I need 1 comment per each post in APA with citation and 2 references per comment not older that 2013.

Post 1

For this week’s discussion, I chose the 5-year old girl with normal weight with obese parents.  Unfortunately, this topic hits close to home as our youngest daughter is 4 ½ and both my husband and I have gained significant weight over the past few years and are in the obese category.  Most children are able to self-regulate diet and balance what they eat with the amount of energy that they are expending. Parental influence at a young age can have a significant effect on the child’s ability to regulate on their own.  Obesity places adults and children alike at a higher risk for hypertension and diabetes than those of normal weight.  A child who has obese parents is at a higher risk of becoming obese due to unhealthy eating habits that are learned at home.  Obesity is defined in the course text as BMI > 95th percentile for age and gender in children ages 2-18 (Ball, Dains, Flynn, Solomon and Stewart, 2015). 

During the child’s health assessment the provider needs to be watchful for any signs of malnutrition as well as over-nutrition.  In addition to standard screening using height, weight and BMI, additional nutritional screening should be performed. Below are three specific questions that could be utilized to further assess nutrition and risk for obesity.  

1. Can you describe to me all of the foods that the child has eaten in the past 24-48 hours? How many sugary drinks such as soda and juice, does the child drink each day? 
2. How many minutes/hours of screen time does your child have per day? 
3. Do you have a standard bedtime? How many hours of sleep does the child typically get per night? 

Describing the foods that the child has eaten over 24-48 hours will provide a more accurate account of overall nutrition.  Specifically asking about sugary drinks such as soda and juice can provide opportunity to discuss the health risks that can be associated with too much sugar intake. Specific questions related to amounts of fruits and vegetables are important as well.  Determining if the child is receiving adequate nutrients from the food that they are eating is important.  If there is concern that the child may not be receiving enough vitamins and minerals from food, it may be necessary to recommend a multi-vitamin to supplement what the child is missing from diet.   

There are multiple studies that have shown that an increased amount of screen time can have devastating effects on children’s health.  High volume of screen time whether that is from television, video games, computers or other hand-held devices can lead to increased risk of obesity as well as behavioral problems.  Asking questions related to screen time also provides the opportunity to determine where the child eats most of their meals.  Does the family eat together at the table? Do they eat while watching television? How often do they eat in the car or on the go due to busy schedules?  These factors can be used to determine the risk of the normal weight child at age 5 becoming overweight or obese as they get older.  These questions also provide an opportunity to educate parents on healthy eating habits that they can utilize as well to improve the overall health of the family.   

Another important factor to determine overall health of the child is determining if the child is getting enough sleep each night.  Children are in a period of rapid growth in early childhood and the body needs time to rest so that it can develop appropriately.  Asking if the child has a standard bedtime and how many hours of sleep the child gets each night can help determine if the child is getting adequate sleep.  In relation to screen time it is important to discuss bedtime habits that the child and parents may have as well.  Does the child have their own bedroom?  Or do they share with an older sibling or parent?  Is there a television in the room? Video games in the room?  There are many children whose parents will tell providers that their children are in bed by 8 pm each evening and while that may be a true statement, the child may not actually be going to sleep until much later due to television or other distractions present in the room. This again provides the opportunity to educate family members on the importance of a good night sleep for overall family health.  

Strategies to encourage parents to be proactive about child’s health 

In addition to the above strategies, maintaining a food dairy can be an excellent tool to determine over time whether there is adequate nutrition for both the child and parents.  There are many tools that can be utilized to keep a food diary.  A simple notebook and pen works well and with all of the technology available, there are multiple apps such as My Fitness Pal that can be used to track more than the type of food.  They can help track calories, fat, cholesterol, sugar as well as exercise.  These apps are only as good as the information that the user puts in them. “Parents influence a child’s weight through interactions that shape the development of child eating behaviors.” (Pietrobelli and Agosti, 2017).  Parents can be educated on modeling good habits of eating such as eating at the table versus in the care or while watching television. Avoid using food as a reward that can lead to child becoming an emotional eater when they are older. (Pietrobelli and Agosti, 2017). Providing good habits that can be passed on to children can also decrease their risk of depression and eating disorders such as anorexia and bulimia.  

