Quality and safety in healthcare and nursing practice

/0 Comments/in /by

QUESTION

QUALITY AND SAFETY IN HEALTHCARE AND NURSING PRACTICE

How will you, as a future DNP-prepared nurse, keep patients safe? This is a multi-layered question with many different answers. Yet, it is important to note that as the nurse leader, quality and safety measures are at the forefront of how you deliver nursing practice.

Quality and safety measures are integral components in healthcare. According to Nash et al. (2019), “Around the end of the twentieth century and the start of the twenty-first, a number of reports presented strong evidence of widespread quality deficiencies and highlighted a need for substantial change to ensure high-quality care for all patients” (p. 5). Understanding the prominence of error, it is important to consider your role as a DNP-prepared nurse.

For this Discussion, take a moment to consider your experience with quality and safety in your nursing practice. Reflect on your experience and consider how your role may support quality and safety measures.

Reference:

  • Nash, D. B., Joshi, M. S., Ransom, E. R., & Ransom, S. B. (Eds.). (2019). The healthcare quality book: Vision, strategy, and tools (4th ed.). Health Administration Press.

O PREPARE:

  • Review the Learning Resources for this week.
  • Reflect on your experience with nursing practice, specifically as it relates to the function of quality and safety. For example, consider whether your current organization supports quality and safety. How might your role help to support these measures in your organization or nursing practice?

Week 1 Discussion 1

Consider your experience with quality and safety in your nursing practice

Reflect on your experience and consider how your role may support quality and safety measures

Post a brief QUESTION of any previous experience with quality and safety

Explain how your role as the DNP-prepared nurse represents a function of quality and safety for nursing practice and healthcare delivery

Be specific and provide examples.

LEARNING RESOURCES

Required Readings

  • Nash, D. B., Joshi, M. S., Ransom, E. R., & Ransom, S. B. (Eds.). (2019). The healthcare quality book: Vision, strategy, and tools (4th ed.). Health Administration Press.
    • Chapter 1, “Overview of Healthcare Quality” (pp. 5–47)
    • Chapter 2, “History and the Quality Landscape” (pp. 49–74)

EDIT APPLICATION OF THE PROBLEM-SOLVING MODEL AND THEORETICAL ORIENTATION PSYCHO DYNAMIC THEORY TO A CASE STUDY, PART 1

/0 Comments/in /by

Question

APPLICATION OF THE PROBLEM-SOLVING MODEL AND THEORETICAL ORIENTATION TO A CASE STUDY, PART 1

The problem-solving model was first laid out by Helen Perlman. Her seminal 1957 book, Social Casework: A Problem-Solving Process, described the problem-solving model and the 4Ps. Since then, other scholars and practitioners have expanded the problem-solving model and problem-solving therapy. At the heart of problem-solving model and problem-solving therapy is helping clients identify the problem and the goal, generating options, evaluating the options, and then implementing the plan.

Because models are blueprints and are not necessarily theories, it is common to use a model and then identify a theory to drive the conceptualization of the client’s problem, assessment, and interventions. Take, for example, the article by Westefeld and Heckman-Stone (2003). Note how the authors use a problem-solving model as the blueprint in identifying the steps when working with clients who have experienced sexual assault. On top of the problem-solving model, the authors employed crisis theory, as this theory applies to the trauma of going through sexual assault. Observe how, starting on page 229, the authors incorporated crisis theory to their problem-solving model.

In this Final Case Assignment, using the same case study you chose in Week 2, you will use the problem-solving model AND a theory from the host of different theoretical orientations you have used for the case study.

You will prepare a PowerPoint presentation consisting of 11–12 slides, and you will use the Personal Capture function of Kaltura to record both audio and video of yourself presenting your PowerPoint presentation.

TO PREPARE

Review and focus on the case study that you chose in Week 2.

Use the Analysis of a Theory worksheet to help you dissect the theory. Use this tool to dissect the theory, employ the information in the table to complete your Assignment, and then keep it to add to your Theories Study Guide in Week 11.

Review the problem-solving model, focusing on the five steps of the problem-solving model formulated by D’Zurilla on page 388 in the textbook.

