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help me adjust the assessment for this health challenge subject just to put all this together to see it aligns with the criteria and expectation I did also get some feedback from my mentor on what to fix its in bold Musculoskeletal health challenge: Rheumatoid arthritis (RA) Haematological health challenge: Deep vein thrombosis (DVT) in left lower limb 1.Provide a brief explanation of the 2 health challenge. (100 wor) 2.Explain the underlying pathophysiology that results in each of the listed abnormal assessment findings, in the context of the health challenge. (400 wor) 3.Explain one example of evidence-based nursing intervention to manage the health challenge. The example must be within the scope of practice of a Registered Nurse. (250 wor) 4.Explain one example of evidence-based collaborative care to manage the health challenge. (250 wor) Provide an explanation of the health challenge. Musculoskeletal health challenge The student has analysed the health challenge. 4.5-5 marks Explain the underlying pathophysiology that results in each of the listed abnormal assessment findings in the context of the health challenge. Musculoskeletal health challenge. The student has analysed the underlying pathophysiology that results in each of the listed abnormal assessment findings in the context of the health challenge. 13-15 marks Explain one evidence-based nursing intervention that could be applied to manage the health challenge. Musculoskeletal health challenge The student has analysed one evidence-based nursing intervention that could be applied to manage the health challenge. The example is within the scope of practice of a Registered Nurse. 8.5-10 marks Explain one example of collaborative care that could be applied to manage the health challenge. Musculoskeletal health challenge. The student has analysed one example of evidence-based collaborative care that could be applied to manage the health challenge. 8.5- 10 marks Provide an explanation of the health challenge. Haematological health challenge. The student has analysed the health challenge. 4.5-5 marks Explain the underlying pathophysiology that results in each of the listed abnormal assessment findings in the context of the health challenge. Haematological health challenge. The student has analysed the underlying pathophysiology that results in each of the listed abnormal assessment findings in the context of the health challenge. 13-15 marks Explain one example of evidence-based nursing care that could be applied to manage the health challenge. Haematological health challenge. The student has analysed one example of evidence-based nursing care that could be applied to manage the health challenge. The example is within the scope of practice of a Registered Nurse. 8.5-10 marks Explain one example of collaborative care that could be applied to manage the health challenge. Haematological health challenge. The student has analysed one example of evidence-based collaborative care that could be applied to manage the health challenge. 8.5-10 marks Communicates Professionally (Academic writing and presentation). Language features and structures are used to convey meaning effectively, clearly, unambiguously, concisely, and in a formal academic style, with few spelling, grammatical, or punctuation errors. Presentation guidelines have been followed. 8.5 – 10 marks Uses evidence to support and build knowledge in practice (Academic referencing). The assessment is supported by & related to a wide variety of peer reviewed references which include journal articles, professional manuals and documents, textbooks, and module readings. Referencing is comprehensive, demonstrates academic integrity, and is error free for the APA 7th ed. style conventions. 8.5 – 10 marks Musculoskeletal health challenge: Rheumatoid arthritis (RA) Provide a brief explanation of the health challenge Rheumatoid arthritis (RA) is a chronic systemic autoimmune disorder that primarily targets the synovial joints, leading to inflammation, synovial proliferation, cartilage damage, and bone erosion. It affects approximately 1% of the global population and is more common in females (Smolen et al., 2018). It is one of the most common inflammatory arthritis that causes joint damage to both sides of the body. It is a musculoskeletal system disorder that results in the body’s immune system attacking its cells. It erodes the bones and deforms the affected joints. The bone cartilage is the first to be affected before it spreads to the rest of the body. Pathophysiology & Abnormal Assessment Pain and stiffness in multiple joints Rheumatoid arthritis is a musculoskeletal system disorder that results in the body’s immune system attacking its cells. It wears away the bones and deforms the affected joints. The main reason RA is chronic synovial inflammation, in which the immune system attacks its own tissues. Autoantibodies, such as rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies, drive this process by