Reference 

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby. 

Pietrobelli, A., & Agosti, M. (2017). Nutrition in the First 1000 Days: Ten Practices to Minimize Obesity Emerging from Published Science. International Journal Of Environmental Research And Public Health, 14(12), doi:10.3390/ijerph14121491 

Rub, G., Marderfeld, L., Poraz, I., Hartman, C., Amsel, S., Rosenbaum, I., & … Shamir, R. (2016). Validation of a Nutritional Screening Tool for Ambulatory Use in Pediatrics. Journal Of Pediatric Gastroenterology And Nutrition, 62(5), 771-775. doi:10.1097/MPG.0000000000001046 

Watkins, F., & Jones, S. (2015). Reducing Adult Obesity in Childhood: Parental Influence on the Food Choices of Children. Health Education Journal, 74(4), 473-484 

Post 2

Diagnostic Tests: Mammography

  Mammography is an effective diagnostic test that can help practitioners identify breast cancer at an early stage (Jerome-D’Emilia & Chittams, 2015). Typically, a mammogram is a series of x-ray images capable of detecting tumors too small to be palpated as well as calcium microcalcifications that are associated with breast cancer growth (National Cancer Institute, 2016). Screening mammograms are performed routinely and diagnostic mammograms, specific targeted imaging, are used when changes are identified on screening exams or when visibility is compromised, for example with breast implants (National Cancer Institute, 2016).

     It is important to evaluate the validity and reliability of important screening tests like mammography to ensure proper screening and early diagnosis and treatment in affected patients. This early detection allows for a greater array of treatment options and an improved overall prognosis (Jerome-D’Emilia & Chittams, 2015). The reliability and validity of the mammogram increases when used in accordance to recommendations, for instance, in patients over the age of 30, as younger women have increased breast density that affects the diagnostic value (Dains, Baumann, & Scheibel, 2016). In addition, for best results, it is important to adhere to regularly scheduled mammograms, typically done annually for women over the age of 40 (National Cancer Institute, 2016). The National Health Service Breast Screening Programme has developed national guidelines to standardize image assessments and screening programs (Hill & Robinson, 2015). The Breast Imaging Reporting and Database System provides radiologists a uniform way to describe and report findings from mammograms, which helps physicians to appropriately coordinate necessary plans of care (National Cancer Institute, 2016).

     At times, mammogram imaging can lead to false-positive results, when radiologists identify abnormalities without the presence of cancer. This can result in over treatment with follow up diagnostic mammograms, ultrasounds, and biopsies to rule out findings (National Cancer Institute, 2016). Predictive values can change if screening is not done properly, and Taylor et al. describes breast positioning as being the most important factor in producing quality mammography images (2017). Ensuring that diagnostic tests provide valuable, accurate, and useful information is key to preventative health care services and early management and treatment of identified disease processes.

References

Jerome-D’Emilia, B., & Chittams, J. (2015). Validation of a cultural cancer screening scale for mammogram utilization in a sample of African American women. Cancer Nursing, 38(2), 83-88. Retrieved from

     https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2015-07872-002&site=eds-live&scope=site

National Cancer Institute. (2016). Mammograms. Retrieved from https://www.cancer.gov/types/breast/mammograms-fact-sheet

Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care  (5th ed.). St. Louis, MO: Elsevier Mosby. 

Hill, C., & Robinson, L. (2015). Mammography image assessment; validity and reliability of current scheme. Radiography, 21, 304-307. Retrieved from https://ezp.waldenulibrary.org/login

     url=https://search.ebscohost.com/login.aspx?direct=true&db=edselp&AN=S1078817415000899&site=eds-live&scope=site

Taylor, K., Parashar, D., Bouverat, G., Poulos, A., Gullien, R., Stewart, E., & … Wallis, M. (2017). Mammographic image quality in relation to positioning of the breast: A multicentre international evaluation of the

     assessment systems currently used, to provide an evidence base for establishing a standardised method of assessment. Radiography, 23(4), 343-349. Retrieved from https://ezp.waldenulibrary.org/login

     url=https://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=28965899&site=eds-live&scope=site

BrT 

Review Healthy People 2020 Global Health Initiatives. Choose one disease process and discuss the disease process, the goal of Healthy People 2020, and how the CDC plays a role in meeting the goal.

