Responses should be at least 150 words for each reply (Content). References words will not be counted in the 150 words. Provide arguments on agreeing/disagreeing, add additional information, etc. in a constructive way, but support your responses with academic details. Uses 1 academic reference less than 5 years old per each response post minimum.
REPLY 1: Based on his presentation, I strongly suspect that he is experiencing pre-renal acute kidney injury (AKI), as evidenced by the symptoms of fever, vomiting, diarrhea, and subsequent dehydration. These symptoms suggest a diminished renal perfusion scenario. Dehydration resulting from gastroenteritis can lead to hypovolemia and decreased blood flow to the kidneys, thereby compromising kidney function. In such cases, one might expect normal underlying kidney function, but decreased renal perfusion due to intravascular volume depletion (e.g., vomiting or diarrhea) can reduce the glomerular filtration rate. Pre-renal AKI stems from reduced renal blood flow, potentially initiated by factors such as dehydration, heart failure, or liver cirrhosis (Haider & Aslam, 2023). Intrinsic AKI arises from internal kidney damage, including acute tubular necrosis, interstitial nephritis, or glomerulonephritis (Haider & Aslam, 2023). Postrenal AKI occurs due to obstruction of urine flow from the kidneys, often associated with conditions like kidney stones or prostate disease (Haider & Aslam, 2023). Risk factors include: Advanced age, at 73, heightens vulnerability to kidney injury due to the natural decline in renal function associated with aging. Dehydration amplifies the patient’s risk of kidney injury, as evidenced by symptoms like vomiting, diarrhea, and fluid intolerance, which are common precursors to acute kidney injury (AKI). Utilization of medication, such as Pepto-Bismol, may potentially contribute to kidney injury, mainly if consumed excessively, although this aspect is not explicitly mentioned in the case. The presence of pre-existing medical conditions like hypertension or diabetes may predispose the patient to kidney injury. Dietary elements, exemplified by consuming potentially contaminated food like burritos, could introduce toxins or pathogens that can directly impact kidney function.
REPLY 2: Ms. P.C. is experiencing lower abdominal pain, nausea, emesis, and a thick greenish-yellowish discharge that has a strong odor. The microscopic exam shows positive for white blood cells and gram-negative intracellular diplococci. The patient also states she has recently had sex without a condom. Ms. P.C. has clinical manifestations, and diagnostic findings consist of gonorrhea. Gonorrhea is transmitted through sexual contact with the penis, vagina, mouth, or anus of an infected person. It is most common in adolescents and young adults under twenty-five (Centers for Disease Control and Prevention, 2021). Often gonorrhea presents asymptomatic or presents with very mild symptoms that can be easily mistaken for bladder or vaginal infections. Although, when symptoms are present in women, they include increased vaginal discharge, low abdominal pain, and green or yellow discharge (Centers for Disease Control and Prevention, 2021). A gram stain of urethral discharge that shows polymorphonuclear leukocytes with intracellular gram-negative diplococci is consistent with N. gonorrhoeae infection
REPLY 3: The scope of practice of a profession refers the boundaries or limitations set by the governing body of that specific profession. when it comes to healthcare professionals, for many of the cases there is clear and defined rules on the services that are to be rendered, responsibilities on duty, activities. Often the scope of Advance Practice Nurses will be based on training, education, and experience requirements within their respective licenses. Because skills and education requirements will be considered on the needs of the population and safety, the scope of practice can vary state by state, with some of them having more flexibility than others. In this case, Alaska and Florida for example, have different practice authorities broken down into statues, when it comes to APRNs. One big difference to stand out is the fact that APRNs in Alaska have “full practice” authority compared to Florida where the authority is considered “Restrictive”. This means that in Alaska APRNs can practice without a physician overseeing treatment whereas Florida nurses are required to have supervised protocols by a physician in order to legally exert their duties. However there’s the potential to become an “autonomous” APRN after completing 3000 clinical hours under the supervision of an allopathic or osteopath physician for the past 5 years according to F.S in section 464.0123.The Florida APRN scope of practice states that the certified nurse practitioner shall maintain supervision for directing the specific course of medical treatment. Within the established framework, an advanced practice registered nurse may prescribe, dispense, administer, or order any drug; manage selected medical problems; order physical and occupational therapy; initiate, monitor, or alter therapies for certain uncomplicated acute illnesses; monitor and manage patients with stable chronic diseases; establish behavioral problems and diagnosis and make treatment recommendations. On the other hand, an advanced practice registered nurse may prescribe or dispense a controlled substance as defined in s. 893.03 only if the advanced practice registered nurse has graduated from a program leading to a master’s or doctoral degree in a clinical nursing specialty area with training in specialized practitioner skills.
REPLY 4: The scope of practice for registered nurses in California is based on section 2725 of the Business and Professionals Code and Nursing Practice Act (NPA). As such, the NPA and the code authorize indirect and direct patient care services, which offer personal hygiene, comfort, safety, and protection of patients (Department of Consumer Affairs, 1998). Further, there is inclusion of the performance of the restorative and disease prevention measures and administration of the medications. Moreover, authority is provided for therapeutic agents to implement rehabilitation regimens, disease prevention and treatment. These include the observation of symptoms and signs of illness, behavior of the patient, and reactions to treatments. In addition, there are guidelines on standardized procedures, which nurses have to follow while providing care to patients. The NPA, Section 1480 and Section 2834 define the nurse practitioner, clinical competency, primary care, and furnishing devices and drugs (Spetz, 2019). These definitions are aligned with the expected scope of practice for registered nurses.
The Florida registered nurse’s scope of practice is based on Section 464.003(3)(a). As such, professional nursing practice involves engaging in activities that involve specialized knowledge, nursing skills, and judgment based on principles of biological, social, psychological and physical sciences (Nursing Law Manual, 2008). Further, the practice involves teaching and supervision of other professionals in the performance and theory of the acts. Moreover, nurses have to engage in authorized or prescribed treatments and medical administration based on the laws of the state. Finally, professional nurses should participate in nursing diagnosis, observation, intervention, planning, evaluation, and assessment of care, as well as health counseling and teaching to promote wellness and prevent illness. In comparing both California and Florida nurse practitioner scope of practice, it is clear that both states focus on ensuring that they provide quality and valuable care to patients. As such, the states recognize the role of nurse practitioners are valuable assets who contribute towards the delivery of care to patients. Further, these states have established laws, which govern how nurses should exercise their duties when delivering care to patients. However, Florida laws seem to be strict since they have several sections, which have to be read and understood by nurse practitioners prior to their engagement in delivering care to patients. In contrast, California seems to have relaxed laws, which increase the autonomy of registered nurses in the provision of care to patients (Department of Consumer Affairs, 1998). This gives California nurse practitioners the freedom to engage in individual decisions at a higher level than is the case of Florida-based practitioners.
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