Respond to at least two of your classmates’ posts using

Respond to at least two of your classmates’ posts using the 3C+Q method. Use reference 2023-2024 for explanation. For example, you will need to include the following components in your response: A compliment: “I appreciate that…” A comment: “I agree with that…I disagree because…” A connection: “I also thought…” A thought-provoking question. Disease-Based Concept Map Activity Image transcription text Labs and Diagnostic Tests Nonpharmacologic Assessment TX Pathophysiology and Risk Factors Disease Patient Education EBP Guideline an… Show more Use the following as a template to fill in the information about the disease you choose. Pathophysiology and Risk Factors In five sentences, explain the underlying pathophysiology of the disease. Pyloric stenosis is caused by a hypertrophic pyloric muscle, resulting in a narrowing of the pyloric sphincter. There is typically hypertrophy and hyperplasia of both the circular and longitudinal muscular layers of the pylorus. The thickening of the muscular layers results in the narrowing of the lumen of the gastric antrum. This will cause the pyloric canal to become lengthened and the mucosa to become thick and edematous causing gastric outlet obstruction. This obstruction then induces postprandial, nonbilious, projectile emesis. Include the incidence of the disease. The incidence is 1 to 3 per 1000 live births, with a four-to sixfold increase in males compared to females. Include the patient’s risk factors for this disease here. Risk factors include familial history, male sex, white race, white first-born males, receiving macrolide antibiotics (ex: oral erythromycin), bottle feeding, preterm birth, cesarean delivery, and maternal smoking during pregnancy. Assessment What should the NP focus on while taking the history? Reports of regurgitation and nonprojectile vomiting; insatiable appetite with weight loss, dehydration, and constipation; reports of a mass that resembles an olive; whether the infant received oral erythromycin in the first 2 weeks of life because this can be associated with pyloric stenosis. Reports of vomiting intermittently or after each feeding. The NP should ask how many bowel movements or wet diapers the infant has had. The NP should focus on what the caregiver is providing them as well as what they are observing. Also, when did these symptoms start? What body systems should be assessed for this disease and why? Digestive system- The digestive system should be assessed for a blockage in the stomach. This blockage can make it impossible for food to pass through which can cause malnutrition. The blockage can cause constipation due to less bowel movements as well as projectile vomiting since the food cannot move like it is supposed to. Renal system- I want to make sure I am checking the infant’s kidneys because of the risk of renal injury with dehydration. Dehydration can significantly decrease kidney function and it is important to consider kidney development with each infant. I would also ask myself whether the infant was pre-term or had any underlying renal problems. Hypokalemia can also affect the kidneys. Cardiovascular system- Dehydration can cause issues with the blood pressure, heart rate, etc. causing the heart to have to work harder. Electrolyte imbalances may also affect the cardiovascular system- especially hypokalemia. Integumentary system- I am going to assess skin turgor, capillary refill, and skin color due to the possibility of jaundice occurring and dehydration. Nervous system- if severe dehydration is present. Also, electrolyte imbalances can cause neurological issues. What assessment findings are consistent with this disease? Regurgitation and nonprojectile vomiting typically after the first week of life that progresses to nonbilious, progressive projectile vomiting around 2 to 3 weeks old. Signs of dehydration- depressed fontanelles, dry mucous membranes, decreased tearing, poor skin turgor, and lethargy. A distinct “olive” mass might be palpated in the epigastrium to the right of the midline. Reverse peristalsis waves may be observed. Mild jaundice- due to elevation in unconjugated bilirubin levels. Are there any advanced skills that the NP should consider? Physical assessment of the infant- for example, palpation of the mass in the epigastrium to the right of the midline and knowing the pathophysiology of pyloric stenosis. List the labs and diagnostic tests required to confirm the disease. The most common test is ultrasound with measurement of the pyloric muscle thickness. If ultrasound is unavailable or inconclusive, an upper gastrointestinal series demonstrates a “string sign”, indicating a fine, elongated pyloric canal. Barium upper can be used to help diagnose pyloric stenosis when ultrasonography is not diagnostic. Lab studies include electrolytes, BUN and