attacking the synovial membrane. This triggers the start of T-cells and macrophages, leading to the release of pro-inflammatory cytokines. These cytokines promote further inflammation, which disrupts the joint structure. Over time, chronic inflammation leads to the formation of pannus tissue, causing cartilage and bone destruction, leading to pain and stiffness (McInnes & Schett, 2017). The pain in RA is caused by several things, like the synovial distention (also known as the swelling or stretching of the inflamed joints) and the inflammatory fluid buildup in the joint area and nerves becoming sensitive. These mechanisms impact the nociceptors and the peripheral nerves causing them to become sensitised. Joint stiffness, especially in the morning, lasts more than 30 minutes and increases with inactivity. This rigidity is mostly due to the accumulation of inflammatory fluid overnight (Baeten, 2009). Joint deformities like ulnar deviation and swan neck deformity are due to this chronic damage over time. Elevated C-reactive protein (CRP) discuss Cytokines – how it causes activation in the liver activating the CRP C-reactive protein is a ring shaped pentameric protein synthesized in the liver, it is a marker for inflammation within the body and anything above 10mg/l in CRP levels suggest substantial inflammation. When CRP is elevated that means there is an inflammation within the body CRP is so this tool is can be both a diagnostic and a monitoring marker in the treatment of RA patients. The CRP is a significant component to the innate immune response, working within the inflammatory pathway. During the inflammatory process, T-cell activation also occurs, and the activation of antibodies that serve as the third party in the inflammatory process. CRP is an acute-phase protein that is secreted by hepatocytes in response to interleukin-6 (IL-6). In RA, systemic inflammation leads to elevated levels of IL-6, which causes the liver to secrete more CRP (Sattar & McCarey, 2020). The pathophysiology of RA involves chronic inflammation that causes access of mesenchymal cells and macrophages into the pannus tissue (Baeten, 2009). Persistent elevated CRP levels are also involved in increased cardiovascular risk in RA patients because systemic inflammation leads to endothelial injury and atherosclerosis. Evidence-based nursing intervention to manage the health challenge. Needs just one example to expand – evidence-based tools and monitor the condition. Like – GCS, FBC, pain assessment. By doing this nursing intervention how does it directly erase stiffness and CRP (200) Patient education on self-management approaches is an important evidence-based nursing intervention for RA management. Registered nurses (RNs) can offer personalised education on exercise, pain management, joint protection, and medication adherence. Regular exercise, such as low-impact exercises like swimming or walking, can help reduce stiffness and increase joint mobility. Instructing patients to do stretching exercises before getting out of bed can help alleviate morning stiffness. Nurses can also teach patients how to use assistive devices such as splints or braces to protect their joints and relieve strain. During flare-ups, the RN might emphasise the necessity of resting, using heat or cold packs, and adhering to medication regimens provided by the healthcare practitioner, such as NSAIDs, corticosteroids, and biologics. Nurses should also keep an eye out for evidence of pharmaceutical side effects, particularly with long-term corticosteroid treatment, and advise patients to schedule regular follow-up appointments with rheumatologists for additional evaluation (Smolen et al., 2020). Additionally, RNs offer nutritional guidance, promoting an anti-inflammatory diet rich in omega-3 fatty acids, fruits, and vegetables. Psychological support is also key, as RA is associated with depression and anxiety due to chronic pain and functional limitations. Nurses can screen for mental health concerns and refer to appropriate services. By promoting patient self-management, nurses enhance adherence and improve quality of life in RA patients (Smolen et al., 2020). Evidence-based of Collaborative Care – pick one example of them and expand on the medication collaboration with that and how it erases stiffness pain and CRP (200) Rheumatologists, nurses, physiotherapists, and occupational therapists form a multidisciplinary team that provides collaborative care for RA patients. One example of collaborative care is the use of disease-adjusting antirheumatic drugs (DMARDs), such as methotrexate, in conjunction with biological therapies such as TNF inhibitors (e.g., etanercept). Rheumatologists teach these therapies, while nurses are responsible for monitoring compliance and educating patients on the purpose, side effects, and dosage of drugs. Nurses also monitor injection reactions, immunosuppression signs and laboratory results, such as liver function tests and complete blood counts (CBCs), to detect potential pharmaceutical side