MDC Standardized Protocols Discussion

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1. Erythrocytes are also called red blood cells in our blood and have the function of transporting gases and nutrients throughout our body. RBCs are made in the red bone marrow by a process called erythropoiesis. Stem cells from erythroid precursors undergo a change to become mature blood cells. RBC’s can survive about 100 to 120 days. After 120 days, RBCs are recycled by macrophages of the spleen, liver, bone marrow and lymph nodes (Vaskovic, 2023).

Anemia refers to not having enough red blood cells or if there is a problem with the function of the cells. A normal hemoglobin level is less than 12.5gm/dl in men and less than 12.0 gm/dl in women. When a person is anemic, they can experience headaches, dizziness, weakness, shortness of breathing, cold hands and feet, and tachycardia (n.d.).

There are different types of anemia. Iron deficiency anemia is the most common anemia and can happen when the body doesn’t have enough iron. This can be from blood loss, poor absorption of iron, pregnancy and childbirth and even having gastric bypass surgery can result in poor absorption. Sickle cell anemia is an inherited condition where hemoglobin proteins are abnormal, causing the RBCs to be clogged during circulation due to their abnormal formation.  Pernicious anemia is an autoimmune condition that prevents the body from absorbing vitamin B12. Vitamin B12 is important because it helps oxygen flow without the red blood cells in your body. If left untreated, this anemia can cause damage to our nervous system (Cleveland Clinic, 2022). Our immune system produces antibodies that attack cells in the lining of our stomach and affects how we absorb vitamin B12. Folate deficiency anemia is when there is a decrease of folate in the body. Folate comes from dark leafy greens and when people do not eat foods containing this, it can cause low levels. Folate is needed to carry oxygen in the bloodstream. Eating foods not rich in vitamin B12 or folate can cause low levels. Lastly, thalassemia is an inherited disorder that causes the body to have less hemoglobin than normal. According to Mayo Clinic, “Hemoglobin molecules are made of chains called alpha and beta chains that can be affected by mutations. In thalassemia, the production of either the alpha or beta chains are reduced, resulting in either alpha-thalassemia or beta-thalassemia” (2023). This is not preventable, but there are ways to help people who have thalassemia to be able to assist them with this diagnosis.

2.

Describe the morphology of erythrocytes, the mechanism, and the primary cause of the following anemias: Pernicious anemia, folate deficiency anemia, iron deficiency anemia, thalassemia, and sickle cell anemia.

Erythrocytes or red blood cells (RBC) are specialized cells within the blood that transport gases and nutrients throughout the body. Erythrocytes have a unique shape and structure that is biconcave and anucleated with ample surface area in order to support the cell’s function of gas exchange. These blood cells are made up of a protein called hemoglobin which is one of the main components responsible for carrying oxygen within the cell. The cells only live for around 120 days and during this time they deliver oxygen from the lungs to all of the peripheral tissues in the body assisting in the process of ATP synthesis. In addition, erythrocytes also collect generated carbon dioxide from the peripheral tissues and return it to the lungs where it is eliminated through exhalation. Erythrocytes are very sensitive to their surroundings and easily react to changes in the environment (Barbalato & Pillarisetty, 2021).

  • Pernicious Anemia

This form of anemia occurs when an individual has a deficiency in cobalamin (vitamin b12) as a result of a deficit of intrinsic factor (IF). This form of anemia is often considered an autoimmune disorder because gastric autoantibodies are responsible for the destruction of intrinsic factors and parietal cells. Clinical manifestations of this anemia include fatigue, general weakness, pallor, incontinence, paraesthesias, and psychosis. If left untreated for an extended period, pernicious anemia can lead to neurological complications and in some cases fatality. Treatments focus on the replenishment of vitamin B12 through oral supplementation or intramuscular injections (Rodrigez & Shackelford, 2022).

Folate Deficiency Anemia

This form of anemia can arise from multiple causes, that range from medication use and alcohol intake, but most often it is due to poor dietary intake of folate. Generally, adults need about 400 mcg/d of folate daily to replenish folate losses. Folate is available in green leafy vegetables, citrus fruits, and animal products, however, it is poorly stored in the body so deficiency can develop quickly over weeks or months in individuals with folate-deficient diets. Folate deficiency leads to impairments in cell division and the accumulation of toxic metabolites in the body. Many symptoms of folate deficiency anemia are similar to that of vitamin B12 deficiency excluding the neurological features of B12 deficiency. A classic sign of folate deficiency anemia is a painful, beefy red tongue. Other signs may include anorexia, depression, cognitive impairment, and dementia  (Khan & JialaI, 2022). 

