Category: Nursing

1. The licensure of Advanced practitioner registered nurse (APRN) in the state of Virginia is regulated by the Board of Medicine and the Board of Nursing equally. Virginia’s nurse practice act (NPA) does require a collaborative agreement with a physician. The APRN and the physician collaborate as members of the patient’s care team (Virginia Law Library, 2020). The collaboration is a safety mechanism that ensures open communication and decision making in providing a safe and effective plan of care and treatment. As the APRN  grows and develops clinical experience, which is defined by five years of full-time experience of 1800 hours per year totaling 9,000 hours, she/he may qualify for autonomous practice (Commonwealth of Virginia, 2020, p. 7).

2. The Commonwealth of Virginia requires APRNs to have a prescribing practice agreement with the collaborating physician who provides prescriptive authority.  The APRN can only prescribe medications within the scope of the written or electronic practice agreement (Virginia Law Library, 2020). When prescribing medications, a prescribing agreement is necessary to ensure regulation that requires the practitioner to remain competent to ensure the required standard of care is being provided to the patient.  Another way the Commonwealth of Virginia ensures patient safety is by limiting the number of collaboration a physician can have with an APRN at one time to 6 (Commonwealth of Virginia, 2020, p. 7).

3. The Commonwealth of Virginia grants authority for APRNs to prescribe Schedule II thorough Schedule VI controlled substances and devices as long as the collaborating physician has designated prescriptive authority to the APRN and the APRN has established a bonafide practitioner-patient relationship (Virginia Law Library, 2020).  In prescribing schedule II through VI medications, the practitioner must  perform an examination, initiate interventions and schedule follow up care to ensure that the medication is effective and that the patient is not experiencing side effects which may cause the patient not to complete the treatment.

4. Treatment of rashes does fall in the scope of practice of a CNP.  As long as the CNP meets the criteria of being properly trained to perform a physical health assessment on the specific age group, can properly identify and diagnosis the rash, and has competency in the drugs to prescribe taking in consideration the patient’s medical history including comorbidities and current medications (Arcangelo, et al., 2017).   then yes the CNP should treat rashes across the lifespan.  In developing a treatment plan, the CNP should collaborate with a physician and only take the case as long as she/he has a thorough understanding of the rash and/or the secondary condition that could have caused the rash.  Prior to prescribing a treatment plan, the CNP must be competent in prescribing a treatment plan to the specific age group and be able to provide a follow up appointment with the patient.  If the CNP is relying on the collaborating physician to be the decision maker due to inexperience or or lack of knowledge with the age group or rash, then the CNP should not treat the patient and should refer the patient to a competent practitioner.

References

Arcangelo, V. P., Peterson, A. M., Wilbur, V. & Reinhold, J. A. (2017). Pharmacotherapeutics  for advanced practice: A               practical approach  (4th ed.). Philadelphia, PA: Wolters Kluwer/Lippincott Williams I Wilkins.

Commonwealth of Virginia regulations governing the licensure of nurse practitioner.  Retrieved from 
http://www.dhp.virginia.gov/media/dhpweb/docs/nursing/leg/Nursepractitioners.pdf

Virginia Law Library. (2020). The code of Virginia. Retrieved from 
https://law.lis.virginia.gov/vacode/54.1-2957.01/

Discussion 1

Locate your state’s nurse practice act (NPA) and associated regulations governing prescribing by advanced practice nurses (CNPs, CRNAs, CNMs, CNSs). Answer and discuss the following in this forum:

Does your NPA require the APRN to have a collaborative agreement with a physician? Discuss whether you think the NPA should or should not require the APRN to have a collaborative agreement, and explain why/why not.

Does your NPA require the APRN to have a prescribing agreement with a physician? Discuss whether you think the NPA should or should not require the APRN to have a prescribing agreement, and explain why/why not.

Does your NPA permit APRNs to prescribe all classes (schedules) of medications? Discuss whether you think the NPA should or should not permit APRNs to prescribe all classes of medications, and explain why/why not.

Describe collaborative approaches to treating rashes across the lifespan. Should the CNP treat without a collaborator or consultant? Support your statements based upon evidence.

Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria.

   The American Association on Nurse Practitioners (AANP) defines full practice authority as the “authorization of nurse practitioners to evaluate patients; diagnose, order and interpret diagnostic tests; and initiate and manage treatments, including prescribing medications and controlled substances, under the exclusive licensure authority of the state board of nursing” (AANP 2020). Twenty-two states and the District of Columbia currently have full practice authorization. Nurse Practitioners (NP) have consistent requirements nationwide regarding education, licensure, and certification. However, there is an inconsistency between states regarding the conditions which authorize NPs to practice.

