Uncategorized
Nurs 6551 Week 9 Assignment Paper
Nurs 6551 Week 9 Assignment Paper Nurs 6551 Week 9 Assignment Paper Permalink: https://nursingpaperessays.com/ nurs-6551-week-9-assignment-paper / The Nursing Division of the Spiritual Care Association focuses on the spiritual dimension of professional nursing practice including registered nurses, advanced practice and specialty practice nurses from a wide variety of hospital and non-hospital-based settings.Nurs 6551 Week 9 Assignment Paper. The Nursing Division of the Spiritual Care Association supports the advancement of the spiritual care component of nursing practice as an integral aspect of high-quality whole person care for all including the professional providing the care.Nurs 6551 Week 9 Assignment Paper Mission: Our mission is to support best-practice nursing spiritual care and self-care through education, mentoring, and resources for nursing professionals and nursing-related organizations. Vision: All nurses will have access to high quality, practical spiritual care information. Nurses specializing in spiritual care as a component of whole-person care will be recognized for their expertise. Nursing-related organizations will work in partnership with SCA to improve health outcomes and support the health of professional care providers.Nurs 6551 Week 9 Assignment Paper Why Join? If you are a nurse interested in incorporating spiritual care into your practice, the Nursing Division of the Spiritual Care Association is perfect for you.Nurs 6551 Week 9 Assignment Paper Advance your career! Learn about the specialty practice of faith community nursing and spiritual care aspects of professional nursing through resources, courses, and presentations from national & international experts. As you develop knowledge of spiritual care and strengthen your understanding of other faiths and cultures, you will also start to discover your inner self as you strengthen your personal spirituality. As a member of the Nursing Division of SCA, you will discover opportunities to find fellowship with nursing colleagues and other allied health professions such as social workers and chaplains, work with a mentor or become a mentor to increase your confidence as a healthcare provider assisting hospitals and other healthcare organizations to integrate spiritual care back into health. Be a force in moving high-quality healthcare forward and support the future of nursing practice that improves outcomes by including steps to honor beliefs and aspects of faith that influence healthcare decisions for all faiths and perceptions of spirituality. You have a voice! Benefits of membership include: Belong to a supportive professional community that welcomes both novice and seasoned nurses Access to current best-practice standards of spiritual care for those of all faiths and no faith preference. Be notified of new research publications related to spiritual care and the specialty practice of faith community nursing Discounted price for online professional educational courses Three free Spiritual Care Grand Round Webinars annually with CNE credit Discounted registration for the Annual Westberg Symposium at the Caring for the Human Spirit® Conference Free electronic subscription to the Journal of HealthCare Chaplaincy Free subscription to the Caring for the Human Spirit® Magazine Free Spiritual Care Tip of the Day emailed to you Free newsletters Membership directory and networking opportunities Access to archived webinars and articles related to nursing & spiritual care Faith community nurse practice information and mentoring Faith Community Nurse leadership development Opportunities to present at the national level and/or publish an article or be featured in our nursing spotlight column Expand your professional value by adding a chaplain certification to your portfolio Access to nursing expert SCA Membership card will be mailed to you How to Join? To become a member, click the Join now button below. Membership is $95 annually and it includes all the member benefits listed above. During the registration process, select the Professional Nurse Membership to be added to the Nursing Division of SCA.Nurs 6551 Week 9 Assignment Paper Bethel U. Godwins Walden University NURS 6551, Section 8, Primary Care of Women July 31, 2016 Abnormal Uterine Bleeding Society for Reproductive Endocrinology and Infertility (SREI, 2012) described abnormal uterine bleeding as bleeding that differs in quality and quantity from normal menstrual bleeding, such as women spotting or bleeding between the womens menstrual periods; bleeding after sex; bleeding heavier or last more days than normal; and bleeding post menopause. According to SREI (2012), factors that can cause abnormal bleeding include structural abnormalities of the reproductive system, such as uterine polyps, fibroids, and adenomyosis. Furthermore, SREI (2012) explained that vaginal, uterine or cervical lesions, miscarriage, ectopic pregnancy, endometritis, adhesions in the endometrium, and use of an intrauterine device (IUD) can also cause abnormal bleeding. Johns Hopkins Medicine (2016) specified that early recognition of abnormal bleeding, and seeing a health care provider immediately for appropriate diagnosis and treatment increase the chance of successful treatment. Therefore, the author will focus on a single patient comprehensive evaluation, which includes the patients personal/health history; physical examination; laboratory/diagnostic tests; diagnosis; treatment/management plan; education strategies; and follow-up care. Comment by DeAllen B Millender: Good introduction.Nurs 6551 Week 9 Assignment Paper General Patient Information Age: 41-year-old Race/Ethnicity: Hispanic American Partner Status: Married Comment by DeAllen B Millender: This information is not in APA format. Current Health Status Chief Complaint: I have heavy, prolonged menstrual bleeding with severe cramping for the past one year. History of Present Illness (HPI): RG is a 41-year-old Hispanic American female who presented to the clinic with complaint of heavy prolonged menstrual bleeding with severe cramping for the past one year. Patient reported sharp pelvic pain during menstruation, bleeding between periods, pain with intercourse, blood clots during periods.Nurs 6551 Week 9 Assignment Paper Abdominal pain/pressure and bloating. Patient suggested that these symptoms started after her second caesarean section surgery one year ago. Patient also reported that she takes over-the counter medication, such as ibuprofen to relieve the pain. she also suggested that she uses heating pad on her abdomen/pelvic for pain relief, and she stated that she soaks in a warm sitz bath to ease pelvic pain and cramping. Patient also reported fatigue and weakness. Patient further stated that she decided to see an obstetrician and gynecologist (OB/GYN) because the heavy prolonged bleeding with severe menstrual cramp interfere with her regular activities. Patient denied nausea, vomiting, diarrhea, fever, and chills.Nurs 6551 Week 9 Assignment Paper Timing/Onset: Patient said one year ago. Location: The location of the problem as stated by the patient is pelvic/uterus/vaginal. Duration: 5 to7 days during periods for the past one year. Quality/Characteristic: Patient reported heavy prolonged menstrual pain; severe, sharp lower abdominal/pelvic cramping/pain, and blood clots during periods. Aggravating Factors: Monthly periods as stated by the patient. Relieving/Alleviating Factors: Patient stated that ibuprofen pain medication, heating pad, and/or warm sitz bath help the pain/cramping.Nurs 6551 Week 9 Assignment Paper Severity: The severity of the pain/cramping on a pain scale is 10/10 reported by the patient. Treatments/Therapies: Patient stated that she had not undergone any treatment for the reported problems. Last Menstrual Period: The last menstrual period reported by patient was 7/5/2016. Sexual Activity Status: Patient reported being sexually active. Barrier Prevention: Patient stated she uses natural barrier methods. Sexual Preference: Patient sexual preference is monogamous/heterogeneous relationship.Nurs 6551 Week 9 Assignment Paper Satisfaction with Sexual Activity: Patient reported that she is sexually satisfied with her partner. Contraception Method: Patient denied using any contraception method. Patient History Past medical History (PMH): Anemia and C-section. Patient was delivered full term through vaginal delivery without complications. The birth weight was 8 pounds 10 oz.Nurs 6551 Week 9 Assignment Paper Psychological/Mental Health: Patient denied depression, mood swings, anxiety, or mental health problem. Medications: RG reported that she takes over the counter Motrin 200-400 mg orally every 4-6 hours as needed for pain and cramping. Allergies: Patient reported no known allergies (NKA). Past Surgical/Hospitalization History: Patient reported history of C-section twice, and she was hospitalized for 3 days post the C-sections.Nurs 6551 Week 9 Assignment Paper Preventive Screening: Patient reported that she had flu shot on 11/20/2015; last mammogram was 2/12/2015 and mammogram was normal; Pap smear was on 2/20/2015, which was also normal; patient also reported that she was up to date with her childhood immunization, but denied pneumococcal vaccination. Family History: Both father and mother have history of diabetes mellitus type 2 and hypertension. Both parents are still living, and two siblings are still living and well. Gynecological History: Patient is multipara with 2 pregnancy resulting in two viable offsprings. Patient had her first child at the age of 33 years. Menarche at age 13; periods last between 5 to 7 days. Patient reported heavy prolonged menstrual bleeding with severe cramping; sharp pelvic pain during menstruation; and bleeding between periods for the past one year. Denied vaginal discharge or sexually transmitted infection/disease.Nurs 6551 Week 9 Assignment Paper Obstetric History: Gravida 2, Para 2, term 2, preterm 0, spontaneous abortion 0, and living 2 (G2T2P2A0L2). Gravida 1: Delivered at 39 weeks by C-section on 4/20/08 male; Gravida 2: Delivered at 40 weeks by C-section on 2/18/15 female. Patient denied therapeutic abortion (TAB) or spontaneous abortion (SAB); Patient denied preterm or low birth weight baby with no delivery complications. Patient also denied having sexual transmitted disease.Nurs 6551 Week 9 Assignment Paper Personal/Social History: Patient is married with 2 children, and lives at home with the husband. Patient is a college graduate; works outside the house as a nurse at a nearby hospital. Patients husband works for a computer company. Patient family is a middle income family. Also, patient denied any physical or psychological abuse. Patient denied being exposed to any environmental or occupational health hazards. Patient also denied alcohol consumption, tobacco, or recreational drug use. Patient denied participating in any exercise or physical activity because she is tired after work, and prefers to rest. Patient reported that she eats healthy; she eats low fat, low carbohydrate meals, and she eats fruits and vegetable at least 3 to 4 times a week. Patient stated that she sleeps well at night, and she usually goes to bed at 9 pm and wakes up at 6 am. Patient drinks a cup of coffee occasional, especially when she is at work to be awake.Nurs 6551 Week 9 Assignment Paper Review of System (ROS) General: RG admitted fatigue and weakness; denied fever /chills; and no weight loss. Head and Neck: Patient denied headache or dizziness. Patient also denied lumps, neck injury, pain/tenderness or jugular vein distention. Chest: Patient denied chest pain, cough or shortness of breath. Heart: RG denied irregular heartbeats, heart attack, or heart murmur.Nurs 6551 Week 9 Assignment Paper Breasts: Patient denied nipple discharge, tenderness or swelling. Gastrointestinal: Patient admitted lower abdominal pain, pressure, and bloating; denied constipation, nausea, vomiting, and diarrhea. Genitourinary: RG denied urinary tract infection, urinary frequency or burning on urination. Genital: Patient admitted heavy prolonged menstrual bleeding with severe cramping for one year. Patient admitted sharp pelvic pain during menstruation, bleeding between periods, pain with intercourse, and blood clots during periods. Patient denied vaginal discharge.Nurs 6551 Week 9 Assignment Paper Musculoskeletal: RG denied varicosities or extremities problem. Psychiatric: RG denied depression, anxiety, or any psychiatric problems. Neurological: Patient admitted fatigue and weakness; denied confusion, seizures, or tingling. Hematologic: Patient admitted history of anemia; denied blood transfusion or easily bruise or bleeding.Nurs 6551 Week 9 Assignment Paper Physical Examination General exam: Patient appeared well developed and pleasant with good hygiene. Patient also appeared pale and weak. Vital signs: Blood pressure 118/76, heart rate 80, respiration 18, temperature 98.8, pulse ox 100% on room air. Weight 78.2 kg, height 67 inches, and body mass index (BMI) 27. HEENT: The head is normaceplalic, atraumatic. The pupils are equal, round, and reactive to light and accommodation. Extraocular movements are intact. Tympanic membrane is gray bilaterally. Oral mucosa is dry. Oropharynx is clear. Nares are patient, no nasal or septal deviation noted. No pharyngeal erythema.Nurs 6551 Week 9 Assignment Paper Neck: Noted to be supple without jugular vein distention (JVD), thyromegaly or lymphadenopathy. Lungs: Noted to be clear to auscultation throughout the lobes; no wheezes or rhonchi noted. Cardiovascular: Regular rate and rhythm on auscultation, S1 S2 present without murmurs. Palpable pulses noted without peripheral edema. Gastrointestinal: Bowel sounds are active in all quadrant. Abdomen is soft and tender on palpation. Breast: The size of the breasts, areolas, and nipples are round and symmetrical with no discoloration, rash, lesions, dimpling, or retraction bilaterally; no masses, lumps, or tenderness noted on palpation bilaterally; and axillary lymph nodes non-palpable.Nurs 6551 Week 9 Assignment Paper Pelvic Examination: Vulva: The hair distribution is normal; no lesion noted. Vagina: Vaginal walls are pink, and pubic hair is shaven; no lesions, masses, inflammation or discharge noted. Cervix: Intact cervix with closed os. Uterus: Enlarged, asymmetrical, soft, boggy and tender. Laboratory and Diagnostic Tests Laboratory Test and Results: Pregnancy test: Result is negative. Hemoglobin and Hematocrit (H/H): Result showed H/H 8.7/26.7, which is positive for anemia.Nurs 6551 Week 9 Assignment Paper Diagnostic: Transvaginal ultrasonography of the uterus: Revealed uterine enlargement measuring 12 cm with no leiomyomata; uterine wall thickening; cystic anechoic spaces in the myometrium; heterogeneous echo texture; obscured endometrial/myometrial border; sub endometrial echogenic linear striations; and thickening of the transition zone measuring 12.8 millimeter. The transvaginal sonography is used to rule out possible uterine tumor (Sakhel & Abuhamad, 2012).Nurs 6551 Week 9 Assignment Paper Magnetic Resonance Imaging (MRI): MRI is ordered to obtain a high resolution image of the uterus as well as verifying/confirming the suspected diagnosis. The MRI result revealed that the junctional zone of the uterus is thickened and measures 12.8 millimeter. Also, MRI revealed an ill-defined ovoid and diffuse region of thickening with striated appearance (Sakhel & Abuhamad, 2012).Nurs 6551 Week 9 Assignment Paper Differential Diagnoses The differential diagnoses of the patient clinical presentation as described by Schuiling and Likis (2013) include: Adenomyosis, uterine fibroids and endometrial hyperplasia. However, the primary diagnosis for the patient is Adenomyosis. Adenomyosis: Schuiling and Likis (2013) described adenomyosis as a benign, common condition that involves the movement