In addition, review this article listed in the Learning Resources: Westefeld, J. S., & Heckman-Stone, C. (2003). The integrated problem-solving model of crisis intervention: Overview and application. The Counseling Psychologist, 31(2), 221–239. https://doi.org/10.1177/0011000002250638

Submit a PowerPoint presentation using the Personal Capture feature of the Kaltura media feature in the online classroom. Record yourself giving the audio-visual presentation much like you would in a case presentation or other public setting. The presentation should include 11–12 slides.

The writing on each slide should use bullet points, meaning no long paragraphs of written text should be in the slides.

The recording takes the place of fully written paragraphs, while the bullet points provide context and cues for the audience to follow along.

Be sure to review the Kaltura Personal Capture—QuickStart Guide item in the Learning Resources.

Your presentation should address the following:

  • Identify the theoretical orientation you have selected to use.
  • Describe how you would assess the problem orientation of the client in your selected case study (i.e., how the client perceives the problem). Remember to keep the theoretical orientation in mind in this assessment stage.
  • Discuss the problem definition and formulation based on the theoretical orientation you have selected.
  • Identify and describe two solutions from all the solutions possible. Remember, some of these solutions should stem from the theoretical orientation you are utilizing.

Describe how you would implement the solution. Remember to keep the theoretical orientation in mind.

Describe the extent to which the client is able to mobilize the solutions for change.

Discuss how you would evaluate whether the outcome is achieved or not. Remember to keep the theoretical orientation in mind.

Explain how well the problem-solving model can be used for short-term treatment of this client.

Describe one merit and one limitation of using the problem-solving model for this case.

Preeclampsia Peer Response

/0 Comments/in /by

QUESTION

Peer Responses – Martha

For peer posts and subsequent posts under the initial discussion board thread add in second and third line treatments and additional considerations (250 word maximum for responses). Example requirement, only evidence-based sources, such as AAFP, CDC, IDSA, ADA, JNC 8 etc. (textbook resources and internet sites affiliated with medical associations are considered credible sources to obtain the information on the most up to date guidelines). Add in the link to the guideline(s) within the discussion board for further reading by your peers.

  • The International Society for the Study of Hypertension in Pregnancy (ISSHP) defines hypertensive disorders in pregnancy as new onset hypertension after 20 weeks of gestation, affecting 10% of pregnancies, including preeclampsia, gestational hypertension, and chronic hypertension (Fox et al., 2019). Hypertensive disorders during pregnancy can significantly impact the mother and fetus’ health, increasing the risk of stroke, cardiovascular death, and long-term hypertension. Prenatal risks include intrauterine growth restriction, oligohydramnios, placental abruption, and preterm birth. Exposure to these disorders during pregnancy can lead to serious long-term consequences (Fox et al., 2019).
  • Risk factors for preeclampsia include hypertensive disease history, maternal diseases such as diabetes, and chronic kidney disease (Fox et al., 2019). Additional risk factors include advanced maternal age, obesity, multifetal pregnancy, or long pregnancy intervals. Preeclampsia risk can be heightened by clinical factors such as elevated blood pressure, polycystic ovarian syndrome, sleep difficulties, and infections. Obstetric history, oocyte donation, and vaginal bleeding during pregnancy increase the risk of preeclampsia (Fox et al., 2019).

Aspirin is the only medication supported by research to lower preeclampsia risk in high-risk women. Current guidelines suggest low-dose aspirin from 12 weeks gestation to delivery (Fox et al., 2019).

Preeclampsia is a condition characterized by hypertension and new-onset proteinuria under 20 weeks gestation (Dynamedex, 2024). In the absence of proteinuria, one of the following criteria must be present: thrombocytopenia, impaired liver function, severe pain, elevated liver transaminases, new renal insufficiency, pulmonary edema, headache, and visual disturbances (Dynamedex, 2024).

Preeclampsia involves dysfunctional placentation, systemic inflammation, and oxidative stress (Fox et al., para. 12, 2019). It causes oligohydramnios, placental abruption, IGUR, preterm birth, chronic placental ischemia, and fetal distress, among adverse outcomes (Fox et al., para. 12, 2019).

