Nephrolithiasis is the third most common problem of the genitourinary system. Identify and discuss risk factors for kidney stones including cultural considerations.Students are expected to:Post an initial substantive response of 250 words to each questionPlease be sure to validate your opinions and ideas with citations and references in APA format. References and citations should conform to the APA 6th edition.Substantive comments add to the discussion and provide your fellow students with information that will enhance the learning environment.The peer postings should be at least one paragraph (approximatelyTimothy's POST:According to Worcester and Coe (2008), Kidney stones affect over 5% of adults in the United States, and the prevalence is rising. The fundamental cause for all stones is supersaturation of urine concerning the stone components; factors affecting solubility include urine volume, pH, and total solute excretion. Calcium stones are the most common, in adults and children, and are associated with several metabolic disorders, the most common of which is idiopathic hypercalciuria. According to Durham, Goldfarb, and Lam (2018), Renal stone disease (nephrolithiasis) is a relatively common problem. The population prevalence increased from 3.8 percent in the period from 1976 to 1980 to 5.2 percent in the period from 1988 to 1994. The prevalence increased in men and women, and in whites and blacks. Although one study suggested that the incidence rates since then may have leveled off, the 2007 to 2010 NHANES data found a continued increase in prevalence to 8.8 percent in the United States population. Dietary factors can play an important role in promoting stone formation, primarily by affecting the composition of the urine. There are several dietary factors that may play an important role in many patients: fluid, calcium, oxalate, potassium, sodium, animal protein, phytate, sucrose, fructose, and vitamin C intake. Lower intake of fluid, calcium, potassium, and phytate and higher intake of sodium, sucrose, fructose, vitamin C, and possibly animal protein are associated with an increased risk for calcium stone formation. The type of beverage may also influence the risk. The effect of calcium intake is paradoxical, with a decreased risk with increased dietary calcium and an increased or no change in risk with calcium supplements. Patients may be advised to drink more fluids to decrease the risk of another stone. The goal is to increase the amount of urine that flows through your kidneys and also to lower the concentrations of substances that promote stone formation. Experts recommend drinking enough fluid that you make more than 2 liters of urine per day. Certain diseases, dietary habits, or medications can increase your risk of developing kidney stones. Patients that have a kidney stone, that is causing no symptoms may or may not need to remove the stone. The decision is based upon the size and location of the stone, as well as the ability to be treated quickly if symptoms were to develop.ReferencesDurham, G., C., Goldfarb, S., and Lam, A., Q. (2018). Risk factors for calcium stones in adults. UpToDate. Retrieved from https://www.uptodate.com/contents/risk-factors-for...Worcester, E. M., & Coe, F. L. (2008). Nephrolithiasis. Primary Care, 35(2), 369–vii. http://doi.org/10.1016/j.pop.2008.01.005Stephen POST:Nephrolithiasis is a common problem among male patients encountered in the primary care setting. Not all kidney stone cases are the same. Understanding the differences is key to both prevention and treatment (Hall, 2009). Furthermore, prevention and early recognition require an understanding of the risk factors for nephrolithiasis. First, sex, race and age play a role in determining the likelihood of developing kidney stones. Caucasian males are at the highest risk for developing kidney stones with prevalence descending through black males and Hispanic males then women. The age of development varies by country. In the US Caucasian males tend to develop kidney stones in their 30s, 40s, and 50s, while in Germany, the likelihood increases well after 65. Italy shows similar yet much less pronounced trending then Germany (Romero, Akpinar, & Assimos, 2010). Other nonmodifiable risk factors beside age, sex, and race include a family history and a previous personal history of kidney stones. Additional risk factors are lifestyle related. Patients with low water intake and/or high protein, sodium, and sugar intake are at higher risk. Obesity is also a risk factor for nephrolithiasis. Certain medical conditions can also increase a patient’s likelihood of developing nephrolithiasis. These include: a history of polycystic kidney disease, a history of gastric bypass or other intestinal surgery, any condition that causes concentration of cystine, oxylate, uric acid, or calcium in the urine, or any condition that causes swelling or irritation of the bowel or joints. Lastly, patients taking diuretics and calcium based antacids are at increased risk for nephrolithiasis (American Kidney Fund, 2018).ReferencesAmerican Kidney Fund. (2018, January 1). Who is at risk for kidney stones? Retrieved from http://www.kidneyfund.org/kidney-disease/kidney-problems/kidney-stones/kidney-stone-risk-factors.html.Hall, P. (2009). Nephrolithiasis: treatment causes and prevention. Cleveland Clinic Journal of Medicine, 76(10): 583-591. Retrieved from https://www.mdedge.com/ccjm/article/95015/nephrology/nephrolithiasis-treatment-causes-and-prevention.Romero, V., Akpinar, H., & Assimos, D. G. (2010). Kidney Stones: A Global Picture of Prevalence, Incidence, and Associated Risk Factors. Reviews in Urology, 12(2-3), e86–e96.

You are the HIM Director in an acute care hospital setting. Your facility has purchased an electronic health record (EHR) system and pressure is mounting to deploy this system as soon as possible by the chief information officer (CIO) and chief of the medical staff (CMS). However, during a testing period, you and your staff discover that the EHR system does not comply with applicable federal privacy and security standards. It is your recommendation to stop the deployment until these issues can be resolved; however, the CIO and CMS disagree.Using Table 6.2 in the textbook titled Steps in Ethical Decision Making, outline your response as the HIM director’s perspective to each of the nine steps as if you were writing the memorandum to the CIO and CMS. If you do not have enough information available for a given step, add questions and/or inquiries you might make to gather the information in your response. Consider your response from the legal, liability, and ethical perspectives.