NR 507 Week 6: Recorded Disease Process Presentation Peer Review

Chamberlain University NR 507 Week 6: Recorded Disease Process Presentation Peer Review– Step-By-Step Guide

This guide will demonstrate how to complete the Chamberlain University NR 507 Week 6: Recorded Disease Process Presentation Peer Review   assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for NR 507 Week 6: Recorded Disease Process Presentation Peer Review              

Whether one passes or fails an academic assignment such as the Chamberlain University NR 507 Week 6: Recorded Disease Process Presentation Peer Review  depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for NR 507 Week 6: Recorded Disease Process Presentation Peer Review              

The introduction for the Chamberlain University NR 507 Week 6: Recorded Disease Process Presentation Peer Review  is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for NR 507 Week 6: Recorded Disease Process Presentation Peer Review              

After the introduction, move into the main part of the NR 507 Week 6: Recorded Disease Process Presentation Peer Review assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for NR 507 Week 6: Recorded Disease Process Presentation Peer Review              

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for NR 507 Week 6: Recorded Disease Process Presentation Peer Review              

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for NR 507 Week 6: Recorded Disease Process Presentation Peer Review

Analyze pathophysiologic mechanism associated with Addison’s Diseas:

Mediated destruction

Sanne van Haren, Hannah, Alex & Gijs (2018) indicated as did you that Addison’s Disease Caused by Tuberculosis.  Just like Aspergillus Pneumonia, Addison’s disease is difficult to diagnose and treat.  Fichna, Żurawek, Bratland, Husebye, Kasperlik-Załuska, Czarnocka & … Nowak. (2015) stated that Interleukin-2 subunit alpha (soluble receptor) reveals and confirms a direct connect between 21OH=directed reactivity and AAD, and 11.2 SNP.  Fichna, Żurawek, Bratland, Husebye, Kasperlik-Załuska, Czarnocka & … Nowak. (2015) continued that Addison’s disease (AAD) has a direct connect to T-cell destruction of the adrenal cortex. 

So there is lyphocytic infiltration of the adrenal gland, autoantibodies, 21 hydroxylase (21OH).  It is also indicated that he etiology remains obscure but genetic and environmental factors can be significant.  Your PowerPoint presentation was excellent.  I read about genes influencing T-cell fate.  Is this true about transcription factors STAT4, GATA3, interleukin-23 (IL23A:  activates STAT4) and interferon-Gamma production aides in the production of interferon-Gamma by the memory CD4+ cells. 

• Relate research findings to the management of patients with complex pathophysiologic dysfunction of the adrenal cortex and how the hormones are all related. I can see the difficulty with the treatment in that rifampicin and steroids is part of the treatment, but low dose of steroids can be a problem with any long disorder, especially those who are immunocompromised. In addition, Aspergillus Pneumonia which is a rare opportunistic fungal infection would have a field day and be invasive to this type of individual.  Any type of compromised disease would contribute to a host of problems later down the line.  As with the disease that I had chosen, systemic considerations should be taken when it comes to signs and symptoms.  For example, similarities exist with both diseases in that weight loss and gastrointestinal symptoms are common signs and symptoms for both.  Clara, Joana, Marina, Fábio, Sara, Alexandre & … Teresa (2018) also agree that it is difficult to diagnose Addison’s disease in that this disease is rare and even gave a case about a teenager having multiple visits to the emergency room to which the teenager was treated with hydro cortisone and fludrocortisone and added that Addison’s disease has unspecific symptomatology. 

References:

Clara, P., Joana, C., Marina, P., Fábio, B., Sara, L., Alexandre, F., & … Teresa, B. (2018).

        Addison’s disease – the difficulty of diagnosis. Nascer E Crasser , Vol 27, Iss 1, Pp

        39-42 (2018), (1), 39.

Fichna, M., Żurawek, M., Bratland, E., Husebye, E. S., Kasperlik-Załuska, A., Czarnocka,

        B., & … Nowak, J. (2015). Interleukin-2 and subunit alpha of its soluble receptor in

       autoimmune Addison’s disease–an association study and expression analysis.

