Peer Response

Instructions:

Please respond to at least 2 of your peer’s posts.  To ensure that your responses are substantive, use at least two of these prompts:

• Do you agree with your peers’ assessment?
• Take an opposing view to a peer and present a logical argument supporting an alternate opinion.
• Share your thoughts on how you support their opinion and explain why.
• Present new references that support your opinions.

Responses need to address all components of the question, demonstrate critical thinking and analysis, and include peer-reviewed journal evidence to support the student’s position.

Please be sure to validate your opinions and ideas with in-text citations and corresponding references in APA format.

Reply from Melisa Tennies

In a comprehensive health assessment, clinicians identify various risks, strengths, and needs through the health history, physical examination, and preventive services.

Hypertension Screening

Blood pressure assessment during a wellness visit may identify an elevated reading (≥130/80 mmHg). It is a risk factor because untreated hypertension increases the risk of stroke, heart attack, and chronic kidney disease (Whelton et al., 2018). Identifying this risk is crucial to initiating interventions such as lifestyle counseling and blood pressure management to prevent complications. Screening can be completed in a comprehensive health assessment, as well as through general health screenings and health fairs. 

Regular Physical Activity

History taking may reveal that a patient engages in at least 150 minutes of moderate exercise per week, which is a strength. Regular physical activity is associated with reduced risk of obesity, diabetes, hypertension, and depression. Exercise also improves overall quality of life (Piercy et al., 2018). Identifying this strength provides an opportunity for the provider to reinforce the positive behavior and encourage its maintenance.

Preventive Screening and Vaccines

A patient who did not have a colonoscopy at age 50 or is not up to date on recommended vaccines (e.g., influenza, shingles) needs preventive services. Identifying this need helps ensure timely interventions that can prevent morbidity and mortality (U.S. Preventive Services Task Force [USPSTF], 2021).

In conclusion, a comprehensive health assessment enables providers to identify various risks (e.g., hypertension), strengths (e.g., exercise), and needs (e.g., preventive screenings) to guide care and promote wellness.

References

Piercy, K. L., Troiano, R. P., Ballard, R. M., Carlson, S. A., Fulton, J. E., Galuska, D. A., George, S. M., & Olson, R. D. (2018). The physical activity guidelines for Americans. JAMA , 320 (19), 2020–2028. https://doi.org/10.1001/jama.2018.14854

U.S. Preventive Services Task Force. (2021). USPSTF A and B recommendations. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-a-and-b-recommendations

Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Dennison Himmelfarb, C., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., MacLaughlin, E. J., Muntner, P., Ovbiagele, B., Smith, S. C., Spencer, C. C., Stafford, R. S., Taler, S. J., Thomas, R. J., … Wright, J. T. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Journal of the American College of Cardiology, 71 (19), e127–e248. https://doi.org/10.1016/j.jacc.2017.11.006

Reply from Emily Byrd

How can we identify health risks, strengths, and needs in our comprehensive health assessment?

Example 1: Medical History Review

The medical history review includes family history, lifestyle factors, previous health history, and current symptoms and conditions. It is critical to inquire about conditions such as cancer or heart disease that run in the family, this may indicate a genetic predisposition to certain risks (FastStats – Diseases and Conditions, 2020).  Ask the patient about diet, exercise, smoking, alcohol use, or illicit drug use as these directly influence a person's health.  By accessing past medical records, this provides information on existing conditions and patterns of patient care. Health assessments can be used to identify what’s happening in the body at this current moment in time and allows us the tools needed to provide perspective on what could happen in the future based on lifestyle choices, the patient’s family history, current medications, allergies, and other risk factors (How to Perform a Health Assessment in Nursing, 2025). A proper assessment is a full head to toe assessment, including vital signs. 

Example 2: Social Assessment

As health care providers, it is important to evaluate the patient's support system and family structure. We should also respectfully assess household and environmental risk factors, including issues such as abuse, homelessness or unemployment that may impact a person's health. We should also determine the patient's willingness to change lifestyle modifications if needed and understand their receptiveness to interventions we may recommend to improve their health. By understanding the patient's unique psychological, social, and spiritual needs, as providers we are able to provide appropriate care (Toney-Butler & Unison-Pace, 2023). 

References:

How to Perform a Health Assessment in Nursing. (2025, May 5). Holy Family University. https://onlinenursing.holyfamily.edu/blog/how-perform-health-assessment-nursingLinks to an external site.

FastStats – Diseases and Conditions. (2020). https://www.cdc.gov/nchs/fastats/diseases-and-conditions.htmLinks to an external site.

Toney-Butler, T., & Unison-Pace, W. (2023). Nursing Admission Assessment and Examination. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK493211/

Peer Response

Instructions:

Please read and respond to at least two of your peers' initial postings. You may want to consider the following questions in your responses to your peers:

• Compare and contrast your initial posting with those of your peers.  
• How are they similar or how are they different?
• What information can you add that would help support the responses of your peers?
• Ask your peers a question for clarification about their post.
• What most interests you about their responses? 

