Chat with us, powered by LiveChat RESPOND#1 Pls Respond to this discussion The male Asian patient presents with challenges for the - Study Help
  

RESPOND#1 Pls Respond to this discussion

The male Asian patient presents with challenges for the nurse. The Asian culture is rich in tradition and highly patriarchal (Centers for Disease Control and Prevention, 2008).   Many Older Asian patients may blend Western and Eastern medical practices.  Holistic practices are used frequently with an emphasis on restoring a balance (Centers for Disease Control and Prevention, 2008).
In the Chinese culture the eldest male is the decision maker and the leader of the family (Centers for Disease Control and Prevention, 2008).  The nurse will have to understand that while the daughter is actively involved with the healthcare of the patient, the patient will make all the decisions himself.  
The patient may have values based on Confucian values (Centers for Disease Control and Prevention, 2008).   The patient may speak in parable to address a topic.  Chinese patients believe that physical illness results in their life being out of balance or a caused from ancestral interference (Centers for Disease Control and Prevention, 2008).  
The questions that should be asked to the patient target health needs while also addressing tenets of the Asian Culture. The nurse must be able to adapt to the various demographics and proved cultural competent care (Center for Disease Control and Prevention, 2020)
 The history of hypertension and dietary deficiencies should be addressed within the few questions.  Ball et al (2019) suggest that Chinese patients may need to be educated on monosodium glutamate and sodium filled soy sauce.  Asking the patient if there are any cultural concerns can make the patient feel more at ease.
Some possible questions to ask the patient are:
What does your diet consist of?  Are you following a low sodium diet? Are you using and herbal supplements or home remedies? Are there any cultural concerns that I should be aware of?  Are you aware of outside help and what services are available? Do you smoke?
 
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Center for Disease Control and Prevention. (2020, October 21). Cultural Competence In Health And Human Services. Retrieved from:
https://npin.cdc.gov/pages/cultural-competence
Centers for Disease Control and Prevention. (2008). Promoting Cultural Sensitivity: A Practical Guide for Tuberculosis Programs That Provide Services to Persons from China. Atlanta, GA: U.S. Department of Health and Human Services

RESPOND#2 Pls Respond to this discussion

Agonist-to-Antagonist Spectrum

            Medications that are agonists have both an affinity to a receptor and efficacy once they reach the targeted receptor (Berg & Clark, 2018).  This means that an agonist drug binds to the target receptor and changes the activity of the receptor to elicit a response (Berg & Clark, 2018).  An Antagonist has an affinity to the target receptor but does not change the receptor’s activity.  When an antagonist medication binds to the targeted receptors, they reduce the number of receptors available for the agonist, thus reducing the overall response of the receptors (Berg & Clark, 2018).  The inhibitory effect of an antagonist can be overcome by increasing the amount of agonists available (Berg & Clark, 2018). 
            The affinity and efficacy of a medication rely on the drug’s structure and the receptor, which is distinctive to each drug-receptor coupling (Berg & Clark, 2018).  Medications with high affinity and efficacy will elicit a more significant response, while a drug with low affinity and efficacy will produce a lower response (Berg & Clark, 2018).  The amount of medication and the number of available receptors also contribute to the reaction (Berg & Clark, 2018). 
            There are full and partial agonists.  A full agonist has high affinity and efficacy, while a partial agonist has a low affinity or low efficacy or both (Berg & Clark, 2018).  This means that a full agonist produces the greatest response while a partial agonist produces less than an optimal response (Berg & Clark, 2018).  There are also inverse agonists, which have a negative efficacy that decreases the activity of a targeted receptor (Berg & Clark, 2018). 

G Couple Proteins and Ion Gated Channels

            Neurotransmitter receptors are classified as ion gated channels or g-coupled-protein receptors. Ion gated channels respond rapidly. An ion flux runs through the channels, which quickly changes the membrane potential and neuronal activity (Camprodon & Roffman, 2016).  The g-coupled-protein receptors respond slower (Camprodon & Roffman, 2016).  They use a secondary messenger system that involves multi-enzyme cascades (Camprodon & Roffman, 2016).  The secondary messenger system produces modifications such as protein phosphorylation which turns on or off the signal at specific branch points (Camprodon & Roffman, 2016). 

The Role of Epigenetics in Pharmacologic Action

            Epigenetic changes do not change DNA but modify how DNA regulates whether a gene is turned on or off (medlineplus.gov, 2021).  These changes vary among individuals and are influenced by personal behavior such as diet and environmental factors such as pollutants (medlineplus.gov, 2021).  It is important to note that these changes are reversible (medlineplus.gov, 2021).
            Epigenetic modifications affect DNA methylation, histone modifications, chromatin remodeling, and microRNA’s, which act as regulatory molecules and affect homeostasis, and disease processes (Rasool et al., 2015).  The modifications in these mechanisms can lead to various disease states, including neurodegenerative diseases such as schizophrenia (Rasool et al., 2015).  If the basis of the disease is of epigenetic origin, traditional drug therapies may not be effective (Rasool et al., 2015). 
            Pharmacoepigenomics provides insights on how medications can modulate the epigenome and explain the individual variations in drug effectiveness and adverse side effects ( Swathy & Moinak, 2017).  DNA methylation can cause impairment of neurotransmitter systems resulting in schizophrenia (Swathy & Moinak, 2017).  The epigenetic changes in miRNAs also contribute to schizophrenia (Swathy & Moinak, 2017).  Due to the reversibility of these epigenetic defects, it could be possible to reverse these defects with drug therapies (Swathy & Moinak, 2017).  Studies have shown that typical antipsychotics such as chlorpromazine and haloperidol can induce epigenetic changes (Swathy & Moinak, 2017).  The question is, Are the epigenetic changes from the antipsychotic medication helping reverse the epigenetic defects or enhance them? 
 
 
 

References

Berg, K. A., & Clarke, W. P. (2018). Making Sense of Pharmacology: Inverse Agonism and Functional Selectivity. The international journal of neuropsychopharmacology, 21(10), 962–977. https://doi.org/10.1093/ijnp/pyy071

Camprodon, J. A., & Roffman, J. L. (2016). Psychiatric neuroscience: Incorporating pathophysiology into clinical case formulation. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 1–19). Elsevier
Medlineplus.gov (2021).  What is epigenetics? U.S. national library of medicine. https://medlineplus.gov/genetics/understanding/howgeneswork/epigenome/

Rasool, M., Malik, A., Naseer, M. I., Manan, A., Ansari, S., Begum, I., Qazi, M. H., Pushparaj, P., Abuzenadah, A. M., Al-Qahtani, M. H., Kamal, M. A., & Gan, S. (2015). The role of epigenetics in personalized medicine: challenges and opportunities. BMC medical genomics, 8 Suppl 1(Suppl 1), S5. https://doi.org/10.1186/1755-8794-8-S1-S5

Swathy, B., & Banerjee, M. (2017). Understanding epigenetics of schizophrenia in the backdrop of its antipsychotic drug therapy. Epigenomics, 9(5), 721-721–736. https://doi.org.dx.doi.org.ezp.waldenulibrary.org/10.2217/epi-2016-0106

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