of endometrial tissue into the uterine muscles.Nurs 6551 Week 9 Assignment Paper The definitive cause of the adenomyosis is unknown, but the condition is common among women with elevated levels of estrogen; the condition usually ceases post menopause when estrogen levels are reduced. Risk factors explained by Taran, Stewart, and Brucker (2013) include multiparity; previous uterine surgery, such as C-section, dilatation/curettage, or fibroids removal surgery; and women at reproductive age, especially between the age of 40s or 50s. furthermore, Taran et al. (2013) specified that the clinical presentation entails chronic pelvic pain, prolonged menstrual cramps, heavy menstrual bleeding, spotting between periods, abdominal tenderness, painful intercourse, longer periods than normal, blood clots during periods. Taran et al. (2013) also explained that finding during physical examination include enlarged, tender, soft and boggy uterus. According to Taran et al. (2013) diagnosis is made based on sonographic or MRI results, and treatment is not recommended for women with mild form of adenomyosis, except when the symptoms interfere with daily activities. Taran et al. (2013) further explained that treatment options include anti-inflammatory medications; hormonal treatments; endometrial ablation; uterine artery embolization, MRI-guided focused ultrasound surged or hysterectomy, which is the definitive treatment for adenomyosis.Nurs 6551 Week 9 Assignment Paper Adenomyosis is selected as the primary diagnosis because the aforementioned patients clinical presentation, physical examination findings, and diagnostic tests results are synonymous with adenomyosis aforementioned associated signs and symptoms; risk factors; physical examination findings; and diagnostic test results. Uterine Fibroids: Womens Health (WH, 2015) described uterine fibroid to be muscular tumors that develop in the uterine wall, which can also be referred to as leiomyoma or myoma. Uterine fibroids are usually non-cancerous, and can be single or multiple tumors in the uterus. According to WH (2015), women risk for developing uterine fibroid are increased by age, such as women in their 30s and 40s until menopause when the fibroids commonly shrink. Other risk factors include family history, ethnic origin, obesity and eating habits. Symptoms of fibroids as explained by WH (2015) involve lower back pain; pain during sex; heavy bleeding; painful menses, enlarged lower abdominal, frequent urination; and lower abdominal/pelvic feeling of fullness. Physical examination shows reveal painless, firm, irregular pelvic mass. According to WH (2015), diagnosis is done using transvaginal ultrasound, MRI, hysteroslpingography, hysteroscopy, and endometrial biopsy. Fibroid is not selected as the primary diagnosis because there is no visualization of the fibroid during pelvic examination or on sonography test. Moreover, severe pain is noted during pelvic exam. Furthermore, sonographic result is more consistent with adenomyosis rather than fibroids.Nurs 6551 Week 9 Assignment Paper Endometrial Hyperplasia: Cancer Research of United Kingdom (CRUK, 2014) described endometrial hyperplasia as thickening of the covering of the uterus due to excessive growth of the cells that covers the uterus, and endometrial hyperplasia can lead to womb cancer. Risk factors according to CRUK (2014) include- age over 35 years; white race; nulliparity; older age at menopause; obesity; cigarette smoking; family history of ovarian, colon, or uterine cancer; early menarche; and history of diabetes, polycystic ovary syndrome, thyroid disease and gallbladder disease. The CRUK (2014), explained that the condition is caused by imbalance of to the estrogen and progesterone. According to CRUK (2014), signs and symptoms of endometrial hyperplasia includes abnormal, prolonged, heavy periods; bleeding between periods; shorter than 21 days menstrual cycles; and bleeding after menopause. Also, diagnosis is established by vaginal ultrasound scan, dilatation and curettage, or hysteroscopy.Nurs 6551 Week 9 Assignment Paper 23rd ed. Philadelphia, PA: Lippincott Williams &.Wilkins; 2014presentation, physical findings during examination; and diagnostic results are not synonymous with the signs and symptoms; physical examination finding, risk factors and diagnostic results associated with endometrial hyperplasia (American College of Obstetricians and Gynecologist, 2016).Nurs 6551 Week 9 Assignment Paper Management Plan Diagnosis: The only definitive diagnosis of adenomyosis is established after uterus is examined post hysterectomy. However, clinical findings that helped in the diagnosis of the patient includes enlarged, asymmetrical, soft, boggy and tender uterus during pelvic examination and aforementioned sonographic and MRI findings, which synonymous with the diagnosis of adenomyosis (Sakhel & Abuhamad, 2012).Nurs 6551 Week 9 Assignment Paper Treatment: Treatment was considered based on the patient clinical presentations, and collaborative agreement with the patient, the author, and the preceptor for total hysterectomy after explanation of the treatment options to the patient. Patient selected hysterectomy because patient does not want to have another child. According to Schuiling and Likis (2013) explanations, patient was advised to continue with the over-the counter anti-inflammatory drug: Motrin 200-400 mg orally every 4-6 hours as needed for pain and cramping until hysterectomy is performed. Also, Ferrous sulfate 325 mg orally three times a day for anemia was prescribed. Patient was educated to take the medication on an empty stomach one hour before meal or 2 hours after meal for optimum absorption.Nurs 6551 Week 9 Assignment Paper Patient Education: Patient was educated on the risk factors for adenomyosis, the causes, symptoms, diagnosis, and treatment options. Patient was educated that most women with adenomyosis does not have any symptoms, but adenomyosis is usually found after the tissue obtained from the uterus has been biopsied after pelvic surgery. Patient was also informed that the C-section she had twice during child birth may have put her at risk for adenomyosis. Patient was informed that the symptoms of adenomyosis goes away after menopause or after hysterectomy.Nurs 6551 Week 9 Assignment Paper Patient was educated that all options of treatment must be tried before hysterectomy, but patient opted for hysterectomy without trying all options of treatment. furthermore, patient was educated to continue the home remedy, such as continuation of the use of the heating pad, warm soak bath, and continuing with the over the counter Motrin to alleviate the pain associate with the condition. Finally, patient was educated on the psychological and emotional effects of adenomyosis and hysterectomy surgery because some women grieve on the loss of their womb, which may put them into depression as a result of that; the patient has to be completely sure that she really wants to do the surgery at her age now or wait and do the surgery in the future (University of Maryland Medical Center, 2016).Nurs 6551 Week 9 Assignment Paper Follow Up Care: In consideration of the Schuiling and Likis (2013) discussion, patient was schedule to follow-up in 6 weeks for follow-up on the patients anemia and surgical work up labs, such as complete blood count, complete metabolic panel, prothrombin time and international normalized ratio(PT/INR). Also, an electrocardiogram (EKG) and chest x-ray was ordered to rule out any cardiac problem that would complicate the hysterectomy surgery. The patients H/H came up to 11.5/38.9 and all the other laboratory and diagnostic result was normal. The Total hysterectomy surgery was performed on 7/27/2016. Surgery was successful, and patient was schedule to follow up in six eek post-surgery.Nurs 6551 Week 9 Assignment Paper Conclusion Comment by DeAllen B Millender: Level 1 headings are centered, in bold print, and in Title Case (Chapter 3, 3.03, pp. 62-63; see Table 3.1 and Figure 2.1). The author selected a patient at the authors clinical site, and obtained a complete health history following the patient care from the beginning of the clinical up to 9 weeks of clinical. The author also used the patient health information and clinical presentation to come up with a diagnosis of adenomyosis. The author developed an appropriate treatment plan with the patient in collaboration with the authors preceptor incorporating the authors classroom knowledge with the authors chosen nursing theorist. Finally, the patient was educated on the condition and follow up care.Nurs 6551 Week 9 Assignment Paper Reflect on your Practicum Experience and select a female patient whom you have examined with the support and guidance of your Preceptor. Think about the details of the patients background, medical history, physical exam, labs and diagnostics, diagnosis, treatment and management plan, as well as education strategies and follow-up care.Nurs 6551 Week 9 Assignment Paper To complete Write an 8- to 10-page comprehensive soap Note paper on Abnormal Uterine Bleeding , that addresses the following: Age, race and ethnicity, and partner status of the patient Current health status, including chief concern or complaint of the patient Contraception method (if any) Patient history, including medical history, family medical history, gynecologic history, obstetric history, and personal social history (as appropriate to current problem) Review of systems Physical exam Labs, tests, and other diagnostics Differential diagnoses Management plan, including diagnosis, treatment, patient education, and follow-up care.Nurs 6551 Week 9 Assignment Paper PLEASE FOLLOW ASSIGNMENT CRITERIA AND SAMPLE PAPER ATTACHED WITH THIS ASSIGNMENT. 100% ORINALITY AND APA FORMATE IS REQUIRED. DO NOT COPY SAMPLE PAPER , JUST FOLLOW THE PATTERN. References Schuiling, K. D., & Likis, F. E. (2013). Womens gynecologic health (2nd ed.). Burlington, MA: Jones and Bartlett Publishers. Chapter 5, Gynecologic Anatomy and Physiology (pp. 81101) Chapter 6, Gynecologic History and Physical Examination (pp. 103131) Tharpe, N. L., Farley, C., & Jordan, R. G. (2013). Clinical practice guidelines for midwifery & Womens health (4th ed.). Burlington, MA: Jones & Bartlett Publishers.Nurs 6551 Week 9 Assignment Paper Chapter 6, Care of the Well Woman Across the Life Span Preventive Health Care for Well Women (pp. 263265) . Retrieved from http://www.womenshealth.gov/screening-tests-and-vaccines/screening-tests-for-women/Screening tests and vaccinesU.S. Department of Health and Human Services. (2012b). Care of the Well Woman: Health Assessment and Screening (pp. 265270) Society for Reporoductive Endocrinology and Infertility. (2012). Abnormal uterine bleeding. Retrieved from http://www.socrei.org/BOOKLET_abnormal_uteine_bleeding/ Taran, F. A., Stewart, E. A., & Brucker, S. (2013). Adenomyosis: Epidemiology, risk factors, clinical phenotype and surgical and interventional alternative to hysterectomy. Geburtshilfe Frauenheilkunde, 73(9), 924-931.Nurs 6551 Week 9 Assignment Paper Welcome to the School of Social Sciences and Education. Degree opportunities include the Associate in Arts, Associate in Science and Associate in Applied Science degrees, and one year certificate programs. As soon as you choose a degree program, youll begin to concentrate your studies in a specific area, and shape your education to increase depth and breadth of study.Nurs 6551 Week 9 Assignment Paper How can a nurse practitioner decide what is important to focus on in a 15- to 30-minute appointment with a woman seeking primary care? Students in this course gain opportunities to teach and promote wellness in women through the process of screening for commonly seen in gynecological disorders. Students learn to analyze data to interpret results for the benefit of women seeking assistance with planning healthy lifestyle behaviors. They also gain clinical experience in a primary healthcare setting that provides opportunities to increase competence in diagnosis, treatment, referrals, or follow-up care with a concentration on improving patient outcomes.Nurs 6551 Week 9 Assignment Paper How can a nurse practitioner decide what is important to focus on in a 15- to 30-minute appointment with a woman seeking primary care? Students in this course gain opportunities to teach and promote wellness in women through the process of screening for commonly seen in gynecological disorders. Students learn to analyze data to interpret results for the benefit of women seeking assistance with planning healthy lifestyle behaviors. They also gain clinical experience in a primary healthcare setting that provides opportunities to increase competence in diagnosis, treatment, referrals, or follow-up care with a concentration on improving patient outcomes.Nurs 6551 Week 9 Assignment Paper Health has many definitions, but the Gospel leads us to view human health as the reconciling of relationships among God, our neighbor, Creation, and our self. Studying health sciences within a Christian liberal arts setting allows students to participate in this reconciliation-ministry by understanding how the skills and knowledge acquired through their education can be used to help others move toward optimal health, healing, and wholeness. Our students learnthrough global health opportunities, local preventative medicine and clinical experiences, and classroom developmentto articulate a clear theological framework for defining and improving human health.Nurs 6551 Week 9 Assignment Paper While students interested in medical or health professional school are all required to take natural science classes, these students are not limited to hard science majors. Humanities and social and behavioral science majors can take the prerequisite MCAT classes in the Pre-Med curriculum; apply to PA, OT, PT, dentistry, veterinary, medical, and other healthcare schools; and be accepted. Discussing how undergraduate humanities or social and behavioral science classes play into the healthcare field could be a great addition to a graduate or professional school application.Nurs 6551 Week 9 Assignment Paper All students interested in preparing for healthcare professional and graduate school programs are encouraged to take health psychology, motivation psychology, medical ethics, medical anthropology, public health, nutrition, exercise as medicine, sustainable agriculture, and environmental health courses. If you are interested in a humanities or social science major and Pre-Med, talk to your Admissions Counselor about adding the MCAT-prep curriculum to your degree.Nurs 6551 Week 9 Assignment Paper Health Science in Practice At Taylor, we seek to shape you on and off campus for your goal of entering the health field. Through interdisciplinary programs, you will have the ability to gain top-of-the-line, hands-on experience in biology, chemistry, kinesiology, public health, and psychology. You can train clients in better health practices, assist in rehabilitation of hospital patients, or teach community members how to prevent and/or treat chronic disease.Nurs 6551 Week 9 Assignment Paper Diabetes Prevention Program Taylors newly minted adult diabetes prevention program brings Taylor student into the local health clinics for nutrition and exercise intervention sessions, as well as individual health education, provided by Taylor students. The curriculum, approved by the Center for Disease Control (CDC), is designed to help individuals at risk of diabetes or other chronic diseases. Participating students take a semester-long training course that covers nutrition education principles, behavior modifications and listening skills, exercise prescription, and medical ethics.Nurs 6551 Week 9 Assignment Paper Cardiac Rehabilitation In collaboration with Ball Memorial Hospital (part of IU Health), this program brings patients to campus for a sustained maintenance cardiac rehab program, which focuses primarily on exercise. Students work with a member of Ball Memorials cardiopulmonary team to provide patients with appropriately tailored exercise sessions. The students check patients vital signs and monitor them during exercise while creating patient-professional relationships with members of the community. IU Health Ball & Blackford Internships Our students intern in the IU Health Blackford and Ball hospitals, participating in valuable observations and experiences. You will assist cardiopulmonary teams in a variety of cardiac rehabilitation opportunitiesincluding cardiovascular surgery, echocardiograms, heart ca