The state of Virginia requires a collaborative agreement with a physician. In 2018, Virginia approved bill 793, allowing nurse practitioners with five years and nine thousand hours of physician supervision to advance to full practice autonomy. The autonomous nurse practitioner in Virginia will provide a plan to refer complicated and emergency patients to a physician or appropriate provider. I agree with allowing NP autonomy following a collaborative practice period with a supervising physician. However, five years is an excessive period. I support a national standard to guarantee the best healthcare.

Nurse practitioners in Virginia can prescribe Schedule II to VI medications. Virginia requires 1000 hours and 30 credit hours of pharmacology education for NP to qualify for prescriptive authority. Nurse Practitioners in Virginia have a prescribing agreement with a physician until the NP has met the requirements for independent practice. I agree that a term of monitored practice is reasonable; however, according to Buppert (2017), the supervision lacks evidence that care is enhanced. Therefore, I support nationwide standardization of NP requirements to certify the safest healthcare.

Rashes are common and can be difficult for nurse practitioners to diagnose. A thorough history and physical examination will aid in identifying these skin conditions. From diaper rash to acne to herpes zoster (shingles), rashes occur throughout the lifespan and can be complicated or straightforward to treat. The symptoms, size, and the affected area can help identify the need for collaborative care. Rashes not responding to conventional treatment would require consultation. The collaborative care model works to improve patient outcomes through an inter-professional team. Dieticians, Physiotherapists, or medical specialists are valuable adjuncts to the primary care team.

 

American Association of Nurse Practitioners (AANP) (2020, October 20). 
State Practice Environment. 
https://www.aanp.org/advocacy/state/state-practice-environment

Buppert, C. (2017). Thoughts About Drafting Bills to Give Nurse Practitioners Full Practice Authority.
 The Journal for Nurse Practitioners, 13
(7), 497-498. 
http://dx.doi.org.americansentinel.idm.oclc.org/10.1016/j.nurpra.2017.05.015

Arcangelo, V. P. & Peterson, A. M. (2017). 
Pharmacotherapeutics for advanced practice: A practical approach (4
th
 ed.)
. Philadelphia, PA: Wolters Kluwer/Lippincott Williams &Wilkins.

Discussion – Week 2

COLLAPSE

Pharmacogenomics and chronic illnesses

 

This article gives a brief history and definition of pharmacogenomics as well as gives some examples of nursing implications as it is translated into clinical practice. According to Cheek et al, “while the terms pharmacogenetics and pharmacogenomics are often used interchangeably, pharmacogenetics is generally used to refer to the role of single genes in drug response while pharmacogenomics is the broader term that encompasses the role of the entire genome, including gene-gene interactions in drug response” (2015, para. 2). Expanding on that, pharmacogenomics is defined as “the knowledge of the specific genetic factors that affect drug response”, with the ultimate goal being the ability to adjust drug doses or suggest alternate therapies to avoid toxicities in patients and yield optimal patient outcomes (Cheek et al 2015). There are several chronic illnesses where the patients would benefit tremendously from this concept. For example, according to Cheek et al, “the most common disease that benefits from pharmacogenomics is cancer. Targeting of specific pharmacological therapies will assist in a greater understanding of the molecular causes of cancer” (2015, para. 12). They also note, “the Clinical Pharmacogenetics Implementation Consortium of the National Institute of Health Pharmacogenomics Research Network recommends that pharmacogenomics information be used in adjusting doses of Warfarin…” (2015, para. 13). Warfarin is often used as anticoagulation therapy in patients diagnosed with certain cardiac arrythmias. And also, per Cheek et al, “pharmacogenomics is also utilized in determining drug efficacy with the antiplatelet agent clopidogrel…” (2015, para. 14). Clopidogrel is often used in patients who have coronary artery disease and have undergone cardiac catheterizations with stent placement to maintain stent patency long-term. Pharmacogenomics is also used in the drug management of mental health disorders. Cheek et al notes, “this is the second largest therapeutic area that the FDA has identified with pharmacogenomics biomarkers in drug labeling” (2015, para. 25). In summary, the use of pharmacogenomics gives providers the ability to prescribe the precise drug and dosages for maximum efficacy and patient outcomes and minimizes, if not completely eliminates, the risk for adverse drug reactions.

