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Current EBP – Acute Health Problem Assignment

Current EBP – Acute Health Problem AssignmentCurrent EBP – Acute Health Problem AssignmentAssignment PromptSelect a client from clinical experience with an acute health problem or complaint requiring at least two visits.  Submit a complete history and physical H & P from the initial visit with this client and a focused SOAP note for the follow-up visit. Based on this client’s condition, conduct a literature search for two research articles that discuss various approaches to the treatment of this condition. Peer reviewed articles must address the standardized procedure or guidelines for this diagnosis. Incorporate the research findings into the decision-making for this client’s treatment. In the paper, compare and contrast or address how treatment or the plan may have been different based on the research findings. The discussion on relating research to practice should be 3-4 pages and the total paper should be no longer than 8 pages including references. The research articles must be an original research contributions (no review articles or meta-analysis) and must have been published within the last five years. Cover the criteria listed below.  The paper should be APA formatted and no longer than 8 pages.· Reviews topic and explains rationale for its selection in the context of client care. (2 pts)ORDER A PLAGIARISM-FREE PAPER HERE· Evaluates key concepts related to the topic. 2 pts)· Describes multiple viewpoints if this is a controversial issue or one for which there are no clear guidelines. (2 pts)· Assesses the merit of evidence found on this topic i.e. soundness of research (5pts)· Evaluates current EBM guidelines, if available. Or, recommends what these guidelines should be based on available research. Discuss the Standardized Procedure for this diagnosis. (5 pts)· Discusses how the evidence did impact/would impact practice.  What should be done differently based on the knowledge gained? (3 pts)Current EBP – Acute Health Problem Assignment· Consider cultural, spiritual, and socioeconomic issues as applicable. (2pts).· Utilizes APA guidelines, cite references (2 pts)· Writing style at the graduate level (2pts) Expectations · Length: no longer than 8 pages, including references· Format: APA Formatted· Research: citations requiredSee USU NUR Research Paper Rubric for additional details and point weighting.HYPOGONADISM 1Clinical evaluation and management of hypogonadismUnited States UniversityFNP: 593 Acute illnesses across the lifespanBrittany Chavez12/10/2021  TITLE OF PAPERClinical evaluation and management of hypogonadismThe purpose of this paper is to discuss Hypogonadism in regard to clinical evaluation,symptomatic presentation, management and evaluation of clinical guidelines. The paper willexplore differing viewpoints and key concepts in relation to hypogonadism. The effects ofcultural, spiritual and beliefs in treatment and evaluation, and the impact of research on thisendocrine imbalance. Also reviewed will be research studies addressing the clinical symptomsand trials for new treatment options.Current EBP – Acute Health Problem AssignmentReview of topic and rationale for selection of topicHypogonadism is a common endocrine disorder originating from two causes. Primaryhypogonadism is caused from a direct androgen imbalance originating from the testes. Thisclinical syndrome which the testes fail to produce physiologic levels of testosterone and a normalnumber of spermatozoa due to defects in the hypothalamic-pituitary-gonadal axis at one or morelevels. (Ross & Bhasin, 2016). This topic was chosen due to the frequency of cases seen in thefamily practice setting. Hypogonadism is a common disorder associated with low bone density,poor muscle mass, anemia, and sexual dysfunction that affects men in a variety of ways. Amongsecondary osteoporosis risk factors, male hypogonadism is one of the most important, accountingfor progressive bone loss in aging men, especially when late-onset hypogonadism isdiagnosed (LOH). (Rochira, 