Alcohols Effect on The Body
The study of h Alcohols Effect on The Body Sample Essay Alcohols Effect on The Body Sample Essay Permalink: https://nursingpaperessays.com/ alcohols-effect- y-sample-essay / ? Dental hygienists and therapists are encouraged to take a holistic approach to their patients care. Holistic medicine is defined as âtreatment of the whole person, taking into account mental and social factors, rather than just the symptoms of a diseaseâ Oxford dictionaries (2015). Dental clinicians therefore require an understanding of all alcohol related issues not just that of the oral cavity. The following section highlights the main complications alcohol can cause for the major organs of the body.Alcohols Effect on The Body Sample Essay Brain â Alcohol affects the brain by altering the chemical processes. The short term alterations consist of slurred speech, vision changes, lack of coordination, impaired judgment and memory loss. Alcohol is a depressant, so long term excessive alcohol drinking can lead to mental health issues such as depression, anxiety and suicide (Singleton et al, 2001). It can also lead to frontal lobe shrinkage causing poor thinking skills (www.nihseniorhealth.gov). Mukherjee, S (2013 p 256-262) states that âAlcohol interacts with the brain receptors, interfering with the communication between nerve cellsâ Heart â Regular alcohol consumption can lead to an increased risk of cardiovascular disease. This can cause hypertension, arrhythmia, strokes or myocardial infarction. (National Institute on Alcohol Abuse and Alcoholism) Digestive System â In the short term alcohol can cause stomach disturbances and lead to vomiting or diarrhoea. Excess alcohol is linked with gastrointestinal ulcers, pancreatitis (inflammation of the pancreas caused by cell damage) and malabsorption of essential nutrients such as B vitamins and folic acid. Cancers of the digestive tract (mouth, oesophagus, stomach and colon) are also a threat (www.healthline.com).Alcohols Effect on The Body Sample Essay Liver â Our liverâs deal with the breakdown of waste products, this also includes alcohol and drugs. Alcohol causes great harm to the liver due to toxins and the effort the liver must use to deal with alcohol (www.drinkaware.co.uk). Alcohol-related liver disease can be categorised in to three main categories; ⢠Fatty liver (first stage of liver disease but can be reversed if addressed early enough) ⢠Alcoholic hepatitis ⢠Cirrhosis (scarring of the liver) (www.nhs.uk) Reproductive System â Alcohol affects both male and female sex hormones, causing imbalance and potentially infertility. If a woman has conceived, drinking during gestation puts the unborn child at risk of Foetal Alcohol Spectrum Disorder (FASD). Alcohol passes through to the child via the bloodstream, and exposure to alcohol can lead to a host of problems during a personâs lifetime which come under the umbrella term FASD these can include; deformities, mental health problems, memory difficulties and addiction. Drinking alcohol whilst pregnant can also lead to miscarriage, still birth, pre-term delivery and low birth weights (drinkaware.co.uk). Immune System â Drinking regularly can weaken a personâs immune system. A session of binge drinking can make your body vulnerable to infection for up to twenty four hours after (www.niaaa.nih.gov).Alcohols Effect on The Body Sample Essay Oral Cavity â As outlined in the introduction to this paper, alcohol has many adverse effects on the oral cavity. These will now be explored in further detail; ⢠Non-carious tooth surface loss â Robb and Smith (1990) showed that in a study of thirty seven alcoholic patients, their teeth had decidedly more erosive wear in comparison to the age and sex matched control subjects. This can be attributed to the acidity of many alcoholic beverages and also the increased incidence of vomiting after excessive alcohol consumption.Alcohols Effect on The Body Sample Essay ⢠Dental caries â Dental caries can occur more frequently in patients who regularly expose their mouth to alcohol. This can have multiple root causes; initially we know that the progression of caries begins with the demineralisation of enamel which occurs when the critical pH of 5.4 is breached. This happens during an acid attack, where the microorganisms in the oral cavity feed off a substrate; sugar. We know that alcohol contains large amounts of sugar; an alcopop such as Smirnoff Ice for example contains 7.5 teaspoons of sugar (shropshirestar.co.uk, 2014).Alcohols Effect on The Body Sample Essay In a drinking session when the alcohol may be sipped over a period of time the oral cavity can never revert back to a neutral pH. If a patient is doing this regularly we can presume demineralisation may result and logically, caries. Often excessive alcohol drinkers will have poorer oral hygiene habits also leading to the possibility of caries developing.Alcohols Effect on The Body Sample Essay ⢠Periodontal disease â Tezal (2001) found that alcohol consumption may affect the periodontium in the following ways, aside from poor plaque control exhibited by frequent alcohol drinkers; Impaired immune response leading to a decrease in neutrophil function which is vital in the response to periodontal bacterium, decrease in liver function leading to inflamed or bleeding gingivae, alcohol also affects tissue healing. ⢠Xerostomia â Use of alcohol can add to dry mouth (Ongole and Praveen, 2012). Consequently it can be deduced that lack of saliva would decrease the antimicrobial benefits especially in dealing with dental caries and periodontitis. ⢠Oral and facial trauma â Hutchinson et al (1998) performed a study of accident and emergency departments over a weekend period in the United Kingdom, to assess how many admittances were dental/facial injuries, they found that fifty five percent of the total admittances were alcohol related. In conclusion they suggested the implementation of a scheme to make young people more aware of the risks associated with drinking and injury.Alcohols Effect on The Body Sample Essay ⢠Oral Cancer â The most life threatening of all the oral implications is oral cancer, Brocklehurst et al (2013) states that it is the sixth most prevalent cancer worldwide and is on the increase. Alcohol is a clear risk factor. Dal Maso et al (2015) found that is some cases patients who both drink alcohol and smoke tobacco the synergistic effect increases the chance of head and neck cancer by 35 times. According to Figuero-Ruiz et al (2004) the active component of alcohol is ethanol, this in itself is not carcinogenic, however the primary metabolite acetaldehyde has been established to be a carcinogen. It goes on to explain that the permeability of the oral mucous membrane, coupled with the cytotoxic effect of acetaldehyde and the lack of salivary buffering can cause cellular mutations and damage to the deoxyribonucleic acid (DNA). Oral cancer lesions tend to be pain free and in sheltered areas of the mouth or oropharynx, sometimes leading to late diagnosis, as the patient may be unaware of changes. A specific screening programme including visual examination may be useful in decreasing mortality rates in oral cancer (Brocklehurst et al, 2013).Alcohols Effect on The Body Sample Essay United Kingdom Alcohol Statistics According to the charity Alcohol Concern, alcohol is the third biggest risk factor for preventable illness and death in the UK, and costs the National Health Service £3.5 billion per year, this equates to a cost of £120 for each tax payer. The Organisation for Economic Co-operation and Development (from henceforth referred to as OECD) is an organisation combining and analysing data from its member countries, primarily Western countries, but also monitoring countries outside the OECD. In 2015 they conducted research on the drinking habits from thirty four Western countries. Their research highlighted that hazardous drinking (defined as drinking double the amount of safe units â 14 units per week for women and 21 for men) is most common amongst women who are both highly educated and of a high socioeconomic status. This can possibly be attributed to women placing a greater importance on forging a career, higher earning jobs requiring networking after work and the stress of balancing work, childcare and living costs. These women are also more likely to drink at home. The survey also noted that teenage girls are catching up with teenage boys, stating that 43% of boys had experienced being drunk by age 15, and 41% of girls in 2010 compared with 30%:26% ratio in 2001. Men in the high education bracket are also the more hazardous drinkers.Alcohols Effect on The Body Sample Essay In light of the findings above, it would be a natural assumption that during the career of a dental clinician, the importance of screening patients using AUDIT (C) and advising as necessary will become an essential part of patient care. This means that dental clinicians need to be equipped with the skillset to give accurate and pertinent advice to the patient and feel confident in doing so.Alcohols Effect on The Body Sample Essay Delivering Better Oral Health Delivering Better Oral Health is a guidance tool, collated by experts using information gathered from multiples resources including systematic reviews, research papers and studies. The evidence included is rated dependent on its strength or weakness. DBOH advocates a preventative approach and urges all dental healthcare professionals to give their patients some form of advice or praise relative to the subheadings in DBOH irrespective of their level of risk or need. A range of topics are covered in DBOH including, fluoride, smoking and oral hygiene.Alcohols Effect on The Body Sample Essay The behavioural change DBOH sets out to achieve is via âbrief interventionâ and âmotivational interviewingâ. Brief intervention involves raising the subject with the patient, gauging their reaction, offering brief advice and either signposting the patient to further assistance or revisiting the issue at the next appointment. DBOH understands that true behaviour change is a lengthy process as it is multifactorial. For example a patient may smoke tobacco and drink alcohol regularly putting them in a high risk category, this would mean the clinician would need to address the reasons behind these choices and encourage changing the behaviour for both issues.Alcohols Effect on The Body Sample Essay Another limiting reason for behaviour change is the patientâs lifestyle and social factors, for example a patient who is grieving due to a recent bereavement would be less motivated to change than a woman who has found out she is expecting her first child after a year of trying to conceive. This ties in to motivational interviewing. Experts now recognise that using health risks as an incentive to change behaviour is not successful with everybody. The clinician needs to talk to the patient to identify what motivates them and use that for encouragement. Some examples of this are; highlighting to a patient how much money they could save if they stopped spending on cigarettes or alcohol or the aesthetic benefits a patient could expect to achieve orally if they stopped smoking and had less staining on their teeth. Experts also note that the ideal person to achieve change is a person with good motivation and a good support network. It is therefore important to get to know the patient to assess when you can best assist them.Alcohols Effect on The Body Sample Essay The alcohol section of DBOH highlights the effect alcohol misuse has generally in the United Kingdom and also specifically to oral health. It illustrates how much a unit of alcohol is using different types of alcohol. It identifies the role dental professionals can have in supporting alcohol misusers and lists useful resources. It also contains AUDIT(C) which stands for âAlcohol use disorder identification testâ. Once completed the patient can be placed in to a category depending on their level of risk, if a patient scores over 10 the importance of referral to their GP or local alcohol support service must be stressed.Alcohols Effect on The Body Sample Essay The fundamental message DBOH encourages dental clinicians to employ is âAsk, Advise, Actâ; this should be actioned to every patient who requires it. Questionnaire Design and Methodology The aim of this questionnaire (Appendix Figure A) was to gather data to attempt to answer the primary research question âAre dental clinicians implementing the alcohol toolkit from delivering better oral health?â As stated initially the questionnaire was created using guidance from the University of Leeds website. To create an appropriate questionnaire the research aims must be clear. Alcohols Effect on The Body Sample EssayFor this research project the author required demographic information on the participants and to create questions which would provide an insight in to the relationship between the dental clinician and their patients regarding the conversations which take place surrounding alcohol consumption and advice. As the primary research aim is to identify if DBOH is being used or not, the author had to ensure no bias was shown toward DBOH in the questions. To ensure this the questions asked in the survey included the mention of multiple publications; there was only one question which asked specifically about DBOH. The intended sample participants were dentists, dental hygienists and dual qualified dental hygienists and therapists working in dental practices in the United Kingdom. The aim was to achieve one hundred participants to garner an adequate cross section of the population of dental clinicians in the United Kingdom, to gather enough data to deduce meaningful conclusions to the primary question in the time frame set and with the resources available to the author.Alcohols Effect on The Body Sample Essay The format of this questionnaire was self-administered and not conducted through one to one interviews. This was chosen to accommodate the resources and time available to the author. The questionnaire was designed on http://www.surveymonkey.com as mentioned in the introduction.Alcohols Effect on The Body Sample Essay The link to the questionnaire was primarily distributed through two mediums to attract the most responses. Firstly the website http://www.gdpuk.com which is a website for dental professionals containing new articles, blogs, classified advertisements and importantly a forum. The link was distributed in the forum along with a cover note (Appendix Fig B) explaining that the project would be looking at alcohol and the oral cavity with an emphasis on alcohol advice, DBOH was not mentioned as this would infer bias. Secondly the questionnaire was distributed on the Facebook group Dental Hygienist and Therapist Network which is a non-public group and has over three thousand members. The link was posted, along with a cover letter. Alcohols Effect on The Body Sample EssayThe link to the questionnaire was also passed on through the authors contacts within the dental industry. The ideal number of participants was one hundred; within forty eight hours of distributing the questionnaire one hundred and five responses had already been submitted. The final amount at the close of the questionnaire was one hundred and twenty respondents. The layout of the questionnaire was determined mainly by surveymonkey.com, there was a ten question limit due to limited funding available to spend on purchasing more questions. Nine questions were tick box and closed questions with single response answers, unless there was an âotherâ selection in which case the respondent would need to specify their answer. One question offered the respondent to add anything they wished to write making it an open question.Alcohols Effect on The Body Sample Essay Tick box answers were chosen for simplicity and time management. According to The University of Leeds guidance, the most successful questionnaires are quick, as people tend to be hesitant to commit to completing a questionnaire that they presume will be complex or take a long time.Alcohols Effect on The Body Sample Essay There is some conflict amongst questionnaire guides whether easy questions such as gender, occupation and location, should be at the start or the end of a questionnaire. In this questionnaire the simple questions were split and inserted both at the beginning and end. Starting with occupation and ending with gender, age and location. All respondents were reassured of their anonymity by completing the questionnaire on surveymonkey.com and also assured that the data they provided would only be used in connection with this research project.Alcohols Effect on The Body Sample Essay Although it is best practice to run a pilot survey first, due to time restraints this was not possible. However the author did ask for proof reading and feedback from colleagues and family to ensure there were no obvious errors or omissions.Alcohols Effect on The Body Sample Essay Data Analysis & Discussion Out of one hundred and twenty respondents, one person did not select their occupation; this meant 44% of respondents were dentists, 21% dental hygienists and 35% dual qualified dental hygienist/therapists.Alcohols Effect on The Body Sample Essay Question two askedâHow often do you ask your patients about their alcohol intake?