 

The nurse’s role is critical because one of our primary duties is safe medication administration. Advocacy involves advocating for and demanding implementation of all available safe administration practices, including precision drug and dosing practices made possible by pharmacogenomics. Nurses also have a duty to communicate with providers results of genetic testing if/when available. Nurses in certain specialties should also be competent to know when genetic testing is actually indicated before certain drugs are prescribed. For example, HIV+ patients with a certain genetic allele can have an adverse drug reaction to the commonly prescribe antiviral medication abacavir, resulting in fatal multi-organ hypersensitivity (Cheek et al, 2015). Nurses have the responsibility of monitoring, assessing, and advocating for the patients, as well as communicating and collaborating with other members of the health care team for the best possible outcomes for the patients. Nurses should also be educating the patients and their families about information that needs to be passed along to other specialties or providers and just so that the patient is aware and informed of his/her own health care information. We also have a duty to safely administer medications based on the correct patient, drug, dose, route and time. We should be monitoring and reassessing for the patient’s response to the drug. Nurses should be communicating immediately with the provider about any adverse drug reactions and provide interventions as indicated. Nurses also have an ethical responsibility to our patients. We have to first ensure that the patient is aware of genetic testing and understands how that information will be used in their health care. We should also ensure that they agree and are willing to have the testing done prior to the actual testing. This is important because it not only affects the patient, but also their family members who may be genetically predisposed, at risk for or managing some of the same conditions or diseases. Cheek et al notes,

The area of precision medicine is here, and the ability to tailor treatment for a myriad of acute and chronic health problems are vast due to the genomic, pharmacogenomic, and genetic explosion. Genetic testing can have a life-altering impact on patients and families. Nurses need to be prepared to first educate patients and families on the value of genetic testing, and then how the information can be used to help families make decisions about the medical management of family members.. Nurses serve as patient advocates for the best possible health outcomes by educating patients about the role pharmacogenomics play in their treatment plan. (2015, para. 31). NURS 4005 NURS 4006: Topics in Clinical Nursing

Pharmacogenomics provides an opportunity for nurses to safely administer the most effective drug and dosage, based on genetics, ultimately resulting in optimal patient outcomes with a minimized risk of adverse drug reactions.

 

Reference:

Cheek, D., Bashore, L., Brazeau, A. (2015). Pharmacogenomics and implications for nursing practice. Journal of Nursing Scholarship., 47(6), 496-504. Doi: 10.1111/jnu.12168

 

Discussion: Providing Genetic Nursing Care to Patients With Chronic Illnesses

There are several chronic health problems with genetic/genomic components that plague the population. These health problems are very difficult and challenging diseases to manage. Evidenced-based nursing practice must include genetic and genomic information when planning patient care. Nurses, through their knowledge and support, play an important role in positive patient outcomes when managing the challenges of these genetically linked diseases.

For this Discussion, you will consider applications of various topics to genetics and genomics. Review the Resources focusing on the application of genetics and genomics to nursing

Choose one of the following subtopics:

Pharmacogenomics and chronic illnesses

Genomics in patient assessment

Genetically competent care for those with chronic illnesses

Note:
 A different subtopic relating to genetics and genomics may be chosen with Instructor approval.

Locate at least one scholarly journal article that discusses your subtopic.

By Day 3

Respond 
to the following:

Identify your subtopic and provide a brief summary of your journal article on how this topic relates to nursing practice.

What is the nurse’s role in providing care in relation to your subtopic and the overarching theme of advocacy?

What ethical implications should be considered with regard to genetics and genomics for nursing practice? Why?

Support your response
 with references from the professional nursing literature.

Note Initial Post: 
A 3-paragraph (at least 350 words) response. Be sure to use 
evidence
 from the readings and include 
in-text citations
. Utilize 
essay-level
 writing practice and skills, including the use of 
transitional material
 and 
organizational frames
. Avoid quotes; 
paraphrase
 to incorporate evidence into your own writing. A 
reference list
 is required. Use the most 
current evidence
 (usually ≤ 5 years old).

By Day 7

Read two or more 
of your colleagues’ postings from the Discussion question (support with evidence if indicated).

Respond 
with a comment that asks for clarification, provides support for, or contributes additional information to 
two or more 
of your colleagues’ postings.

Post a Discussion entry on 
three different days of the week
. Refer to the Discussion Rubric found in the 
Course Information
 and 
Grading Criteria
 area.

 

Discussion – Week 2

COLLAPSE

 

This week, I chose the subtopic of genomics in patient assessment, but the journal article also falls under the subtopic of genetically competent care for those with chronic illness. This week’s article focuses on the fact that in 2006, the American Nurses Association (ANA) created important competencies for all RNs, but over half of the nurses in practice receive no pre-licensure education on genetics and genomics (G/G) competencies. The article subsequently describes the current utilization of G/G nursing competencies in the acute setting in hospitals and the nurses’ perceptions of them (Newcomb et al., 2019).