effects. Early reporting of side effects, such as hepatotoxicity or infections, can assist in avoiding problems. Pharmacists review the patient’s medication regimen and reports made from nurses and doctors to make sure the medication remains in a safe range for the patient, particularly with NSAIDs or corticosteroids. Nurses also work with physiotherapists usually in community health to create exercise routines that enhance range of motion and strength and with occupational therapists to recommend adapted equipment to help with daily activities. This collaborative care strategy provides a holistic approach to RA management, increasing patient outcomes by addressing both medical and functional elements of the condition (Smolen et al., 2020). Haematological health challenge: Deep vein thrombosis (DVT) in left lower limb Provide a brief explanation of the health challenge. Deep Vein Thrombosis (DVT) is blood clots that form deep in the veins of the lower and upper parts of your body—most commonly in the thighs, calves, and/or pelvis. It can become a serious medical condition as it poses high risks to a fatal illness known as pulmonary embolism (PE). As this is a formation of deep blood clots known as thrombus that can possibly travel up the bloodstream and get stuck, blocking the blood flow in the lungs. When they occur together, it can be called venous thromboembolism. Risk factors include immobility, surgery, obesity, smoking, dehydration, and vascular injuries from surgery or trauma. 50-70% of patients admitted to hospital have one risk factor, while 40% have three or more. (Cleveland Clinic, 2022) Pathophysiology & Abnormal Assessment Oedema, warmth, and erythema of the affected limb DVT develops when a thrombus forms in the deep veins as a result of venous stasis, endothelial damage, and hypercoagulability, also known as the Virchow’s Triad (Kesieme et al., 2011). Venous stasis, which is commonly induced by immobility, reduces blood flow and encourages clot formation. Endothelial damage, which is commonly caused by trauma, surgery, or infection, activates the coagulation flow, encouraging clot formation. Hypercoagulability may be genetic for example like Factor V Leiden or acquired such as, cancer and pregnancy. As a result, blood flow is blocked, causing increased venous pressure. This causes fluid to flow into the surrounding tissues, resulting in oedema. When the body detects the blood clot it activates the inflammatory response, activating the cytokines such as IL-1 and TNF-α, to respond and this amplifies the inflammation. This increases the blood vessel permeability around the thrombus causing vasodilation and leukocyte buildup, which are exhibited as erythema and warmth of the limb. The result of all this causes the fluid leaks into interstitial tissues to cause oedema and warmth. Calf pain Blood clots in deep veins are caused by complex factors that affect the circulation and the clotting process. One of the main factors is venous stasis, which is the slowing or stagnation of blood flow within the veins. The blood cells and platelets then build up in the veins, causing the decrease of blood flow and slow circulation, which raises the possibility of clot formation. (Kesieme et al., 2011). The Calf pain is a result of venous pressure rise and inflammation locally. Linking back to previous comments of the blood vessel permeability around the thrombus (blood clot) leading to warmth, it can also cause discomfort. A thrombus causes pain because of congestion which stretches the vein walls and activates pain receptors. Local inflammation mediators make the area more sensitive, causing local tenderness and cramping pain. Pain is generally unilateral in one leg at a time and is worsened on dorsiflexion. Homans sign refers to pain in the movement of the foot going upwards towards the shin as it as a possible sign for DVT, putting strain on the affected veins but its inconclusive (Line, 2001). Evidence-based nursing intervention to manage the health challenge. The use of compression stockings is an evidence-based nursing strategy for controlling DVT. These stockings are intended to prevent additional swelling and lower the risk of post-thrombotic syndrome. Compression stockings promote venous return, reduce oedema, and inhibit clot advancement. – needs more in-text use resources – VTE Profalxis Nurses should also monitor for consequences, such as pulmonary embolism (PE), and evaluate the efficacy of anticoagulation therapy, ensuring the patient is taking the right medicine to prevent further clot formation. Nurses also monitor for bruising, bleeding, or haematuria indicating complications from anticoagulants. Compression stockings are an important nursing intervention for DVT therapy because they minimise swelling and prevent further clot formation. Nurse instructs the patient on how to properly use and fit the stockings, ensuring that they are worn regularly throughout the day and removed at night. Education for the patient is an important role, explaining DVT