\u00a0<\/span><\/p>\n\u202f<\/span><\/p>\nA Sample Answer 2 For the Assignment: Week 6: Recorded Disease Process Presentation Peer Review<\/strong><\/h2>\nTitle: <\/strong> Week 6: Recorded Disease Process Presentation Peer Review<\/strong><\/h2>\n\n- Analyze pathophysiologic mechanism associated with Addison\u2019s Diseas:<\/span>\u00a0<\/span><\/li>\n<\/ol>\n
Mediated destruction<\/span>\u00a0<\/span><\/p>\nSanne van Haren, Hannah, Alex & Gijs (2018) indicated as did you that Addison\u2019s Disease Caused by Tuberculosis.\u202f Just like Aspergillus Pneumonia, Addison\u2019s disease is difficult to diagnose and treat.\u202f Fichna, \u017burawek, Bratland, Husebye, Kasperlik-Za\u0142uska, Czarnocka & … Nowak. (2015) stated that Interleukin-2 subunit alpha (soluble receptor) reveals and confirms a direct connect between 21OH=directed reactivity and AAD, and 11.2 SNP.\u202f Fichna, \u017burawek, Bratland, Husebye, Kasperlik-Za\u0142uska, Czarnocka & … Nowak. (2015) continued that Addison\u2019s disease (AAD) has a direct connect to T-cell destruction of the adrenal cortex.\u202f<\/span>\u00a0<\/span><\/p>\nSo there is lyphocytic infiltration of the adrenal gland, autoantibodies, 21 hydroxylase (21OH).\u202f It is also indicated that he etiology remains obscure but genetic and environmental factors can be significant.\u202f Your PowerPoint presentation was excellent.\u202f I read about genes influencing T-cell fate.\u202f Is this true about transcription factors STAT4, GATA3, interleukin-23 (IL23A:\u202f activates STAT4) and interferon-Gamma production aides in the production of interferon-Gamma by the memory CD4+ cells.\u202f<\/span>\u00a0<\/span><\/p>\n\n- Relate research findings to the management of patients with complex pathophysiologic dysfunction of the adrenal cortex and how the hormones are all related. I can see the difficulty with the treatment in that rifampicin and steroids is part of the treatment, but low dose of steroids can be a problem with any long disorder, especially those who are immunocompromised. In addition, Aspergillus Pneumonia which is a rare opportunistic fungal infection would have a field day and be invasive to this type of individual.\u202f Any type of compromised disease would contribute to a host of problems later down the line.\u202f As with the disease that I had chosen, systemic considerations should be taken when it comes to signs and symptoms.\u202f For example, similarities exist with both diseases in that weight loss and gastrointestinal symptoms are common signs and symptoms for both.\u202f Clara, Joana, Marina, F\u00e1bio, Sara, Alexandre & … Teresa (2018) also agree that it is difficult to diagnose Addison\u2019s disease in that this disease is rare and even gave a case about a teenager having multiple visits to the emergency room to which the teenager was treated with hydro cortisone and fludrocortisone and added that Addison\u2019s disease has unspecific symptomatology.\u202f<\/span>\u00a0<\/span><\/li>\n<\/ol>\n
References:<\/span>\u00a0<\/span><\/h2>\nClara, P., Joana, C., Marina, P., F\u00e1bio, B., Sara, L., Alexandre, F., & … Teresa, B. (2018).<\/span>\u00a0<\/span><\/p>\n\u202f\u202f\u202f\u202f\u202f\u202f\u202f Addison’s disease – the difficulty of diagnosis.\u202f<\/span>Nascer E Crasser<\/span><\/i>\u202f, Vol 27, Iss 1, Pp<\/span>\u00a0<\/span><\/p>\n\u202f\u202f\u202f\u202f\u202f\u202f\u202f 39-42 (2018), (1), 39.<\/span>\u00a0<\/span><\/p>\nFichna, M., \u017burawek, M., Bratland, E., Husebye, E. S., Kasperlik-Za\u0142uska, A., Czarnocka,<\/span>\u00a0<\/span><\/p>\n\u202f\u202f\u202f\u202f\u202f\u202f\u202f B., & … Nowak, J. (2015). Interleukin-2 and subunit alpha of its soluble receptor in<\/span>\u00a0<\/span><\/p>\n\u202f\u202f\u202f\u202f\u202f\u202f autoimmune Addison’s disease–an association study and expression analysis.