2020) This disorder can affect all aspects of life and greatly impactthe emotional state and feelings of self-worth. This paper will address primary hypogonadism interms of diagnostic, and treatment based on guidelines.Evaluation of key concepts related to the topicThe key concepts evaluated for the paper includes disease process in formation ofandrogen deficiency. Androgens are important for male reproductive and sexual functions, bodyCurrent EBP – Acute Health Problem Assignment TITLE OF PAPER 3composition, erythropoiesis, muscle and bone health, and cognitive functions. Symptomspresentation commonly seen in the primary care setting. Diagnostic criteria in the evaluation todetermine the extent of deficiency in relation to the symptoms presented and the treatmentguidelines based on efficacy and positive outcomes.Primary Hypogonadism (PHG) is often underdiagnosed in the clinical setting due to theambiguous symptoms presented often mimicking depression or often overlooked as normalaging process. These symptoms may present with decreased libido, weight gain, fatigue, lowstamina, decrease in muscle mass, decreased energy, sleep disturbances, mood fluctuations andirritability.It is essential for the provider to consider hormonal deficiency into the differentialdiagnosis to effectively diagnose and rule out PHG. Diagnosis of PGH include total serumtestosterone taken in a time sensitive manner as the peak testosterone in men is roughly 8am.Diagnosis requires at minimum 2 low testosterone levels in different occasions. Deficiency isnoted to be below 300 testosterone. FSH and LH are required to be tested in addition totestosterone as well as ruling out other factors such as endocrine, thalamus, pituitary, and thyroidas a cause for the decrease in testosterone. Age is a consideration in the diagnosis of PHG asthere are multiple types of hypogonadism that should be considered for a younger patient such ascongenital hypogonadism. In the patient case presented in appendix B the patient was found tohave serum testosterone of 250. The treatment however was to be delayed until further testingwas completed to follow diagnostic guidelines.Current EBP – Acute Health Problem AssignmentTreatment of PHG has been debated as there are pro’s and cons of this therapy. Recentstudies have indicated that testosterone replacement therapy (TRT) can greatly improve thepatients quality of life as well as can be cardioprotective. Testosterone administration was found  TITLE OF PAPER 4to increase skeletal muscle mass and performance while also increasing myogenic geneprogramming, myocellular translational efficiency and capacity, resulting in higher proteinturnover and net protein accretion. (Gharahdaghi et al., 2019). Some studies have found that TRTcould potentially be harmful in the older population, however there is lack of supportingevidence for this case.Description of multiple viewpointsAndrogens are important for male reproductive and sexual functions, body composition,erythropoiesis, muscle and bone health, and cognitive functions. (Professionals, 2021).Guidelines for treatment of this disorder differ in the aspect of age. Multiple studies were foundto state there despite lack of full study to the matter there is thought to be a potentialcardiovascular risk associated with TRT in patients who are older. On the other hand there is alsodata and research studies finding that TRT can reduce LDLs total cholesterol, increase skeletalmuscle mass and improve gene function. The risk associated with not treating this conditioncould lead to depression, impaired relations, increase in cholesterol, increased weight gain, andosteoporosis.Current EBP – Acute Health Problem AssignmentAssessment of the merit of evidence found on this topic (soundness of research)The research in the 2 studies reviewed were sound in their method based on the method,large sample size, randomization, time frame of research study conducted, and the findings of theresults closely aligned with the current guidelines in terms of diagnosis and treatment.Evaluation of current EBM