Please be sure to validate your opinions and ideas with citations and references in APA format.

Reply from Talibah Tyson

Ion Channels 

The two major classes of ion channels that target drug action include ligand gated ion channels and voltage gated or voltage sensitive ion channel. Ligand gated ion channels are linked to receptors that regulate the opening and closing action of the neurotransmitter. They act as both a receptor and form an ion channel. The voltage gated or voltage sensitive ion channels opening and closing is regulated by the voltage potential or ionic charge across the membrane (Stahl, 2021.) This class of ions has voltage sensitive sodium and calcium channels that many drugs such as anticonvulsants bind to. Voltage gated ions channels are the most common drug targets (Alexander et al., 2021.)

A full agonist is characterized by the full array of downstream signal transduction which is the maximum activation of the signal transduction cascade. Antagonists block the action of the agonist by causing no change in the signal transduction. An antagonist is thought to be neutral as is has no action of its own (Stahl, 2021.) Partial antagonists are thought to be stabilizers of neurotransmission as they do not give the full amount of signal transduction. It has the capability to boost insufficient neurotransmitter activity and block any excessive activity. Inverse agonist creates a functional reduction in transducing signals opposite of the agonist.

Reference

Alexander, S. H., Mathie, A., Peters, J. A., Veale, E. L., Striessnig, J., Kelly, E., Armstrong, J. F., Faccenda, E., Harding, S. D., Pawson, A. J., Southan, C., Davies, J. A., Aldrich, R. W., Attali, B., Baggetta, A. M., Becirovic, E., Biel, M., Bill, R. M., Catterall, W. A.,…Zhu, M. (2021). The concise guide to pharmacology 2021/22: Ion channels. British Journal of Pharmacology, 178(S1). https://doi.org/10.1111/bph.15539Links to an external site.

Stahl, S. M. (2021). Stahl's essential psychopharmacology: Neuroscientific basis and practical applications (5th ed.). Cambridge University Press.

Reply from Ralph Annam

The Two Major Classes of Ion Channels 

Ligand-gated ion channels (LGICs): Open upon neurotransmitter or ligand binding. Multimeric proteins (pentamers, tetramers, or trimers) are responsible for fast synaptic signaling. They often have multiple modulatory sites (e.g., GABA, NMDA, and nicotinic AChR). (Rao et al., 2022; Alexander et al., 2023).

Voltage-gated ion channels (VGICs): Open in response to membrane potential changes. The system is constructed from large subunits with voltage-sensing domains. The brain is responsible for driving action potentials, pacemaking, and muscle contraction. Represent primary drug targets for anesthetics, antiarrhythmics, and analgesics. (Jiang et al., 2022; Harris et al., 2024).

In contrast, LGICs convert chemical → electrical signals, while VGICs convert voltage → gating changes. Pharmacologically, LGICs are well suited for orthosteric/allosteric drugs, while VGICs demand state- or subtype-selective modulators.

Agonists and Related Ligands 

Full agonist: Binds and produces a maximal effect (high efficacy).

Partial agonist: Causes a less than maximum effect even when all receptors are occupied; can block the effects of full agonists (for example, ar (Mohr et al., 2022). 

Antagonist: Binds without changing basal activity and blocks the action of an agonist.

Inverse agonist: Opposes constitutive activity by reducing it below baseline and stabilizing inactive receptor conformations. (Qin et al., 2022; Michel et al., 2020).

Key point: Whether a ligand is an agonist, partial agonist, or antagonist depends on receptor reserve, tissue context, and constitutive activity. (Watts et al., 2023). 

References

Alexander, S. P. H., et al. (2023). The Concise Guide to PHARMACOLOGY 2023/24: Ion channels. Br J Pharmacol, 180(Suppl 2), S145–S222. https://doi.org/10.1111/bph.16178
Harris, B. J., et al. (2024). Toward high-resolution modeling of small molecule–ion channel interactions. Front Pharmacol, 15, 1411428. https://doi.org/10.3389/fphar.2024.1411428
Jiang, D., et al. (2022). Structural advances in voltage-gated sodium channels. Front Pharmacol, 13, 908867. https://doi.org/10.3389/fphar.2022.908867
Mohr, P., et al. (2022). Dopamine receptor partial agonists: Do they differ in clinical efficacy? Front Psychiatry, 12, 781946. https://doi.org/10.3389/fpsyt.2021.781946
Qin, J., et al. (2022). Molecular mechanism of agonism and inverse agonism in ghrelin receptor. Nat Commun, 13, 300. https://doi.org/10.1038/s41467-022-27975-9
Rao, R., et al. (2022). Ligand-gated ion channels as therapeutic targets. Front Physiol, 13, 839437. https://doi.org/10.3389/fphys.2022.839437
Watts, S. W., et al. (2023). Receptor theory and hypertension therapy. Am J Hypertens, 37(4), 248–260. https://doi.org/10.1093/ajh/hpad121
Michel, M. C., et al. (2020). Inverse agonism at adrenoceptor subtypes. Cells, 9(9), 1923. https://doi.org/10.3390/cells9091923

• Reply to post from Ralph AnnamReply

Criteria 

1. 750 words (excluding reference list);
2. First-person is permitted.
3. Organize work using headings that correlate to each section of the discussion.
4. Follow APA format for all in-text citations and references (line spacing may be single-spaced in the discussion forum). 
5. Avoid the use of direct quotes. Provide in-text citations for information from sources.
6. Use of generative AI is not allowed except where indicated for the PICOT question development.
7. Use current, peer-reviewed references, in addition to textbook.