<\/span>\u00a0<\/span><\/p>\n\u202f\u202f\u202f\u202f\u202f\u202f Autoimmunity<\/span><\/i>, 48, 2, 100-107. doi:10.3109\/08916934.2014.976628<\/span>\u00a0<\/span><\/p>\nSanne van Haren, N., Hannah, V., Alex, M., & Gijs, L. (2018). Addison\u2019s Disease<\/span><\/b>\u00a0<\/span><\/p>\n\u202f\u202f\u202f\u202f\u202f\u202f Caused by Tuberculosis: Diagnostic and Therapeutic Difficulties.\u202f<\/span><\/b>European<\/span><\/i><\/b>\u00a0<\/span><\/p>\n\u202f\u202f\u202f\u202f\u202f Journal of Case Reports In Internal Medicine<\/span><\/i><\/b>\u202f(2018), doi:10.12890\/2018_000911<\/span><\/b>\u00a0<\/span><\/p>\nA Sample Answer 3 For the Assignment: Week 6: Recorded Disease Process Presentation Peer Review<\/strong><\/h2>\nTitle: <\/strong> Week 6: Recorded Disease Process Presentation Peer Review<\/strong><\/h2>\nWeek 6 Disease Process Peer Review for Paige Schnittker (Chronic Renal Disease)<\/span><\/b>\u00a0<\/span><\/p>\nPaige,<\/span>\u00a0<\/span><\/p>\nI thought your presentation was outstanding. Great job! You presented the material in a very clear and concise manner with no distractions. Your slides are easy to read and well organized. I see that you covered all the required information, so it is difficult to disagree or come up with any negative feedback. Therefore, I will ask some questions related to your presentation that I am interested in hearing more about that I did not see in the presentation.<\/span>\u00a0<\/span><\/p>\n\u202f<\/span>\u00a0<\/span><\/p>\n#5 Link changes in tissue, organ, and system functioning to the initial presenting signs and symptoms seen in primary care of the disease.<\/span><\/b>\u00a0<\/span><\/h2>\nRegarding this question, if a patient is told they will need dialysis, but they refuse, they have an approximate survival time of six months. What would you do to change the patient\u2019s mind about dialysis?<\/span>\u00a0<\/span><\/p>\nShafi, Saleem, Anjum, Abdullar, and Shafi (2018) give the results of a six-month study on patients hospitalized with chronic kidney disease. The study included 125 patients, in Pakistan, who were patients in a hospital within a 6-month\u2019s time-frame.\u202f\u202fThe mean patient age was 47.9\u00b112.1 years. Of all patients, 72 agreed to dialysis and 53 refused.\u202f\u202fThe study showed that those in middle to higher income groups agreed more frequently to dialysis than those in lower income groups. Trust in the primary care provider (86%) was the most common reason to accept dialysis.\u202f\u202fThe most common reasons for refusing were frequency of dialysis during the week (52.8%), permanent nature of dialysis (50.9%), and perception of poor quality of life (35.8%).\u202f\u202fIn this study the median survival after withholding dialysis was 6 months.<\/span>\u00a0<\/span><\/p>\n#7 Provide a brief description of the pharmacological and non-pharmacological interventions used to treat and manage the disease.<\/span><\/b>\u00a0<\/span><\/h2>\nIf a patient does receive a kidney transplant, is there a lifetime medication regimen?<\/span>\u00a0<\/span><\/p>\nSpivey, Burns, Garrett, Duke (2014) explain how immunosuppressant therapy (IST) plays a very important role in maintaining graft function in kidney transplantation.\u202f\u202fIn a meta-analysis, 22.6% of low-income and minority groups are vulnerable to an increased risk of non-compliance.\u202f\u202fThere may be severe consequences to this non-adherence such as, rejection or failure of the transplanted organ.\u202f\u202fThe complexity of medication regimens can be overwhelming to some recipients as well as the high cost of the multiple medications that are needed to prevent graft rejection.<\/span>\u00a0<\/span><\/p>\n\u202f<\/span>\u00a0<\/span><\/p>\nAny information about these two topics that you could add would be great.\u202fAgain, GREAT JOB!!<\/span>\u00a0<\/span><\/p>\nReferences<\/span>\u00a0<\/span><\/h2>\nShafi, S., Saleem, M., Anjum, R., Abdullah, W., & Shafi, T. (2018). Refusal of hemodialysis by hospitalized chronic kidney disease patients in Pakistan.\u202f<\/span>Saudi Journal of Kidney Diseases and Transplantation, 29<\/span><\/i>(2), 401-408.