â. The answer with the most responses was âAt every appointment/3+ times per yearâ with a total of 38, however âOnce per yearâ was close behind with 36 selections (Appendix Fig 2). It is interesting to note that when the results were broken down in to occupation the most popular selections were as follows; dentists â Twice per year 71%, dental hygienists â Never 41% and dental hygienists/therapists â At every appointment/3+ times per year 55% (Appendix Fig 3). The survey indicated that the majority of sole qualified dental hygienists in this survey are not asking their patients about their alcohol intake at all. When the author asked a sole qualified dental hygienist colleague why he thought this might be, the colleague disclosed that he had never been taught anything during his studies to do with alcohol, nor DBOH. This response may go some way to establishing the cause, but it also identifies a need for further research to investigate the reason for this.Alcohols Effect on The Body Sample Essay Question three is one of the most important questions in the survey as it concerns where dental clinicians are obtaining their alcohol advice. The most popular answer was âNICE guidelinesâ with 37% (Appendix â Fig 4). Once it has been disseminated in to occupation the results are as follows; Dentists â NHS Scotland: Alcohol and Oral health 70%, Dental hygienists â NHS Live Well Guide 26% and Dental hygienists/therapists â Delivering Better Oral Health 47%.Alcohols Effect on The Body Sample Essay When considering range, the age group which uses DBOH the most are 18-24 years at 60%, 65-74 years do not use DBOH at all and 45-54 years comes in second least with 17% (Appendix Fig 6). A possible reason for this could be the time at which the participant qualified. Currently many dental hygiene and therapy programmes in the United Kingdom promote and encourage the use of DBOH these results may imply that those in the younger age group qualified recently so continued using DBOH in practice as they were in university. Whereas the older age groups may not be as aware or comfortable using it. However this highlights a need for further research.Alcohols Effect on The Body Sample Essay Question four asks the question how does a dental clinician decide what advice is appropriate. Interestingly the most popular answer was âI do not normally give alcohol adviceâ (40%) and the second most popular answer with only a difference of 0.17% was âI check to see if their units of alcohol per week are over or under the national recommendationsâ (Appendix â Fig 7). Whilst it may be suitable to assess a patients level of risk by checking their weekly units of alcohol, it does not provide as much in depth information as AUDIT (C), nor does it place a person in an official risk category as outlined by DBOH. More concerning is the fact that nearly half of the participants surveyed do not offer any alcohol advice at all. Many patients are unaware of what constitutes a unit, how many units per week are advisable and importantly the risks associated with drinking alcohol.Alcohols Effect on The Body Sample Essay The most popular results per occupation are as follows (Appendix â Fig 8); dentists equally chose âI do not normally give alcohol adviceâ and âI check to see if their units of alcohol are over or under the national recommendationsâ with 47% each, dental hygienists â âI do not normally give alcohol adviceâ and dental hygienists/therapists â âI ask the patient to complete AUDIT (C) from DBOHâ. As mentioned previously further research is needed to highlight any reasons for the varied choices from the three professions.Alcohols Effect on The Body Sample Essay Question five relates to the advice advocated by DBOH, which is the aforementioned âAsk, Advise, Actâ. If it has become apparent the patient requires professional support it is the responsibility of the clinician to encourage referring them on to their GP or local alcohol support service. Whilst only 93% of clinicians had never referred a patient and 7% had (Appendix â Fig 9). More females have referred than males at a ratio of 9%:3%, however this may not be significant if the research was repeated with a larger sample size as this survey had more female respondents than male with a ratio of 86:34.Alcohols Effect on The Body Sample Essay Question six is also important in answering the question for the primary research goal. This question asks for the participantâs opinion on the alcohol chapter of DBOH. Interestingly 71% of respondents replied âI do not use itâ and only 16% like it (Appendix â Fig 11). From the occupation groups the highest non-users were the dental hygienists (Appendix Fig 12). As there are currently no publications regarding the usage or the opinion of clinicians using DBOH, there are no points of comparison or studies for the author to speculate the reasons why such a large proportion does not use DBOH. This study has highlighted a need for a further field of study in to DBOH and patient care, and to identify the best way for patients to receive best practice, standardised care, whether this is via DBOH or other relevant guidelines.Alcohols Effect on The Body Sample Essay From the demographic questions we can see that out of 120 participants 86 were female and 34 were male (Appendix â Fig 13). Of the age groups sampled jointly the 25-34 years and 35-44 years had a total of 36 respondents, the highest amount out of all the age categories (Appendix â Fig 14). This may be indicative of the platforms the questionnaire was distributed, via Facebook and a website. Paper copies or emails sent directly to dental practices might allow for more varied age range responses. The most popular location was the South East of England with 24 respondents (Appendix â Fig 15).Alcohols Effect on The Body Sample Essay Statistical Significance To test the validity of this research and to identify whether the hypothesis is correct the statistics must be tested. The data in this research consists of categorical variables; this simply means the options can be placed in to categories, for example occupation, the variables are not numeric. For data with categorical variables a chi square test is performed to identify significance. The categorical variables in this research can also be further broken down in to independent and dependent variables. This research consists of mostly dependent variables. Dependent variables are things that can be changed by other factors, some examples of this are; ⢠A dental hygienist may do further training to become a dental therapist.Alcohols Effect on The Body Sample Essay ⢠A dentist may not currently like DBOH but once the publication has been altered or updated they may change their mind. Independent variables are things that cannot be changed by other factors for example eye colour or gender. Using question six âHow do you feel about section 8âAlcohol misuse and oral healthâ in DBOH?â An online chi-square calculator was used to analyse the relevant information as depicted in Fig 16; This table sets out the observed values, expected values in round brackets and chi-square values for each cell in square brackets. To interpret your chi-square statistic you must first decide your significance value, this is usually 5% or 0.05. Alcohols Effect on The Body Sample EssayThen it is necessary to identify your degree of freedom, this is a table which allows you visualise how much your statistic is allowed to vary. To work out your degree of freedom a simple equation must be calculated; (Number of rows-1) X (Number of columns-1) =Degree of freedom So for this table we have; (3-1) X (5-1) = 8 degrees of freedom Fig 17 is a chi-square degree of freedom table; The chi square statistic for this research is 21.90, and the degree of freedom as highlighted in blue above is 15.51. This means the statistic is greater than the degree of freedom therefore the null hypothesis (H0) âDental clinicians are implementing DBOHââ is rejected and the alternative hypothesis (H1) âDental clinicians are not implementing the alcohol toolkit from DBOHââ is accepted.Alcohols Effect on The Body Sample Essay The p-value of this study also confirms the above statement. The significance value was set at 0.05, so a small p-value or a p-value of less than 0.05 confirms rejection of the null hypothesis and acceptance of the alternative hypothesis. The p-value was 0.005. Therefore the primary research identifies that the majority of clinicians are either not using the alcohol toolkit of DBOH at all, or are only using some parts of it, not in its entirety.Alcohols Effect on The Body Sample Essay Why is there a reluctance to address alcohol consumption? Question seven on the questionnaire asked the participants âAnything you would like to add?â. The answers provided a thorough insight in to some of the reasons why dental clinicians may be reluctant to address alcohol with their patients.Alcohols Effect on The Body Sample Essay Many participants commented that alcohol consumption was answered on the medical history form, this may indicate that they believe as long as they have a written record of the patientâs alcohol consumption that would be enough information or they are covered medico-legally. However if they do not discuss it further with the patient they will not know whether the patient understands what a unit of alcohol is or even if the patient understands the risks associated with drinking regularly. The clinician may also be placing themselves in a risky position regarding negligence. In 2013 a patient took dentist Ian Hughes to the high court for failing to diagnose her oral cancer, he was in this instance cleared of the charges (www.manchestereveningnews.co.uk). However it should be a warning to clinicians who fail to either risk assess the patient or perform a thorough examination.Alcohols Effect on The Body Sample Essay Another participant stated âalready too much to do for my £8.30 (Scottish exam fee) without doing this. Writing the notes alone takes long enough!â this seems to broach the idea that time and money are a factor in what dental professionals should be or are capable of covering in their appointments with patients. Further participants mentioned the constraint of time. There is a huge demand in the United Kingdom for access to dental care, especially National Health Service practices, therefore there is pressure placed upon clinicians to treat as many patients as possible. Alcohols Effect on The Body Sample EssayThere may be an argument to suggest that dental clinicians are not afforded the time to cover all the areas necessary as part of a standard dental visit. Some participants made reference to the fact that they would only discuss alcohol consumption if they found an âoral developmentâ they felt could link to alcohol or evidence of acid erosion. However the opposing argument to this is if they had addressed alcohol earlier in their professional relationship where possible, would the patient be exhibiting those oral manifestations.Alcohols Effect on The Body Sample Essay A common reaction is that smoking is a topic that is easier to address, one participant divulged âI find patients are more defensive about how much they drink than smoking (sic) and many do not understand its relevance to oral healthâ. The government has spent a lot of money on resources attempting to encourage people to stop smoking by highlighting the associated risk. Some key events were the ban on smoking in all enclosed work places in 2007 (www.politics.co.uk) and graphic images being printed on to cigarette packets in 2008 (www.bbc.co.uk). There has not been such government investment in exploring alcohol related disease and formulating nationwide advertisements or publications to explain the health implications to the general public.Alcohols Effect on The Body Sample Essay There seems to be a social acceptance that the risks of smoking and encouragement to quit can be openly discussed with smokers without undue tension. Therefore this ties in with the overwhelming reaction from the participants that there is an awkwardness surrounding discussions about alcohol consumption. One participant stated âPatients can be even more coy about alcohol consumption than they are about smokingâ, this might suggest that they feel patients would not provide an accurate or truthful answer to begin basing advice on.Alcohols Effect on The Body Sample Essay Some further comments to illustrate participants feeling awkward are âAlcohol can be a sensitive issue to approachâ; ââ¦it is not my responsibility to question their lifestyle choicesâ, âI find it too awkward an area to broach with patientsâ and âWe all have bad habitsâ. Unlike smoking, historically alcohol tends to still be a socially accepted activity. Fermented drinks can be dated as far back as the Stone Age (www.nytimes.com). Alcohol is commonly consumed as part of a celebration or social time spent with colleagues, family or friends, as part of religious services and might even be a personâs career e.g. professional wine taster.Alcohols Effect on The Body Sample Essay It is therefore not surprising that dental clinicians find it a tricky subject to deal with because the probability is that they too consume alcohol. Underwood, Fox and Manogue (2010) conducted a survey of tobacco, alcohol and drug use among dental undergraduates at an English university. They compared results from 1998 and 2008. The 2008 results showed that 63% of males and 69.5% of females drank alcohol.Alcohols Effect on The Body Sample Essay There has also been an increase in binge drinking amongst both sexes since 1998. Underwood, Hackshaw and Fox (2007) also conducted a survey of tobacco, alcohol and drug use amongst newly qualified dentists completing a yearâs vocational training comparing data from 2000 and 2005. The findings showed that whilst the amount of males and females drinking alcohol had decreased since 2000, it was still at a high proportion with 82% of males and 81% of females in 2005. It can consequently be suggested that as many dental clinicians are consuming alcohol despite being aware of the risks, thus they feel it is hypocritical to evaluate and admonish another person for their decisions.Alcohols Effect on The Body Sample Essay The Role of the Dental Hygienist/Therapist From an ethical and medical point of view alcohol intake must be part of gathering a complete history about your patient. Thorough soft and hard tissue checks should be completed to check for any abnormalities. The patient should be informed of their relative level of risk for oral disease from any of their habits. Advice should be offered where appropriate and done with evidence based backing. The clinician must be able to identify where further specialist referral is required.Alcohols Effect on The Body Sample Essay How could this research be furthered? If the author were to continue this research the initial change
