Peer Responses – Pratiksha

Citations: At least two high-level scholarly reference in APA per post from within the last 5 years

• Relate to another journal reading
• Polycystic ovary syndrome, also known as PCOS or Stein Leventhal syndrome is a disorder that primarily affects women in their childbearing years. It is a condition characterized by periods, difficulty getting pregnant, excessive hair growth, acne and weight gain. The causes of PCOS are varied. Include factors, insulin resistance and environmental influences. Factors such as levels of hormones disruptions in hormone release from the brain and irregular development of ovarian follicles play a role in the development of this syndrome. (Singh et al 2023) 
• Epidemiology 

 Globally Polycystic Ovary Syndrome (PCOS) affects around 8% to 20% of women during their years according to diagnostic criteria (Singh et al., 2023). The prevalence varies across populations due, to environmental factors.   

Pathophysiology 

 The underlying mechanisms of PCOS involve metabolic disruptions mainly characterized by levels of androgens and insulin. Increased androgen levels originating from the ovaries and adrenal glands result in symptoms such as hair growth (hirsutism) and acne while disturbing ovarian function (Witchel et al., 2019). Imbalances in the ovarian axis worsen excess androgen production, influenced by genetic factors affecting steroid production. Additionally, insulin resistance contributes to insulin levels, which in turn stimulate androgen production and lower sex hormone binding globulin levels intensifying the effects of androgens. 

Clinical Presentation 

 Common symptoms include cycles, hirsutism, acne, weight gain and difficulty conceiving. Long term implications involve metabolic issues, like diabetes, abnormal lipid levels and cardiovascular problems (Bulsara et al., 2021). 

Diagnostic Criteria  

 To diagnose syndrome (PCOS) healthcare providers consider various criteria outlined by the Rotterdam ESHRE/ASRM Sponsored PCOS Consensus Workshop Group in 2004. These criteria involve the presence of two out of three key features; hyperandrogenism (HA) ovulatory dysfunction (OD) and polycystic ovarian morphology (PCOM) observable on ultrasound scans. The Androgen Excess and PCOS Society (AE PCOS) criteria also consider hyperandrogenism and ovarian dysfunction for diagnosis. Anti Mullerian hormone (AMH) plays a role as an indicator in PCOS reflecting the maturation and development of ovarian follicles. Elevated levels of AMH can hinder development contributing to the dysfunction commonly seen in PCOS cases. 

Non-Drug Treatment Approaches  

 For women with PCOS lifestyle modifications are fundamental in managing the condition alongside medication. Engaging in activity is vital as it improves insulin sensitivity and overall metabolic health. Including both aerobic exercise and resistance training in routines has been shown to enhance insulin sensitivity and regulate androgen levels. Following glycemic index (LGI) diets that’re high in fiber and plant-based fats can provide metabolic benefits by helping to regulate glucose levels and hormones that control appetite. 

It’s important to steer diets that’re high in calories, sugar and saturated fats to help reduce inflammation and insulin resistance linked to PCOS (Singh et al., 2023). 

Pharmacological Management 

Oral contraceptives (OCPs), including both progesterone-only pills and combined estrogen-progesterone pills, serve as first-line therapy for menstrual irregularities and ovulation suppression (Bulsara et al., 2021). Antiandrogens such as spironolactone, flutamide, and cyproterone acetate are preferred for managing hirsutism. Insulin sensitizers like metformin improve insulin resistance and restore menstrual regularity, while thiazolidinediones (TZDs) offer additional benefits in improving ovulation and reducing androgen levels (Bulsara et al., 2021).  

Education 

Patient education on lifestyle modifications, contraception, and long-term health risks is crucial. Encourage adherence to treatment and regular follow-ups. 

Follow-up 

Regular monitoring of menstrual cycles, androgen levels, and metabolic parameters is essential. Adjust management strategies based on patient response and goals. 

Peer Responses – Martha

Citations: At least two high-level scholarly reference in APA per post from within the last 5 years

• Relate to another journal reading
• 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).

Instructions: 

You should respond to peers by extending, refuting/correcting, or adding additional nuance to their posts. 

Please respond to student below:

• Advanced practice nursing was initially created in the mid-1960s to address health services gaps. Since then, it has played a significant role in improving healthcare outcomes and meeting the healthcare needs of diverse populations. Three barriers that have slowed down the progress of advanced practice nursing include regulatory restrictions, lack of interprofessional collaboration, and reimbursement challenges.

      Regulatory restrictions are one of the barriers that have impacted the progress of advanced nursing. Regulations regarding the scope of practice and licensure differ across the states and regions in the U.S. It is necessary to establish uniform standards for education and regulations (Lowe et al., 2012). Furthermore, approximately one-third of the country has fully authorized NPs to practice law and be licensed, whereas the other states have limited or restricted licensure and practice options (Hein & Fleck, 2014). The disparities in state regulations could impede access to healthcare. One strategy that can help combat this particular barrier is advocating for state legislative reforms and policies that allow advanced nurses to practice fully. Advanced practice nurses and associated organizations can also advocate for standardized licensure and practice regulations across all states.

      The second barrier that has reduced the progress of advanced practice nursing is the need for interprofessional collaboration. While enhancing patient outcomes is a shared aim between physicians and NPs, there are obstacles to their successful cooperation (Hein & Fleck, 2014). Successful collaboration is hampered by a need for more understanding of NPs’ scope of practice (Hein & Fleck, 2014). Lack of collaboration among the interdisciplinary team, which often includes both advanced practice nurses and physicians, frequently harms a patient’s health outcome. Strategies such as developing educational programs and campaigns to raise healthcare professionals’ understanding of their mutual roles and responsibilities can help overcome the lack of collaboration among advanced practice nurses and physicians. Establishing and initiating collaborative care models that clearly outline each healthcare professional’s duties and obligations is another strategy that can aid in combating this barrier.

      The third barrier mentioned that has slowed down the progress of advanced practice nursing is reimbursement challenges. NPs are frequently not recognized as primary care providers by commercial health plan payment regulations, which might vary (Hein & Fleck, 2014). Additionally, these payers may be reluctant to pay NPs for their services directly or to credential them (Hein & Fleck, 2014). For advanced practice nurses, reimbursement is crucial because it impacts their capacity to work autonomously. Financial impediments to practice may result from reimbursement systems that favor services rendered by physicians over those rendered by advanced practice nurses. Strategies that can help overcome reimbursement challenges include creating or participating in collaborative campaigns that advocate for changes in reimbursement regulations to guarantee fair compensation for the services rendered by advanced practice nurses.

      Although advanced practice nursing has evolved, many barriers continue to exist. Barriers such as regulatory restrictions, lack of interprofessional collaboration, and reimbursement challenges have slowed the progress of advanced practice nursing. Strategies to help overcome such barriers include advocating for state legislative reforms and policies, establishing and initiating collaborative care models with clear roles, and creating or participating in collaborative campaigns that advocate for changes in reimbursement regulations.