Iron Deficiency Anemia

This form of anemia is the most common anemia in the world. Iron is a mineral that is essential for the production of hemoglobin. Low iron stores can occur due to blood loss, poor iron intake, impaired absorption, and increased demand. Most patients with iron deficiency anemia are asymptomatic and diagnosis is done through a blood test. The most common sign is pallor but it is generally not visible until hemoglobin levels fall below 7-8g/dL. Other signs and symptoms may include fatigue, shortness of breath, cognitive impairment, bleeding, resting tachycardia, and worsening congestive heart failure. Treatment involves first identifying the source of the anemia and treating any active bleeding and absorption issues. If anemia is due to poor iron intake, oral ferrous sulfate supplements can be given. In more severe cases, iron can be also given intravenously for faster absorption (Warner & Kamran, 2021)

Thalassemia

Thalassemia is a group of genetic disorders that are caused by decreased synthesis of alpha or beta chains of hemoglobin. It is an inherited disease caused by the deletion of certain key gene fragments that are responsible for creating hemoglobin proteins. If an individual does not have an adequate amount of these proteins within the erythrocyte,  the cells cannot sufficiently carry oxygen causing anemia in early childhood and is a lifelong illness. The clinical manifestations of thalassemia can vary widely depending on be specific type and severity, however, there are several signs and symptoms that point to thalassemia. Individuals with thalassemia will present with fatigue and generally show pallor and jaundice due to hyperbilirubinemia caused by intravascular hemodialysis. There can also be disruptions in cardiac rhythm leading to various arrhythmias as well as heart failure. An excess of bilirubin can also lead to the development of gallstones in pain from cholelithiasis. Finally, children with thalassemia will also have slowed growth and development with delays in puberty (Bajwa & Basit, 2022).

Sickle Cell Anemia

This form of anemia occurs due to a mutation in the gene encoding the beta protein of hemoglobin in the erythrocyte cell. Sickle cell anemia is a lifelong condition that is characterized by two major components: hemolysis and vaso-occlusive crisis. A defect in the beta-globin gene causes sickling of the erythrocyte where cells oscillate between a normal biconcave shape to an abnormal crescent shape in the presence of low oxygen pressure. Individuals with sickle cell anemia can present with either acute complications or chronic complications associated with this disease. The most common acute complication is a vaso-occlusive crisis which is episodic and extremely painful and can present in children as young as six months of age. Vaso-occlusive crisis can develop anywhere in the body however the extremities and chest are the most commonly involved. Other signs and symptoms are swelling of the hands and feet, frequent infections, delays in growth or puberty, and vision problems. There is currently no cure for sickle cell anemia treatment geared towards pain management of acute episodes and chronic pain management (Mangla, et al., 2022).

3. When using internet-based research, there are several ethical issues to keep in mind. Beginning with informed consent, clearly communicate the purpose of the research, the data you will collect, and how it will be used. Seeking explicit permission from participants before collecting any personal information is imperative. Ensure that the data collected is stored securely and inaccessible to unauthorized individuals. Familiarize yourself with the legal requirements in your jurisdiction and ensure compliance (Tappen, 2015, p.279).

The internet provides a vast amount of information, but not all of it is reliable or accurate. It is essential to critically evaluate the sources you use. To address this issue, you must assess the expertise and reputation of the sources. Rely on reputable websites, academic journals, and authoritative institutions. Compare findings from multiple sources and cross-reference to ensure consistency and accuracy. Be transparent about the potential limitations of internet-based research and clearly communicate them to your audience (Tappen, 2015, p.279).

Internet-based research involves accessing and using various digital resources such as articles, images, and videos. It is important to respect intellectual property rights and familiarize yourself with copyright regulations. Make sure to provide proper citations and acknowledgments for any content you use that is not your original creation.

Internet-based research often relies on data collected from online platforms, which may not fully represent the broader population or specific demographics. Recognize and disclose the potential biases and limitations of your data sources, seek a wide range of perspectives and data from various platforms to minimize bias. Consider using multiple research methods, including offline approaches, to enhance the representativeness of your findings.

I have taken the time to take all these factors into account and will continue to do so as I put together my research proposal and continue looking up pertinent articles and related literature using online sources. I have considered the possible biases and gaps that internet-based research can attribute to a study and for that reason have included several sources and carefully ensured that they were suitable for the study.

Overall, conducting internet-based research requires researchers to be mindful of ethical considerations, ensuring privacy, accuracy, fairness, and inclusivity throughout the research process.