The Impact of Chronic Illness Assignment Paper
The Impact of Chronic Illness Assignment Paper The Impact of Chronic Illness Assignment Paper The purpose of this study was to assess the impact of chronic illness on patients in relation to its physical, psychological, and social effects, and its effects on activities of daily living. A structured questionnaire was used to interview 177 patients. Chronic illness had the greatest effect on psychological functioning, followed by physical and social functioning. The least affected aspects of a patients functioning were related to performing activities of daily living (ADLs). Results indicated that the diagnosis, duration of disease, and developmental stage of the patients children were useful in predicting the impact of a chronic illness on a patients physical functioning. Diagnosis, duration of disease, and economic status had a significant impact on a patients psychological functioning. Diagnosis, duration of disease, age, sex, occupation, education, and marital and economic status were important factors relative to social functioning. Diagnosis, age, marital status, the developmental stage of the children, and the primary caregiver were the most important factors related to the effects of chronic illness on ADLs. The results of the study serve as a guide for a comprehensive assessment of chronically ill patients.The Impact of Chronic Illness Assignment Paper Permalink: https://nursingpaperessays.com/ the-impact-of-ch assignment-paper / ? Advances in medicine have prolonged the life of many people with chronic diseases. Chronic diseases may not kill but they consume a lot of health care resources and threaten the quality of life of the sufferers. 1 11 The ultimate goal of modern health care for patients with chronic disease is not only to delay death but also to promote health and quality of life. Health-related quality of life (HRQOL) has become an important measure of the outcome of care for patients with chronic diseases in the last two decades. It has also been found to be predictive of health service utilization and mortality. 2 , 12 14 It is subjective and should include the essential domains of physical, psychological, daily role and social functioning, and general health perception The Impact of Chronic Illness Assignment Paper Australias population is ageing: our average healthy life expectancy of 73.2 years is second only to that of Japan (74.5 years).1 Total life expectancy is some 10 years longer, but this further longevity may be accompanied by significant and increasing disabilities.2 Burden-of-disease data show that depression, dementia, asthma, osteoarthritis, hearing loss and diabetes account for nearly 30% of the years of life lost due to disability in Australia. These are all chronic conditions that are increasingly prevalent,3 in the face of healthcare workforce shortfalls in Australia.4 Thus, there is a need to explore alternative models of healthcare delivery. These need to be collaboratively developed and should provide a range of healthcare professionals with broad knowledge and competency to care for patients with chronic illness.The Impact of Chronic Illness Assignment Paper Recently, Wagner defined what constitutes a patient care team and outlined strategies necessary for the effective functioning of chronic disease programs.5 A patient care team comprises diverse healthcare professionals who communicate regularly about the care of a defined group of patients and participate in that care on a continuing basis.6 The strategies that underpin this team care include:5 Population-based care; Treatment planning, which should be negotiated with the patient; Evidence-based clinical management; Self-management support, with the emphasis on patient self-education, self-care and counselling in behavioural change; More effective consultations; and Sustained follow-up, which may not need to be face to face, but could be carried out, for example, over the telephone The Impact of Chronic Illness Assignment Paper It is apparent that some elements of a chronic disease management program (Box 1) need not involve clinicians. But one important issue that does is that of managing the team. This is still seen to be the responsibility of a healthcare professional, but increasingly there is a need for specific management expertise within the team. Role delineation is also an important issue. In the paradigm of diagnosis and management, there is no doubt that medical graduates have the major role in diagnosis and initial assessment of patients, but management can and should be shared with other healthcare professionals.9 The development of team care for chronic disease needs to involve and cater for both institutional and community care, and these may be very system dependent: public and private hospitals and community facilities can have quite different systems and approaches. Current organisational structures for healthcare delivery are discipline-based, but we need to abandon this paradigm in dealing with chronic disease. Healthcare structures are often, by their nature, hierarchical ego systems10 and can interfere with the ability to develop comprehensive healthcare delivery services. It is important to break through the barriers between these silos.The Impact of Chronic Illness Assignment Paper The concept of multidisciplinary disease clinics where orthopaedic surgeons and rheumatologists work closely with physiotherapists is well accepted. Cardiologists and cardiac surgeons combine to provide advice on acute intervention in chronic cardiovascular disease. These concepts work well within the hospital system, but need to be adapted for community care. Another problem with disease management for chronic conditions is that the healthcare system is predominantly geared for healthcare professionals rather than for patients, and for episodes of acute care (albeit often in chronic disease) rather than for chronic care. In the shift of care delivery, it is critical that the team work across the interfaces of the community and institutions and that communication between specialists and the primary care teams be maximised for the patients good. The development of multidisciplinary disease-specific healthcare delivery teams helps to break down those barriers, but patients need to be involved more in that dialogue. Future healthcare professionals will need to have some skills or knowledge of case management and integration of care. They will need to: Be aware of health promotion and disease prevention issues; Be able to act as the patients advocate; and Empower patient self-care through education and provision of basic skills for self-care. Patients with chronic disease will have increasing knowledge of their conditions and will want to be involved in decision-making. Healthcare professionals will need to be aware of this patient empowerment The Impact of Chronic Illness Assignment Paper These issues of health promotion, patient advocacy and patient empowerment, along with education in healthcare systems, need to be addressed at both undergraduate and postgraduate levels so that future healthcare professionals will understand the vagaries of healthcare systems how they work and how they can be made to work better, and how to promote patient self-management. In a way, the aim is to shift the healthcare system from one concerned with illth to one concerned with health. Many of these skills may be acquired by healthcare professionals through multidisciplinary learning. Programs can be developed in which individuals from different disciplines learn together around particular clinical problems, and see what skills each can bring to the problem.12 The generic healthcare professional There may be a role for a more generic healthcare professional who has a defined range of allied health skills (physiotherapy, occupational therapy, nursing, etc), but not necessarily the specialty expertise of any one discipline. These people would work closely with other members of the healthcare team, particularly general practitioners. Generic healthcare professionals with various skills may be useful in the care of patients with chronic disease or in assessing elderly patients in a community setting. They might be particularly useful in rural areas where allied health professionals are often in short supply. These generic healthcare professionals could use technologies such as video or computer to link with specialists, medical or other (physiotherapists, pharmacists, etc), in urban centres. Similarly, generic healthcare practitioners with skills in acute resuscitation, dental care, basic physiotherapy, counselling and limited prescribing could provide useful care in local communities, especially if they have contact with, and are regarded as part of a team of, healthcare professionals in regional centres. This model might also have a place in providing services in community aged-care facilities, closely linked with local general practice and community services.The Impact of Chronic Illness Assignment Paper Data from the United States suggest that partnerships between primary care physicians and advanced practice nurses can provide better patient outcomes.13 If the training of advanced practice nurses were extended to include knowledge of physiotherapy, occupational therapy and pharmacy, these generic healthcare professionals could provide a broad range of advice and services in partnership with other disciplines. Assessing alternative systems The important issue is that we should consider alternative models of healthcare delivery for chronic disease, and assess whether they might work in Australia. In some other areas of healthcare, particularly in the US and Europe, other healthcare professions have taken on roles hitherto considered the purview of the doctor. Nurse anaesthetists are well accepted in Scandinavia, where they have an important role in assessing chronic pain and managing post-operative pain.14 , 15 The idea of medical practitioner assistants, where nurses or others can be trained to be anaesthetic assistants or assist in other procedures, has long existed in the US. The supply of non-medical clinicians in the US is growing significantly, with the number of non-physician clinicians in primary care expected to be equivalent to 20% of the supply of physicians by 2015.16 A recent US study17 of the trend towards care by non-physician clinicians has shown that, although the number of patients visiting non-physician clinicians is increasing, many are seeing physicians as well. This is accompanied by a shift towards the provision of preventive services by non-physician clinicians and an increase in the proportion of patients seen by both types of providers. It is important that these physicians and non-physicians are truly complementing each other, delivering the same services to different groups or different services to the same group. For patients, the type of clinician may be less important than whether the care meets their needs and achieves a better or equivalent outcome. The success of these models depends on close collaboration and communication between the various care providers. It is important to evaluate these models carefully from the start to ensure that continuity and quality of care are not reduced The Impact of Chronic Illness Assignment Paper We need to work together to identify tasks performed by one professional group that might be equally well performed by others. This would then free that group to concentrate their expertise in other important areas. For example, pharmacists or nurses might be involved in providing repeat prescriptions, or reviewing medication and compliance; radiographers or expert systems could be involved in x-ray interpretation; and human movement professionals might be involved in exercise programs for obesity, osteoporosis and chronic arthritis. Optometrists might play a role in the management of specified eye problems. Indeed, it should be asked whether it is possible to train non-medical practitioners to perform specific procedures such as gastrointestinal tract endoscopy, cataract extraction or arthroscopy. We could also consider professional groups outside the healthcare system, such as teachers. Developing closer links between the healthcare and education systems could have significant effects on what children learn about the most important thing they have their own bodies. Teachers could play a very important public health role as health educators to children in the 816-year age bracket. Development of basic knowledge, particularly on the importance of exercise, could play an important role in reducing the current epidemic of obesity in young people, which will inevitably lead to chronic diseases such as diabetes, arthritis and cardiovascular disease.The Impact of Chronic Illness Assignment Paper The aim of this study was to assess the impact of chronic diseases on the HRQOL of Chinese patients in a primary care clinic in Hong Kong. Most previous studies on the relationship between chronic diseases and quality of life were carried out in Western populations, which might not be applicable to our population, 96% of whom are Chinese. 18 We wanted to know whether different diseases affected HRQOL differently and whether one aspect of HRQOL might be affected more than others. We hoped that the information could help doctors and health administrators to identify the needs of patients with chronic diseases better so that their services could be more patient-centred. The impact of each chronic disease on HRQOL was measured in terms of the likelihood of sub-optimal functioning or health instead of numerical scores used by many other studies. 4 6 , 8 We hoped that this would make the clinical significance of the results easier to interpret, and that doctors in primary care could use them to predict the risk for their patients.The Impact of Chronic Illness Assignment Paper Many earlier studies have shown that co-morbidity is common and may influence the patients HRQOL. 6 8 , 11 , 19 21 Demographic factors such as age, gender and socioeconomic status could also affect peoples health perception. Therefore, we also estimated the effect of each chronic disease and compared their relative impact independently of the effects of demographic factors and co-morbidity. The study was carried out in a teaching family medicine practice in Hong Kong. The practice was one of 60 Government outpatient clinics (GOPCs) which provides low-cost primary care for the public. The majority of patients with chronic diseases in Hong Kong are followed up in GOPCs for financial reason. 