NR603 Week 1 Discussion: Compare and Contrast

NR603 Week 1 Discussion: Compare and Contrast – Step-by-Step Guide

The first step before starting to write the NR603 Week 1 Discussion: Compare and Contrast is to understand the requirements of the assignment. The first step is to read the assignment prompt carefully to identify the topic, the length and format requirements. You should go through the rubric provided so that you can understand what is needed to score the maximum points for each part of the assignment. 

It is also important to identify the paper’s audience and purpose, as this will help you determine the tone and style to use throughout. You can then create a timeline to help you complete each stage of the paper, such as conducting research, writing the paper, and revising it to avoid last-minute stress before the deadline. After identifying the formatting style to be applied to the paper, such as APA, review its use, including writing citations and referencing the resources used. You should also review the formatting requirements for the title page and headings in the paper, as outlined by Chamberlain University.

How to Research and Prepare for NR603 Week 1 Discussion: Compare and Contrast

The next step in preparing for your paper is to conduct research and identify the best sources to use to support your arguments. Identify a list of keywords related to your topic using various combinations. The first step is to visit the Chamberlain University library and search through its database using the important keywords related to your topic. You can also find books, peer-reviewed articles, and credible sources for your topic from the Chamberlain University Library, PubMed, JSTOR, ScienceDirect, SpringerLink, and Google Scholar. Ensure that you select the references that have been published in the last 5 years and go through each to check for credibility. Ensure that you obtain the references in the required format, such as APA, so that you can save time when creating the final reference list. 

You can also group the references according to their themes that align with the outline of the paper. Go through each reference for its content and summarize the key concepts, arguments and findings for each source. You can write down your reflections on how each reference connects to the topic you are researching. After the above steps, you can develop a strong thesis that is clear, concise and arguable. Next, create a detailed outline of the paper to help you develop headings and subheadings for the content. Ensure that you plan what point will go into each paragraph.

How to Write the Introduction for NR603 Week 1 Discussion: Compare and Contrast

The introduction of the paper is the most crucial part, as it helps provide the context of your work and determines whether the reader will be interested in reading through to the end. Begin with a hook, which will help capture the reader’s attention. You should contextualize the topic by offering the reader a concise overview of the topic you are writing about so that they may understand its importance. You should state what you aim to achieve with the paper. The last part of the introduction should be your thesis statement, which provides the main argument of the paper.

How to Write the Body for NR603 Week 1 Discussion: Compare and Contrast

The body of the paper helps you to present your arguments and evidence to support your claims. You can use headings and subheadings developed in the paper’s outline to guide you on how to organize the body. Start each paragraph with a topic sentence to help the reader know what point you will be discussing in that paragraph. Support your claims using the evidence collected from the research, and ensure that you cite each source properly using in-text citations. You should analyze the evidence presented and explain its significance, as well as how it relates to the thesis statement. You should maintain a logical flow between paragraphs by using transition words and a flow of ideas.

How to Write the In-text Citations for NR603 Week 1 Discussion: Compare and Contrast

In-text citations help readers give credit to the authors of the references they have used in their work. All ideas that have been borrowed from references, any statistics and direct quotes must be referenced properly. The name and date of publication of the paper should be included when writing an in-text citation. For example, in APA, after stating the information, you can put an in-text citation after the end of the sentence, such as (Smith, 2021). If you are quoting directly from a source, include the page number in the citation, for example (Smith, 2021, p. 15). Remember to also include a corresponding reference list at the end of your paper that provides full details of each source cited in your text. An example paragraph highlighting the use of in-text citations is as below:

“The integration of technology in nursing practice has significantly transformed patient care and improved health outcomes. According to Morelli et al. (2024), the use of electronic health records (EHRs) has streamlined communication among healthcare providers, allowing for more coordinated and efficient care delivery. Furthermore, Alawiye (2024) highlights that telehealth services have expanded access to care, particularly for patients in rural areas, thereby reducing barriers to treatment.”

How to Write the Conclusion for NR603 Week 1 Discussion: Compare and Contrast

When writing the conclusion of the paper, start by restating your thesis, which helps remind the reader what your paper is about. Summarize the key points of the paper by restating them. Discuss the implications of your findings and your arguments. Conclude with a call to action that leaves a lasting impression on the reader or offers recommendations.

How to Format the Reference List for NR603 Week 1 Discussion: Compare and Contrast

The reference helps provide the reader with the complete details of the sources you cited in the paper. The reference list should start with the title “References” on a new page. It should be aligned center and bolded. The references should be organized in an ascending order alphabetically, and each should have a hanging indent. If a source has no author, it should be alphabetized by the title of the work, ignoring any initial articles such as “A,” “An,” or “The.” If you have multiple works by the same author, list them in chronological order, starting with the earliest publication. 

