Nurs 6521 week 4 assignment solved answers walden university
Sara is a 45-year-old female presenting for her annual exam. Her blood pressure today is 160/90 HR 84 RR 16. Her height is 64 inches and her weight is 195. Her
last visit to the clinic 3 months ago shows a BP of 156/92. She is currently taking ibuprofen 600 mg tid for back pain. She has no known allergies. What is the goal for her blood pressure? What medication would you prescribe to treat her blood pressure? What education would you prescribe?
Case Scenario 1: Sara’s Case (Stage 1 Hypertension)
Sara’s problem is uncontrolled hypertension, as evidenced by the current blood pressure reading of 160/90mmHg and supported by the pressure reading of 152/92mmHg. According to The American Heart Association (2023), blood pressure higher than 140/90mmHg indicates stage 2 hypertension. It requires assessing and evaluating the underlying cause with the patient and developing a treatment plan to address the specific needs. Based on the provided history, Sara’s chronic pain and the use of Ibuprofen 600mg 8 hours every day could be significant contributing factors that may cause her high blood pressure. Tabassum et al. (2023) indicate that long-term use of NSAIDs has been associated with chronic cardiovascular conditions. Therefore, Sara’s use of Ibuprofen could be one of the significant factors contributing to high blood pressure and fluid retention.
Care aims to educate Sara on measure how to manage her blood pressure readings that will fall within her normal parameters of 120/80mmHg (American Heart Association, 2023). Maintaining Sara’s blood pressure will be a critical health promotion strategy for preventing end-stage organ dysfunctions and failure, reducing the risk of cardiovascular-related disability, and minimizing the chances of premature and preventable mortality. In this case, controlling Sara’s blood pressure will require pharmacotherapy with the recommended first-line treatment options, including a thiazide diuretic agent, ACE inhibitors, ARBs, and calcium channel blockers (American Association of Family Physicians, 2022) Nurs 6521 week 4 assignment solved answers walden university. Although any of these agents may be used, the client’s long-term use of NSAIDs predisposes her to renal failure and potential for medication toxicity due to decreased elimination (Hinkle et al., 2021). Therefore, ACE agents are preferred since they protect the renal system. The nurse practitioner must instruct the client on appropriate and safe pain management strategies to minimize the associated health risks. The prescription for Sara will be as follows:
Lisinopril 10mg once daily
Take one tablet of the medication at the same time of the day by mouth.
The quantity supplied is 30 tablets
Refills 2
Dietary and lifestyle medications are critical lifestyle modifications the nurse practitioner should instruct the client to advocate. These health promotion measures include increasing daily fruits, vegetables, whole grains, and omega-3 fats intake. The client should limit sodium intake to less than 2300g daily, consume fewer food choices in saturated fats, and avoid foods high in calories. In addition, the client should increase aerobic activities to at least 150 minutes every week and reduce body weight to maintain a healthy BMI; if smoking or drinking alcohol, the nurse practitioner should encourage the client to avoid such habits since they will increase the risk of complications (Hinkle et al., 2021). Furthermore, the nurse practitioner should discuss with the client the need to adhere to the recommended treatment, promote an understanding of the NSAID’s effects on blood pressure and multiple organs, and discuss options for managing back pain. The follow-up plan for this client includes a one-month visit to evaluate adherence, effectiveness of the treatment, any side effects, adjustment of the management plan, and discuss any concerns that the client may raise.
GET A HUMAN-WRITTEN PAPER HERE
Directions:
For each of the scenarios below, answer the questions below using clinical
practice guideline where applicable. Explain the problem and explain how you would
address the problem. If prescribing a new drug, write out a complete medication order
just as you would if you were completing a prescription. Use at least 3 sources for each
scenario and cite sources using APA format.
1.
Sara is a 45-year-old female presenting for her annual exam. Her blood pressure
today is 160/90 HR 84 RR 16. Her height is 64 inches and her weight is 195. Her
last visit to the clinic 3 months ago shows a BP of 156/92. She is currently taking
ibuprofen 600 mg tid for back pain. She has no known allergies. What is the goal
for her blood pressure? What medication would you prescribe to treat her blood
pressure? What education would you prescribe?
2.
Monty is a 52-year-old male following up on his labs that were drawn last week.
He smokes 1 pack per day. He is currently on Lisinopril 20 mg po daily. He is
allergic to penicillin. Fasting lipid profile shows total cholesterol 266, LDL
cholesterol 180, HDL cholesterol 40, and Triglycerides 185. What treatment plan
would you implement for Monty’s lipid profile? What is the goal Total Cholesterol
(TC), HDL-C, and LDL-C level for Monty? How would you monitor the
effectiveness of your treatment plan? How many risk factors for coronary artery
disease does this patient have? Identify them specifically.