The American College of Obstetricians and Gynecologists (ACOG) recommends that pregnant women with preeclampsia or hypertension undergo blood tests, including liver enzymes, electrolytes, serum creatinine, and platelet counts (Dynamedex, 2024). For women without severe features and under 37 weeks of gestation, ongoing observation, biweekly blood pressure monitoring, and weekly measurements of liver enzymes, serum creatinine, and platelet counts (Dynamedex, 2024).

Standard measures for fetal surveillance include monitoring fetal movements, biophysical profiles, cardiotocography, amniotic fluid volume assessment, ultrasound growth assessment, and ultrasound Doppler measurements (Fox et al., 2019).

Preeclampsia-related problems in the fetus are managed with antenatal corticosteroids and magnesium sulfate infusions to prevent adverse outcomes (Fox et al., 2019). The only effective treatment for preeclampsia is delivery. However, the delivery decision involves weighing the mother’s health against the fetus and gestation. Optimizing the mother’s health with antihypertensives (labetalol, nifedipine, methyldopa, or a beta-blocker) and magnesium sulfate may also benefit the fetus (Fox et al., 2019).

Patient education should include warning signs of preeclampsia, including shortness of breath, weight gain, visual changes, unrefractory headache, and nausea and vomiting in the second half of pregnancy (Roberts et al., 2023). Patients should be encouraged to exercise, maintain a healthy weight, and eat a well-balanced diet low in fat and sugar. Additionally, they should be advised to take prenatal vitamins and low-dose aspirin if indicated. Home blood pressure monitoring should be discussed in the care plan. Patients require cardiac monitoring after delivery, and yearly follow-up is recommended to evaluate for cardiovascular disorders (Roberts et al., 2023).

responsee.

/0 Comments/in /by

QUESTION

Respond to discussion

Subjective Information to Be Gathered

To accurately diagnose the 78-year-old and formulate a comprehensive care plan, it is crucial to inquire about additional subjective and objective information on top of the patient’s complaints (Mason et al., 2020). The additional subjective information I will obtain from the patient is the duration and severity of fatigue, her medical history, changes to her sleeping pattern, and her appetite. Also, I will ask if the patient has had any past mental health disorders or any references to psychiatric treatment. Another crucial subjective information to gather is whether the patient has a social support system.

Objective Findings to Be Examined

In addition to the vital signs presented by the patient, I will conduct physical and medical examinations to examine objective findings such as general appearance, gait, posture, walking, and general hygiene (Ma et al., 2020). I will also conduct physical examinations and assess the patient’s neurological functioning, focusing on neurological deficits and abnormalities in her reflexes. I will also examine her mental health status, nutritional status, functional and occupational assessment, and musculoskeletal system function.

Differential Diagnoses

Based on the patient’s clinical manifestation and the physical assessment, the primary differential diagnoses include major depressive disorder because she lost her sister recently and showcasing fatigue, sadness, and confusion (Liu et al., 2021). Other diagnosis possibilities include bereavement-related adjustment disorder, which can be explained by the sudden change in her health following the death of her sister. The patient’s complaints of reduced appetite and self-neglect are critical indicators of possible malnutrition and dehydration, thus potential differential diagnoses. Other potential differential diagnoses include anemia, hyperthyroidism, and cardiovascular diseases.

Laboratory Tests to Rule Out Some of the Differential Diagnoses

I will utilize several laboratory assessments and tests to rule out some differential diagnoses (Liu et al., 2021). I will conduct serum albumin level tests to rule out potential malnutrition or dehydration cases. A complete blood count will determine the patient’s iron status concerning potential anemia. Other tests to rule out differential diagnoses are thyroid-stimulating hormone tests and lipid profiling for hyperthyroidism and cardiovascular infections.

Screening Tools to be Utilized on the Patient

The patient must be screened to assess whether she has suspected health conditions. I shall utilize a Geriatric Depression Scale (GDS) to screen the patient for significant depression disorders and the severity of the condition (Ma et al., 2020). An additional screening tool I shall utilize is the mini-nutritional assessment (MNA) tool to assess the patient’s nutritional and hydration status. An Instrumental Activities of Daily Living (IADL) tool will determine the patient’s functional and occupational capabilities. MMSEs are recommended as screening tools for assessing a patient’s cognitive functioning and well-being.