       Autoimmunity, 48, 2, 100-107. doi:10.3109/08916934.2014.976628

Sanne van Haren, N., Hannah, V., Alex, M., & Gijs, L. (2018). Addison’s Disease

       Caused by Tuberculosis: Diagnostic and Therapeutic Difficulties. European

      Journal of Case Reports In Internal Medicine (2018), doi:10.12890/2018_000911

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Sample Answer 2 for NR 507 Week 6: Recorded Disease Process Presentation Peer Review

Risk factors

I agree with you that congenital malformations, pre-existing kidney, genetics, and infections are some of the risk factors for chronic renal disease.

 Obesity, low birth weight, nephrotoxins, age, and ethnicity, are also risk factors associated with the disease (Kazancioğlu, 2013). According to Chang & Kramer, 2013, Glomerular hypertrophy and hyperfiltration increase capillary wall tension of the glomeruli and decreasing podocyte density. Obesity can also contribute to the pathogenesis of kidney damage through hypervolemia, adipokine disorders, inflammation, oxidative stress and endothelial dysfunction. Intrauterine growth restriction can also cause low nephron number that leads to intraglomerular hypertension and hyperfiltration in the available nephrons (Vikse, Irgens, Leivestad, Hallan, & Iversen, 2018). According to the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI), the elderly population is more prone to develop chronic kidney disease (CKD) after several renal insults. Exposure to heavy metals, alcohol, and other drugs has linked to constant kidney disease progression (Falodia & Singla, 2013).

Treatment and prevention

You haven’t included nephrectomy anywhere in the treatment of chronic kidney disease. Nephrectomy is the surgical removal of the kidney to treat kidney cancer and other related kidney diseases. Partial and radical nephrectomy can be done to treat chronic renal disease. According to Charytoniuk et al., 2018, partial Nephrectomy is done on the diseased or injured portion of the kidney, and radical nephrectomy includes removing the entire organ together with a section of the tube leading to the bladder. Retroperitoneal robotic partial nephrectomy is, however, more effective in the treatment of chronic kidney disease due to reduced operative time and a shorter Length of stay as compared to trans peritoneal nephrectomy (Paulucci et al., 2018). Good job on your presentation.

References

Chang, A., & Kramer, H. (2013). CKD progression: a risky business. Nephrology Dialysis Transplantation, 27(7), 2607-2609. doi:10.1093/ndt/gfs095

Charytoniuk, T., Małyszko, M., Bączek, J., Fiedorczyk, P., Siedlaczek, K., & Małyszko, J. (2018). Progression to chronic kidney disease in patients undergoing nephrectomy for small renal masses: a price to pay for a therapeutic success? Postgraduate Medicine. doi:10.1080/00325481.2018.1511211

Falodia, J., & Singla, M. K. (2013). CKD epidemiology and risk factors. Clinical Queries: Nephrology, 1(4), 249-252. doi:10.1016/j.cqn.2012.09.004

Kazancioğlu, R. (2013). Risk factors for chronic kidney disease: an update. Kidney International Supplements, 3(4), 368-371. doi:10.1038/kisup.2013.79

Paulucci, D. J., Beksac, A. T., Porter, J., Abaza, R., Eun, D. D., Bhandari, A., … Badani, K. K. (2018). A Multi-institutional Propensity Score Matched Comparison of Transperitoneal and Retroperitoneal Partial Nephrectomy for cT1 Posterior Tumors. Journal of Laparoendoscopic & Advanced Surgical Techniques. doi:10.1089/lap.2018.0313

Sample Answer 3 for NR 507 Week 6: Recorded Disease Process Presentation Peer Review

Hello, I must commend you for a thorough presentation on the chronic renal disease.

 Based on criteria numbers seven and eight.

 Provide a brief description of the pharmacological and non-pharmacological interventions used to treat and manage the disease (#7).

You  mentioned starting the patient on dialysis in stage four (4) chronic renal disease (CKD)