The disease process I chose to discuss is heart disease and stroke. Heart disease is caused by various risk factors including, smoking, hypertension, high cholestrerol, poor diet, and inactivity. Patients can also be genetically predisposed to heart disease. Healthy people 2020 has set a goal and interventions to help reduce the amount of people affected by this disease and to improve the quality of life of those that are affected. Improve cardiovascular health and quality of life through prevention, detection, and treatment of risk factors for heart attack and stroke; early identification and treatment of heart attacks and strokes; prevention of repeat cardiovascular events; and reduction in deaths from cardiovascular disease (Healthy People 2020, 2018). This goal can be met by patients becoming aware of their risk for heart disease. This takes place by having screenings such as labs to check for high cholesterol, smoking cessation counseling, and management of high blood pressure. The CDC supports Healthy People 2020 in reaching their goal. With $165 million for heart disease and stroke programs (including WISEWOMAN) in Fiscal Year 2018, CDC supports all 50 states and the District of Columbia to conduct heart disease and stroke prevention efforts (CDC, 2018). The goal can be met with interventions being implemented not only by patients but healthcare providers. Healthcare providers must use screenings to determine the risk of heart disease. Also important would be educating the patient of the effects of the disease and management of the disease including compliance with medication such as a daily regimen of aspirin if not contraindicated. Heart disease and stroke are big topics in the United states that need awareness and initiatives for meeting goals. In addition to being the first and fifth leading causes of death, heart disease and stroke result in serious illness and disability, decreased quality of life, and hundreds of billions of dollars in economic loss every year (Healthy People 2020, 2018).

What is the difference between model, theory, framework, and philosophy? How are they related? (Discriminate between the concepts.) 

R/ A framework is a “broad overview, outline, or skeleton of interlinked items which supports a particular approach to a specific objective, and serves as a guide that can be modified as required by adding or deleting items (Business Dictionary, 2017). This is the most basic version of the concept or idea. A framework can lead to a model, which leads to a theory. The best way to explain the differences and similarities between a model and a theory is Maslow’s Hierarchy of Needs Theory. A model is a “graphical, mathematical (symbolic), physical, or verbal representation or simplified version of a concept, phenomenon, relationship, structure, system, or an aspect of the real world” (Business Dictionary, 2017). In Maslow’s Theory, the model is the colorful pyramid that we all remember seeing in our first text book in nursing school; it is a simple, and easy to remember, version of Maslow’s theory.  However, the theory is the full explanation and clarification of those simplified ideas on the pyramid. In Maslow’s full theory, each level of the pyramid is detailed and explained to further the learner’s understanding of his ideas. Therefore framework, model, and theory have a relationship to each other.

Philosophies and theories are similar, in that they are both guides; and they are different in that they guide differently. A philosophy is “careful thought about the fundamental nature of the world, the grounds for human knowledge, and the evaluation of human conduct (The Philosophy Pages)” (Mastin, 2008). The best example to explain these differences is nursing theory and nursing philosophy. Nursing theory is based upon assumptions regarding nursing care and practice, that are then researched, and then put into practice for a large group, such as a hospital system or nursing university. Whereas, nursing philosophy guides the personal practice of each individual nurse separately. 

References

Business Dictionary. (2017). Model. Retrieved from http://www.businessdictionary.com/definition/model.html

Business Dictionary. (2017). Framework. Retrieved from http://www.businessdictionary.com/definition/framework.html

Mastin, L. (2008). What is Philosophy? The Basics of Philosophy. Retrieved from http://www.philosophybasics.com/general_whatis.html

Although  health care professionals play a significant role in health outcomes,  the day-to-day management of a patient’s health is also a personal  responsibility. Physicians and nurses can provide diagnoses,  interventions, treatments, and prescriptions, but they will only have an  impact if patients follow through with their health care provider’s  recommendations.  

