normal red blood cells in the bone marrow, which are instead more significant.
• Alcoholism: Alcohol affects folate metabolism and red blood cell formation, and when taken in the long run, it can lead to macrocytic anemia.
• Liver disease: Liver disease may also affect the metabolism of vitamin B12 and other nutrients, resulting in macrocytic anemia.
• Medications: Some drugs, like methotrexate or antiretroviral agents, interfere with the synthesis of red blood cells, leading to macrocytic anemia.

The article also describes the signs of macrocytic anemia; however, some patients may not show any signs or symptoms until the disease progresses to the more advanced stage, which may include fatigue, weakness, and pallor. The management of macrocytic anemia depends on the primary cause. If there is vitamin B12 or folate deficiency, these vitamins should be administered to treat the anemia. For patients with alcohol or liver issues, it is vital to treat the underlying condition in combination with the administration of micronutrients to enhance the patients’ status (Koury & Hausrath, 2024).

The article is directly related to my knowledge of macrocytic anemia as it presents a literature-based review of the causes and management of the condition. The article also pays much attention to early diagnosis; even if it is inconclusive, it is an essential aspect of nursing practice. This way, I will be able to recognize macrocytic anemia and its clinical manifestations and, hence, help manage patients and prevent complications arising from untreated anemia.

Conclusion

Macrocytic anemia is a frequent but severe problem that clinicians should not overlook. Understanding the pathophysiology, symptoms, and factors that can lead to it means that nurses are well-equipped to help diagnose and treat this condition. Macrocytic anemia can be managed with the correct approach to patient education, interprofessional collaboration, and proper medical management. Thus, knowledge of macrocytic anemia risk factors, diagnostic criteria, and possible complications is crucial for nurses to provide their patients with the highest level of care.

References

Koury, M. J., & Hausrath, D. J. (2024). Macrocytic anemias. Current Opinion in Hematology, 31(3), 82–88. https://doi.org/10.1097/moh.0000000000000804Links to an external site.

Moore, C. A. (2022, July 11). Macrocytic anemia. NCBI. https://www.ncbi.nlm.nih.gov/books/NBK459295/#:~:text=Macrocytosis%20affects%202%25%20to%204,and%20vitamin%20B12%20and%20medicationsLinks to an external site..

Rogers, J. L. (2023). McCance & Huether’s pathophysiology: The biologic basis for disease in adults and children (9th ed.). Elsevier.

Soliman, M., Grayland-Leech, B., & Villines, Z. (2024). Macrocytic anemia: Causes, symptoms, treatment, and types. Medical News Today. https://www.medicalnewstoday.com/articles/321620Links to an external site..

Based on your life experiences, explain why statistics is important to your daily life and to your field of study. ( Nursing)

* initial post should be at least 200 words/numbers or a combination of both /Additional readings must be cited and formatted in the current APA style.

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Good afternoon Dr and classmates,

1. Select a condition covered in this course that interests you or is relevant to your nursing practice. Identify the condition you’ve selected. 
2. Briefly explain your rationale for selecting this particular condition. What influenced your selection? 
3. Investigate the prevalence and incidence of the chosen condition in the United States (U.S.). What are the incidence, prevalence, and affected populations? 
4. Find and summarize a scholarly article that discusses your selected condition. What does the article say about your condition and its pathophysiology and manifestations? How is the article relevant to your understanding of the condition? 

1. Type 1 hypersensitivity, allergic reaction to tree nuts

2.

I have 4 children and my two youngest sons both have allergies to peanuts. The severity of their allergy varies. We as a family are fortunate that their allergy is not as sensitive as other children at their schools. At this point my boys are aware of their allergy and what to avoid. However, we had a bad experience with my children eating holiday candy. We were not aware that candy had nuts in it. It was determined that as long as my children don’t ingest the nuts they are not affected by the exposure. I feel that we are lucky as I have seen children can’t be in the same room as some nuts. I found this interesting to learn how and why their bodies react to this type 1 hypersensitivity. 

3.

Peanut allergy (PA) is a significant public health concern in the United States that affects millions and results in severe health implications. The prevalence of peanut allergies is approximately 2.2% among children and about 1.8% among adults (Bilaver et al., 2024; Chinthrajah et al., 2020). 

A significant portion of those with peanut allergies are children. Statistics suggest that approximately one-quarter of peanut allergy cases arise from individuals who initially appear to be at low risk for developing this condition.

4.

The article titled “Accuracy of component‐resolved diagnostics in peanut allergy: Systematic literature review and meta‐analysis” by Nilsson et al. provides insights into the pathophysiology and clinical manifestations of peanut allergy through its emphasis on diagnostic precision and molecular characterization of allergens. Nilsson et al., (2020) states this systematic review highlights how component-resolved diagnostics (CRD) can identify specific IgE responses to peanut components, which is crucial for understanding the diverse clinical presentations associated with peanut allergy.

Peanut allergy is primarily mediated by immunoglobulin E (IgE) antibodies, which bind to peanut proteins, leading to various allergic reactions upon exposure.

In summary, Nilsson et al.’s article is relevant as it increases understanding of the pathophysiology of peanut allergy, showing the utility of advanced diagnostic tools. This better understanding sets the way for more effective management strategies tailored to individual sensitization profiles and clinical manifestations.

Thank you, 

References:

Bilaver, L., Ariza, A. J., Binns, H. J., Jiang, J., Cohn, R. D., Sansweet, S., … & Gupta, R. S. (2024). 

Design of the intervention to reduce early peanut allergy in children (ireach): a practice‐based clinical 

trial. Pediatric Allergy and Immunology, 35(4). https://doi.org/10.1111/pai.14115Links to an external site.

Nilsson, C., Berthold, M., Mascialino, B., Orme, M., Sjölander, S., & Hamilton, R. G. (2020). 

Accuracy of component‐resolved diagnostics in peanut allergy: systematic literature review and 

meta‐analysis. Pediatric Allergy and Immunology, 31(3), 303-314. https://doi.org/10.1111/pai.13201

• List and define the seven types of elder abuse that were identified by the National Center on Elder Abuse (NCEA).
• How would you approach the Ethical Dilemmas and Considerations that might arise regarding Euthanasia, Suicide, and Assisted Suicide?

should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. 

***Price is Firm****

***Turnitreport needed, NO AI, NO Plagiarism*** 

Respond to at least two of your peers’ initial posts that offer a different plan of action than yours for either issue. Include the following details in your response:

• Identify at least one different approach to increase the number of participants in your program that was shared by your peers that you did not mention in your post, and explain why considering this solution is useful.
• Identify at least one different plan of action shared by your peers to address the timeline-related issues that you did not mention in your initial post, and explain why considering this solution is useful.

In the Book of Proverbs (Chapter 4), we read this passage (per the JUB translation) under the title: A Father’s Wise Instruction. It says that these words of wisdom are medicine to the flesh. The passage is copied here in a modified prescription format. Please reflect on three of the five prescribed “medicines” and how they might work to bring healing to the flesh. (12 points)

“My son, attend to my words; incline thine ear unto my words. Let them not depart from thine eyes; keep them in the midst of thine heart. For they are life unto those that find them and medicine to all their flesh”:

1) Above all else, guard thy heart; for out of it flows the issues of life.

2) Put away from thee the perversion of the mouth, and the deviation of the lips put far from thee.

3) Let thine eyes look upon that which is right, and let thine eyelids straighten thy path before thee.

4) Ponder the path of thy feet, and let all thy ways be established.

5) Turn not to the right hand nor to the left; remove thy foot from evil.

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.
• Checked for plagiarism and  AI