4. The Internet now plays a huge role in the research landscape, where inter-based research methods are now vastly used by researchers for collecting data. However, certain ethical issues need to be kept in mind by the researchers while conducting internet-based research. Some of the ethical issues are based on the areas of informed consent, confidentiality, disparities of the patients in accessing the internet, and privacy (Hokke, Hackworth, Quin, Bennetts, Win, Nicholson,… & Crawford, 2018). Furthermore, there can be certain ethical issues regarding the storage of the data since there can be risks concerning the accessibility of the patient data by unauthorized personnel.

On the other hand, the issues regarding non-compliance with the laws can also persist. Herein, the issue regarding consent can be solved by ensuring transparency during recruiting through proper knowledge of the study. Furthermore, confidentiality and privacy-related issues regarding the data can be solved by using a password-protected directory in the computer for securing the data. In addition, a privacy statement also needs to be provided to the participants for maintaining confidentiality, anonymity, and effective data protection (Gupta, 2017). By considering the ethical issues and ways of mitigating them, it can be stated that no edits in required in the developed literature review. This is because the literature review has been made considering the ethical principles that need to be considered while collecting the data with the inclusion of effective measures of securing the data.

5. Qualitative research is a valuable approach that involves collecting and analyzing non-numerical data, such as interviews, observations, and textual analysis, to generate insights into specific topics. Ethical considerations are crucial when conducting qualitative research due to the potential impact on participants and the need to maintain trust and integrity (Tappen, 2015, p.54).

Obtaining informed consent is fundamental in qualitative research. Participants should have a clear understanding of the research purpose, procedures, risks, benefits, and their rights. Consent should be voluntary, without any coercion, and participants should have the opportunity to ask questions and withdraw their participation at any time. Protecting the privacy and confidentiality of participants is essential. Researchers should ensure that all identifiable information is kept secure and accessible only to authorized individuals. Anonymizing data by removing personally identifiable information can further safeguard participant identities.

Researchers must respect the autonomy of participants, allowing them to make decisions about their involvement in the research and the extent to which they share personal information. Researchers should also be cautious when discussing sensitive topics and avoid invading the privacy of participants.

Recognize power imbalances between researchers and participants, acknowledging the potential vulnerability of certain individuals or groups. Researchers should create a safe and respectful environment, fostering open communication, and empowering participants to freely express their opinions and experiences. Maintaining trustworthiness in qualitative research is important. Researchers should be transparent about their intentions, research design, methods, and potential conflicts of interest. Clearly communicating the purpose and intended use of the research findings helps establish trust with participants (Tappen, 2015, p.193).

Some qualitative research may involve exploring sensitive or personal topics that could evoke emotional responses in participants. Researchers should be prepared to provide appropriate support and debriefing, ensuring the emotional well-being of participants and referring them to relevant resources if needed (NIH, 2018).

Researchers should present their findings accurately and honestly, avoiding misrepresentation or selective reporting. They should also consider how their research might affect the individuals or communities involved and aim to share the results in an accessible manner that respects the dignity and privacy of participants (NIH, 2018).

By considering these ethical considerations, researchers can conduct qualitative research in a manner that respects the rights, well-being, and privacy of participants, ultimately enhancing the credibility and validity of the research outcomes.

6. The value of internet-based qualitative research is that it helps the researchers are getting access to populations that are hard to reach by traditional research methods. The internet has enabled various opportunities through which populations in various geographical locations can be reached for collecting data based on common practices, experiences, and identities. The flexibility that has been provided to qualitative research through the internet is the most valuable element. Furthermore, there is also a wide number of methods of data collection provided by internet-based qualitative research such as message boards, blogs, and websites among others (Wilkerson, Iantaffi, Grey, Bockting, & Rosser, 2014). Through these values of qualitative research, the required small or large population can be reached.

The ethical considerations for the concerned research methods include the distinction between the private and the public so that private information can be protected. This will help in maintaining the sensitivity and confidentiality of the data in the public sphere. Furthermore, the other ethical considerations are concerning the areas of vulnerable groups and children since these groups need personalized protection and boundaries (NESH, 2019). On the other hand, responsibility for obtaining informed consent, sharing the obtained data, and responsibility in maintaining anonymity as well as the confidentiality of the information are some of the other ethical considerations that need to be kept in mind.

7. State Practice Assignment  (Texas)

How do you think these standardized protocols and procedures guide advanced nursing practice?

