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DEVELOPING A QUESTION – STATIN THERAPY: PICOT

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Patients with high levels of cholesterol in their body usually undergo the statin therapy which helps in preventing and reducing the high risks of suffering from the cardiovascular disease, are the statins drugs right for the patients or lead to the increased cases of liver disease?

The nursing problem relating to the proper management of the cardiovascular disease and ensuring that administration of statins therapy leads to the desired impact is observed mainly among the patients having heart and liver diseases in the health centers. Statins are the group of drugs that help in lowering the levels low-density lipoprotein in one’s blood.

The statins are responsible for blocking the substances that form cholesterol in the liver (Shehata et al, 2015). The recent incidents related to the effectiveness of the statins prompts the researchers to conduct the interventional studies to establish whether the statin drugs cause the increase of the liver diseases among patients (Shehata et al, 2015).

The statin drugs ensure that any excess cholesterol within the body is converted into bile salts that absorb the vitamins and fats in the intestines (Shehata et al, 2015). Scientific research gives out evidence that high levels of the low-density lipoprotein cause the progression of the cardiovascular diseases. By the previous studies conducted, there is a significant relationship between the high LDL cholesterol and the cardiovascular disease among the patients. Therefore, cholesterol has been seen as a risk factor for the high mortality rates among the cardiovascular disease patients (Shehata et al, 2015).

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Taking the prescribed medication appropriately, maintenance of a healthy diet and involvement in the physical exercises is efficient in controlling the cholesterol levels in the body. The populations that are more vulnerable to the disease are the elderly and the smokers. The people above the age of fifty are the most likely to suffer from diseases. The smokers take in a chemical that transports the cholesterol from the deposits of fat to the liver.

The elderly population is vulnerable as the arteries usually narrow causing atherosclerosis. The increased levels of serum cholesterol make the smokers and elderly more vulnerable to the heart disease. The various health institutions are therefore monitoring the liver function test among the patients that have undergone the statin therapy (Shehata et al, 2015).

Joint British Societies and also the NICE has recommended the adoption of statin therapy as the remedy to help in the reduction of cardiovascular disease related mortality rates. There has been significant reduction in the mortality rate by about 10% which gives credit to the intervention adopted. The remedy is significant in the nursing profession as it enhances the better and more efficient management of the problem.

The management of the disease is highly beneficial to the people most vulnerable to developing the disease. The efficient monitoring of the liver function tests among the patients is highly recommended to ensure the proper management (Shehata et al, 2015). Prior to the establishment of the significant results of the tests conducted, the statin therapy seems to be cumbersome in nature. Such a case acts as a fault to the statin drugs been used to manage and properly intervene for the problem.

The statin drugs also induce liver enzymes which cause the high levels of alanine transaminase which requires the testing to be done several months in the early weeks of ALT (Shehata et al, 2015). The patients might develop obesity or the drug-induced toxicity influencing the function of the liver. In addition to the liver function tests’ monitoring, it is essential to include the histological techniques.

Considering other factors that might influence abnormalities during the liver functions test is essential before identifying the probability of the influence caused by the statins on the disease. Measuring the patient’s baseline during the statin therapy while conducting the liver function test results into reduced cases of the cardiovascular disease which is the required outcome.

Population used is the adults between 18-55 years of age who have been clinically diagnosed with the cardiovascular disease in the past and have undergone the statin therapy at least ones during their medication process. The patients facing the liver diseases are also include to identify whether the statin therapy contributes to increased levels of their illness.

Intervention for the problem is adoption of statin therapy as the remedy to help in the reduction of cardiovascular disease related mortality rates. The management of the disease is highly beneficial to the people most vulnerable to developing the disease. The efficient monitoring of the liver function tests among the patients is highly recommended to ensure the proper management among the patients experiencing the liver disease (Shehata et al, 2015).

The standards supervised process that would not involve the establishment the significant liver test conducted which acts as a control group for the patients is used for comparison. The nitrates used by the cardiovascular patients as drugs to manage the disease would be administered to the patients for comparison with the stating therapy and the effects.

The outcome assessed during the research of the issues includes the changes in number of LDL receptors in the liver of the patients. The reduced risk of suffering from cardiovascular disease and the mortality and morbidity rates are also measured as an outcome (Shehata et al, 2015). The time frame for the outcome would be evaluated and measured monthly for 6 months.

Rapid appraisal

How does each article describe the nature of the problem, issue, or deficit you have identified?

The article has efficiently described the issue of statin therapy, its effectiveness among the cardiovascular disease patients and other impacts it causes.

Does each article provide statistical information to demonstrate the gravity of the issue, problem, or deficit?

The article has been helpful in describing the problem and its gravity to the extent of providing a clear insight about the issue of interest.

