What components of the ACA (Affordable Care Act) do you think will have a positive effect on improving health care outcomes and decreasing costs? 

Individual Rights & Vaccination Policy School board trustees are requesting public comment before they vote on a vaccination policy for all children in a local school district. Should individual rights (e.g., parents’ rights to decide whether to vaccinate their children) be compromised to control the spread of communicable diseases for the good of society? Submission Instructions: Your initial post should be at least 600 words, formatted and cited in current APA style with support from at least 2 academic sources.   You should respond to at least two peers by extending, refuting/correcting, or adding additional nuance to their posts.   All replies must be constructive and use literature where possible. Each response should be 150 words plus the reference. Materials to use: Mauer, F.A. & Smith, C. M. (2013). Chapters 7-9 & 30 Watch The Healthcare System of the United States (7:35) Healthcare Triage. (2014, February 17). The healthcare system of the United States [Video]. The Healthcare System of the United States (Links to an external site.) Online Materials & Resources Explore your state’s Department of Community Health (Links to an external site.) website. Explore your county/community’s Health Department website. You can find them on the website above.  POST  hi, here are the documents for the peer responses. I need to submit it in 24 hrs. thank you.response 1 negron: This has been a major worry in liberal democracies, and it remains an unsolvable puzzle between parents and government officials. Parents have the right to raise their children according to their own religious or personal convictions. The government can only pass laws prohibiting vaccine refusal based on the risk factor, but it can never force vaccination refusal on parents. It is appropriate to allow youngsters who have not been vaccinated to attend school. It is a danger to the other children, yet they all have the same right to attend school. This is due to the fact that not all parents and children support vaccination.Every child in the world has the right to vaccinations. This is because there are numerous diseases that cause significant morbidity and mortality. There are a few religious sects and groups who do not believe in modern medicine (Troeger, 2018). Some of them hold such extremist views that they refuse to take their sick children to the hospital.The government has the responsibility of ensuring that every child receives all vaccines according to their schedule. This should be backed up with a policy that demands immunization before entering school.Enforcing vaccination will ensure that most children have the necessary vaccinations to attend school. Leaving vaccine decisions to parents, on the other hand, may result in a percentage of children not being vaccinated due to their parents' views on vaccines. The government should also make certain that there are laws in place to hold guardians accountable.Individuals from various socioeconomic levels have differing views on whether or not schoolchildren should be vaccinated.Parents that refuse to vaccinate their children do so to defend their position, which they believe is in their children's best interests. Parents' views, on the other hand, differ or are influenced by their social ideas, with some believing that vaccines will not assist or will hurt their children. Some parents believe that they would be better off enjoying herd immunity and not exposing their children to the dangers of free-riding (Giubilini et al., 2018). Furthermore, some people resist to vaccination for non-medical reasons, which could be justified by conspiracy theories.  Because various people have different religions and ideas, it is sometimes necessary to oppose immunization programs.Vaccines are quite successful at preventing the spread of any disease, but they are especially effective against infectious diseases like polio, smallpox, and other diseases of this nature. The government should not meddle or adopt vaccination regulations that jeopardize the rights of parents, and immunization or vaccination should not be mandatory.People will believe they are being bullied and, on the other side, that they are not being listened to, and this will lead to violence between the government and some of its population.Making respectful communication with individuals, listening to them, and providing valuable, trustworthy, and acute information is an effective strategy for improving the vaccination process among school children (Giubilini et al., 2018). Attempting to coerce people to vaccinate their children is a bad idea that will eventually lead to negative consequences, making things worse.At the very least, the government should persuade parents that vaccination is the greatest and safest way to protect children from dangerous diseases. This can be accomplished by informing schoolchildren and their guardians about the benefits of vaccinations. They should also be taught on the operation of immunizations.ReferencesTroeger, C., Khalil, I. A., Rao, P. C., Cao, S., Blacker, B. F., Ahmed, T., ... & Reiner, R. C. (2018). Rotavirus vaccination and the global burden of rotavirus diarrhea among children younger than 5 years. JAMA pediatrics, 172(10), 958-965.Giubilini, A., Douglas, T., & Savulescu, J. (2018). The moral obligation to be vaccinated: utilitarianism, contractualism, and collective easy rescue. Medicine, Health Care and Philosophy, 21(4), 547-560.peer response 2: Christian, Vaccinations have long been a source of debate within the United States and arguably across the world.  However, “vaccinations have been the most successful public health interventions of all time” (Barraza, Reeves, & Campos-Outcalt, 2020). The debate of individual rights versus the protection of the community at large has long been an argument within the US.  