penicillin-binding proteins

1. Alexa just received devastating news of her HIV diagnosis and of her long-term boyfriend being unfaithful. At any age there truly is no greater heartbreak than to find out the one you were planning on spending forever with has been unfaithful. Add being 17 and being diagnosed with HIV on top of this is the hardest thing Alexa will ever have to go through. As a nurse I must develop trust with Alexa so she knows everything between us is confident and private. “If trust is broken and mistrust develops, it is very difficult for the informer (nurse) to regain trust” (Butts & Rich, 2016, pg. 195). This is the very thing I would want to avoid with her. I want to gain her trust and never lose it. I would do this by sharing with her my own heartbreak story so she feels equal with me and knows that I’ve been there and I won’t discount her feelings. If I share a personal story she may be more inclined to share more with me and trust me. Nurse-adolescent relationships are so important. You want them to be professional and respectful, but on some level personal so they feel comfortable coming to you.

When Alexa comes back to visit me I will take this as a sign that she is comfortable around me and can confide in me. I would take this time to further educating her on her HIV and possible next steps. I would make sure to respect her autonomy no matter my opinions because this diagnosis is hard for anyone especially a 17-year-old. I would apply the ethical competencies of beneficence and nonmaleficense as well by expressing what I believe to be best for her and what would bring her no harm.

Alexa is in such complicated situation and it is important for me to be understanding of her feelings and keep our conversation private so she knows she can always come back to speak to me about any concerns. Working with a 17-year-old girl can be tough but that is why it is extremely important to build a strong nurse-adolescent relationship immediately.

2. In my opinion the situation at hand is tough. Alexa is very young and she has not yet experienced life. With Alexa’s situation there are many different approaches I would take. I would first have to put myself in Alexa’s shoes to reach her on a personal level of emotions and stress. Alexa’s emotions are everywhere at this point because the person she loved and expected to be with for the rest of her life betrayed her. I would simply take my time with Alexa to show my compassion and care. I would then transition into a professional aspect, giving Alexa great facts about HIV and possibly different programs she could attend to help her cope with her situation. I would inform Alexa on how imperative it is to start treatment right away to slow down the progression of the HIV (CDC, 2018). I would inform Alexa of antiretroviral therapy which is the medicine she will be taking to protect her immune system. The medicine can help Alexa stay healthy for many years and greatly reduce any chances of transmission with future partners (CDC, 2018).

Next, I would follow some ethical principles: nonmaleficence (do no harm), autonomy, justice, and beneficence. With nonmaleficence (do no harm), I would provide Alexa with proper treatment and referrals outside the clinic. I would make sure Alexa does not have any allergies from the medication she has to take for the HIV to prevent any harm. Using Autonomy, Alexa has the right to make her own decisions (Butts & Rich, 2016, pg. 36), so if she chooses not to take the medications provided, I as the nurse must respect her decisions and not be judgmental. Using justice I would treat Alexa the same (Butts & Rich, 2016, pg. 46) despite the fact she has HIV. Using beneficence I would simply make sure I follow protocol for maintaining Alexa’s confidentiality so our relationship will not become compromised.

Lastly, I would suggest that Alexa meet me every other week for follow ups. During the follow ups I would provide Alexa with more general information about her condition, and simply talk to her about how she is doing. This is just to show that Alexa at least has her nurse to confide in when things get too tough.

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1.The transport of oxygen and carbon dioxide in the blood is critical for survival. The victims with the most severe symptoms would need mechanical ventilation to overcome the inability of their respiratory systems to maintain normal blood levels of oxygen and carbon dioxide. Phosgene gas would reduce the amount of oxygen available for transport to the tissues. In addition, the metabolic waste product carbon dioxide is transported by three mechanisms back to the alveoli in the blood. Here carbon dioxide crosses the respiratory membrane, driven by a pressure gradient that favors its exit via the lungs during exhalation. By knowing which mechanism transports the most CO2, predict what would happen to the blood pH if the CO2 level dramatically increased?

While 10% of CO2 travels in the plasma, and 20% bound to hemoglobin as carbaminohemoglobin (not to be confused with carboxyhemoglobin, which occurs when CO irreversibly binds to Hb), the majority (70%) travels as the bicarbonate ion, HCO3-. A dramatic increase in PCO2, also known as hypercapnea, would cause a decrease in pH (blood becomes more acidic). In response, central chemoreceptors trigger hyperventilation in order to expel the excess CO2 upon expiration. However, if pulmonary edema is severe enough, gas exchange is prevented since the alveoli are filled with fluid and thus have a higher surface tension. This also prevents O2 from entering the lungs and so leads to hypoxemia, as well.

2.Phosgene exposure causes inflammation and pulmonary edema that is deleterious to the function of the lungs. (a) What are the three physical factors that influence pulmonary ventilation? How would each of these factors be affected by inflammation and edema?