<\/span>\u00a0<\/span><\/p>\nSpivey, C., Chisholm-Burns, M., Garrett, C., & Duke, K. (2014). Serving underserved transplant recipients: Experience of the medication access program.\u202f<\/span>Patient Preference and Adherence, 8<\/span><\/i>, 613-619.<\/span>\u00a0<\/span><\/p>\nA Sample Answer 4 For the Assignment: Week 6: Recorded Disease Process Presentation Peer Review<\/strong><\/h2>\nTitle: <\/strong> Week 6: Recorded Disease Process Presentation Peer Review<\/strong><\/h2>\n\u202f\u202f\u202f\u202f\u202f\u202f\u202f\u202f\u202f\u202f\u202f Thank you for your response and all of your kind words in regard to my presentation. I hope that my presentation allowed for a better understanding of renal disease and how as nurse practitioners we can provide the best care possible for these patients. I am so pleased with the questions you asked and was able to do some further research into this disease and gain some helpful knowledge because of them. Both questions you asked are addressed below.<\/span>\u00a0<\/span><\/p>\n\n- Regarding this question, if a patient is told they will need dialysis, but they refuse, they have an approximate survival time of six months. What would you do to change the patient\u2019s mind about dialysis?<\/span>\u00a0<\/span><\/li>\n<\/ol>\n
\u202f<\/span>\u00a0<\/span><\/p>\nFor patients who are instructed to use dialysis for a treatment method, this can be scary and life changing. For patients that refuse at the initial instruction of dialysis it is essential to educate and ensure that he or she has an understanding of the outcome if refusal continues. One initial response, as was mentioned in the case you presented to me, the amount of time per week that the patient must set aside for the treatments. One important factor to mention to the patient is the possibility of performing the hemodialysis at home. In all cases it is not necessary to go to an outpatient setting to have dialysis performed. This option is often more acceptable to patients and allows them more independence than having to attend scheduled appointments. Another important fact that I did not mention in the presentation is the choice to do either hemodialysis or peritoneal dialysis. If the choice of peritoneal dialysis is made the patient will need to be aware a surgical procedure to place a abdominal catheter will be needed in order for treatments to take place. \u201cDuring PD, sterile dialysate fluid is introduced in the patient\u2019s peritoneal cavity and remains there for 6\u20138 hours while excess body fluid and toxins are filtered across the peritoneal membrane; at the completion of treatment, the dialysate fluid is drained from the peritoneal cavity\u201d (Schub, Mennella, 2018, p. 1). This type of dialysis differs from hemodialysis because typically a catheter is placed in the chest until a graft can be established in the arm and then the blood is filtered rather than the peritoneal fluid. Again, it is important to educate the patient that both can be performed at home independently as long as compliance is achieved. After explaining all options of dialysis to the patient, inform the patient of the complications of not having dialysis such as electrolyte imbalances, fluid overload, toxin build up, and ultimately death. Healthcare is patient driven and ultimately it will be the patient\u2019s decision whether or not he or she wants to have dialysis or not. The job of the healthcare provider is to educate and supply patients with the appropriate options and tools the live the best life possible living with this chronic disease.<\/span>\u00a0<\/span><\/p>\n\u202f<\/span>\u00a0<\/span><\/p>\n\n- If a patient does receive a kidney transplant, is there a lifetime medication regimen?<\/span>\u00a0<\/span><\/li>\n<\/ol>\n