Example(s): morbidity, mortality, rate of incidence or rate of occurrence in the general population.

There has been significant reduction in the mortality rate by about 10% which gives credit to the intervention adopted

Does the article support your proposed change?

The article has provided more information regarding the proposed change by describing the positive impacts for the intervention.

Reference

Shehata, M., Fayez, G., & Nassar, A. (2015). Intensive Statin Therapy in NSTE-ACS Patients Undergoing PCI: Clinical and Biochemical Effects. Texas Heart Institute Journal, 42(6), 528-536. doi:10.14503/THIJ-14-4891

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Introduction

Gonorrhea is a sexually transmitted infection (STI) ,caused by Neisseria gonorrhoeae a bacteria which infects the mucous membranes. The bacteria is often transmitted from one individual to another during sexual contact, including anal, oral or vaginal intercourse. However, babies can also be infected with this condition during childbirth if the mother is infected. In babies, the disease affects their eyes. Hethcote &Yorke (2014) report that some of the factors that may increase the risk of one getting the infection include age, new sex partner, history of gonorrhea infection, multiple sex partners, and co-infection with other sexually transmitted diseases.

The bacteria cannot survive outside human body for long therefore it cannot be transmitted by sharing baths and towel, cups, toilets and seats, kissing or hugging.

Once infected, one presents with urethral discharge while urinating. The infection is treatable therefore one should seek medical attention early after noticing the symptoms.

Presentation of Gonorrhea

Usually, the infection causes no symptoms. However, when they appear it affects multiple body parts, but it appears commonly in the genital tract. Men who have been diagnosed with gonorrhea pus-like discharge from the tip of the penis, painful urination, and swelling and pain in one testicle. In women, the infection causes increased vaginal discharge, dysuria, dyspanuria, pelvic or abdominal pain, and vaginal bleeding between periods such as after vaginal intercourse.

The infection can also infect other body parts such as the rectum where it causes anal itching, discharge of the pus-like substance from the rectum, strains during bowel movements, and bleeding. When it infects the eyes, it may cause light sensitivity, eye pain, and pus-like discharge from one or both eyes. Patients may also develop a sore throat or swollen lymph nodes in the neck if the infection spreads to the throat. It can also disseminate to the various joints causing septic arthritis whereby the affected joints become red, warm, swollen, and extremely painful during movements.

Treatment of Gonorrhea

Adults who have been diagnosed with gonorrhea are prescribed with antibiotics. The Centers for Disease Control and Prevention (CDC) has recommended that patients with uncomplicated gonorrhea should be given a ceftriaxone injection in combination two oral antibiotics, that is, either doxycycline or azithromycin. This is advisable because the drugs provide a wide range of activity which is required due to the emergence of strains of drug-resistant Neisseria gonorrhoeae(Kerani et al. 2015).

Babies who are infected during childbirth are given two eye drops of erythromycin to prevent the spread of the infection. To avoid reinfection with gonorrhea, the patients are advised to abstain from unprotected sex for seven days after he/she has completed the treatment regimen and the symptoms have resolved.

The infection can cause some complications if it is untreated. For instance, it can cause infertility in women by spreading to the oviduct and the uterus cause Pelvic Inflammatory Disease (PID) which causes scarring of the fallopian tubes, increase in pregnancy complications as well as infertility. Infertility can also occur in men if the infection affects the epididymis. Most importantly, the gonorrhea infection predisposes a person to the risk of being infected with STIs such as the Human Immunodeficiency Virus (HIV).

The following steps should be taken to reduce the risk of gonorrhea infection. First, sexually active women should be encouraged to visit health centers annually for gonorrhea screening (Jackson, McNair & Coleman, 2015). Condoms should also be used if a person is having sex with a new sex partner. For those who have been diagnosed with the disease, they should encourage their partners to also go to a hospital for testing.

Prognosis

Gonorrhea has a good prognosis especially if antibiotic therapy is administered early enough. Usually, the infection clears within 2 to 4 weeks if the Neisseria gonorrhoeaeis susceptible to the antibiotics that have been administered. For individuals who have are immune-compromised such as patients with HIV, the infection may last for months and become more severe.

References

Hethcote, H. W., & Yorke, J. (2014). Gonorrhea transmission dynamics and control (Vol. 56). Springer.

Jackson, J. A., McNair, T. S., & Coleman, J. S. (2015). Over-screening for chlamydia and gonorrhea among urban women age≥ 25 years. American journal of obstetrics and gynecology, 212(1), 40-e1.

Kerani, R. P., Stenger, M. R., Weinstock, H., Bernstein, K. T., Reed, M., Schumacher, C., … & Golden, M. (2015). Gonorrhea treatment practices in the STD Surveillance Network, 2010–2012. Sexually transmitted diseases, 42(1), 6-12.

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