As stated in our text, governments and public health officials have struggled with the problem of balancing individual rights with the right of the community to be protected from infectious disease. Regardless of our individual opinion about whether to vaccinate or not, the role of the community health nurse forces us to weigh the benefits and disadvantages of mandated vaccination for all community members versus allowing an individual to decide for themselves.      Throughout US history, “the right of the public to be protected may take precedence over an individual's right to refuse treatment” (Maurer & Smith, 2013).  For example, in the early 20th century, the first widespread mandatory vaccination  program was started to control the spread of typhoid. At present, there are mandatory vaccination policies in place that are intended to curb the potential spread of infectious disease such as measles.  As recently as 2019, the United States experienced a record number of confirmed measles cases, then it had seen in the prior 25 years.  This increase in cases is likely due to a refusal parents to have their children vaccinated (Barraza, Reeves, & Campos-Outcalt, 2020).     I believe that individual rights have to be compromised to control the spread of communicable disease for the good of the entire community.  While I agree that we should all have the right to decide, based on circumstances, whether or not vaccination is necessary, the community as a whole have rights too.  They have the right to not knowingly be exposed to infectious disease, if there are mechanisms in place to minimize or eliminate the exposure.  Since it is widely believed that vaccinations are “the most effective primary prevention method for controlling communicable diseases in populations”, I am in favor of mandatory vaccinations which removes the rights of parents to make the decision.  “The freedom of parents as to how to raise their children should not result in avoidable risk of death” (Pierik, 2018) of other community members.  While I recognize that parents should be allowed to determine medical decisions for their own children, because of the amount of evidenced based research supporting the use of vaccines, the potential for widespread outbreaks, serious illness, or even death of the most vulnerable segments of the greater population makes that a public health issue.References     Barraza L., Reeves C., Campos-Outcalt, D. (2020). Outcome of Coronavirus Disease 2019 on School Vaccination Policies for 2020-2021. JAMA Health Forum,1(8):e201018. doi:10.1001/jamahealthforum.2020.1018     Maurer, F.A. & Smith, C. M. (2013). Community/public health nursing practice: Health for families and populations (5th ed.). St. Louis, MO: Elsevier Saunders. ISBN:9781455707621     Pierik, R. (2018), Mandatory Vaccination: An Unqualified Defence. J Appl Philos, 35: 381-398. https://doi.org/10.1111/japp.12215

Case Study Chief complaint: “I’m here for a medication refill because I ran out of my medicines”. HPI:  Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home. She started taking her medications, but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway. PMH: Primary Hypertension, Previous history of MI 1 year ago Surgeries: 1 year ago-Left Anterior Descending (LAD) cardiac stent placement Allergies: Penicillin Vaccination History:  Up-to-date Social history: High school graduate married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago. Family history: Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52. ROS: Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks. Psychiatric: Non-contributory. Physical examination: Vital Signs: Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111, R 22 and non-labored HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease.  NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.  LUNGS: + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress.  HEART: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally.  ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.  GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred.  MUSCULOSKELETAL: + Heberden's nodes at the DIP joints, hands. + Crepitus, bilateral knees. Slow gait but steady. No Kyphosis.  PSYCH: Normal affect. Cooperative.  SKIN: No rashes. Positive for dry skin. Labs: Hgb 13.2, Hct 38%, K+ 4.0, Na+137, Cholesterol 228, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98. A: Primary Diagnosis: Congestive Heart Failure (CHF) Secondary Diagnoses: Primary Hypertension, Obesity, Osteoarthritis (OA) Differential Diagnosis: Peripheral Vascular Disease (PVD) Plan: Medications: Tylenol 650 mg PO Q4 hours as needed for arthritis pain Labs: UA; Brain natriuretic peptide (BNP); LFTs and TSH; 12-lead EKG, Chest X-ray; Initial 2D echo with Doppler; Ankle-brachial index. Additional lab results: Echo results 1 week ago: Left ventricular EJ Fraction decreased to 35 % BNP – not available. As a future FNP, you need to determine the medications for CHF/ASCVD. (Arteriosclerotic Cardiovascular Disease). Questions: 1.    According to the ACC/AHA guidelines, what medications should this patient be prescribed? 2.    Does he need medication(s) given his history of MI? 3.   Considering that you have a case study, you only need 2 posts for this discussion board, 1 initial and 1 reply. As usual, all posts must be supported by at least 2 peer reviewed references and all paragraphs must be cited. Peer response 1: The ACC/AHA guideline highlights different guidelines on the prevention of cardiovascular diseases. Referencing these guidelines the patient can be prescribed a range of medications such as HMG-CoA reductase inhibitors, acetylsalicylic acid, and regimes to lower her blood pressure. The patient can be prescribed aspirin but in low dose for approximately ten days and moderate statin therapies with drugs like Crestor (Rosuvastatin) and Lipitor (Atorvastatin) (Byrne et al., 2019). To reduce her high blood pressure level therapies such as long-acting ACE inhibitors or Angiotensin II receptor blockers (ARBs) should be included in her prescription. The practitioner should also look for other combinations such as calcium antagonist in her prescription. A combination of these medications would alleviate her suffering from atherosclerosis and control major hypertension/comorbidities that she is experiencing. 