guidelinesGuidelines indicate that treatment with TRT should be started and have been shown toimprove the overall health and outcome of patients. The one consideration of withholdingtreatment includes obesity as there is greater risk of adverse outcomes. These patients should first Current EBP – Acute Health Problem AssignmentTITLE OF PAPER 5be initiated on a lifestyle/weight reduction plan prior to starting to decrease comorbidities thatmay place them at greater risk. Although the effects of testosterone treatment are usually minor,they can have a positive impact on body composition, metabolic control, psychological, andsexual parameters. Observational studies reveal a link between restored physiologicaltestosterone levels, muscle mass, and strength, as measured by leg press strength and quadricepsmuscle volume. (Professionals, 2021)Current EBP – Acute Health Problem AssignmentCultural, spiritual, and socioeconomic considerationsConsiderations to spiritual and cultural beliefs should be included in practice whenconsidering treatment with hormone therapy. Certain religious beliefs forbid any form of animalor human product be put in the body. For these patients it is important to explore natural optionsto improve the bodies ability to manufacture the testosterone on its own and any type of hormonereplacement is contraindicated for these groups and they are considered unclean.Discussion regarding the Standardized Procedure for this diagnosisStandardized treatment for primary hypogonadism should include lipid panels, cardiacevaluation and EKG prior to initiating treatment due to the variability and lack of evidence forthe true effect on cardiac function in the geriatric population. The treatment measures wouldremain the same due to the risk of osteoporosis and significant mental health and changes in therelationship that can occur along with the patients physical symptoms.Current EBP – Acute Health Problem AssignmentDiscussion on how the evidence did impact/would impact practiceThe outcomes of increase virility, improved mood, improved stamina and decrease inlipids outweight the risk of a possible cardiac challenge that has yet to be proven. I would wantto conduct more specific testing on the affects of testosterone replacement in the olderpopulation. After reviewing in depth this topic and guidelines I would be more aware of the risk  TITLE OF PAPER 6factor of hypogonadism and be more willing to approach the topic before simply assumingdepression based on the patients changes in mood and fatigue.ConclusionIn conclusion, primary hypogonadism is a common occurrence in primary care and oftenunderdiagnosed. This condition affects all age groups and can cause significant health concernsthat affect the patients overall health both physical and mental. Understanding the reasoningbehind the condition and having the insight to consider this in the differential diagnosis is animportant factor to consider when addressing patient care. Patients may present with ambiguoussymptoms that often mimic depression. Treatment should be initiated baring significant riskfactors such as morbid obesity, cardiac failure or renal impairment. The guidelines arecomprehensive and recommend the treatment with TRT to improve quality of life and positiveoutcomes.Current EBP – Acute Health Problem Assignment  TITLE OF PAPER 7ReferencesGharahdaghi, N., Rudrappa, S., Brook, M. S., Idris, I., Crossland, H., Hamrock, C., Abdul Aziz, M. H., Kadi, F., Tarum, J., Greenhaff, P. L., Constantin-Teodosiu, D., Cegielski, J., Phillips, B. E., Wilkinson, D. J., Szewczyk, N. J., Smith, K., & Atherton, P. J. (2019). Testosterone therapy induces molecular programming augmenting physiological adaptations to resistance exercise in older men. Journal of cachexia, sarcopenia and muscle, 10(6), 1276– 1294. https://doi.org/10.1002/jcsm.12472Current EBP – Acute Health Problem AssignmentProfessionals, S.