Plan of Care

The care plan is intended to address immediate psychological health concerns and formulate a long-term care plan (Mason et al., 2020). I shall offer supportive counseling and empathy to address the patient’s fatigue and sadness. The other part of the plan of care will be ordering laboratory tests to detect any underlying health conditions the patient might be suffering from. Additionally, I shall oversee the patient using self-care techniques and formulate a working follow-up plan.

Additional Teachings and Consultation

Additional teachings I shall provide the patient include the essence of self-care, including proper nutrition, hydration, and rest (Mason et al., 2020). During the treatment, I will teach the patient strategies for managing stress and improving coping skills. As a final teaching component, I will provide information on local grief support groups and counseling services. Regarding consultation, the core practitioners I can consult with are a psychiatrist for mental health assessment and a nutritionist for evaluation and guidance on optimizing nutritional intake.

Case study schizophrenia

/0 Comments/in /by

Question

Woody is a 30-year-old male who presents in your office with a history of psychosis starting at age 21. He started becoming psychotic and paranoid while living with roommates in college. He was noted to withdraw and worry about the government spying on him. He decided that he could only eat white foods like cottage cheese, frozen yogurt, and vanilla ice cream. His roommates noticed that he began talking to himself, started hiding from others, and quit going to class so they called his mom who took him to the hospital and began getting his treatment and moved home with his mom.

He was started on olanzapine and did well for two years, but it was discontinued. He was then changed to an SGA which made it painful and hard to keep his legs still. He trialed another Second Generation Antipsychotic next that was dosed high very quickly and he began to experience gynecomastia. Some mood stabilizers were trialed, but one caused tremors and he became toxic when dehydrated. He was then hospitalized for malnutrition after he stopped eating. He claimed that he was chosen, and it was time to fast for the month. While inpatient, he was treated for dehydration and given Haldol which was effective for his psychosis, and he was discharged in stable condition. He remained on Haldol for a year and was able to work at the local grocery until he became to display some severe EPS making it difficult for him to continue bagging groceries at the store.

After losing his job he began to start withdrawing and refusing his medication. He began to start hiding from the mailman every day thinking that the government was spying on him. He said that the military was whispering in his ear telling him to kill himself to protect the world. He attempted to hang himself with his bedsheet, but his mom walked in and saved him. He was immediately admitted to the hospital. He continued to have suicidal ideations and whispered so that the government could not hear him.

General Questions related to this case and similar cases where antipsychotic and mood-stabilizing medications are prescribed:

Both delusions and hallucinations are part of the constellation of symptoms of psychosis. How are they different?

What are some organic conditions that may present with symptoms of psychosis?

  1. What side effects of antipsychotic medications could be so troublesome that they get in the way of normal everyday activities?
  2. Which SGA is most likely to cause gynecomastia and why? What questions would you ask your patient to assess for this side effect and what lab would you order for monitoring?
  3. What are the indications for prescribing a Long-Acting Injectable (LAI) antipsychotic? What must occur prior to starting an LAI?
  4. What mood-stabilizing medication is most likely to cause tremors and dehydration? What special monitoring does this medication require?
  5. What is the Clozapine REMS? What are the serious side effects of clozapine? Explain the requirements for prescribing and patient monitoring, and what changes would you make depending on the results.
  6. Do you agree that Clozapine should be reserved for patients who have failed multiple previous trials of antipsychotic medications?
  7. What are the special considerations for each of the following frequently prescribed Second-Generation Antipsychotics? (For example which one is most likely to cause gynecomastia, which has been associated with akathisia, which is more highly associated with the chance for prolonged QTC interval in which an EKG may be helpful for a baseline,  which is more weight neutral, which is more sedating, etc)
  8. Aripiprazole:
  9. Asenapine:

Lurasidone:

  • Quetiapine:
  • Quetiapine XR: (What would be the advantage of the XR formulation? Disadvantage?)
  • Risperidone:
  • Ziprasidone

PGCC Critical Thinking Question and Shared Decision Making Case Study

/0 Comments/in /by

Question

PART 1 Shared Decision-Making Case Study

Instructions

Using the case study provided, respond to the critical thinking questions. Each response should be original (in your own words) and a minimum of 2–3 sentences in length.