2.Allen’s previous history of myocardial infarction (MI) does not require her to have certain medications. Since there are already statin medications included during her prescription to control atherosclerosis would reduce risks associated with or occurrence of MI. Statins are prescribed to alleviate cholesterol plague and induces other pleiotropic effects, including the inhibition of inflammatory responses, antioxidant effects such as increased endothelial function (Bahiru et al., 2017). As such statin drugs like Lipitor and Crestor can prevent Mrs. Allen from the risks associated with myocardial infarction (MI) even though she had a history of MI. References Bahiru, E., de Cates, A. N., Farr, M. R., Jarvis, M. C., Palla, M., Rees, K., ... & Huffman, M. D. (2017). Fixed?dose combination therapy for the prevention of atherosclerotic cardiovascular diseases. Cochrane Database of Systematic Reviews, (3). Byrne, P., Cullinan, J., Smith, A., & Smith, S. M. (2019). Statins for the primary prevention of cardiovascular disease: an overview of systematic reviews. BMJ open, 9(4), e023085. Marchio, P., Guerra-Ojeda, S., Vila, J. M., Aldasoro, M., Victor, V. M., & Mauricio, M. D. (2019). Targeting early atherosclerosis: a focus on oxidative stress and inflammation. Oxidative medicine and cellular longevity, 2019.  https://www.cvpharmacology.com/vasodilator/renin https://www.aafp.org/afp/2014/1001/afp20141001p503...  Peer response 2: The guideline recommends various alternatives for patients with similar diagnoses as the one Mrs. Allen have. Arteriosclerotic cardiovascular disease, which is a thickening of arteries due to the buildup of plaque in their walls, that may restrict the blood flow to essential organs and may include medications like drugs for high cholesterol (Statins) and high blood pressure respectively; also, some lifestyles change like healthy diet alongside with a good exercise regimen may be need it for a safety treatment outcome. In this specific case, the health care professional needs to be aware of the patient's ejection function, which is decreased, and the severity of his symptomatology. Based on these, Mrs. Allen would be classified for the New York Heart Association (NYHA) to be class IV heart failure, which is the inability to carry on physical activity without distress and heart failure signs and indicating that the first treatment would need to include the angiotensin-converting enzyme inhibitors (ACEs). This first treatment is because studies such as the one conducted by (Herman et al.,2020) indicated that these drugs significantly reduce both the mortality and morbidity associated with CHF, especially in those who also present with left ventricular dysfunction the patient in this scenario. The advantage of the ACE inhibitors relies on the fact that they have a vasodilating effect that decreases left ventricular post load and reduces the process of ventricular remodeling. Moreover, studies show that in progressive doses, they reduce mortality in the first 3-6 months of therapy, reduce hospitalization and relieve symptoms. For maximum effect, this therapy is recommended in combination with a beta-blocker in patients with an ejection fraction below 40%. There might be one limitation as ACE inhibitors tend to be less effective in African Americans due to their reduced level of renin (Helmer et al.,2018). Even so, until this is proven, the administration of beta-blockers together with ACE inhibitors and diuretics can be a suitable therapy for Mrs. Allen. In terms of beta-blockers, the most suitable one for this patient would be Metoprolol because it is less expensive and is useful in decreasing the heart rate of the patient and high blood pressure, respectively. At a BP of 160/92, Mrs. Allen would be diagnosed with Stage II Hypertension, but due to the cardiac heart failure, she is considered a high-risk patient, which requires a drastic reduction of these values. (Morris,2020) Nevertheless, the patient presents with shortness of breath and mild crackles, which can be the initial signs and symptoms of a possible respiratory decompensation. To reduce the risk of pulmonary edema, administration of a diuretic such as 12.5 mg of Hydrochlorothiazide can be useful. Despite all of these, it is essential to monitor Mrs. Allen's potassium levels to avoid further complications. Additional Medication. Due to her history of MI, the patient should receive aspirin to prevent eventual episodes as the guidelines recommend this drug, especially for those who were previously diagnosed with a STEMI. Even so, another risk factor that should be considered is her high cholesterol level (288) with low HDL and high LDL. In this scenario, the nurse practitioner should include 40 mg of Atorvastatin in the patient’s treatment plan to reduce these levels. Li et al. (2019) pointed out in their study that this drug's administration was more effective than the placebo in reducing the risk of cardiovascular complications, especially in patients who had a previous episode of MI. References Helmer A, Slater N, Smithgall S.(2018) A Review of ACE Inhibitors and ARBs in Black Patients With Hypertension. Ann Pharmacother. 2018 Nov;52(11):1143-1151. DOI: 10.1177/1060028018779082. Epub 2018 May 29. PMID: 29808707. Herman LL, Padala SA, Annamaraju P, et al. (2020) Angiotensin-Converting Enzyme Inhibitors (ACEI)]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431051/ Li, M., Wang, X., Li, X., Chen, H., Hu, Y., Zhang, X., Tang, X., Miao, Y., Tian, G., & Shang, H. (2019). Statins for the Primary Prevention of Coronary Heart Disease. BioMed research international, 2019, 4870350. https://doi.org/10.1155/2019/4870350