Case Study 2: Monty’s Case (Dyslipidemia)
Monty’s lipid profile indicates dyslipidemia, characterized by high total cholesterol, high low-density lipoproteins, high triglycerides, and low high-density lipoproteins. This state increases the risk of developing cardiovascular conditions such as coronary artery disease. According to the American Heart Association’s guidelines, Monty’s target lipid levels should be less than 200mg/dl for total cholesterol, less than 100mg/dl for low-density lipoprotein, more than 40mg/dl for high-density lipoprotein (Arnett et al., 2019). The target lipid profile must be achieved for Monty to maintain good health and enhance the functionality of several body organs and systems.
Managing Dyslipidemia requires the initiation of pharmacotherapy to decrease total cholesterol and LDLs. The treatment should be initiated immediately since Dyslipidemia increases Monty’s risk for developing various chronic conditions which may result in disability. Therefore, the prescription for Monty will be as follows:
Medication: Atorvastatin 40mg
Instruction: Take one tablet by mouth once daily, preferably in the evening with meals
Quantity: 30 tablets
Refills: 2
Other than pharmacotherapy, lifestyle modification is a critical component of his treatment plan that will ensure that his cholesterol levels are adequately and effectively managed—dietary modification through decreasing intake of saturated and trans fats and foods rich in high cholesterol content. The nurse should encourage Monty to increase his intake of fruits, vegetables, whole grains, fish, and nuts to promote a balanced diet and supply healthy high-density lipoprotein. In addition, the client should increase physical activity and participate in at least 150 minutes of vigorous activity to manage Dyslipidemia (Centers for Disease Control and Prevention, 2021). Lastly, smoking cessation should be incorporated into his plan since smoking may double the risk of cardiovascular diseases. Thus, I would also assess and offer directions, support, and instructions for achieving these goals.
Monitoring the effectiveness of the treatment plan will require several strategies that predict the outcome of the plan. First, the nurse practitioner must repeat the lipid profile after four weeks of initiating the treatment to assess the response and adherence. If good progress is recorded, the nurse practitioner should schedule a follow-up lipid profile every three months as clinically indicated (Burchum & Rosenthal, 2022). Lastly, evaluating effectiveness will also require an assessment of the medication’s adverse effects, such as muscle pain and weakness, which may require a review of the treatment plan.
Monty’s additional risk factors that need to be evaluated and managed include addressing the smoking behavior since it may double her risk of developing coronary artery disease. Secondly, he has Dyslipidemia, which increases the risk of developing atherosclerotic plaque that will eventually form the hallmark of coronary artery disease. Furthermore, Monty is also on Lisinopril, which indicates that he has hypertension, one of the critical risk factors for coronary artery disease and other cardiovascular conditions.
3.
Beatrice is a 17-year-old female diagnosed with mild persistent asthma since age
7. During her visit today, she reports having to use her albuterol MDI 3 to 4 days
per week over the past 2 months. Over the past week she has been using
albuterol at least once per day. She reports being awakened by a cough three
nights during the last month. She is becoming more short of breath with exercise.
She also has a fluticasone MDI, which she uses “most days of the week.” Her
current medications include: Flovent HFA 44 mcg, two puffs BID, Proventil HFA
two puffs Q 4–6 H PRN shortness of breath, Yaz one PO daily, Propranolol 80
mg PO BID. What treatment plan would you implement for this patient?
What
medication changes would you make
? How would you monitor the effectiveness
of this plan?
4.
Daute is a 56-year-old man seeking evaluation for increasing shortness of
breath. He noticed difficulty catching his breath about 3 years ago. Physical
activity increases his symptoms. He avoids activity as much as possible to
prevent any SOB. His previous physician had placed him on
salmeterol/fluticasone (Advair Diskus) one inhalation twice daily 2 years ago. He
thinks his physician initiated the medication for the shortness of breath, but he is
not entirely sure Nurs 6521 week 4 assignment solved answers walden university. He did not refill the prescription and has not been taking it.
Pertinent history – Chronic bronchitis X 8 years with one exacerbation in last 12
months of treatment with oral antibiotics. He has a 40-pack-year smoking history.
What treatment plan would you implement for this patient? What medication(s)
would you prescribe? How would you monitor the effectiveness of this plan?