The completion of the Human Genome Project has broadened the opportunities for the prevention, diagnosis and management of many diseases resulting in more demands for genetic services. The increasing demands are utilizing nongenetic health professionals to take family histories, conduct family history assessments, interpret results of genetic tests, provide G/G education, and advocate for patient referrals for genetic evaluations. For non-genetic nurses, mostly staff nurses, keeping up with genetic advancements is difficult partially because of the lack of genomic competencies, skills and confidence in integrating G/G into patient education and assessments. Because of the increasing demands of bedside nursing and the education involved to maintain staff nurse competencies, little attention is paid to G/G assessment competencies and patient education (Talwar, et al., 2017).

Clinical performance for nurses is usually evaluated using competencies that compare nurses’ current work performance with previously established standards of performance. Competencies should reflect the current realities in practice, connecting to performance improvement data and is ever changing. That being said, clinical nurses are expected to master many competencies directly related to their work specific environment, and there are some universal competencies, regardless of practice setting. NURS 4005 NURS 4006: Topics in Clinical Nursing

The ANA created a new set of essential G/G competencies because they usually have a disease or health disorder component. However, most clinical nurses are age 34 and over, with the average age being 48 years old. Many currently practicing nurses who attended nursing school immediately after high school or those who graduated before 2006, received no education about the G/G competencies in their prelicensure programs, but currently, there is very little empirical evidence of that clinical nurses are actually using these competencies. This journal takes a quick look at 10 hospitals over a four -week period and assess in a 38-item questionnaire and direct observation of the EMR to assess for evidence of RN documentation of G/G related care activities (Newcomb, et al., 2019).

While nurses with a graduate degree tended to report more significant competency performance, bedside nurses performed less if any and generally didn’t report any continuing education focusing on G/G. Only six components were performed by most of the respondents in the study with two of them being more concrete activities such as collecting health histories and conducting a physical exam with G/G in mind. Obtaining a family history has been taught as a nursing fundamental for decades, but the ANA suggests going back three generations, which was rarely performed (Newcomb, et al., 2019).

Medical management of chronic illness consumes 75% of money spent on healthcare in the United States making accessible, high quality care a major concern (Shaw, et al., 2014). With the vast amount of ever improving advances in personal  monitors, smart phones, watches, and the plethora of data on the internet, many conditions can be identified early, but an ethical issue remains of misuse of information or patients who may manipulate data to get information or push for a diagnosis of an illness that may not actually be appropriate. Genome sequencing is getting more affordable, allowing for the identification of risks that in some cases can be mitigated if not eliminated completely. However sometimes, more information can cause more ethical dilemmas and complicates decision making because genome sequencing is accurate in some case but can be just a predictor in other cases (Mehrian-Shai, et al.,2015).

Yearly competencies added to the multiple online and in person education for nurses both inpatient and outpatient settings, would be a great step towards obtaining pertinent data and increasing nurse confidence related to the education and integration of G/G. Much of this education should include the ethical complications of more advanced G/G testing. Also, a brief understanding of the role genetics plays in the treatment and prevention of disease should be reviewed each year to help bridge the gap for nurses who need a reminder of competencies and those who didn’t receive it in nursing school prior to actual nursing practice.

 

 

 

 

 

 

References

 

Mehrian-Shai, R., & Reichardt, J. K. V. (2015). Genomics is changing personal healthcare and medicine: the dawn of iPH (individualized preventive healthcare). 
Human Genomics
, 
9
, 29. https://doi-org.ezp.waldenulibrary.org/10.1186/s40246-015-0052-0

 

Newcomb, P., Behand, D., SLEUTEL, M., WALSH, J., BALDWIN, K., & LOCKWOOD, S. (2019). Are genetics/genomics competencies essential for all clinical nurses? 
Nursing
, 
49
(7), 54–60. https://doi-org.ezp.waldenulibrary.org/10.1097/01.nurse.0000554278.87676.ad NURS 4005 NURS 4006: Topics in Clinical Nursing

 

Shaw, R. J., McDuffie, J. R., Hendrix, C. C., Edie, A., Lindsey-Davis, L., Nagi, A., Kosinski, A. S., & Williams, J. W., Jr. (2014). Effects of nurse-managed protocols in the outpatient management of adults with chronic conditions: a systematic review and meta-analysis. 
Annals of Internal Medicine
, 
161
(2), 113–121. https://doi-org.ezp.waldenulibrary.org/10.7326/M13-2567

 

Talwar, D., Tseng, T.-S., Foster, M., Xu, L., & Chen, L.-S. (2017). Genetics/genomics education for nongenetic health professionals: a systematic literature review. 
Genetics in Medicine : Official Journal of the American College of Medical Genetics
, 
19
(7), 725–732. https://doi-org.ezp.waldenulibrary.org/10.1038/gim.2016.156 NURS 4005 NURS 4006: Topics in Clinical Nursing

N521- Advanced Pharmacology Reproductive System Medications

Module 8 Overview

Introduction

This week we will focus on the pharmacotherapeutics of reproductive system disorders, including commonly occurring conditions and their commonly prescribed medications.

