Please respond to the discussions below done by others seperately and reference each in APA format
Discussion 1 by osheka:-
Why was the study done
This was a retrospective study to determine the length of time once the patient enters the emergency department during a vaso-occlusive crisis to the initiation of analgesia. The study cites the American Pain Societies recommendation for treatment of acute pain related to vaso-occlusive crisis with enteral analgesia within 15-30 minutes of entering the emergency department (ED) (Inoue et al., 2016, pp. 221).
What is the sample size? Size can and should vary according to the nature of the study. Since determining a valid minimum sample size in a single study can be difficult, taking into account multiple studies is beneficial.
The sample size was male and female pediatrics less and 18 and adults greater than 18 over a 7-year period, that presented to the ED between January 2007 and December 2013.
The answer to this question alone should not remove a study from the appraisal process.
Are instruments of the variables in the study clearly defined and reliable? Make sure the variables were consistently applied throughout the study and that they measured what the researchers said they were going to measure.
The study separated children and adults but the variable were consistent throughout the study.
How was the data analyzed?
Make sure that any statistics are relevant to the clinical question.
The data was organized per year during the 7 year period through chart review. The chart compared number of patients per year, number of visits per year, time to first medication, and initial pain score in both adults and children. The study also compared how gender was affected.
Were there any unusual events during the study? If the sample size changed, for example, determine whether that has ramifications if you wish to replicate the study.
Although there were no unusual events during this study, it is noteworthy because of the longevity. Although the study is hypothesis driven and provides only descriptive results.
How do the results fit in with previous research in this area? Make sure the study builds on other studies of a similar nature.
As stated previously this was a long-term study that evaluated how well emergency room providers following evidenced based recommendations provided for the treatment of sickle cell patients during vaso-occlusive crisis. Since it was a 7-year study, with a large sample size that included both adults and children and both genders.
What are the implications of the research for clinical practice? Ask whether the study addresses a relevant and important clinical issue.
This study recognized there may be some bias in initiation and treatment for females during vaso-occlusive crisis, as they tended to report higher pain scores but had longer enteral analgesia initiation times than men in the study with lesser pain scores.
Reference
Inoue, S., Khan, I., Mushtaq, R., Sanikommu, S., Mbeumo, C., LaChance, J., “¦ Sanikommu, S. R. (2016). Pain management trend of vaso-occulsive crisis (VOC) at a community hospital emergency department (ED) for patients with sickle cell disease. Annals of Hematology, 95(2), 221. Retrieved from https://search-ebscohost-com.southuniversity.libpr”¦

