The case study I was presented was “An 83-year-old resident of a skilled nursing facility presents to the emergency department with generalized edema of extremities and abdomen. History obtained from staff reveals the patient has a history of malabsorption syndrome and difficulty eating due to lack of dentures. The patient has been diagnosed with protein malnutrition”. 

When looking into protein malnutrition, protein energy-malnutrition is the most commonly seen terminology, or PEM, that is the result of starvation (with or without catabolic stress). PEM is considered a disease and is the result of chronic inadequate protein or energy intake not meeting the body’s needed intake of nutrients. In some cases, the loss of fat is reduced due to a slowed energy use accomplished by decreasing the metabolism and instead using the body’s storage of lean protein. Typically, the majority of the protein is released from muscle tissues and the kidneys, blood, immune cells, GI tract and liver are spared for the most part. In cases where the ration of energy and protein are not obsolete, the body can adapt to the environment by decreasing the energy and protein needed to sustain homeostasis. PEM results in “a lowered metabolic rate and reduced muscle mass (including reduced cardiac and respiratory muscle mass); its clinical consequences include muscle weakness and functional disability, reduced cardiac and respiratory capacity, mild hypothermia and a reduced body protein reserve” (Hoffer, 2001). In PEM, the extracellular fluid also shifts and can cause generalized edema. 

In consideration of protein malnutrition, there are two conditions that come up in various articles, Kwashiorkor and marasmus. “Kwashiorkor is predominantly a protein deficiency, while marasmus is a deficiency of all macronutrients — protein, carbohydrates and fats. People with marasmus are deprived of calories in general, either because they’re eating too little or expending too many, or both. People with kwashiorkor may not be deprived of calories in general but are deprived of protein-rich foods” (C.C. Medical, n.d.). In this case study, though the primary diagnoses is protein malnutrition, marasmus may be more fitting and in align with the physiologic problems this patient is facing. “For older adults, adverse health outcomes associated with malnutrition can often be more complex and disproportionally worse than outcomes associated with overweight or obesity. Malnutrition in older adults can lead to weight loss. Functional recovery from this weight loss is unlikely to occur due to the loss of skeletal muscle mass, even with full nutritional support” (Dent et. al, 2023).  “Marasmus is equally distributed between the genders, however, as a result of cultural differences in some parts of the world women may be at an increased risk of marasmus” (NCBI, 2023).

 

• Respectfully agree or disagree with your colleague’s assessment and
• Explain your reasoning. In your explanation, include why their explanations make physiological sense or why they do not. Support each of your replies with at least 0ne citation and reference.

  Patient: 17-year-old male with a diagnosis of testicular torsion

******Please use OLDCARTS  for the history of the present illness*****

answer everything and remove all instructions on the template

PLEASE RESPOND TO THE FOLLOWING IN 50 WORDS OR MORE:

Since Week 1, I have learned a lot. My perspective on the concepts of trends in nursing has changed to say the least. This class has helped me build and evolve the way of thinking that nurses have to deal with low pay, lateral violence, long hours, not being heard etc, just because it’s part of our job. There are ways for us to use our voice and join different groups to help us be heard in the healthcare field. Discussion 6 I thought was especially important because it shows different ways for nurses to get involve and advocate for nurses. Trends and issues in nursing is something we can overcome with time and effort. Providing the right care and education in all aspects of nursing will help change the view people have of nursing and the believe that nursing is a just a job and not a profession.

Learning Activity Content

1.

Top of Form

During this week's learning activity we will begin to develop your PICCO question.

Choose a topic that you would like to research in nursing. You may use a topic previously used in the assignments for this week. 
Develop a literature review abstract list (1 for each source) of 3 or more sources that support this topic. This means you will cite your article and write 1-2 paragraphs on how this research study/article supports your PICO question.

The PICO Question is Due this week and is a required assignment. Submit it with your Literature Review [with this assignment].

Here is a very useful link on how to write a literature review and complete a literature review.

How to write a Literature Review

How to write a PICO Question

Please review the rubric prior to submission.

Criteria	Excellent 100%	Satisfactory 75%	Unsatisfactory 50%	Poor 25%
Learning activity questions    50 %	The learning activity questions are answered comprehensively. The word count if applicable has been met, and it is accurate, non-evaluative, coherent, readable, and concise. All the following elements are included: a. The problem or issue you are presented and clearly explained, and b. the author's conclusions are clear and concise are explained.	The learning activity questions are not answered comprehensively. The word count is 50 words short of meeting the required count, and it is accurate, has some non-cohesive thoughts, readable, and is concise. All the following elements are included: a. The problem or issue you are presented and clearly explained, and b. the author's conclusions are clear and concise are explained.	The learning activity questions are not answered comprehensively. The word count is 50 words short of meeting the required count, but it is not clear and accurate, has some non-cohesive thoughts, and struggles to be coherent, readable, and concise. All the following elements are included: a. The problem or issue you is not presented and clearly explained, and b. the author's conclusions are not clear and concise are explained.	The learning activity questions are not answered comprehensively. The word count is more than 50 words short of meeting the required count, but it is not clear and accurate, has some non-cohesive thoughts, and struggles to be coherent, readable, and concise. All the following elements are included: a. The problem or issue you is not presented and clearly explained, and b. the author's conclusions are not clear and concise are explained.
Grammar, Spelling, APA  25%	Minimal spelling, APA, and/or grammar mistakes.	Some spelling, APA, and or grammar mistakes.	Noticeable spelling, APA, and/or grammar mistakes.	An unacceptable number of spelling and/or grammar mistakes.
Reference Page 25%	All sources 3 are current within 5 years and are cited following APA format.	At least 1 source is NOT current (within 5 years) but ALL are cited following APA format.	More than 2 sources are NOT current (within 5 years) and some are cited NOT following APA format.	All sources are NOT current (within 5 years) and some are cited NOT following APA format.

 

Where can you find evidence to inform your thoughts and scholarly writing? Throughout your degree program, you will use research literature to explore ideas, guide your thinking, and gain new insights. As you search the research literature, it is important to use resources that are peer-reviewed and from scholarly journals. You may already have some favorite online resources and databases that you use or have found useful in the past. For this Discussion, you explore databases available through the Walden Library.

Discussion post ( question to answer)

Using proper APA formatting, cite the peer-reviewed article you selected that pertains to your practice( PHMNP) area and is of particular interest to you and identify the database that you used to search for the article. Explain any difficulties you experienced while searching for this article. Would this database be useful to your colleagues? Explain why or why not. Would you recommend this database? Explain why or why not.