\u202f<\/span>\u00a0<\/span><\/p>\nFor patients with renal disease a kidney transplant is life changing and unless complications occur, will allow for a life without the disease. Patients who received a kidney transplant will be required to take medications for immunosuppression. The reasoning behind this is to prevent the body from rejecting the transplanted kidney. In the event of rejection, the patient will begin so show symptoms similar to that of infection and ultimately if not treated the patient can lose the transplanted kidney, enter into a state of shock, or even death. Drugs that are often times used in the immunosuppressive therapy are as follows: Rituxan, Rapamune, Prograf, Astagraf XL, Prednisone, CellCept, Nulojix, Cytoxan, Cyclosporine, Campath, Thymoglobulin, Imuran, and Simulect (Colaneri, 2014). These drugs are often times used in combination and it is imperative the patient does not miss a dose. Patients will also need to see the primary care provider to have blood drawn regularly in order to monitor levels such as with the medication Prograf. \u201cimmunosuppression should modify the immune system enough to prevent rejection, but not allow infection, malignancies, and other side effects\u201d (Colaneri, 2014, p. 550). It is imperative to monitor transplant patients to ensure proper kidney health and the optimal life post-surgery.<\/span>\u00a0<\/span><\/p>\n\u202f<\/span>\u00a0<\/span><\/p>\nReferences<\/span>\u00a0<\/span><\/h2>\nColaneri, J. (2014). An Overview of Transplant Immunosuppression \u2013 History, Principles, and Current Practices in Kidney Transplantation.\u202f<\/span>Nephrology Nursing Journal<\/span><\/i>,\u202f<\/span>41<\/span><\/i>(6), 549-561.<\/span>\u00a0<\/span><\/p>\nSchub, T. B., & Mennella, H. A. (2018). Hemodialysis vs Peritoneal Dialysis.\u202f<\/span>CINAHL Nursing Guide<\/span><\/i>.<\/span>\u00a0<\/span><\/p>\nA Sample Answer 5 For the Assignment: Week 6: Recorded Disease Process Presentation Peer Review<\/strong><\/h2>\nTitle: <\/strong> Week 6: Recorded Disease Process Presentation Peer Review<\/strong><\/h2>\nRisk factors<\/span><\/b>\u00a0<\/span><\/h3>\nI agree with you that congenital malformations, pre-existing kidney, genetics, and infections are some of the risk factors for chronic renal disease.<\/span>\u00a0<\/span><\/p>\n\u202fObesity, low birth weight, nephrotoxins, age, and ethnicity, are also risk factors associated with the disease (Kazancio\u011flu, 2013). According to Chang & Kramer, 2013, Glomerular hypertrophy and hyperfiltration increase capillary wall tension of the glomeruli and decreasing podocyte density. Obesity can also contribute to the pathogenesis of kidney damage through hypervolemia, adipokine disorders, inflammation, oxidative stress and endothelial dysfunction. Intrauterine growth restriction can also cause low nephron number that leads to intraglomerular hypertension and hyperfiltration in the available nephrons (Vikse, Irgens, Leivestad, Hallan, & Iversen, 2018). According to the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K\/DOQI), the elderly population is more prone to develop chronic kidney disease (CKD) after several renal insults. Exposure to heavy metals, alcohol, and other drugs has linked to constant kidney disease progression (Falodia & Singla, 2013).<\/span>\u00a0<\/span><\/p>\nTreatment and prevention<\/span><\/b>\u00a0<\/span><\/h2>\nYou haven’t included nephrectomy anywhere in the treatment of chronic kidney disease. Nephrectomy is the surgical removal of the kidney to treat kidney cancer and other related kidney diseases. Partial and radical nephrectomy can be done to treat chronic renal disease. According to Charytoniuk et al., 2018, partial Nephrectomy is done on the diseased or injured portion of the kidney, and radical nephrectomy includes removing the entire organ together with a section of the tube leading to the bladder. Retroperitoneal robotic partial nephrectomy is, however, more effective in the treatment of chronic kidney disease due to reduced operative time and a shorter Length of stay as compared to trans peritoneal nephrectomy (Paulucci et al., 2018). Good job on your presentation.<\/span>\u00a0<\/span><\/p>\nReferences<\/span>\u00a0<\/span><\/h2>\nChang,\u202fA., & Kramer,\u202fH. (2013). CKD progression: a risky business.\u202f<\/span>