Discussion 2 by Luz 6999:-
Why was the study done? Make sure the study is directly relevant to the clinical question.
This study was done to explore how female patients with a breast cancer diagnosis conducts physical activity (PA) during adjuvant (treatment given after surgery) chemotherapy treatment.
What is the sample size? Size can and should vary according to the nature of the study. Since determining a valid minimum sample size in a single study can be difficult, considering multiple studies is beneficial.
The sample size for the study involved sixteen women diagnosed with breast cancer and who were actively participating in a supervised 16-week PA intervention program during adjuvant chemotherapy treatment (Backman, Browall, Sundberg, Wengstrom, 2016).
The answer to this question alone should not remove a study from the appraisal process.
Are instruments of the variables in the study clearly defined and reliable? Make sure the variables were consistently applied throughout the study and that they measured what the researchers said they were going to measure.
Yes, the variables in the study were clearly defined as all the patients in the study were patients with breast cancer. All the patients were receiving the same kind of chemotherapy, which was producing all of the same adverse side effects, for all the participants.
How was the data analyzed?
The data in this study was analyzed inductively with content analysis (Backman et al, 2016)
Make sure that any statistics are relevant to the clinical question.
Were there any unusual events during the study? If the sample size changed, for example, determine whether that has ramifications if you wish to replicate the study.
Symptom burden, time and lack of motivation were reported as barriers to continuing PA program during the treatment. If I was going to replicate this study, I would have made some changes, which would include coaching, mentoring and direct follow-up with the patients through the use of the healthcare providers, which would include nurses, nurse practitioners, and doctors.
How do the results fit in with previous research in this area? Make sure the study builds on other studies of a similar nature.
This study’s findings should fit with previous research, of which I found in this respective area of study. Furthermore, this study presents more data not only as how PA decreases the adverse side effects of the treatments, but how a structured PA program can produce a positive impact on how patients with cancer perceive their state of health.
What are the implications of the research for clinical practice? Ask whether the study addresses a relevant and important clinical issue.
The implications of the research for clinical practice showed that it was possible to exercise despite increasing symptom burdens from treatment. Furthermore, that a PA program was perceived as a tool that supported health processes and gave the female patients a feeling of getting respite from the illness (Backman et al., 2016). This study addresses a very relevant and important clinical issue that is seen in the oncology field with patients receiving treatment. One class of the patient that are mostly affected by chemotherapy’s adverse side effects and anxiety are the younger females’ patients diagnosed with breast cancer. Patients with depression and higher anxiety levels experience more symptoms from cancer treatments (Faller et al., 2016). If patients are able to find empowerment, motivation, and independence in a physical activity program does reduce their level of anxiety and depression and consequently the experience of adverse side effects related to chemotherapy treatments. Many patients during chemotherapy treatments suffer from anticipatory nausea and vomiting when they arrive at the oncology office or increase fatigue related to feeling depressed due to a new medical diagnosis (Faller et al., 2016)
References
Backman, M., Browall, M. Syndberg, C.J., & Wengstrom, Y. (2016). Experiencing health–physical activity during adjuvant chemotherapy treatment for women with breast cancer. European Journal of Oncology Nursing, 21, 160-167. Retrieved from https://www.sciencedirect.com/science/article/pii/S1462388915300302
Faller, H., Weis, J., Koch, U., Brähler, E., Härter, M., Keller, M., “¦ & Reuter, K. (2016). Perceived need for psychosocial support depending on emotional distress and mental comorbidity in men and women with cancer. Journal of Psychosomatic Research, 81, 24-30. Retrieved from https://www.sciencedirect.com/science/article/pii/”¦

Discussion 3 by charlotte 6440:-
As a family nurse practitioner you are working in a rural health clinic. You are evaluating a 16-year-old adolescent patient who comes in complaining of having a difficulty concentrating in school. On exam you also note that the patient is very thin and frail in appearance and is asking you for diet pills.

What are some initial areas for concern? My initial concern is her thin and frail appearance, and the fact that she is asking for diet pills. I am also concerned about her difficulty with concentrating in school, but I want to find out why her presentation is the way it is. What is her home situation? Does she receive adequate healthcare? Does she have family support and their resources to healthy food choices? What is her relationship like with peers and friends? How does she view her self-image? Has there been any significant life changing event? Is she depressed? So I would be concerned about anorexia nervosa, bulimia, depression, hyperthyroidism, attention deficit hyperactive disorder, substance abuse, victim of physical, emotional, or sexual abuse, and sexually transmitted diseases.
What screening tools can help lead you closer to your diagnosis? According to Harrington 2015, there are several screening tools that are used to help identify eating disorders: HEADSS (Home life/Family, Education/ Employment/Eating/Exercise, Activities and peer/social relationships, Drugs /cigarettes/alcohol, Sexuality/relationships, Suicide/depression/mood/safety/spirituality. HEADSS is a useful tool in assessing the patient’s personal and family history of mental health disorders (Harrington, 2015). SCOFF is a 5-question screening tool that is used when there is suspicion of an eating disorder (Harrington, 2015). SCOFF (Do you make yourself Sick because you feel uncomfortably full? Do you worry you have lost Control over how much you eat? Have you recently lost (Over) more than 6.35kg in a three-month period? Do you believe yourself to be Fat when others say you are too thin? Would you say Food dominates your life?), an answer to “˜yes’ to two or more questions indicates the need for a more comprehensive assessment (Harrington, 2015). According to Harrington 2015, a further two question indicate a high sensitivity and specificity for bulimia nervosa: Do you ever eat in secret? And Are you satisfied with your eating patterns?. The Eating Attitudes Test (EAT-26) is one of the most widely used standardized measures of symptoms for eating disorders (Garner, 2014). According to Garner, early identification of an eating disorder can lead to earlier treatment which will reduce morbidity and mortality.
Describe 1 health promotion strategy you can discuss with the patient. One health promotion to complete with her is Health Nutrition. It will be important for her to learn how to eat healthy and have healthy self-image. Having a dietician speak with her and her family will be beneficial. Educating her on how diet pills work would be important.
Be sure to address the following in your plan of care: pharmacological and non-pharmacological (OTC) interventions, labs, follow-up, teaching, and referral/s. The plan of care would consist of the following: complete blood count (CBC), complete metabolic panel (CMP), thyroid stimulating hormone (TSH), thyroxine (T3), free thyroid (T4), amylase, lipase, phosphors, magnesium, ferritin, lactic acid, LFT, PT/INR, urinalysis (specific gravity for hydration, pH level, ketone level, kidney damage, liver function test, luteinizing hormone, follicle stimulating hormone, estradiol, albumin, electrocardiogram; anti-depressants (SSRIs) are used in treating eating disorders and depression. Cognitive behavioral therapy (CBT) and psychotherapy is useful. Treatment depends on the severity and that will depend on if inpatient or outpatient will be warranted.