Case Study

Your patient is in the last stages of metastatic lung cancer. She is receiving oral pain medications to control pain associated with the metastatic involvement of her spine. She is in the hospital after falling at home but has not suffered a fracture; her length of stay is estimated to be no more than 3 to 4 days. She eats very few calories, but she can take in about 250 kcal in supplemental nutrition.

85-year-old woman in hospital bed with oxygen

You assess her risk for pressure ulcers, and she is at high risk due to her nutritional status, time spent in bed, and need for assistance to move in the bed. She has no breaks in her skin at this time, and she is on a regular hospital mattress. She has been incontinent of urine.

Two key pieces of evidence for her care include:

  • Use higher-specification foam mattresses rather than standard hospital foam mattresses for all individuals assessed as being at risk for pressure ulcer development. (Strength of evidence = A)
  • Strength of evidence A: The recommendation is supported by direct scientific evidence from properly designed and implemented controlled trials on pressure ulcers in humans (or humans at risk for pressure ulcers), providing statistical results that consistently support the guideline statement (Level 1 studies required). (NPUA-EPUAP, 2009)
  • Avoid use of urinary catheters in patients and nursing home residents for management of incontinence. (Category 1B)
  • Category 1B: A strong recommendation supported by low-quality evidence suggesting net clinical benefits or harms or an accepted practice (e.g., aseptic technique) supported by low- to very low-quality evidence Inappropriate catheter use includes “a substitute for nursing care of the patient or resident with incontinence” (Center for Disease Control and Prevention, 2009).

Acceptable use is to improve comfort for end-of-life care if needed (Centers for Disease Control and Prevention, 2009).

  1. Given the two pieces of evidence, what are the key clinical questions to consider when caring for this patient?
  2. If the evidence of meaning existed, what questions would you ask about the meaning of a patient’s experience?
  3. What are the potential conflicts between the decision that the evidence would point to and what the patient may desire?
  4. How could you use the principles of patient-centered care to resolve any conflict between the evidence and patient desires?
  5. Considering this case study, what is the role of patient-centered care and patient preferences in evidence-based practice?
  6. Considering this case study, do you think the weight that patient preferences take in evidence-based clinical decision-making should be equal to the evidence?
  7. Considering this case study, what role does the level of evidence—i.e., the confidence in the evidence—play in determining the interplay between the evidence and patient preferences?
  8. Considering this case study, what is nursing’s role in negotiating patient-centered, evidence-based clinical decisions?

PART 2 CRITICAL THINKING QUESTION

Create a Microsoft Word document and answer the following questions based on this module’s readings. Your response should be a minimum of 3–5 sentences in length, original (in your own words), and use professional writing.

  1. What is the role of patient-centered care and patient preferences in evidence-based practice?
  2. Do you think the weight that patient preferences take in evidence-based clinical decision-making should be equal to the evidence?
  3. What role does the level of evidence—i.e., the confidence in the evidence—play in determining the interplay between the evidence and patient preferences?
  4. What is nursing’s role in negotiating patient-centered, evidence-based clinical decisions?

reflection 2

/0 Comments/in /by

QUESTION

Social Work Values

Objective:  Define social work and introduction to social work values.

Social work is a dynamic and demanding profession that requires a variety of skills and qualities. Whether these skills are innate or acquired, success in the field requires social workers to continually develop them throughout their career. While this list is not exhaustive, the following skills are vital for all social workers.

Social workers rely on their values and skills to help individuals address issues.  One of the core values of social work is the importance of human relationships.  To start building a strong relationship a social worker will begin applying the skills we learned about in this module.  One of the most significant one being empathy.