Introduction (3 points)

1. Describe the topic being explored by your group. ( Rheumatoid arthritis )

2. Discuss the population you plan to investigate related to the topic/problem (men, women, children, adolescents, adults, elderly, specific race or gender). 

3. Describe the topic/problem in relation to nursing and nursing care.

4. Describe how each of the following affect client outcomes:

• the care provided
• patient education
• health disparities

5. Support with at least one peer-reviewed reference.

Research, EBP, & Quality Improvement (3 points)

1. Describe the differences between research, evidence-based practice (EBP), and quality improvement. Be specific and make sure to differentiate the concepts.

2. Describe the purpose of an EBP project.

3. Support this section with at least one reference (may be a website or article) other than the textbook.

PICOT Question Development and Use of Artificial Intelligence (AI) (3 points)

1. Using the template below, develop a PICOT (population, intervention, comparison, outcome, and time) question related to your assigned topic. See Chapter 4 in your textbook.

In ____________ (P), how does _________________________ (I), compared to _________________________ (C) affect __________________________________ (O) within _______________________ (T)?

2. Next, create a PICOT on ChatGPT using the same topic.

• Go to ChatGPT: https://chatgpt.com/Links to an external site.
• Follow the directions below once you reach the ChatGPT site. 
  • You can Sign Up or Login if you desire, or you can simply copy and paste the information needed into the search box.
  • Take your group topic and ask ChatGPT to form a PICOT and clinical question for you. 
• Reflect on the question you created and the ones provided by ChatGTP. Which do you prefer and why? Are there parts of your question and the AI generated questions that you would like to blend together?
• Write the PICOT question you would use moving forward for your research.

Finding Evidence (3 points)

1. Provide basic background information for at least two databases used to locate literature for your topic (see Ch. 5). You must discuss two from this list:

• PubMed
• CINAHL
• PsycINFO
• Google Scholar
• Joanna Briggs
• Cochrane Library

2. Discuss terms related to your topic that may be used for the keywords, subject headings (CINAHL), or MeSH (PubMed) when searching in the selected databases. You can use words from the PICOT question to build a search strategy.

3. Describe the use of Boolean operators when searching for evidence. Provide an example using your topic.

4. Discuss the use of limits and filters. Provide an example using your topic.

5. Support with at least one reference other than the textbook (may use a website).

Plagiarism, Paraphrasing, and Artificial Intelligence (3 points)

1. Describe the differences between:

• quoting
• paraphrasing
• and summarizing information from a source (See APA Manual 7th Edition and Ch. 5). 

2. What strategies can be used to avoid potential plagiarism, including self-plagiarism?

3. Discuss the purpose of a copyright and what may be viewed as potential violations.

4. How can artificial intelligence (AI) be used in scholarly writing? Present at least one positive and one negative aspect related to student use.

5. Support with at least one reference other than the textbook

textbooks

 American Psychological Association. (2019). Publication manual of the American Psychological Association (7th ed.). American Psychological Association.
Schmidt, N.A., & Brown, J.M. (2024). Evidence-based practice for nurses: Appraisal and application of
research (6th ed.) Jones & Bartlett Learning. 

  First, what are the 2 main objectives of a health delivery system? Next, what are the 10 characteristics of the U.S. health care system? Next, select 2 of the 10 characteristics identified and discuss difference and similarities with at least one other developed country. 

https://investor.deere.com/sec-filings/default.aspx   financial statements 

Create a PowerPoint presentation for a forecasting scenario for Deere & Company using the financial statements in this week’s Required Resources and two outside scholarly or credible sources.

In your presentation you must

• list the criteria used to evaluate how cash flows influence capital budgeting decisions,
• identify at least five criteria necessary for making a good capital budgeting recommendation, and
• explain the rationale for considering these criteria before making a recommendation.

The Capital Budgeting PowerPoint Presentation,

• must be eight to 10 slides in length

 What considerations will you consider in preparation for drafting your policy? 

 Identify 3 factors that could pose a disaster threat to health information along with suggestions for disaster recovery.

Explain how you will be guided by the AHIMA Code of Ethics by specifically identifying the relevant ethics principle(s) and interpreting it in your own words. 

  As a new HIM director of a large healthcare system composed of multiple sub-acute care facilities with locations in multiple states of the US. You could use the example of Atlantic Health System or other similar health care organization of your choice (the selected organization must extend health care operations in more than one state). The organization uses an EHR but has some paper records, as well. One of your tasks is to put together a health record retention policy for the entire organization.