Comment and Feedback

As you rightly mentioned, stage four CKD is characterized by a glomerular filtration rate (GFR) of 15-29 milliliters/minute (ml/min). At this point, though the kidney functions had deteriorated significantly but the patient is not yet in kidney failure hence dialysis is usually not initiated at that stage. A recent multicenter prospective cohort study by Park et al. and other multiple studies showed that early initiation of dialysis with GFR of over 15ml/min was associated with higher mortality rate and it did not enhance patient survival rate (Park et al., 2017). It was shown that premature initiation of dialysis increases the loss of kidney residual function, which is harmful to the patient (Park et al., 2017). Dialysis is indicated in stage five when GFR is less than 15 ml/min and this is considered as end-stage renal disease or kidney failure (Kaplan, Fedorowicz, & Aird, 2018). The indication and timing of starting dialysis was recommended when there are life-threatening changes in fluid, electrolytes, and acid-base balance or when one or more of the following conditions exists in a CK D patient: Signs of serositis, life-threatening fluid and electrolyte balance, pruritus, uncontrollable blood pressure, cognitive impairment, malnutrition that is not responding to dietary intervention. These usually manifest when the GFR is between 5 to 10 ml/ per minute (Kaplan, Fedorowicz, Aird, & Trebbin, 2016).

In conclusion, the primary aim of treatment in CK D is to slow down the progression of kidney damage and avoid the loss of residual kidney functions and these could be undermined by premature initiation of dialysis (Kaplan, Fedorowicz, Aird, & Trebbin, 2016).

   The implications for nurse practitioner practice #8

Question: what other healthcare professionals should be involved in the care of patients with a chronic renal disease?

Feedback: According to the Kidney Disease Outcomes Quality Initiatives (KDOQI) recommendations, stage 4 CK D patients (GFR 15-29 ml/min) should be provided with treatment options education for available renal replacement therapy modalities and be made aware that dialysis will be needed when the GFR drops below 10 to 15 ml/ minute with the manifestation of life-threatening symptoms (Kaplan, Fedorowicz, Aird, & Trebbin, 2016).

A team approach was highly recommended before and even after the initiation of dialysis both the American Society of Nephrology and Canadian Society of nephrology recommended against and the initiation in the absence of clinical indications and without an established shared decision-making process that involves the patients, their families, and nephrology healthcare team. A study shows that early referral to nephrologist was associated with a reduced mortality rate in CK D (Kaplan, Fedorowicz, Aird, & Trebbin, 2016).

Sample Answer 4 for NR 507 Week 6: Recorded Disease Process Presentation Peer Review

Thank you for your response and all of your kind words in regard to my presentation. I hope that my presentation allowed for a better understanding of renal disease and how as nurse practitioners we can provide the best care possible for these patients. I am so pleased with the questions you asked and was able to do some further research into this disease and gain some helpful knowledge because of them. Both questions you asked are addressed below.

1. Regarding this question, if a patient is told they will need dialysis, but they refuse, they have an approximate survival time of six months. What would you do to change the patient’s mind about dialysis?

For patients who are instructed to use dialysis for a treatment method, this can be scary and life changing. For patients that refuse at the initial instruction of dialysis it is essential to educate and ensure that he or she has an understanding of the outcome if refusal continues. One initial response, as was mentioned in the case you presented to me, the amount of time per week that the patient must set aside for the treatments. One important factor to mention to the patient is the possibility of performing the hemodialysis at home. In all cases it is not necessary to go to an outpatient setting to have dialysis performed. This option is often more acceptable to patients and allows them more independence than having to attend scheduled appointments. Another important fact that I did not mention in the presentation is the choice to do either hemodialysis or peritoneal dialysis. If the choice of peritoneal dialysis is made the patient will need to be aware a surgical procedure to place a abdominal catheter will be needed in order for treatments to take place. “During PD, sterile dialysate fluid is introduced in the patient’s peritoneal cavity and remains there for 6–8 hours while excess body fluid and toxins are filtered across the peritoneal membrane; at the completion of treatment, the dialysate fluid is drained from the peritoneal cavity” (Schub, Mennella, 2018, p. 1). This type of dialysis differs from hemodialysis because typically a catheter is placed in the chest until a graft can be established in the arm and then the blood is filtered rather than the peritoneal fluid. Again, it is important to educate the patient that both can be performed at home independently as long as compliance is achieved. After explaining all options of dialysis to the patient, inform the patient of the complications of not having dialysis such as electrolyte imbalances, fluid overload, toxin build up, and ultimately death. Healthcare is patient driven and ultimately it will be the patient’s decision whether or not he or she wants to have dialysis or not. The job of the healthcare provider is to educate and supply patients with the appropriate options and tools the live the best life possible living with this chronic disease.

• If a patient does receive a kidney transplant, is there a lifetime medication regimen?