Empathy is the ability to identify with and understand another person’s experience and point of view. NASW defines it as “the act of perceiving, understanding, experiencing and responding to the emotional state and ideas of another person.”¹

“Stepping into someone else’s shoes” and recognizing that experiences, perceptions and worldviews are unique to each individual enables social workers to better understand and build stronger relationships with clients. It is a vital skill that helps social workers to determine a client’s needs based on his or her unique experiences in order to efficiently provide services.

¹Barker, R. L. (2003). The Social Work Dictionary. 5th ed. Washington, DC: NASW Press.

The difficult thing about empathy, as you saw in the video On Empathy  is that sometimes we might not agree with our client or in an attempt to be positive, we want to cheer them on and say something completely opposite so they feel better, what I like to call “the cheerleader response”.  See examples below:

Client (when discussing her daughter) :   “I am a terrible parent, she just doesn’t listen to me and I have to yell at her to get her attention”

In this situation we might be tempted to say “Of course you are a good parent…don’t be so hard on yourself”...however that is not true empathy.  Empathy would be  something like “What I hear you say is that parenting is hard” or “That sounds like a struggle, it must be very hard for you”.

Adolescent Client (when discussing his dad):  “My dad hates me, he is the worst dad ever!”

In this situation we might be tempted to say “No he doesn’t! He loves you so much, he buys you food and clothes…” or “You are mad, but you know that’s not true.”  An empathic response would be something such as, “I am sorry to hear that, what does it meant to you that he hates you?” or “Help me understand why he hates you, that must be lonely and hard for you…”

Submission and Grading

1. In your own words, define Social Work and state how it is different from other professions you have encountered or your own (if Social Work is not your major). See section Social Work and Other Helping Professions to help with this question.

2. Reflect on empathy, how can you practice using it to strengthen the core value of  importance of human relationships.  Think of your everyday interactions at work or in your community.  Even if you do not work in social work, you can use empathy with any type of customer, consumer or individual in your community.  In a full paragraph, describe

1. How you will implement empathy and do you think it will benefit those relationships?

2. Do you foresee any difficulties as you practice implementing empathy?

reflection 1f

/0 Comments/in /by

QUESTION

Social Work Values

Objective:  Define social work and introduction to social work values.

Social work is a dynamic and demanding profession that requires a variety of skills and qualities. Whether these skills are innate or acquired, success in the field requires social workers to continually develop them throughout their career. While this list is not exhaustive, the following skills are vital for all social workers.

Social workers rely on their values and skills to help individuals address issues.  One of the core values of social work is the importance of human relationships.  To start building a strong relationship a social worker will begin applying the skills we learned about in this module.  One of the most significant one being empathy.

Empathy is the ability to identify with and understand another person’s experience and point of view. NASW defines it as “the act of perceiving, understanding, experiencing and responding to the emotional state and ideas of another person.”¹

“Stepping into someone else’s shoes” and recognizing that experiences, perceptions and worldviews are unique to each individual enables social workers to better understand and build stronger relationships with clients. It is a vital skill that helps social workers to determine a client’s needs based on his or her unique experiences in order to efficiently provide services.

¹Barker, R. L. (2003). The Social Work Dictionary. 5th ed. Washington, DC: NASW Press.

The difficult thing about empathy, as you saw in the video On Empathy  is that sometimes we might not agree with our client or in an attempt to be positive, we want to cheer them on and say something completely opposite so they feel better, what I like to call “the cheerleader response”.  See examples below:

Client (when discussing her daughter) :   “I am a terrible parent, she just doesn’t listen to me and I have to yell at her to get her attention”

In this situation we might be tempted to say “Of course you are a good parent…don’t be so hard on yourself”...however that is not true empathy.  Empathy would be  something like “What I hear you say is that parenting is hard” or “That sounds like a struggle, it must be very hard for you”.

Adolescent Client (when discussing his dad):  “My dad hates me, he is the worst dad ever!”

In this situation we might be tempted to say “No he doesn’t! He loves you so much, he buys you food and clothes…” or “You are mad, but you know that’s not true.”  An empathic response would be something such as, “I am sorry to hear that, what does it meant to you that he hates you?” or “Help me understand why he hates you, that must be lonely and hard for you…”

Submission and Grading

1. In your own words, define Social Work and state how it is different from other professions you have encountered or your own (if Social Work is not your major). See section Social Work and Other Helping Professions to help with this question.