creatinine levels (due to risk of kidney injury). What is an expected normal finding? Normally, the pyloric muscle thickness should be less than 3 mm and the length should not extend 15 mm. What constitutes an abnormal finding? On ultrasound- pyloric wall thickness 3 mm or greater and pyloric channel length 15 mm or greater. Lack of gastric emptying. Barium upper: string sign, double-track sign, or beak sign. Labs: Hypochloremic, hypokalemic metabolic alkalosis is the classic biochemical abnormality seen. Nonpharmacologic Tx List nonpharmacologic treatment options for this disease process. Surgical intervention (pyloromyotomy) is corrective. List five education facts the NP should discuss with the patient and support person related to the disease. Vomiting and fluid and electrolyte imbalances will need to be analyzed and corrected before surgical intervention (pyloromyotomy). Caregivers should contact the healthcare provider’s office immediately if signs of postoperative infection were to occur including redness or drainage around surgical site, fever or chills, vomiting, etc. There is a strong family risk of pyloric stenosis. It is vigilant that parents identify symptoms in their future offspring as soon as possible. Postoperatively, there will be a continuation of intravenous fluids until the infant can tolerate feedings. Feeding can begin 4 to 8 hours after recovery from anesthesia. Contact the healthcare provider’s office is there is continued signs of dehydration: ex: fewer wet diapers. Ideas include explaining the diagnosis, symptoms that warrant a return to the clinic or ER, medication adverse side effects, required lab monitoring, etc. Provide a link to an evidence-based educational resource the NP should provide to the patient (i.e. CDC, UpToDate, national association like the AHA). https://publications.aap.org/pediatricsinreview/article-abstract/42/10/539/181204/Hypertrophic-Pyloric-Stenosis?redirectedFrom=fulltext Name the drug of choice used to treat the condition, including the MOA, Indications, Common AE, Serious AE, Dosing, Administration, CI, and Interactions. If a class of medication is first line, choose a medication in that drug class to discuss here. Surgery is the first line treatment for pyloric stenosis. Atropine has been studied as a medication option for pediatric pyloric stenosis. MOA: Anticholinergic. Inhibits action of acetylcholine at parasympathetic sites in smooth muscle, CNS, and secretory glands. Indications: Sialorrhea, pylorospasm, and other spastic conditions of the GI tract. Common AE: tachycardia, flushing, nausea, vomiting, fever, rash, constipation, bloating. Serious AE: Coma, hallucinations, arrythmia, laryngospasm, pulmonary edema, dyspnea, paralytic ileus, anaphylaxis. Dosing & Administration: IV Dose: ranges from 0.04 to 0.225 mg/kg/day and is given 1-10 days. Oral Dose: 0.08-0.45 mg/kg/day is continued after IV therapy for 3 weeks to 4 months. CI: Hypersensitivity to anticholinergic drugs; use cautiously in children with down syndrome, brain damage, salivary secretion disorder, hiatal hernia, reflex esophagitis. Interactions: *There are several*: glucagon, pramlintide, amitriptyline, galantamine, maprotiline, etc. Evaluation What should the NP focus on after the initial plan of care has been implemented? Rehydrating the infant to restore electrolytes before surgical intervention. Addressing any questions or concerns the family may have. Consultation with a neonatal surgeon. Follow up visits once the infant is discharged home and providing educational resources. What if the patient’s symptoms do not improve or worsen? Surgical intervention is corrective. The prognosis is excellent. There are other causes of vomiting in infancy, such as midgut volvulus, a web of the gastric antrum, duodenal web, annular pancreas. Referral to a neonatal surgeon is necessary with pyloric stenosis. Think about assessing patient responses, collecting additional data, adjusting the plan of care, patient education, and referrals. EBP Guideline and Source Name the EBP Guideline for the disease and provide a URL link to it. Pyloric Stenosis: https://www.ncbi.nlm.nih.gov/books/NBK555931/ Cite the source used to complete this activity. (2022). Aap.org. https://publications.aap.org/pediatricsinreview/article-abstract/42/10/539/181204/Hypertrophic-Pyloric-Stenosis?redirectedFrom=fulltext Dawn Lee Garzon, Dirks, M., Driessnack, M., Duderstadt, K. G., & Gaylord, N. M. (2023). Burns’ Pediatric Primary Care – E-Book. Elsevier Health Sciences. Garfield, K., & Sergent, S. R. (2020). Pyloric Stenosis. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK555931/ Pediatric Pyloric Stenosis Medication: Anticholinergic, Antispasmodic Agents. (n.d.). Emedicine.medscape.com. https://emedicine.medscape.com/article/803489-medication?form=fpf ‌

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