The  advent of diverse health-related technologies is providing  unprecedented opportunities to assist patients in maintaining control of  their health.  Consider for a moment health and fitness mobile apps,  talking pill bottles, and smart apartments. New patient-centered  technologies are being developed every day!

For  this Assignment, you will select a health-related mobile app, personal  health record, smart technology, or an interactive social media site  that is helping patients to better manage their health.

Note: For  the purposes of this assignment, a “mobile app” is defined as a  technology application that can be viewed, played, and stored on  smartphone devices and tablets.

To prepare:

• Review Chapter 35, “Consumer/Patient Engagement and eHealth Resources”, in the course text, Essentials of Nursing Informatics, and consider how technological innovations are transforming the ways patients’ access health-related information.
• Reflect  on the various patient-centered technologies that you or others may  use, as well as those gaining attention in the media. 
• Conduct research on patient-centered technologies that assist users in managing their own health.
• Select  one technology category such as apps, personal health records, smart  technologies, or interactive social media sites to further explore.  Examine the parameters of a specific patient-centered technology within  this category. How does this technology put patients in control of their  health?

To complete:

Submit a  1-page paper that addresses the following:

• Identify  the patient-centered technology that you selected, as well as the  population of patients for whom this technology is designed.
• Describe  how this technology is tailored toward patient use. Specifically,  explain how the features, functions, and design can help patients manage  their own health.
• Explain the risks and benefits this technology might bring to users.
• Predict  the impact this technology might have on patient health outcomes. Be  sure to support your work with specific citations from the Learning  Resources and any additional sources. 

Note: If  you choose to select an interactive social media site, text- or  article-based websites such as WebMD or Health.gov may not be selected.  For the purposes of this course, interactive social media is defined as a  digital technology that allows users to manipulate, interact with,  and/or engage with other users. Ensure that if you choose an interactive  social media site, it adheres to this rule.

I NEED A POSITIVE COMMENT BASED  IN THIS ARGUMENT..BETWEEN 100-120 WORDS

To affect better patient outcomes, new knowledge must be transformed into clinically useful forms, effectively implemented across the entire care team within a systems context, and measured in terms of meaningful impact on performance and health outcomes. The recently-articulated vision for the future of nursing in the IOM Future of Nursing report focuses on the convergence of knowledge, quality, and new functions in nursing. The recommendation that nurses lead interprofessional teams in improving delivery systems and care brings to the fore the necessity for new competencies, beyond evidence-based practice (EBP), that are requisite as nurses transform healthcare. These competencies focus on utilizing knowledge in clinical decision making and producing research evidence on interventions that promote uptake and use by individual providers and groups of providers (Stevens, 2013). I work in an environment that promotes continued evidence based practice by asking all BSN prepared nurses to do one EBP project a year. In order to continue to integrate evidence into practice I plan on attending conferences to gain new knowledge and put together an evidence based practice project every year. One challenge to overcome is getting other staff nurses to comply. With all BSN nurses participating, it sometimes gets difficult to implement lasting change due to the demands of an already heavy workload. The hard part of enforcing new practices is finding the right balance. It is important to use evidence to create better policies and get better patient outcomes. However, it is equally important to strategize and create ways to implement change that does not burden the nurse so much that it actually decreases patient safety. A good way to overcome this is to have both regular staff meeting and allow for anonymous feedback so that nurses feel safe to be honest. Everyone should be allowed to participate in the evaluation phase so that necessary changes can reflect the true needs of the unit.

Stevens, K., (May 31, 2013) “The Impact of Evidence-Based Practice in Nursing and the Next Big Ideas” OJIN: The Online Journal of Issues in Nursing Vol. 18, No. 2, Manuscript 4