Each reference entry should include specific elements depending on the type of source. For books, include the author’s last name, first initial, publication year in parentheses, the title of the book in italics, the edition (if applicable), and the publisher’s name. For journal articles, include the author’s last name, first initial, publication year in parentheses, the title of the article (not italicized), the title of the journal in italics, the volume number in italics, the issue number in parentheses (if applicable), and the page range of the article. For online sources, include the DOI (Digital Object Identifier) or the URL at the end of the reference. An example reference list is as follows:

References

Morelli, S., Daniele, C., D’Avenio, G., Grigioni, M., & Giansanti, D. (2024). Optimizing telehealth: Leveraging Key Performance Indicators for enhanced telehealth and digital healthcare outcomes (Telemechron Study). Healthcare, 12(13), 1319. https://doi.org/10.3390/healthcare12131319

Alawiye, T. (2024). The impact of digital technology on healthcare delivery and patient outcomes. E-Health Telecommunication Systems and Networks, 13, 13-22. 10.4236/etsn.2024.132002.

NR603 Week 1 Discussion: Compare and Contrast Example

Trigeminal Neuralgia vs. Giant Cell Arteritis

Presentation:

A painful neurological disorder known as Trigeminal Neuralgia (TN) typically affects adults over age 50, with a female predominance. Affected patients may experience these brief pain flare-ups several times during the day, which can be debilitating. A patient with TN may have an onset of facial discomfort that is sudden, sharp, and shooting, commonly referred to as electric shocks (Xu et al., 2022). Pain is unilateral and affects one or more branches of the trigeminal nerve (CN V). Patients frequently report brief periods of intense pain caused by basic actions such as touching their face, chewing, or brushing their teeth. These episodes can last seconds or minutes and may become more frequent with time.

Risk factors for TN include sex, age, and demyelinating disease such as multiple sclerosis. Similar to TN, a patient with giant cell arteritis (GCA) will present to the clinic with complaints of new-onset facial pain. However, a patient with GCA will have bilateral pain usually in the temporal artery area and may be described as a headache. The patient may also have complaints of scalp tenderness, jaw claudication, and visual disturbances along with bilateral facial pain (Awisat et al., 2023). GCA typically affects individuals over age 50, most commonly over 70, with a strong female predominance similar to TN. Risk factors for GCA include sex, age, polymyalgia rheumatica, and genetic predisposition.

Pathophysiology:

The trigeminal nerve is the fifth and largest of the cranial nerves, and its primary role is to convey sensory inputs from the skin, sinuses, and mucous membrane of the face. As a result, the brain receives information about touch, pain, and temperature. It is the largest nerve since it has three branches: ocular, maxillary, and mandibular. TN is caused by vascular compression of the trigeminal nerve root, which leads to demyelination and deregulation of neuronal activity (Xu et al., 2022). Have a look at NR603 Week 2 Discussion Dementia vs Delirium.

An abnormal loop in an artery causes vascular compression of the nerve root. The demyelination of the root causes ectopic impulse production and poor signal inhibition, which leads to paroxysmal pain. Unlike TN, GCA does not affect the trigeminal nerve but instead affects blood vessels. GCA is a granulomatous form of vasculitis that affects large and medium-sized arteries, both cranial and extracranial (Paroli et al., 2024). Inflammation of the vascular wall causes intimal proliferation and luminal narrowing. This complication is believed to occur as an immune-mediated disease leading to the activation of vascular dendritic cells. The activation of the cells leads to the destruction and narrowing of the vessels, which reduces blood flow and causes ischemia symptoms, particularly in the optic nerve.

Assessment & Diagnosis:

When diagnosing TN and GCA, gathering history using OLDCARTS is the key component. Physical examination of patients with trigeminal neuralgia may not always reveal a specific neurologic impairment. A thorough physical examination of the head, neck, eyes, ears, teeth, mouth, and temporomandibular joint is essential to rule out other reasons of facial pain. Positive findings for TN would include unilateral facial pain without painful stimulation, location of trigger points, and characteristics of pain such as sudden, sharp, shooting.

In contrast to TN, the physical assessment of a patient with GCA may present positive findings such as the temporal artery region being painful, nodular, or having a decreased pulse. In addition, a fundoscopic examination may detect optic disc edema accompanied by vision changes. The duration of pain relayed by the patient is also crucial in diagnosis. TN may be intermittent while GCA will be constant. The diagnostic testing for TN is primarily clinical, although ordering an MRI to rule out differential diagnoses such as multiple sclerosis, tumors, vascular abnormalities.

Other differential diagnoses for a TN patient should include dental pathology, TMJ disorder, and postherpetic neuralgia. Patients with suspected GCA should have a temporal artery biopsy or a color Doppler ultrasonography (CDUS). Temporal artery biopsy is the gold standard for the diagnosis of GCA. The biopsy should be performed on the side where pain is predominant. Ideally, the biopsy should be conducted prior to glucocorticoid medication. However, due to the danger of permanent vision loss, healthcare providers should initiate glucocorticoid medication as soon as GCA is detected.