- O. (2021). EAU guidelines: Male hypogonadism. Uroweb. Retrieved December 16, 2021, from https://uroweb.org/guideline/male-hypogonadism/#5Rochira, V. (2020). Late‐onset hypogonadism: Bone Health. Andrology, 8(6), 1539–1550. https://doi.org/10.1111/andr.12827Ross, A., & Bhasin, S. (2016). Hypogonadism: Its Prevalence and Diagnosis. The Urologicclinics of North America, 43(2), 163–176. https://doi.org/10.1016/j.ucl.2016.01.002 https://doi.org/10.1002/jcsm.12472https://doi.org/10.1016/j.ucl.2016.01.002 TITLE OF PAPER 8Appendix ASoap comprehensiveSubjective:Patient: SG Age: 65 DOB: 04/23/1956 Gender: MaleEthnicity: CaucasianCC“I don’t feel like I used to”HPIMr. G was last seen in clinic 1 year ago for a wellness check. Today he is here because he has notbeen feeling himself. He reports increased fatigue, low libido, weight gain and loss of musclemass. He feels this has been going on for a while now and he is concerned because it was neveran issue before. His wife has noticed a difference in his energy and stamina, he is no longerinterested in many activities he used to enjoy and he is more easily fatigued. He is healthyoverall and works out 3x weekly but has been struggling with this in the last couple months. Hereposts there has been no change in his diet or lifestyle.Current EBP – Acute Health Problem AssignmentPMI: I10 Essential hypertension E78.00 Pure cholesterolPMP: Surgery on left knee for meniscus repair 1987MEDICATIONS: -Lisinopril 10 mg tab PO once daily -Vitamin D3 1000IU gel capsules: 2 capsules PO once dailyALLERGIES: NKDA, no environmental or food allergies  TITLE OF PAPER 9IMMUNIZATIONS: -Quadravalent influenza 10/18/2021 -Moderna covid vaccine 3/25/2021, 04/28/2021, 12/08/2021FAMILY HISTORY: Parents: deceased -Father: age 87, HTN, AMI -Mother: 89 breast cancer No siblings. 3 children: no health concernsSOCIAL HISTORY Exposure to substance/tobacco/ Illicit or rec drugs: non-smoker, denies alcohol or drug use.Occupation: Construction workerNutrition: Follows dash diet and exercises 3 x weekly.Sleep: Having difficulty sleeping, feels tired throughout the day. He guesses he sleeps maybe 6 hours nightly.Leisure activities/hobbies: Enjoys outdoor activities, hiking kayaking, camping. In the winter snow shoeing.Stress: Has been having increased stress due to frustration in lack of energy and libido.Safety: No weapons in the homes, smoke detectors present and functional, fire extinguisher in home.ROS: Constitutional: Negative for appetite change, fever and unexpected weight change.HENT: Denies congestion, dental/mouth issues, hearing loss, trouble swallowing, loss of smell or rhinorrheaEyes: Denies any discharge or visual disturbancesCardiovascular: Denies chest pain, shortness of breath, palpations and leg swelling.Pulmonary: Denies difficulty breathing, wheezing, cough, hemoptysis, or chest tightnessGastrointestinal: Negative for abdominal distention, abdominal pain, or blood in stoolGenitourinary: Negative for decreased urine volume, difficulty urinating and pelvic pain.Musculoskeletal: Negative for gait problems, pain in muscle or joints bilaterally.Skin: denies skin changes or issues, no rash, color changes or excessive drynessCurrent EBP – Acute Health Problem Assignment TITLE OF PAPER 10Neurological: Denies weakness, headaches, difficulty with memory or dizzinessAllergic/Immunologic: no food or medication allergies and has never been diagnosed with seasonal allergies. Has not experienced frequent or long-term sickness.Psychiatric/Behavioral: Denies behavior issues, Admits to sleep disturbance, increased stress and depressionObjectiveVitals BP: 145/89 HR: 68 RR: 16 Temp: 98.6 Height: 5’9 Weight: 177lbs BMI: 26.14 kg/m2General: Is well-dressed and tidy, and well developed. He appears to be aware and active, and he does not appear to be in mental or physical discomfort. Able to maintain adequate eye contact throughout the interview and exam.HEENT: Extraocular Movements: Right eye- normal extraocular motion, and no nystagmus. Left eye- normal extraocular motion and no nystagmus. Normal conjunctiva/sclera, PERRLA noted. Head symmetrical without deformities. lesions or masses. Hair evenly disbursed. Ear canals clear with no erythema, or moisture. TM intact bilaterally.Lungs/Thorax- Bilateral breath sounds, in