For patients with renal disease a kidney transplant is life changing and unless complications occur, will allow for a life without the disease. Patients who received a kidney transplant will be required to take medications for immunosuppression. The reasoning behind this is to prevent the body from rejecting the transplanted kidney. In the event of rejection, the patient will begin so show symptoms similar to that of infection and ultimately if not treated the patient can lose the transplanted kidney, enter into a state of shock, or even death. Drugs that are often times used in the immunosuppressive therapy are as follows: Rituxan, Rapamune, Prograf, Astagraf XL, Prednisone, CellCept, Nulojix, Cytoxan, Cyclosporine, Campath, Thymoglobulin, Imuran, and Simulect (Colaneri, 2014). These drugs are often times used in combination and it is imperative the patient does not miss a dose. Patients will also need to see the primary care provider to have blood drawn regularly in order to monitor levels such as with the medication Prograf. “immunosuppression should modify the immune system enough to prevent rejection, but not allow infection, malignancies, and other side effects” (Colaneri, 2014, p. 550). It is imperative to monitor transplant patients to ensure proper kidney health and the optimal life post-surgery.

References

Colaneri, J. (2014). An Overview of Transplant Immunosuppression – History, Principles, and Current Practices in Kidney Transplantation. Nephrology Nursing Journal, 41(6), 549-561.

Schub, T. B., & Mennella, H. A. (2018). Hemodialysis vs Peritoneal Dialysis. CINAHL Nursing Guide.

Sample Answer 5 for NR 507 Week 6: Recorded Disease Process Presentation Peer Review

Thank you for your question Caitlin. I will expand more on the diagnosis and pharmacological treatments of Multiple Sclerosis (MS).  I would like to add that early recognition of multiple sclerosis is imperative because it offers the provider the chance to seek treatment for the patient and plan for the future (Ghasemi, Razavi, & Nikzad, 2017). A definite diagnosis is based upon medical history and neurological exams and utilizing imaging approaches such as the magnet resonance imaging (MRI).  

The McDonald Criteria, which was established in 2001 by an international expert panel and revised numerous times, most recently in 2017, offers recommendations on the diagnosis of MS, including diagnosis of a single attack MS known as clinically isolated syndrome (CIS) (Roman & Menning, 2017). The criteria consist of a composite of medical history on present and past symptoms, imaging utilizing an MRI and diagnostic tests like the cerebral spinal fluid analysis (Roman & Menning, 2017).

MRI– Lesions in the brain identified by MRI may show signs of distribution of lesions and damage in the central nervous system in the both time and space (Roman & Menning, 2017).

Lumber puncture for cerebral spinal fluid (CSF) – Analysis of spinal fluid shows a high percentage of protein IgG bands that may be detected in the spinal fluid which is a further confirmatory test (Roman & Menning, 2017).

Blood sample analysis – Utilized to identify vitamin deficiencies can be diagnostically beneficial (Ghasemi, Razavi, & Nikzad, 2017).

Pharmacological treatments for multiple sclerosis include:

Immunotherapy- Immunotherapy is utilized to lessen the frequency of relapses and slow the progression of the disease, for example, Avonex or interferon beta-1b (Dargahi, Katsara, Tselios, Androutsou, de Courten, Matsoukas, & Apostolopoulos, 2017).

Corticosteroids- Lessens MS exacerbations by suppressing the immune response and reduce inflammation, for example, methylprednisolone (Dargahi, et al., 2017)

Antispasmodics- They are muscle relaxers that reduce spasticity of the muscles for example, Baclofen (Dargahi, et al., 2017)

Supplements- Supplements like vitamin D can decrease the risk of MS (Roman & Menning, 2017).-

References

Dargahi, N., Katsara, M., Tselios, T., Androutsou, M., de Courten, M., Matsoukas, J., & Apostolopoulos, V. (2017). Multiple sclerosis: Immuneopathology and treatment updates. Brain Sciences, 7(7), 1-27. doi:10.3390/btainsci7070078

Ghasemi, N., Razavi, S., & Nikzad, E. (2017). Multiple sclerosis: Pathogenesis, symptoms, diagnosis and cell-based therapy. Cell Journal, 19(1), 1-10.

Roman, C., & Menning, K. (2017). Treatment and disease management of multiple sclerosis patients: A review for nurse practitioners. Journal Of The American Association Of Nurse Practitioners, 29(10), 629-638. doi: 10.1002/2327-6924.12514