2. Reflect on empathy, how can you practice using it to strengthen the core value of  importance of human relationships.  Think of your everyday interactions at work or in your community.  Even if you do not work in social work, you can use empathy with any type of customer, consumer or individual in your community.  In a full paragraph, describe

1. How you will implement empathy and do you think it will benefit those relationships?

2. Do you foresee any difficulties as you practice implementing empathy?

give feedback and add 2 references

/0 Comments/in /by

Question

Hi all! There are five key dopamine pathways, including the thalamic, tuberoinfundibular, nigrostriatal, mesolimbic, and mesocortical dopamine pathways (Stahl, 2021, p. 84). To begin, the thalamic dopamine pathway extends to the thalamus and emerges from various locations, including the ventral mesencephalon, periaqueductal gray, lateral parabrachial nucleus, and hypothalamic nuclei (Stahl, 2021, p. 85). The overall function of the thalamic dopamine pathway is not fully understood. That said, it is thought it be involved in arousal and sleep processes by controlling information that passes through the thalamus to other brain areas, such as the cortex (Stahl, 2021, p. 85). There is not much of an implication for antipsychotic use in this pathway given that no evidence currently exists showing atypical processing of this pathway in schizophrenia (Stahl, 2021, p. 85). Second, the tuberoinfundibular pathway includes dopamine neurons that extend from the hypothalamus to the anterior pituitary gland (Stahl, 2021, p. 85). The main purpose of this pathway is to regulate prolactin secretion into circulation, with dopamine acting as a prolactin secretion inhibitor (Stahl, 2021, p. 85). Dopamine antagonists result in increased prolactin levels and could cause symptoms such as amenorrhea and galactorrhea (Stahl, 2021, p. 165). Thirdly, the nigrostriatal dopamine pathway extends from dopamine cell bodies located in the brainstem substantia nigra by ways of axons which end in the striatum (Stahl, 2021, p. 85). This pathway is part of the extrapyramidal nervous system and plays a role in the regulation of motor movements (Stahl, 2021, p. 85). A decrease in dopamine can cause parkinsonism, with symptoms including rigidity, tremor, bradykinesia, and akinesia (Stahl, 2021, p. 87). An excess of dopamine can result in hyperkinetic motor movements, including dyskinesias and tics (Stahl, 2021, p. 87). This said, medication administration can be tricky when it comes to the nigrostriatal dopamine pathway. Acutely, dopamine antagonists can result is motor symptoms associated with drug-induced parkinsonism (Stahl, 2021, p. 165). On the other hand, blocking dopamine receptors chronically can result in tardive dyskinesia (Stahl, 2021, p. 166). Next, the mesolimbic dopamine pathway extends from the ventral tegmental area located within the brainstem to the nucleus accumbens (Stahl, 2021, p. 90). This system is involved in a variety of behaviors including euphoria associated with drug abuse, sensations of pleasure, and hallucinations and delusions of psychosis (Stahl, 2021, pp. 84-85). A hyperactive state of this pathway is connected with positive symptoms of psychosis and drug-induced highs (Stahl, 2021, p. 90). On the other hand, a hypoactive state of this pathway is connected with manifestations including apathy, anhedonia, negative symptoms of schizophrenia, and lack of energy (Stahl, 2021, p. 90). Decreasing dopamine within the mesolimbic system through the use of antipsychotic medications results in a reduction of positive symptoms of schizophrenia (Stahl, 2021, p. 90-92). It is interesting to note that typical and atypical antipsychotics have the ability to decrease dopamine, however, atypical antipsychotics may have a higher ability to do so (Grinchii & Dremencov, 2020). Lastly, the mesocortical dopamine pathway extends from the midbrain ventral tegmental area to the prefrontal cortex (Stahl, 2021, p. 85). This pathway plays a role in mediating affective and cognitive symptoms of schizophrenia (Stahl, 2021, p. 85). In addition, many professionals believe that negative symptoms of schizophrenia are related to deficiency of dopamine in the mesocortical pathway (Stahl, 2021, p. 93). That said, antipsychotics that can increase dopamine levels, such as various atypical antipsychotics, would result in a reduction of negative symptoms of schizophrenia (Grinchii & Dremencov, 2020). 