18 At the time of the study, the practice had 5305 Chinese patients with an average of 70 persons consulting each day. All patients aged 18 years or above consulting the practice from July 5 to August 3, 1995 were invited to take part in the study. Each patient in the study was interviewed with a structured questionnaire before the consultation with the doctor. The subject answered the questions in person unless he/she could not communicate, in which case the accompanying person (proxy) answered the questionnaire.The Impact of Chronic Illness Assignment Paper The questionnaire consisted of questions on demographic and morbidity data and the Chinese version of the Dartmouth COOP Functional Health Assessment Charts/WONCA (COOP/WONCA charts). Morbidity data were collected by a checklist for the presence of eight common chronic diseases that represented a wide range of problems from the asymptomatic to the potentially fatal. Each respondent was asked specifically if he/she had ever been diagnosed by a doctor as having hypertension, diabetes mellitus, asthma or chronic obstructive pulmonary disease (COPD), heart disease of any kind, stroke, osteoarthritis (OA) of the knee, joint diseases other than those of the knees (other joints) and depression. Asthma and COPD were considered as one group because there is considerable clinical overlap between them. No distinction was made for the different types of heart diseases because patients cannot always tell the difference between them. The records of the respondents were also reviewed for the presence of these diagnoses. A subject was considered to have the particular disease if he or she was sure that such a diagnosis had been made by a doctor or the diagnosis was documented in his/her record.The Impact of Chronic Illness Assignment Paper The COOP/WONCA charts consist of one chart each on physical fitness, feelings, limitation in daily activities, limitation in social activities, overall health and change in health. They have been validated and tested on patients in primary care in different cultures including the Chinese. 22 , 23 The first five charts cover the essential concepts of HRQOL. 15 17 The chart on change in health does not assess HRQOL but provides additional information for the interpretation of the results of the other charts. Each chart is rated on a five-point Likert scale, with higher scores indicating worse function or health status. A summary of the questions and response choices of the COOP/WONCA charts is shown in Appendix A.The Impact of Chronic Illness Assignment Paper The scores of each of the five COOP/WONCA charts on HRQOL were grouped into two categories (optimal and sub-optimal) for further analysis. The optimal category consisted of scores 1 and 2 and the sub-optimal category consisted of scores 3, 4 and 5 for the charts on physical fitness, feelings, daily activities and social activities. Scores 1, 2 and 3 were grouped into the optimal category, while scores 4 and 5 were grouped into the sub-optimal category for the overall health chart. The proportions of sub-optimal COOP/WONCA scores for each disease group were compared with those of patients without any of the chronic diseases (control group). The difference in proportion between them was tested by the chi-square test. The effects of diagnosis, age, social class by occupation, 24 marital status, education and gender on the COOP/WONCA scores were analysed by multivariate forward logistic regression. All the independent variables were fitted together into the logistic regression model, and P -values ?0.05 were considered statistically significant. All data analyses were carried out by the SPSS for Windows 8.0 program The Impact of Chronic Illness Assignment Paper Seven hundred and sixty (97.8%) of 777 eligible patients completed the survey. Twenty-three (3%) of the questionnaires were answered by proxies. There were 222 (29.2%) males and 538 (70.8%) females. The mean age was 57.6 years (range 1894 years, SD 18). One hundred and ninety-one (25.1%) people were not known to have any of the surveyed chronic diseases, 202 (26.6%) had one, 188 (24.7%) had two, 89 (11.7%) had three, 28 (3.7%) had four, three (0.4%) had five and one (0.1%) each had six and seven of the chronic diseases. Fifty-seven (7.5%) people were not sure if they had any of the diagnoses. The number of persons and demographic characteristics of the sample and each disease group are shown in Table 1. Patients with chronic diseases were more likely than controls to be older, less educated, unskilled workers and persons whose spouses were deceased.The Impact of Chronic Illness Assignment Paper Table 2 compares the unadjusted proportions of sub-optimal COOP/WONCA scores of each disease group with those of patients without any of the diagnoses (control group). Apart from hypertension and diabetes mellitus, the presence of any one chronic disease tended to increase the risk of sub-optimal scores for all the charts. The differences in physical fitness scores were statistically significant for all disease groups. The difference in the feelings scores was statistically significant for depression. The differences in daily activities scores were significant for stroke, OA of the knee, other joint diseases and asthma/COPD. The difference in social activities scores was significant for depression. The differences in the overall health scores were significant for asthma/COPD and depression.The Impact of Chronic Illness Assignment Paper Table 3 shows the results of multivariate forward logistic regression of the COOP/WONCA scores on each diagnosis and demographic variables. Subjects who were unsure of the diagnosis were categorized into the absence of the diagnosis group for the logistic regression in order not to exclude too many cases from the analysis. All the odds ratios for sub-optimal COOP/WONCA scores shown were significant at the 5% level. Each odds ratio was the ratio between the odds of a sub-optimal score of those with and those without the relevant diagnosis, after controlling for the effects of demographic variables and co-existing chronic diseases. Most odds ratios approximated the relative risks since the absolute risk in the unexposed was <20%, except for the physical fitness score. The odds ratios of sub-optimal physical fitness scores for hypertension and depression corresponded to relative risks of 1.3 and 1.8, respectively The Impact of Chronic Illness Assignment Paper The effects of most chronic diseases on the physical fitness score became insignificant when they were controlled for demographic variables and co-morbidity. Hypertension increased the odds of sub-optimal physical fitness scores but reduced the risk of sub-optimal feelings and overall health scores. Diabetes mellitus significantly reduced the likelihood of sub-optimal scores for feelings, social activities and overall health. Heart disease did not have any significant independent effect on any COOP/ WONCA scores. OA of the knee increased the risk of sub-optimal scores for daily activities and overall health. Stroke, other joint diseases and asthma/COPD each increased the risk of sub-optimal scores for daily activities. Depression was a risk factor of sub-optimal scores for all but the daily activities charts. Age, educational level and gender had some effects on the COOP/WONCA scores but social class and marital status had no effects. Increasing age increased the risk of sub-optimal physical fitness scores. Education decreased the likelihood of sub-optimal physical fitness scores when compared with no formal schooling (primary education OR = 0.4925, CI = 0.320.75; secondary education OR = 0.4096, CI = 0.250.68; tertiary education OR = 0.3075, CI = 0.140.69). Females were more likely than males to have sub-optimal feelings scores.The Impact of Chronic Illness Assignment Paper This study confirmed that many chronic diseases had an adverse effect on the HRQOL of Chinese patients and that different conditions affected different aspects of life. Sixty-seven per cent of subjects had at least one of the eight chronic diseases, and 41% had more than one. These prevalences were relatively high compared with those reported in the literature. 3 , 19 , 21 This was because the study practice was a GOPC, which had a high proportion of elderly patients with chronic diseases. The unadjusted risks of sub-optimal COOP/WONCA scores shown in Table 2 represented what primary care doctors might expect to find in the real clinical setting. A Chinese patient with depression is likely to have an 88% chance of reporting sub-optimal physical fitness, a 36% chance of moderate to severe emotional problems, a 26% chance of limitation in his/her social activities and a 32% chance of fair or poor health. These risks were twice or more than those expected for patients without any of the common chronic diseases. Some of the observed effects might be the result of the patients age, gender, educational level or co-existing diseases, but some demographic and morbidity characteristics tend to cluster together and it is almost impossible to separate one effect from the other in clinical practice. 20 On the other hand, it is important to control for the effects of co-morbidity and demographic variables in the evaluation of the effectiveness of care and medical risk adjustment so that these confounding factors will not bias the results.The Impact of Chronic Illness Assignment Paper The finding that heart diseases were not associated with any significant effect on any COOP/WONCA score was unexpected since previous studies showed that they adversely affected all HRQOL domains. 4 , 5 There was a tendency for our cardiac patients to have a higher risk of sub-optimal scores for all the COOP/WONCA charts than the controls, although the differences did not reach statistical significance. This suggested the possibility of a type II statistical error in that the sample size of 49 subjects was too small to show a statistical significance for a small effect. 27 However, a statistically significant change might not be clinically important and further studies are required to determine the minimum clinically important change in quality of life rating for cardiac patients. The other possible explanation was that 86% of the cardiac patients in this study had co-existing chronic diseases; the effects of these diseases might have cashed in before heart disease could be entered into the regression model. The last, but not the least important, reason was that cardiac patients with severe disease or disability are followed up by cardiologists, thus most patients in primary care have only mild diseases with little disability. An evaluation on a larger sample of cardiac patients with different severities of illness could help to clarify the relationship between heart disease and HRQOL.The Impact of Chronic Illness Assignment Paper It seemed contradictory that diabetes mellitus reduced the risk of sub-optimal scores for feelings, social functioning and overall health. De Grauw et al. and others have shown that diabetes mellitus was associated with worse ratings in both physical fitness and overall health domains. 5 , 11 Our finding was unlikely to be a confounding effect of co-morbidity because the latter was controlled for in the regression analysis and the majority of patients with diabetes mellitus did not have other chronic diseases except hypertension. Quality of life rating is subjective and relative to the persons life expectation. It has been found that successful adjustment has a positive effect on patients perceived HRQOL. 28 Differences in peoples adaptation to their illnesses and life expectations between the Chinese and Western cultures could be the reason for the different results. The Chinese culture promotes endurance, acceptance and adaptation to ones fate, including the presence of illnesses. Chinese patients with diabetes mellitus might down-regulate their expectations for life and would feel happy and contented as long as they remained asymptomatic and free from complications. They might even consider themselves fortunate and rate their health status more positively compared with the worst that they could expect from their illness. The promotion of a positive attitude could be as important as perfect glycaemic control in the care of diabetic patients.The Impact of Chronic Illness Assignment Paper Depression was the most disabling disease affecting not only the psychological well-being but also the physical and social functioning of the person. This finding reinforces the importance of recognizing and treating this disease adequately in primary care. The effect of depression on physical fitness has not been found by others. 5 , 10 Physical and mental health are often considered to be two independent factors of HRQOL, and psychological diseases are not expected to affect the physical component of health. 16 This unique finding in our patients could be due to a cultural tendency for Chinese patients to somatize their psychological problems The Impact of Chronic Illness Assignment Paper Patients seemed to perceive OA of the knee to be more disabling than hypertension, diabetes mellitus and heart disease, although these latter three diseases are regarded as the most important chronic diseases by doctors. The amount of resources and number of research studies on hypertension, diabetes mellitus and heart diseases are countless, but those invested in the care of patients with OA are negligible. 14 There seems to be a discrepancy between how doctors and patients define the importance of an illness. OA of the knee is often ignored by doctors until the disease is very advanced because it does not kill and is often considered a normal ageing process. 14 , 30 This study and that by De-Bock et al. consistently showed that OA of the knee was a risk factor, independent of associated psychosocial factors or co-morbidity, of limitation in daily activities and poor general health. 6 Research on the pathophysiology and mechanics of the knee joint has not advanced the care for patients with OA of the knee very far; it may be time for a paradigmal shift towards a more patient-centred approach to this disabling disease The Impact of Chronic Illness Assignment Paper The effects of hypertension on HRQOL reported in the literature are variable. 4 , 5 , 8 Our findings of a negative effect on physical fitness but a positive effect on feelings are similar to those of Krousel-Wood et al. 8 and Nelson et al. 5 Krousel-Wood et al. also found that females with hypertension had better overall health ratings than females seen for other conditions. 8 This study was carried out among patients in primary care who tended to have milder diseases and more stable conditions than patients under specialist care; therefore, the results may not be applicable to the latter setting. Furthermore, the findings from patients of one clinic might not be generalizable to all primary care practices in Hong Kong. We realize that self-reported data are subject to measurement errors, but the same bias should have been present for the disease and control groups so it should not have affected the results of the relative risk estimation and regression analysis.The Impact of Chronic Illness Assignment Paper The numbers of patients in the heart disease, asthma/ COPD and stroke groups were small; the sample sizes had enough power to detect only a medium effect of 1520% difference in proportions. 27 This study could not exclude some small effects that these chronic diseases might have on the quality of life of patients. We would also like to point out that the controls in this study could have diseases other than the eight chronic conditions surveyed, which could have deflated the difference in HRQOL ratings between them and the disease groups. With these limitations, the study did prove that measurement of HRQOL was feasible for Chinese patients in a busy primary care clinic and gave a different perspective on how the importance of a disease could be defined. This study confirmed that many common chronic diseases adversely affected the quality of life of Chinese patients, as they did for Caucasian patients. Depression, OA of the knee, other joint diseases, stroke, asthma/ COPD and hypertension were each associated with a 30200% relative increase in the risk of disability or ill health measured by the COOP/WONCA charts. Depression was the most disabling disease and daily role functioning was the most commonly affected HRQOL domain.The Impact of Chronic Illness Assignment Paper OA of the knee was more disabling than hypertension and diabetes mellitus from the patients point of view. This raised the questions of how the importance of a disease should be measured and whether doctors or patients should be the judges. We need to include HRQOL as a routine outcome measure of care for patients with chronic diseases if health services are really for the betterment of the quality of life of people. The positive impact of diabetes mellitus on HRQOL and the negative effect of depression on physical fitness found in our Chinese patients has not been reported in other cultures. Further studies on more representative samples are required to confirm whether there are true cultural differences in how Chinese people adjust to chronic diseases. It would be useful if we could identify the postitive and negative coping behaviours in each culture so that appropriate counselling could be given to patients. The Chinese are the worlds largest ethnic group who live in all parts of the world. We hope doctors world-wide will be more aware of the possible impact of chronic diseases on the quality of life of their Chinese patients.The Impact of Chronic Illness Assignment Paper What are some effects of a chronic illness? In addition to disease speci