all lung fields are clear and equal. No difficulty breathing noted. Chest wall symmetrical without barreling of chest.Cardiovascular- Heart sounds are WNL, strong pulses throughout, no swelling in left or right lower legs.Neurological: Alert and oriented to person, place and time. Speech is normal, without delay, memory and thought process is intact. Cranial Nerves II, III, IV, VI intact, visual fields normal in all quadrants. No sensory deficits noted. No tremor or abnormal muscle tone. Rapid alternating movements normal, gait is steady and as expected.Musculoskeletal – General: Normal range of motion Right Shoulder: No tenderness or crepitus, normal range of motion normal strength Left Shoulder: No tenderness or crepitus, normal range of motion normal strength Cervical back: Normal range of motion, no tenderness, swelling, edema, deformity, erythema or rigidity, normal range of motion. Normal sensationGastrointestinal: Bowel tones brisk and equal all quadrants. Abdomen is flat and soft to palpation with no notable masses, or herniations. No distention or guarding with palpation.Lymphadenopathy: No cervical adenopathy  TITLE OF PAPER 11Neuro: A/O x4, gait even and smooth, bilateral muscle strength with no weakness noted.Psychiatric: Appropriate mood and affect, behaviors, speech and judgement as expected.Skin: Free of lesions or masses, smooth, with dryness noted on upper arms.Assessment:Differential DX:– Z00.01 encounter for adult examination with abnormal findings.– E29.1 Hypogonadism– G47.00 Insomnia Unspecified– Z13.29 Screening for endocrine abnormalities– E34.9 Screening for hormonal imbalanceFinal diagnosis: Z00.01 encounter for adult examination with abnormal findings.Plan:Diagnostic:Current EBP – Acute Health Problem Assignment– Laboratory blood draw for TSH, testosterone, lipid panel, CBC, and CMPTreatment: None at this timeEducation:– Discussed nutrition/ diet and exercise– Setting routine for sleeping, avoiding read, or watching TV or using phone in bed.– Keep log over next week twice daily of blood pressure readings to bring to next visit.Follow up: Follow up in 1 week for lab results and further testing if needed.Goals:  TITLE OF PAPER 12– Increase sleep from 6 to 8 hours nightly– Address increased fatigue at next visit.Appendix B  TITLE OF PAPER 13Follow up SOAPSubjective:Patient: SG Age: 65 DOB: 04/23/1956 Gender: MaleEthnicity: CaucasianCC“Here to follow up on laboratory results”HPIMr. G was last seen in clinic 1 week ago with complaints of fatigue, decreased stamina,decreased libido, and insomnia. He is here today with his wife to review his resent labs to helpdetermine if her has an endocrine or hormonal imbalance causing his symptoms. He reports thathe continues to struggle with sleep and decreased libido. He was not able to work out this weekas he was not “feeling up to it”. He denies illness, fever, or malaise at this time.PMI: I10 Essential hypertension E78.00 Pure cholesterolPMP: Surgery on left knee for meniscus repair 1987MEDICATIONS: -Lisinopril 10 mg tab PO once daily -Vitamin D3 1000IU gel capsules: 2 capsules PO once dailyALLERGIES: NKDA, no environmental or food allergiesIMMUNIZATIONS: -Quadravalent influenza 10/18/2021 -Moderna covid vaccine 3/25/2021, 04/28/2021, 12/08/2021FAMILY HISTORY: Parents: deceased -Father: age 87, HTN, AMI -Mother: 89 breast cancer No siblings. 3 children: no health concernsCurrent EBP – Acute Health Problem Assignment TITLE OF PAPER 14SOCIAL HISTORY Exposure to substance/tobacco/ Illicit or rec drugs: non-smoker, denies alcohol or drug use.Occupation: Construction workerNutrition: Follows dash diet and exercises 3 x weekly.Sleep: Having difficulty sleeping, feels tired throughout the day. He guesses he sleeps maybe 6 hours nightly.Leisure activities/hobbies: Enjoys outdoor activities, hiking kayaking, camping. In the winter snow shoeing.Stress: Has been having increased stress due to frustration in lack of energy and libido.Safety: No weapons in the homes, smoke detectors present and functional, fire extinguisher in home.ROS:Constitutional: Negative for appetite