References

Garner, D. (2014). Assessment of an eating disorder. Retrieved from
https://www.edreferral.com/assessment
Harrington, B. (2015). Initial Evaluation, Diagnosis, and Treatment of Anorexia Nervosa and Bulimia Nervosa. Retrieved from https://www.aafp.org/afp/2015/0101/p46.html

Discussion 4 by Sonya 6440:-
As a family nurse practitioner, you are working in a rural health clinic. You are evaluating a 16-year-old adolescent patient who comes in complaining of having difficulty concentrating in school. On exam you also note that the patient is very thin and frail in appearance and is asking you for diet pills.

What are some initial areas for concern? Just from visual observation, I would have some concerns. The patient is very thin and frail. Further investigation is necessary and would have to be obtained from the parent(s) and the patient. In addition, my assessment and evaluation will also be utilized to obtain the proper diagnosis so the patient can receive the proper treatment.
What screening tools can help lead you closer to your diagnosis? According to Cowden (2017), the SCOFF questionnaire is the recommended tool to screen patients suspected of having an eating disorder. SCOFF stands for sick, control, one, fat, food. This questionnaire is a simple, five-question screening measure to assess the possible presence of an eating disorder. It was developed in the United Kingdom by Morgan and colleagues in 1999. Answering yes to two or more of the following questions indicates a possible case of anorexia nervosa or bulimia nervosa or other eating disorder: A) Do you make yourself sick because you feel uncomfortably full? B) Do you worry you have lost control over how much you eat? C) Have you recently lost more than 15 lbs in a 3-month period? D) Do you believe yourself to be fat when others say you are thin? E) Would you say that food dominates your life?
Describe 1 health promotion strategy you can discuss with patient. This condition would require more than medical education. She is in need of specialized, professional intervention to determine the underlying cause of her eating disorder. Adolescence is a critical period of development and a window of vulnerability during which eating disorders can develop. The explosive physical and cognitive development that occurs during this period lends itself to substantial differences in the presentation of eating disorders in children and adolescents; pediatricians are frequently the front-line providers diagnosing these disorders. An eating disorder should be suspected in a patient of any weight who presents with weight loss, unexplained growth stunting or pubertal delay, restrictive or abnormal eating behaviors, recurrent vomiting, excessive exercise, trouble gaining weight, or body image concerns (Campbell & Peebles, 2014).

Be sure to address the following in your plan of care: pharmacological and non-pharmacological (OTC) interventions, labs, follow up, teaching, and referrals.
Pharmacological and non-pharmacological (OTC) interventions: Usually, the first medication recommendation to treat eating disorders is anti-depressant medication. Three meals a day and Ensure with 3 meals. Labs would include CBC, CMP, EKG, TSH, T3, T4, TIBC, Ferritin, Lactic acid, UA, LFT, PT/INR. Pt will need to follow up in clinic in 1 week. The Provider will notify her parent of any abnormal lab findings. Will consider admission based on lab and condition of patient. Pt and parent will be advised that no prescriptions for weight loss will be provided and that if her condition does not improve, she will face life-threatening challenges. Pt will need to start therapy. Provided list of counselors and psychiatrists.
References
Campbell, K. & Peebles, R. (2014). Eating disorders in children and adolescents: State of the art review. In Pediatrics 134(3). Retrieved on 3/27/2019 from https://pediatrics.aappublications.org/content/134/3/582
Cowden, S. (2017). The SCOFF questionnaire to screen for eating disorders. Retrieved on 3/27/2019 from https://www.verywellmind.com/the-scoff-questionnai”¦