Cuyamaca College Endocrine System Biology Lab
Cuyamaca College Endocrine System Biology Lab Cuyamaca College Endocrine System Biology Lab medium of exchange regulates the functioning of every cell, tissue, and organ in the body. It acts to maintain a stable internal body environment, regardless of changes occurring within or outside of the body. Endocrine cells have the ability to sense and respond to changes via the excretion of specific chemicals known as hormones. Hormones are carried in the blood, usually attached to specific plasma proteins, and circulate around the body. When the hormone-protein complex reaches a target cell (the cell at which a chemical message is aimed), the hormone detaches from the protein and enters the cell to induce a specific reaction. Hormones work in different ways, depending upon their chemical structures. For example, polypeptide hormones, composed of chains of amino acids, work by first attaching to a protein receptor in the cell membrane, initiating a series of reactions in the membrane resulting in cyclic adenosine monophosphate (cAMP) entering the cell. The entrance of this chemical into the cell induces the cell to work harder and faster. Steroid hormones and thyroxine (a hormone secreted by the thyroid, which we will be examining in detail shortly) enter the cell to attach to a cytoplasmic receptor. The hormone-receptor complex then enters the nucleus of the cell to attach to specific points on the DNA. Each attachment causes the production of a specific mRNA, which then moves to the cytoplasm to be translated into a specific protein. Most regulation of hormone levels in the body is conducted by negative feedback: if a particular hormone is needed, production of that hormone will be stimulated; if there is enough of a particular hormone present, production of that hormone will be inhibited. In a few very specific instances, hormonal output is controlled by positive feedback mechanisms. One such instance is the output of the posterior pituitary hormone oxytocin. This hormone causes the muscle layer of the uterus, the myometrium, to contract during childbirth. Contraction of the Endocrine System Physiology EXERCISE 4 OBJECTIVES 1. To define the following: hormones, target cell, negative feedback, metabolism, thyroxine, thyroid stimulating hormone (TSH), thyrotropin releasing hormone (TRH), hypothalamus, hypothalamic pituitary portal system, portal vein, hormone replacement therapy, diabetes type I, diabetes type II, glucose standard curve 2. To give examples of how negative feedback loops regulate hormone release 3. To explain the role of thyroxine in maintaining an animals metabolic rate 4. To explain the effects of thyroid stimulating hormone (TSH) on an animals metabolic rate 5. To understand the role of the hypothalamus in the regulation of thyroxine and TSH production 6. To understand how hypothalamic hormones reach the pituitary gland 7. To understand how estrogen affects bone density 8. To explain how hormone replacement therapy works 9. To explain how fasting plasma glucose is used to diagnose diabetes 10. To understand how levels of cortisol and ACTH can be used to diagnose endocrine diseases 41 04_041_062_PhyEx8_HP_Ch04 1/11/08 7:59 AM Page 41 42 Exercise 4 (a) FIGURE 4.1 Metabolism and the thyroid gland. (a) Opening screen of the Metabolism experiment. (b) The regulation of thyroid secretion. indicates stimulation of release, indicates inhibition of release, T3 triiodothyronine, T4 thyroxine, TRH thyrotropin-releasing hormone, TSH thyroid-stimulating hormone. Cuyamaca College Endocrine System Biology Lab Hypothalamus TRH TSH T3, T4 Thyroid gland (b) Pituitary gland (hypophysis) 04_041_062_PhyEx8_HP_Ch04 1/11/08 7:59 AM Page 42 myometrium causes additional oxytocin to be released to aid in the contraction, regardless of the amount of hormone already present. Studying the effects of hormones on the body is difficult to do in a wet lab, since experiments can often take days, weeks, or even months to complete, and are quite expensive. In addition, live animals may need to be sacrificed, and technically difficult surgical procedures are sometimes necessary. The PhysioEx simulations you will be using in this lab will allow you to study the effects of given hormones on the body by using virtual animals rather than live ones. You will be able to carry out delicate surgical techniques with the click of a button. You will also be able to complete experiments in a fraction of the time that it would take in an actual wet lab environment. Hormones and Metabolism Metabolism is the broad term used for all biochemical reactions occurring in the body. Metabolism involves catabolism, a process by which complex materials are broken down into simpler substances, usually with the aid of enzymes found in body cells. Metabolism also involves anabolism, in which the smaller materials are built up by enzymes into larger, more complex molecules. When bonds are broken in catabolism, energy that was stored in the bonds is released for use by the cell. When larger molecules are made, energy is stored in the various bonds formed. Some of the energy liberated may go to the formation of ATP, the energy-rich material used by the body to run itself. However, not all of the energy liberated goes into this pathway. Some of that energy is given off as body heat. Humans are homeothermic animals, meaning they have a fixed body temperature. Maintaining this temperature is very important to maintaining the metabolic pathways found in the body. The most important hormone in maintaining metabolism and body heat is thyroxine. Also known as tetraiodothyronine, or T4, thyroxine is secreted by the thyroid gland, located in the neck. However, production of thyroxine is really controlled by the pituitary gland, which secretes thyroid stimulating hormone (TSH). TSH is carried by the blood to the thyroid gland (its target tissue) and causes the thyroid to produce more thyroxine. It is also important to understand the role of the hypothalamus in thyroxine and TSH production. The hypothalamus, located in the brain, is a primary endocrine gland that secretes several hormones affecting the pituitary gland (also located in the brain.)Cuyamaca College Endocrine System Biology Lab Among these hormones is thyrotropin releasing hormone (TRH), which stimulates production of TSH in the pituitary gland. If the hypothalamus determines that there is not enough thyroxine circulating to maintain the bodys metabolism, it will secrete TRH to stimulate production of TSH by the pituitary gland, which in turn will stimulate production of thyroxine by the thyroid (a classic example of a negative feedback loop). TRH travels from the hypothalamus to the pituitary gland via the hypothalamic-pituitary portal system, a specialized arrangement of blood vessels consisting of a single portal vein that connects two capillary beds. The hypothalamic-pituitary portal system transports many other hormones from the hypothalamus to the pituitary gland. Primarily, the hormones secreted by the hypothalamus are tropic (or trophic) hormones, which are hormones that stimulate or inhibit the secretion of other hormones. TRH is an example of a tropic hormone, since it stimulates the release of TSH (which is itself a tropic hormone, since it stimulates the release of thyroxine). In the following experiments you will be investigating the effects of thyroxine and TSH on an animals metabolic rate. To begin, follow the instructions for starting PhysioEx in the Getting Started section at the front of this manual. From the drop-down menu, select Exercise 4: Endocrine System Physiology and click GO. Before you perform the activities watch the BMR Measurement video to see an experiment in which basal metabolic rate is meaasured. Then click Metabolism. The opening screen will appear in a few seconds (see Figure 4.1). Select Balloons On/Off from the Help menu for help identifying the equipment on-screen (you will see labels appear as you roll over each piece of equipment). Select Balloons On/Off to turn this feature off before you begin the experiments. Study the screen. You will see a jar-shaped chamber to the left, connected to a respirometer-manometer apparatus (consisting of a U-shaped tube, a syringe, and associated tubing). You will be placing animalsin this case, ratsin the chamber in order to gather information about how thyroxine and TSH affect their metabolic rates. Note that the chamber also includes a weight scale, and that next to the chamber is a timer for setting and timing the length of a given experiment. Under the timer is a weight display. Two tubes are connected to the top of the chamber. The left tube has a clamp on it that can be opened or closed. Leaving the clamp open will allow outside air into the chamber; closing the clamp will create a closed, airtight system. The other tube leads to a T-connector. One branch of the T leads to a fluid-containing U-shaped tube, called a manometer. As an animal uses up the air in the closed system, this fluid will rise in the left side of the U-shaped tube and fall in the right. The other branch of the T-connector leads to a syringe filled with air. Using the syringe to inject air into the tube, you will measure the amount of air that is needed to return the fluid columns to their original levels. This measurement will be equal to the amount of oxygen used by the animal during the elapsed time of the experiment. Soda lime, found at the bottom of the chamber, absorbs the carbon dioxide given off by the animal so that the amount of oxygen used can be measured easily. Cuyamaca College Endocrine System Biology Lab The amount of oxygen used by the animal, along with its weight, will be used to calculate the animals metabolic rate. Also on the screen are three white rats in their individual cages. These are the specimens you will use in the following experiments. One rat is normal; the second is thyroidectomized (abbreviated on the screen as Tx), meaning its thyroid has been removed; and the third is hypophysectomized (abbreviated on the screen as Hypox)meaning its pituitary gland has been removed. The pituitary gland is also known as the hypophysis, and removal of this organ is called a hypophysectomy. To the top left of the screen are three syringes containing various chemicals: propylthiouracil, thyroid stimulating hormone (TSH), and thyroxine. TSH and thyroxine have been previously mentioned; propylthiouracil is a drug that inhibits the production of thyroxine by blocking the incorporation of iodine into the hormone. You will be performing four experiments on each animal: 1) you will determine its baseline metabolic rate, 2) you will determine its metabolic rate after it has been injected with thyroxine, 3) you will determine its metabolic rate after it Endocrine System Physiology 43 04_041_062_PhyEx8_HP_Ch04 1/11/08 7:59 AM Page 43 has been injected with TSH, and 4) you will determine its metabolic rate after it has been injected with propylthiouracil. You will be recording all of your data on Chart 1 (see p. 45). You may also record your data onscreen by using the equipment in the lower part of the screen, called the data collection unit. This equipment records and displays the data you accumulate during the experiments. The data set for Normal should be highlighted in the Data Sets window, since you will be experimenting with the normal rat first. The Record Data button lets you record data after an experimental trial. Clicking the Delete Line or Clear Data Set buttons erases any data you want to delete. ACTIVITY 1 Determining the Baseline Metabolic Rates First, you will determine the baseline metabolic rate for each rat. 1. Using the mouse, click and drag the normal rat into the chamber and place it on top of the scale. When the animal is in the chamber, release the mouse button. 2. Be sure the clamp on the left tube (on top of the chamber) is open, allowing air to enter the chamber. If the clamp is closed, click on it to open it. 3. Be sure the indicator next to the T-connector reads Chamber and manometer connected. If not, click on the T-connector knob. 4. Click on the Weigh button in the box to the right of the chamber to weigh the rat. Record this weight in the Baseline section of Chart 1 for Weight. 5. Click the () button on the Timer so that the Timer display reads 1.00. 6. Click on the clamp to close it. This will prevent any outside air from entering the chamber, and ensure that the only oxygen the rat is breathing is the oxygen inside the closed system. 7. Click Start on the Timer display. You will see the elapsed time appear in the Elapsed Time display. Watch what happens to the water levels in the U-shaped tube. 8. At the end of the 1-minute period, the timer will automatically stop. When it stops, click on the T-connector knob so that the indicator reads Manometer and syringe connected. 9. Click the clamp to open it so that the rat can once again breathe outside air. 10. Look at the difference between the level in the left and right arms of the U-tube and estimate the volume of O2 that will need to be injected by counting the divider lines on both sides. Then click the () button under the ml O2 until the display reads that number. Then click Inject and watch what happens to the fluid in the two arms. When the volume is equalized the word Level will appear and stay on the screen. If you are under, click the () and then Inject. If you are over the word Level will flash and then disappear. Cuyamaca College Endocrine System Biology Lab You will then have to click the Reset button and try a lower volume. (This is equivalent to the amount of oxygen that the rat used up during the 1 minute in the closed chamber.) Record this measurement in the Baseline section of Chart 1 for ml O2 used in 1 minute. 