Pulmonary ventilation is the process of moving air into and out of the lungs. There are three physical factors that influence pulmonary ventilation: airway resistance, alveolar surface tension, and pulmonary compliance. Due to inflammation, airway resistance can be increased. The inflammation can narrow the air passages (diameter decreases). A difficulty for air to pass through the airways can occur. Due to pulmonary edema, alveolar surface tension can be increased. Excess fluid in the lungs can cause the alveoli to collapse during expiration. Due to pulmonary edema, pulmonary compliance (the ability of the lungs to stretch) can be decreased. An excess fluid in the lungs requires a greater pressure to apply which causes an increase in resistance. A breathing difficulty with inhalation can occur.

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3. Reflection: “Despite well over 60 years of prolific, extensive, and indiscriminate use of penicillin, Streptococcus pyogenes continues to be universally susceptible. Even though most other streptococcal organisms have developed antibacterial resistance, and even S. pyogenes has demonstrated resistance to other antibacterials, why would S. pyogenes still remain susceptible to penicillin?” 

While Streptococcus pyogenes has been and continues to be susceptible to penicillin, that does not mean the Group A Streptococci will be susceptible to the antibiotic forever. Since it takes a different amount of time for each strain of bacteria to develop antibiotic resistance, it could still happen in the future and lead to a quick turnaround. It has been discovered that S. pyogenes has restriction barriers, which include extracellular DNA enzymes that make it more difficult to accept a different source of DNA via conjugation or transformation. Thus, this process that could potentially lead to the development of antibiotic resistance has been ineffective in this strain of bacteria. In addition, this form of bacteria already lacks the ability to readily accept other sources of DNA. Strains of bacteria that have developed a resistance to penicillin have the ability to produce penicillin-binding proteins, which allow the bacteria to maintain the peptidoglycan component of the cell wall while also displaying a low affinity for the antibiotic. However, in S. pyogenes, tests have shown that the biological makeup of the bacteria would be negatively affected by these pencillin-binding proteins. Therefore, additional research needs to be done to test additional ways to potentially develop resistance to penicillin in this strain of bacteria.

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1.I believe that parents, medical professionals (especially pediatricians), food marketers, educators (especially health and gym teachers), and our government officials are all responsible for addressing childhood obesity. Controversy 13 states that, “parents and other caregivers have a unique opportunity to help children form healthy habits related to the foods they eat, the physical activities they participate in, and their emotional well-being”. (Sizer et.al, 2018). I also recommend that mothers that can breastfeed do breastfeed because studies have shown “that breastfeeding was associated with a reduced risk of obesity among infants, young children, older children, and adults” (Savage et. al, 2007) This starts after conception for mothers. It is important to have a healthy diet during pregnancy and to feed children healthy and nutritious foods from a very young age, as this will affect their taste preferences in the future. I think that pediatricians play a large role in monitoring children’s weight, nutrition, and exercise, and if something is not healthy, I think they should provide steps for children to get back on track. I think that food marketers, including the FDA, need to implement changes to the nutrition labels of food to make them easier to understand for children. I also believe that child educators should make sure to educate children in proper nutrition, diet, and exercise and to ensure that students understand what a balanced diet is. According to a study from Columbia University,”nutrition education is more likely to be effective when it focuses on behavior/action (rather than knowledge only) and systematically links relevant theory, research and practice.” (Hard et. al, 2015 ). Because of this I propose that teachers explain nutrition labels and do a field trip to the grocery store to have students try to pick healthy breakfast, lunch, dinner, and snack options.Finally, I think responsibility falls on our government to focus more on the issue of obesity in our country.

2.The childhood obesity epidemic is such a multifacited problem, that I think the only way to work toward a solution is to have multiple individuals, groups and agencies combine forces. On the individual level, parents and their children need to make healthier choices. If a child is young, parents need to provide healthy foods, and teach healthy eating and physical activity practices. Children learn by example, so parents who have unhealthy habits and are obese themselves are more likely to pass these behaviors down to their children. At the group level, organizations like schools and after-school programs need to provide healthy meals and opportunities for adequate physical activity. These groups also need to teach healthy habits. Finally, agencies are responsible for the broadest and farthest-reaching interventions. Government agencies should support positive food advertising, useful food labels and food programs for low-income families.

I think a serious contributor to the childhood obesity problem is family income. Low-income families often don’t always have access to grocery stores with healthy options, and even if they do they often can’t afford those options. In order to save money, low-income families may turn to fast food or convenience store foods. The low cost and easy access of these foods increases consumption in low-income areas. In order to combat the obesity epidemic, healthy food options need to be made available and affordable. This type of change has to start at the agency level and trickle down to the individual level.

Another solution that has already been shown effective is school programs to address healthy eating and physical activity. An example of a program already in place is the NFL’s Play 60 initiative. This program encourages children to be active for at least 60 minutes a day. The program includes various challenges and rewards. I think children are especially reward driven, so if more schools would adopt programs incentivizing healthy habits, more children would participate. Practicing these habits on a daily basis, in a fun environment, would hopefully ingrain them into children so they become second nature.