Standardized protocols and procedures help to standardize and legally structure the delivery of care provided to patients by advanced practice registered nurses (APRNs) such as Nurse Practitioners (NP), Clinical Nurse Specialists (CNS), Certified Nurse-Midwives (CNM), Certified Registered Nurse Anesthetists (CRNA). The protocols and procedures guide patient assessment, diagnosis, management, and evaluation. Standardized protocols and procedures also help to enhance the quality of care and promote patient safety (Texas Board of Nursing, 2021).

What components should each standardized procedure include according to your state requirements?

According to the Texas Board of Nursing, each standardized procedure should include specific nursing interventions, patient selection criteria, and clinical outcomes. The standardized procedure should also comply with relevant state and federal laws, policies, and regulations. SOPs must be signed by the collaborating physician, APRN, and kept on-site per Texas rules governing nursing practice (Texas Board of Nursing, 2021).

Discuss the difference between a disease-specific standardized procedure and a process protocol.

A disease-specific standardized procedure guides the management of a particular disease. For example, a standardized procedure may be created to manage hypertension, including interventions and outcomes specific to that disease process. A process protocol, on the other hand, guides a process such as prescribing controlled substances or epidural anesthesia (Texas Board of Nursing, 2021).

What steps are required to enable NPs to prescribe in your state, and are there additional requirements for prescribing controlled substances?

In Texas, for NPs to prescribe as independent prescribers, they must have a Controlled Substance Prescriptive Authority (CSPA), which requires nurse practitioner graduates to complete advanced pharmacology and pathophysiology. The NP must have at least 3,600 hours of practice within the past two years, with 960 clinical hours supervised by a physician. In addition, the NP needs at least ten hours of continuing education credits in the field of controlled substances. The NP then may register with the US Drug Enforcement Administration to prescribe controlled substances (Texas Board of Nursing, 2021)

8. In the field of advanced nursing practice, standardized protocols and procedures play a crucial role in guiding the delivery of safe and effective patient care. Standardized protocols and procedures serve as essential guidelines for advanced nursing practice, ensuring consistency and quality in patient care (FBON, 2023). These standardized guidelines provide a framework that allows healthcare professionals to deliver evidence-based and patient-centered care (FBON, 2023). They serve as a reference for clinical decision-making, promoting uniformity and reducing variability in practice (FBON, 2023). By standardizing procedures, advanced practice registered nurses (APRNs) can enhance patient safety, improve outcomes, and ensure professional accountability (FBON, 2023). 

According to the Florida Board of Nursing, standardized procedures should include several key components. These components typically encompass, but are not limited to, the following:

a. Purpose and Scope: Clearly define the purpose and scope of the procedure, outlining the specific clinical situations or conditions to which it applies (FBON, 2023). 

b. Patient Selection Criteria: Identify the criteria for patient selection, including demographic factors, medical history, and clinical presentation (FBON, 2023).

c. Assessment and Evaluation: Detail the necessary assessments and evaluations required before, during, and after the procedure. This may include physical examinations, diagnostic tests, and monitoring parameters (FBON, 2023).

d. Interventions and Actions: Outline the specific interventions, actions, and treatments that should be implemented during the procedure. This section should include step-by-step instructions, dosages, administration routes, and potential side effects or complications (FBON, 2023).

e. Documentation and Follow-up: Specify the documentation requirements and the necessary follow-up procedures, including any necessary referrals, consultations, or patient education (FBON, 2023).

Disease-specific standardized procedures focus on a particular disease or condition and provide guidelines for assessment, diagnosis, and treatment related to that specific condition (Newsom, n.d.). They offer detailed recommendations and algorithms tailored to specific patient populations (Newsom, n.d.). On the other hand, process protocols are broader in scope and guide the management of common processes or procedures across multiple disease entities (Newsom, n.d.). These protocols typically outline the necessary steps, actions, and assessments involved in a particular process, such as wound care or medication administration (Newsom, n.d.). Process protocols provide a standardized framework that can be adapted to various clinical scenarios (Newsom, n.d.).

In Florida, nurse practitioners (NPs) are authorized to prescribe medications, including controlled substances, under certain conditions (FBON, 2023). The steps required to enable NPs to prescribe in Florida include their education and certification which means NPs must hold a valid license as an advanced registered nurse practitioner (ARNP) in Florida (FBON, 2023). They should also possess a national certification as an NP in their respective specialty (FBON, 2023). NPs are required to establish a collaborative practice agreement with a supervising physician (FBON, 2023). This agreement outlines the relationship, responsibilities, and protocols for collaboration between the NP and the supervising physician (FBON, 2023). To prescribe controlled substances, NPs in Florida must complete additional educational requirements, including a course on controlled substance prescribing (FBON, 2023).

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