pathology, the importance of leg elevation, hydration, mobilization, and the need for follow-up blood test (e.g., INR for warfarin control). The intervention prevents clot extension, relieves symptoms, and prevents recurrence. Nurses may also provide anticoagulants, such as low molecular weight heparin (LMWH), to prevent the clot from developing or spreading to the lungs (AHRQ, 2018). How does it manage the calf pain and eodema warmth (250) Evidence-based Collaborative Care – need one example and expand and how it helps with collaboration with nursing and helps manage oedema and calf pain (200) Collaborative care for DVT is a multidisciplinary strategy that includes nurses, physicians, and pharmacists. To prevent the clot from expanding or breaking off, physicians may administer heparin or direct oral anticoagulants (DOACs). Registered nurses monitor patient responses, watch for bleeding complications, and ensure proper dosing schedules. Nurses also check INR levels in patients on warfarin and contact the physician to adjust the dose. Pharmacists review for drug interactions, especially in the elderly or patients on numerous medications, and offer suggestions regarding timing and food-drug interactions (e.g., consumption of vitamin K with warfarin). In extreme cases or high risk of pulmonary embolism, vascular specialists may consider interventions like thrombolysis or insertion of an IVC filter. Physiotherapists may assist by mobilizing the patient safely to prevent further stasis. Collaborative care for DVT involves a team-based approach. Line (2001) explains that a collaborative team needs to be on the same page to provide efficient patient care which includes the primary health provider, a secondary health provider, nurses, pharmacist and at times physiotherapists. The collaborative model improves outcomes by rendering the anticoagulation strategy safe, effective, and tailored to the individual’s risks and comorbid conditions (Kesiime et al., 2011). References: Mayo Clinic. (2022). Deep vein thrombosis (DVT). Retrieved from https://www.mayoclinic.org/diseases-conditions/deep-vein-thrombosis/symptoms-causes/syc-20352557 Kesieme, E., Kesieme, C., Jebbin, N., Irekpita, E., & Dongo, A. (2011). Deep vein thrombosis: A clinical review. Journal of Blood Medicine, 2, 59-69. https://doi.org/10.2147/JBM.S19009 Dugan, C., & Sheu, E. G. (2022). Deep vein thrombosis. JAAPA: Journal of the American Academy of PAs, 35(3), 22-27. Retrieved from https://journals.lww.com/jaapa/citation/2022/03000/deep_vein_thrombosis.9.aspx Thrombosis and Haemostasis Society of Australia and New Zealand (THANZ). (2024). Venous thromboembolism clinical care standard. Australian Commission on Safety and Quality in Health Care. Retrieved from https://www.thanz.org.au/wp-content/uploads/2024/06/ACQSHC-VTE-CCS.pdf Lories, R. J., & Baeten, D. L. (2009). Differences in pathophysiology between rheumatoid arthritis and ankylosing spondylitis. Rheumatology,4, 218 Kahn, S. R., Shapiro, S., Wells, P. S., Rodger, M. A., Kovacs, M. J., Anderson, D. R., Tagalakis, V., Houweling, A. H., Ducruet, T., Holcroft, C., Johri, M., Solymoss, S., Miron, M.-J., Yeo, E., Smith, R., Schulman, S., Kassis, J., Kearon, C., Chagnon, I., Wong, T., Demers, C., Hanmiah, R., Kaatz, S., Selby, R., Rathbun, S., Desmarais, S., Opatrny, L., Ortel, T. L., & Ginsberg, J. S. (2014). Compression stockings to prevent post-thrombotic syndrome: A randomised placebo-controlled trial. The Lancet, 383(9920), 880-888. https://doi.org/10.1016/S0140-6736(13)61902-9 Smolen, J. S., Landewé, R. B. M., Bijlsma, J. W. J., Burmester, G. R., Dougados, M., Kerschbaumer, A., McInnes, I. B., Sepriano, A., van Vollenhoven, R. F., de Wit, M., Aletaha, D., Aringer, M., Askling, J., Balsa, A., Boers, M., den Broeder, A. A., Buch, M. H., Buttgereit, F., Caporali, R., … van der Heijde, D. (2020). EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Annals of the Rheumatic Diseases, 79(6), 685-699. https://doi.org/10.1136/annrheumdis-2019-216655 McInnes, I. B., & Schett, G. (2017). Pathogenetic insights from the treatment of rheumatoid arthritis. The Lancet, 389(10086), 2328-2337. https://doi.org/10.1016/S0140-6736(17)31472-1 Garcia, D. A., & Baglin, T. P. (2012). Management of bleeding in patients receiving direct oral anticoagulants. Blood, 121(23), 4443-4449. Sattar, N., McCarey, D. W., Capell, H., & McInnes, I. B. (2003). Explaining how “high-grade” systemic inflammation accelerates vascular risk in rheumatoid arthritis. Circulation, 108(24), 2957-2963. https://doi.org/10.1161/01.CIR.0000099844.31524.05 Waheed, S. M., Kudaravalli, P., & Hotwagner, D. T. (2023, January 19). Deep vein thrombosis. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK507708/ Line, B. R. (2001). Pathophysiology and diagnosis of deep venous thrombosis. Seminars in Nuclear Medicine, 31(2), 90-101. https://doi.org/10.1053/snuc.2001.22211 Also help me with intext referencing for these I need to remove the highlighted old ones

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