Temporal artery biopsy should be performed within two weeks of starting glucocorticoid medication. False-negative results occur in up to 44% of patients with a confirmed diagnosis of GCA (Simon et al., 2023). A Doppler ultrasound should also be performed within one week of starting therapy, as this lowers the sensitivity of the results. Bilateral “halo signs” in the temporal arteries are highly specific for GCA. The compression sign, which manifests as the halo remaining visible during the ultrasonic probe’s compression of the vascular lumen, has a sensitivity of 79% and a specificity of 100% (Awisat et al., 2023).

A significant increase in acute-phase reactants, such as ESR, CRP, and platelet levels, is indicative of GCA. Laboratory tests to evaluate GCA include complete blood count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), serum transaminases, blood glucose levels, creatinine kinase, and aldolase (Simon et al., 2023). Differential diagnoses for GCA include migraine, tension headache, meningitis, stroke, and chronic sinusitis. There is no laboratory diagnostic needed for the diagnosis of TN.

Management:

The first-line treatment for TN is medication therapy using anticonvulsants. The suggested initial treatment drugs are carbamazepine or oxcarbazepine, with carbamazepine being the only one approved by the US Food and Drug Administration (FDA) for trigeminal neuralgia management (Lambru et al., 2021). The starting dosage of carbamazepine should be 100mg twice daily and titrated up when needed. Patients who fail medication therapy may benefit from treatment with gabapentin, clonazepam, and other antiepileptics such as lamotrigine, phenytoin, and valproic acid.

Patients with classic TN who have not responded to maximal medical treatment should consider surgery. Some nonpharmacological treatments are procedures that include microvascular decompression, rhizotomy, and peripheral nerve block. Microvascular decompression is the most frequently elected procedure. In contrast, patients with GCA should get high-dose glucocorticoids as their initial treatment. The dosage and route of delivery are determined by whether or not visual loss is imminent or has already occurred.

Patients are treated once GCA is suspected with prednisone 40-60mg once a day. This dosage should be continued for around 2 to 4 weeks, or until all symptoms have resolved and acute-phase reactants have returned to normal. For patients with visual changes or loss at the time of diagnosis, 500 to 1000 mg of IV methylprednisolone for 3 days should be administered. Relapses occur in nearly 50% of patients affected by GCA (Simon et al., 2021). Patients who relapse while on moderate to high doses of glucocorticoids should receive further therapy with tocilizumab or methotrexate rather than increasing their glucocorticoid dose.

There is no nonpharmacological treatment for GCA, unlike TN. Education for patients with GCA is crucial due to the long-term treatment with glucocorticoids. Lifestyle therapies, such as weight-bearing exercise, strength training, smoking cessation, and adequate calcium intake, are important. Calcium and vitamin D supplementation should be supplied as needed, along with regular monitoring of bone mineral density. Patients should also be seen every 3 months to monitor glucose levels as part of their medication regimen.

Patients with TN should be educated on the side effects of their medications, the intermittent process of the disease and the various treatment options including non-pharmacological. TN patients should be seen for a follow-up after initiating medication therapy to evaluate for effectiveness and referred to a neurologist for further evaluation of possible subform diagnoses. However, GCA patients should be referred to an ophthalmologist for routine eye exams and vascular surgery.

References

Awisat, A., Keret, S., Silawy, A., Kaly, L., Rosner, I., Rozenbaum, M., Boulman, N., Shouval, A., Rimar, D., & Slobodin, G. (2023). Giant Cell Arteritis: State of the Art in Diagnosis, Monitoring, and Treatment. Rambam Maimonides Medical Journal, 14(2), e0009. https://doi.org/10.5041/RMMJ.10496

Lambru, G., Zakrzewska, J., & Matharu, M. (2021). Trigeminal neuralgia: a practical guide. Practical neurology, 21(5), 392–402. https://doi.org/10.1136/practneurol-2020-002782

Paroli, M., Caccavale, R., & Accapezzato, D. (2024). Giant Cell Arteritis: Advances in Understanding Pathogenesis and Implications for Clinical Practice. Cells, 13(3), 267. https://doi.org/10.3390/cells13030267

Simon, S., Ninan, J., & Hissaria, P. (2021). Diagnosis and management of giant cell arteritis: Major review. Clinical & Experimental Ophthalmology, 49(2), 169–185. https://doi.org/10.1111/ceo.13897

Xu, R., Xie, M. E., & Jackson, C. M. (2021). Trigeminal Neuralgia: Current Approaches and Emerging Interventions. Journal of Pain Research, 14, 3437–3463. https://doi.org/10.2147/JPR.S331036