Advanced Pathophysiology Discussion 1 reply

/0 Comments/in /by

QUESTION

reply to the below post:

The potential most common sites for Metastasis

    The potential most common sites for metastasis on patient J.C with pancreatic cancer include the liver, peritoneum, lungs, and distant lymph nodes. Pancreatic cancer often metastasizes to the liver due to the close anatomical proximity and the hepatic portal circulation, which facilitates tumor cell dissemination (Garajova et al., 2023).

    Peritoneal metastasis occurs when cancer cells move from the primary tumor and spread within the peritoneal cavity, leading to ascites and peritoneal carcinomatosis. Lung metastasis can occur through hematogenous spread, where cancer cells travel via the bloodstream to the lungs, forming secondary tumors.

     Lastly, distant lymph nodes, such as those in the mediastinum or supraclavicular region, can be involved due to lymphatic drainage pathways from the pancreas. Metastasis to these sites can significantly worsen the prognosis and complicate treatment approaches (Garajova et al., 2023).

                                                                                  Tumor Cell Markers

    Tumor cell markers, such as CA 19-9 and CEA, are ordered for patients with pancreatic cancer to diagnosis, assess treatment response, and monitor disease progression (Loveday et al., 2019). CA 19-9, in particular, is commonly elevated in pancreatic cancer and serves as a prognostic indicator.    Elevated levels of tumor markers can indicate the presence of cancer, help in staging, and guide treatment decisions.

    Additionally, serial measurements of tumor markers can provide information about treatment efficacy and disease recurrence, allowing clinicians to adjust therapeutic interventions consequently.

TNM Stage Classification

    The TNM staging system categorizes tumors based on their size and extent of spread (T), involvement of regional lymph nodes (N), and presence of distant metastasis (M). This classification is crucial as it helps determine prognosis, guide treatment decisions, and standardize communication among healthcare providers. By accurately staging the tumor, clinicians can adapt treatment strategies, estimate patient outcomes, and facilitate comparison of results across different studies and patient populations (Loveday et al., 2019).

     In J.C’s case, the TNM stage classification would provide valuable information about the extent of his pancreatic cancer, guiding the selection of appropriate therapeutic interventions and predicting his prognosis.

Characteristics of Malignant Tumors

    Malignant tumors exhibit several characteristic features, including uncontrolled proliferation, invasion into surrounding tissues, and metastatic potential. These tumors often demonstrate abnormal cellular morphology, with variable nuclear size, pleomorphic, and increased mitotic activity. Moreover, malignant cells can evade apoptosis, sustain angiogenesis, and acquire the ability to invade lymphatic and blood vessels, facilitating distant metastasis. Unlike benign tumors, malignant tumors lack encapsulation and demonstrate infiltrative growth patterns, leading to tissue destruction and functional impairment (Patel, 2020).

Carcinogenesis Phase of Metastasis

    The process of metastasis involves multiple steps, including local invasion, circulation through blood or lymphatic vessels, extravasation, and colonization at distant sites. During carcinogenesis, as a tumor metastasizes, cancer cells acquire genetic mutations that confer invasive and migratory properties. These alterations disrupt cellular adhesion molecules, promote cytoskeletal rearrangements, and enhance protease activity, facilitating tumor cell dissemination. Additionally, changes in the tumor microenvironment, such as inflammation and angiogenesis, contribute to the metastatic cascade by promoting tumor cell survival and migration to distant organs (Patel, 2020).

Tissue Level Affected

    In the case of J.C with pancreatic cancer, the tissue level primarily affected is the epithelial tissue. Pancreatic cancer originates from the ductal epithelium of the pancreas, leading to the formation of ductal adenocarcinoma. Epithelial tissue comprises the majority of the pancreas and lines the pancreatic ducts, where the tumor arises. As the cancer progresses, it infiltrates surrounding epithelial structures and may involve adjacent organs, further demonstrating the epithelial origin of the malignancy (Garajova et al., 2023).