Case Study 4: Daute’s Case (COPD)
Daute’s case represents a history of chronic bronchitis, a significant history of smoking, shortness of breath, and dyspnea on exertion. These features are suggestive of worsening COPD, which should be adequately and effectively managed to improve the overall outcomes of the patient by preventing disease progression. De Matteis (2022) indicates that smoking is one of the key factors that predispose individuals to chronic obstructive pulmonary disease. Therefore, smoking cessation is one of the critical components of the treatment plan that should be initiated to prevent triggers and minimize the disease progression. Non-pharmacological and pharmacological interventions should be used to help Daute achieve smoking cessation goals. These approaches may include psychotherapy and nicotine replacement therapy, which should be combined to achieve optimal results.
In COPD management, muscarinic antagonists and beta-2 agonists are the cornerstone of management. Therefore, given that the long-term therapeutic effects of these medications are targeted, long-acting treatment options may be used in this case. The client previously used inhaled corticosteroids because of the previous history of chronic bronchitis; thus, reintroducing the ICS/LABA combination may benefit the patient. In this case, the client should start with Salmeterol/fluticasone once inhalation twice daily (Global Initiative for Asthma, 2023). This prescription should be adequate to control the features. However, if the symptoms are not adequately controlled, the provider may consider adding a long-acting muscarinic antagonist such as tiotropium. The prescription should be as follows:
Continue Salmeterol/Fluticasone (Advair Diskus) with one inhalation twice daily.
Add: Tiotropium (Spiriva) one inhalation daily
Albuterol one puff as needed for rescue (Exacerbations)
Nurs 6521 week 4 assignment solved answers walden university
Other strategies that should be included in the management plan include vaccinations for common pulmonary and respiratory tract infections such as influenza and pneumococcal vaccines, which can be vital for reducing infectious agents. The pulmonary rehabilitation program is vital for progressively increasing Daute’s tolerance to exercise and activities and improving independence. The follow-up plan should include a follow-up review every 3-6 months or more frequently, depending on the degree of control of the features. At each visit, assessment of the administration technique, adherence, and control of symptoms may offer effective measures for analyzing the underlying symptoms. Patient education may involve adherence to smoking cessation, avoiding trigger agents, and timely management of respiratory infections (Hinkle et al., 2021). The provider must demonstrate the correct technique for administering medication, the early features of exacerbations, and when to seek immediate medical management for the underlying features.
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References
American Association of Family Physicians. (2022).
Management of High Blood Pressure in Adults
.
https://www.aafp.org/family-physician/patient-care/clinical-recommendations/all-clinical-recommendations/highbloodpressure.html
American Heart Association. (2023, May 25).
The facts about high blood pressure
. Www.heart.org.
https://www.heart.org/en/health-topics/high-blood-pressure/the-facts-about-high-blood-pressure
Arnett, D. K., Blumenthal, R. S., Albert, M. A., Buroker, A. B., Goldberger, Z. D., Hahn, E. J., Himmelfarb, C. D., Khera, A., Lloyd-Jones, D., McEvoy, J. W., Michos, E. D., Miedema, M. D., Muñoz, D., Smith, S. C., Virani, S. S., Williams, K. A., Yeboah, J., & Ziaeian, B. (2019). 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease.
Circulation
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140
(11), e596–e646.
https://doi.org/10.1161/cir.0000000000000678
Burchum, J., & Rosenthal, L. (2022).
Lehne’s pharmacology for nursing care
(11th ed.). Saunders.
Centers for Disease Control and Prevention. (2021, July 29).
How much physical activity do you need?
Centers for Disease Control and Prevention.
https://www.cdc.gov/physicalactivity/basics/age-chart.html#:~:text=Adults%20(18%2D64%20years)
De Matteis, S. (2022). Occupational causes of chronic obstructive pulmonary disease: an update.
Current Opinion in Allergy & Clinical Immunology
,
22
(2), 73–79.
https://doi.org/10.1097/aci.0000000000000817
Global Initiative for Asthma. (2023).
Global Initiative for Asthma – GINA
. Global Initiative for Asthma – GINA.
Hinkle, J. L., Cheever, K. H., Overbaugh, K., & Brunner, L. S. (2021).
Brunner & Suddarth’s Textbook of medical-surgical nursing.
Lippincott Williams & Wilkins.
Tabassum, S., Naeem, A., Uzzam Ahmed Khawaja, & Nashwan, A. J. (2023). Can nonsteroidal anti-inflammatory drugs lead to first-time heart failure in patients with diabetes mellitus type-2? Is there a link?
Pharmacology
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(5), 492–494.
https://doi.org/10.1159/000531604
Nurs 6521 week 4 assignment solved answers walden university
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