change, fever and unexpected weight change.HEENT: Denies congestion, dental/mouth issues, hearing loss, trouble swallowing, loss of smell or rhinorrheaEyes: Denies any discharge or visual disturbancesCardiovascular: Denies chest pain, shortness of breath, palpations and leg swelling.Pulmonary: Denies difficulty breathing, wheezing, cough, hemoptysis, or chest tightnessGastrointestinal: Negative for abdominal distention, abdominal pain, or blood in stoolGenitourinary: Negative for decreased urine volume, difficulty urinating and pelvic pain.Musculoskeletal: Negative for gait problems, pain in muscle or joints bilaterally.Skin: denies skin changes or issues, no rash, color changes or excessive drynessNeurological: Denies weakness, headaches, difficulty with memory or dizzinessAllergic/Immunologic: no food or medication allergies and has never been diagnosed with seasonal allergies. Has not experienced frequent or long-term sickness.Psychiatric/Behavioral: Denies behavior issues, Admits to sleep disturbance, increased stress and depressionCurrent EBP – Acute Health Problem Assignment TITLE OF PAPER 15ObjectiveVitals BP: 145/89 HR: 68 RR: 16 Temp: 98.6 Height: 5’9 Weight: 177lbs BMI: 26.14 kg/m2General: Is well-dressed and tidy, and well developed. He appears to be aware and active, and he does not appear to be in mental or physical discomfort. Able to maintain adequate eye contact throughout the interview and exam.HEENT: Extraocular Movements: Right eye- normal extraocular motion, and no nystagmus. Left eye- normal extraocular motion and no nystagmus. Normal conjunctiva/sclera, PERRLA noted. Head symmetrical without deformities. lesions or masses. Hair evenly disbursed. Ear canals clear with no erythema, or moisture. TM intact bilaterally.Lungs/Thorax- Bilateral breath sounds, in all lung fields are clear and equal. No difficulty breathing noted. Chest wall symmetrical without barreling of chest.Cardiovascular- Heart sounds are WNL, strong pulses throughout, no swelling in left or right lower legs.Neurological: Alert and oriented to person, place and time. Speech is normal, without delay, memory and thought process is intact. Cranial Nerves II, III, IV, VI intact, visual fields normal in all quadrants. No sensory deficits noted. No tremor or abnormal muscle tone. Rapid alternating movements normal, gait is steady and as expected.Musculoskeletal – General: Normal range of motion Right Shoulder: No tenderness or crepitus, normal range of motion normal strength Left Shoulder: No tenderness or crepitus, normal range of motion normal strength Cervical back: Normal range of motion, no tenderness, swelling, edema, deformity, erythema or rigidity, normal range of motion. Normal sensationGastrointestinal: Bowel tones brisk and equal all quadrants. Abdomen is flat and soft to palpation with no notable masses, or herniations. No distention or guarding with palpation.Lymphadenopathy: No cervical adenopathyNeuro: A/O x4, gait even and smooth, bilateral muscle strength with no weakness noted.Psychiatric: Appropriate mood and affect, behaviors, speech and judgement as expected.Skin: Free of lesions or masses, smooth, with dryness noted on upper arms.Current EBP – Acute Health Problem Assignment TITLE OF PAPER 16Assessment:Differential DX:– Primary Hypogonadism– Central Hypogonadism– DepressionFinal DX: Primary HypogonadismPlan:Laboratory results from last week:TSH – 2.4Total serum Testosterone: 250Diagnostic:– FSH, LH hormonal testing, Total testosterone in 1 week at 8amTreatment:– None prescribed until further testing. Once completed if indication remainsHypogonadism. We will begin Hormone replacement therapy as below.– Testosterone Ciponate 200mg/ml injectable solution: inject 1ml= 200mg IM Q 2 weeks.Education:– Hormonal replacement may not be covered by insurance, it is important to speak withyour insurance provider if you wish to begin this treatment.Follow up: Follow up in 2 weeks once further testing has been completed to begin treatment. Current EBP – Acute Health Problem Assignment

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