11. Determine the oxygen consumption per hour for the rat. Use the following formula: ml O2/hr Record this data in the Baseline section of Chart 1 for ml O2 used per hour. 12. Now that you have the amount of oxygen used per hour, determine the metabolic rate per kilogram of body weight by using the following formula (Note that you will need to convert the weight data from g to kg before you can use the formula): Metabolic rate ___________ ml O2/kg/hr Record this data in the Baseline section of Chart 1 for Metabolic rate. 13. Click Record Data. 14. Click and drag the rat from the chamber back to its cage. 15. Click the Reset button in the box labeled Apparatus. 16. Now repeat steps 115 for the thyroidectomized (Tx) and hypophysectomized (Hypox) rats. Record your data in the Baseline section of Chart 1 under the corresponding column for each rat. Be sure to highlight Tx under Data Sets (on the data collection box) before beginning the experiment on the thyroidectomized rat; likewise, highlight Hypox under Data Sets before beginning the experiment on the hypophysectomized rat. Which rat had the fastest baseline metabolic rate? Cuyamaca College Endocrine System Biology Lab________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ Why did the metabolic rates differ? ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ If an animal has been thryoidectomized, what hormone(s) would be missing from its blood? ________________________________________________ ml O2/hr wt. in kg 60 minutes hr ml O2 consumed 1 minute 44 Exercise 4 04_041_062_PhyEx8_HP_Ch04 1/11/08 7:59 AM Page 44 As a result of the missing hormone(s), what would the overall effect on the body be? ________________________________________________ ________________________________________________ ________________________________________________ How could you treat a thyroidectomized animal so that it functioned like a normal animal? ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ Endocrine System Physiology 45 Chart 1 Normal Rat Thyroidectomized Rat Hypophysectomized Rat Baseline Weight _______ grams _______ grams _______ grams ml O2 used in 1 minute _______ ml _______ ml _______ ml ml O2 used per hour _______ ml _______ ml _______ ml Metabolic rate _______ ml O2 /Kg./Hr. _______ ml O2 /Kg./Hr. _______ ml O2 /Kg./Hr. With Thyroxine Weight _______ grams _______ grams _______ grams ml O2 used in 1 minute _______ ml _______ ml _______ ml ml O2 used per hour _______ ml _______ ml _______ ml Metabolic rate _______ ml O2 /Kg./Hr. _______ ml O2 /Kg./Hr. _______ ml O2 /Kg./Hr. With TSH Weight _______ grams _______ grams _______ grams ml O2 used in 1 minute _______ ml _______ ml _______ ml ml O2 used per hour _______ ml _______ ml _______ ml Metabolic rate _______ ml O2 /Kg./Hr. _______ ml O2 /Kg./Hr. _______ ml O2 /Kg./Hr. With Propylthiouracil Weight _______ grams _______ grams _______ grams ml O2 used in 1 minute _______ ml _______ ml _______ ml ml O2 used per hour _______ ml _______ ml _______ ml Metabolic rate _______ ml O2 /Kg./Hr. _______ ml O2 /Kg./Hr. _______ ml O2 /Kg./Hr. 04_041_062_PhyEx8_HP_Ch04 1/11/08 7:59 AM Page 45 If an animal has been hypophysectomized, what effect would you expect to see in the hormone levels in its body? ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ What would be the effect of a hypophysectomy on the metabolism of an animal? ________________________________________________ ________________________________________________ ________________________________________________ ______________________________________________? ACTIVITY 2 Determining the Effect of Thyroxine on Metabolic Rate Next you will investigate the effects of thyroxine injections on the metabolic rates of all three rats. Please note that in a wet lab environment you would normally need to inject thyroxine (or any other hormone) into a rat daily for at least 12 weeks in order for any response to be seen. However, in the following simulations you will only inject the rat once and will be able to witness the same results as if you had administered multiple injections over the course of several weeks. In addition, by clicking the Clean button while a rat is inside its cage, you can immediately remove all residue of any previously injected hormone from the rat and perform a new experiment on the same rat. In a real wet lab environment you would need to either wait weeks for hormonal residue to leave the rats system or use a different rat. 1. Choose a rat to test. Cuyamaca College Endocrine System Biology Lab. You will eventually test all three, and it doesnt matter what order you test them in. Do not drag the rat to the chamber yet. Under Data Sets, the simulation will highlight Normal, Tx, or Hypox depending on which rat you select. 2. Click the Reset button in the box labeled Apparatus. 3. Click on the syringe labeled thyroxine and drag it over to the rat. Release the mouse button. This will cause thyroxine to be injected into the rat. 4. Click and drag the rat back into the chamber. Perform steps 112 of Activity 1 again, except that this time, record your data in the With Thyroxine section of Chart 1. 5. Click Record Data. 6. Click and drag the rat from the chamber back to its cage, and click Clean to cleanse it of all traces of thyroxine. 7. Now repeat steps 16 for the remaining rats. Record your data in the With Thyroxine section of Chart 1 under the corresponding column for each rat. What was the effect of thyroxine on the normal rats metabolic rate? How does it compare to the normal rats baseline metabolic rate? ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ Why was this effect seen? ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ What was the effect of thyroxine on the thyroidectomized rats metabolic rate? How does it compare to the thyroidectomized rats baseline metabolic rate? ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ Why was this effect seen? ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ What was the effect of thyroxine on the hypophysectomized rats metabolic rate? How does it compare to the hypophysectomized rats baseline metabolic rate? ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ Why was this effect seen? ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ ______________________________________________? 46 Exercise 4 04_041_062_PhyEx8_HP_Ch04 1/11/08 7:59 AM Page 46 ACTIVITY 3 Determining the Effect of TSH on Metabolic Rate Next you will investigate the effects of TSH injections on the metabolic rates of the three rats. Select a rat to experiment on first, and then proceed. 1. Under Data Sets, highlight Normal, Tx, or Hypox, depending on which rat you are using. 2. Click the Reset button in the box labeled Apparatus. 3. Click and drag the syringe labeled TSH over to the rat and release the mouse button, injecting the rat. 4. Click and drag the rat into the chamber. Perform steps 112 of Activity 1 again. Record your data in the With TSH section of Chart 1. 5. Click Record Data. 6. Click and drag the rat from the chamber back to its cage, and click Clean to cleanse it of all traces of TSH. 7. Now repeat this activity for the remaining rats. Record your data in the With TSH section of Chart 1 under the corresponding column for each rat. What was the effect of TSH on the normal rats metabolic rate? How does it compare to the normal rats baseline metabolic rate? ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ Why was this effect seen? ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ What was the effect of TSH on the thyroidectomized rats metabolic rate? How does it compare to the thyroidectomized rats baseline metabolic rate? ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ Why was this effect seen? ________________________________________________ ________________________________________________ ________________________________________________ What was the effect of TSH on the hypophysectomized rats metabolic rate? How does it compare to the hypophysectomized rats baseline metabolic rate? ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ Why was this effect seen? ________________________________________________ ________________________________________________ ______________________________________________? ACTIVITY 4 Determining the Effect of Propylthiouracil on Metabolic Rate Next you will investigate the effects of propylthiouracil injections on the metabolic rates of the three rats. Keep in mind that propylthiouracil is a drug that inhibits the production of thyroxine by blocking the attachment of iodine to tyrosine residues and interfering with the conversion of thyroxine with triiodothyronine. Select a rat to experiment on first, and then proceed. 1. Under Data Sets, the simulation will highlight Normal, Tx, or Hypox, depending on which rat you are using. 2. Click the Reset button in the box labeled Apparatus. 3. Click and drag the syringe labeled Propylthiouracil over to the rat and release the mouse button, injecting the rat. 4. Click and drag the rat into the chamber. Perform steps 112 of Activity 1 again, except this time record your data in the With Propylthiouracil section of Chart 1. 5. Click Record Data. 6. Click and drag the rat from the chamber back to its cage, and click Clean to cleanse it of all traces of propylthiouracil. 7. Now repeat this activity for the remaining rats. Record your data in the With Propylthiouracil section of Chart 1 under the corresponding column for each rat. 8. Click Tools ? Print Data to print your data. What was the effect of propylthiouracil on the normal rats metabolic rate? How does it compare to the normal rats baseline metabolic rate? ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ Endocrine System Physiology 47 04_041_062_PhyEx8_HP_Ch04 1/11/08 7:59 AM Page 47 Why was this effect seen? ________________________________________________ ________________________________________________ ________________________________________________Cuyamaca College Endocrine System Biology Lab. What was the effect of propylthiouracil on the thyroidectomized rats metabolic rate? How does it compare to the thyroidectomized rats baseline metabolic rate? ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ Why was this effect seen? ________________________________________________ ________________________________________________ ________________________________________________ What was the effect of propylthiouracil on the hypophysectomized rats metabolic rate? How does it compare to the hypophysectomized rats baseline metabolic rate? ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ Why was this effect seen? ________________________________________________ ________________________________________________ ______________________________________________? Hormone Replacement Therapy Follicle-stimulating hormone (FSH) stimulates ovarian follicle growth. While the follicles are developing, they produce the hormone estrogen. As the female enters menopause, the ovaries stop producing estrogen. One of the symptoms of menopause is loss of bone density, which can result in osteoporosis and bone fractures. Postmenopausal treatments to prevent osteoporosis include the administration of estrogen to increase bone density. Calcitonin is a hormone that inhibits osteoclast activity and stimulates calcium uptake for deposit in bone. In this experiment we will use three ovariectomized rats because they are no longer producing estrogen due to the removal of their ovaries. The three rats were chosen because each has a baseline T score of 2.6, indicating osteoporosis. T scores are interpreted as follows: normal 1 to 0.99; osteopenia (bone thinning) 1.0 to 2.49; osteoporosis 2.5 and below. You will administer either estrogen therapy or calcitonin therapy, two types of hormone replacement therapy.Cuyamaca College Endocrine System Biology Lab. The third rat will serve as an untreated control and receive daily injections of saline. The vertebral bone density (VBD) of each rat will be measured with dual X-ray absorptiometry (DXA) to obtain the T score. Start by selecting Hormone Replacement Therapy from the Experiment menu. A new screen will appear (Figure 4.2) with three ovariectomized rats in cages. (Note that if this were a wet lab, the ovariectomies would have been performed on the rats a month prior to the rest of the experiment in order to ensure that no residual hormones remained in the rats systems.) Also on screen are a bottle of saline, a bottle of estrogen, a bottle of calcitonin, a clock, and a dual X-ray absorptiometry bone density scanner. ACTIVITY 5 Hormone Replacement Therapy 1. Click on the syringe, drag it to the bottle of saline, and release the mouse button. The syringe will automatically fill with 1 ml of saline. 2. Click and hold the syringe and drag the syringe to the control rat and place the tip of the needle in the rats lower abdominal area. Injections into this area are considered intraperitoneal and will quickly be picked up by the abdominal blood vessels. Release the mouse buttonthe syringe will empty into the rat and automatically return to its holder. Click Clean on the syringe holder to clean the syringe of all residue. 3. Click on the syringe again, this time dragging it to the bottle of estrogen, and release the mouse button.Cuyamaca College Endocrine System Biology Lab The syringe will automatically fill with 1 ml of estrogen. 4. Click and hold the syringe, drag it to the estrogentreated rat, and place the tip of the needle in the rats lower abdominal area. Release the mouse buttonthe syringe will empty into the rat and automatically return to its holder. Click Clean on the syringe holder to clean the syringe of all residue. 5. Click on the syringe again, this time dragging it to the bottle of calcitonin, and release the mouse button. The syringe will automatically fill with 1 ml of calcitonin. 6. Click and hold the syringe, drag it to the calcitonintreated rat, and place the tip of the needle in the rats lower abdominal area. Release the mouse buttonthe syringe will empty into the rat and automatically return to its holder. Click Clean on the syringe holder to clean the syringe of all residue. 7. Click on the clock. You will notice the hands sweep the clock face twice, indicating that 24 hours have passed. 8. Repeat steps 17 until each rat has received a total of 7 injections over the course of 7 days (1 injection per day). Note that the # of injections displayed below each rat cage records how many injections the rat has received. The control rat should receive 7 injections of saline, the estrogen-treated 48 Exercise 4 04_041_062_PhyEx8_HP_Ch04 1/11/08 7:59 AM Page 48 rat should receive 7 injections of estrogen, and the calcitonintreated rat should receive 7 injections of calcitonin. 9. You are now ready to measure the effect of each of the solutions. First, predict the effect that each solution will have on the rats vertebral bone density. Saline injections ___________________________________ ___________________________________________________ Estrogen injections _________________________________ ___________________________________________________ Calcitonin injections ________________________________ ___________________________________________________ 10.Cuyamaca College Endocrine System Biology Lab. A gaseous anesthetic will be applied to immobilize the rats for imaging. Click on the Anesthesia button for the control rat to immobilize the rat. 11. Click on the control rat and drag it to the exam table. Release the mouse to release the rat. 12. Click the Scan button to activate the scanner. Record the T score. T score (control): _____________ 13. Click Record Data. 14. Click and drag the rat to return it to its cage. 15. Repeat steps 1014 for the estrogen-treated rat. T score (estrogen): _____________ 16. Repeat steps 1014 for the calcitonin-treated rat. T score (calcitonin): _____________ 17. Click Tools ? Print Data to print your recorded data for this experiment. Recall that the baseline value for all three rats was 2.6. T scores are interpreted as follows: normal 1 to 0.99; osteopenia (bone thinning) 1.0 to 2.49; osteo
Use Promo Code: FIRST15