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Learning Objectives

After completing this module, you will be able to:

Utilize advanced nursing and pharmacological interventions in reproductive system disorders to resolve complex and biological, psychological, physiological and pathophysiologic conditions. N521- Advanced Pharmacology Reproductive System Medications

Teach patients, family members, and others from diverse populations regarding safe and effective use of drugs and natural products in reproductive system disorders.

Reading & Resources

Read Chapters 55-58 & 36-37 in Arcangelo, V. P., & Peterson, A. M. (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins. N521- Advanced Pharmacology Reproductive System Medications

Learning Activities

Discussion
: Participate in Discussion 8.

Assignment
: NA

Test: 
Complete Progress Test 4. Click on the Progress Test 4 link for more details.

Evaluations
: Complete the Student Course Evaluation.

Discussion 8

J. L., a 27-year-old African-American female account executive, presents to the Family Medicine office for her annual checkup with her CNP. She has no significant past medical history. Her medications include calcium carbonate 500 mg orally twice a day and a multivitamin daily. She exercises regularly. Her family history is significant for cardiovascular disease (her father had an MI at age 54 and died of a further MI at age 63). She notes that she has been dating her current partner for approximately 5 months. N521- Advanced Pharmacology Reproductive System Medications She is interested in a reliable form of contraception. After discussing the various contraceptive options, she decides that an oral contraceptive (OC) would best fit her needs.

In this discussion forum:

Discuss what tests or examinations the CNP would likely perform before prescribing an OC regimen, and why.

Discuss two different OC regimens that could be chosen for J. L. Discuss their differences and why you chose them.

Discuss the potential side effects of each OC regimen that need to be relayed to J. L. Discuss especially those effects for which she should seek immediate medical care.

Discuss health promotion recommendations you would consider for J. L.

What ethical issues should be considered? N521- Advanced Pharmacology Reproductive System Medications

Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria N521- Advanced Pharmacology Reproductive System Medications.

J. L., a 27-year-old African-American female account executive, presents

N521- Advanced Pharmacology Discussion 8

J. L., a 27-year-old African-American female account executive, presents to the Family Medicine office for her annual checkup with her CNP. She has no significant past medical history. Her medications include calcium carbonate 500 mg orally twice a day and a multivitamin daily. She exercises regularly. Her family history is significant for cardiovascular disease (her father had an MI at age 54 and died of a further MI at age 63). She notes that she has been dating her current partner for approximately 5 months. She is interested in a reliable form of contraception. After discussing the various contraceptive options, she decides that an oral contraceptive (OC) would best fit her needs J. L., a 27-year-old African-American female account executive, presents.

BUY A PLAGIARISM-FREE PAPER HELP HERE

In this discussion forum:

Discuss what tests or examinations the CNP would likely perform before prescribing an OC regimen, and why.

Discuss two different OC regimens that could be chosen for J. L. Discuss their differences and why you chose them.

Discuss the potential side effects of each OC regimen that need to be relayed to J. L. Discuss especially those effects for which she should seek immediate medical care. J. L., a 27-year-old African-American female account executive, presents

Discuss health promotion recommendations you would consider for J. L.

What ethical issues should be considered?

Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria. J. L., a 27-year-old African-American female account executive, presents

L. P., age 23, is a Hispanic woman who graduated from college

N521- Advanced Pharmacology Assignment 3

L. P., age 23, is a Hispanic woman who graduated from college last year. She reports to the CNP in her local community mental health center. She began working as an accountant 1 month after graduating L. P., age 23, is a Hispanic woman who graduated from college. Approximately 2 months ago, she moved into a two-bedroom apartment with another woman who works at the same accounting firm. She states that her roommate recommended that she see a doctor to find out if she has anemia or “some sort of fatigue syndrome.” She states that she has felt “restless” and “on edge” for most of the past 9 months. She becomes easily fatigued and irritable and has difficulty concentrating and falling asleep. She states that sometimes her mind “just goes blank,” and she is worried that her work performance is no longer excellent. She reports that all her life she had good grades in school and was very successful in everything she attempted. Although she has been “a worrier from the day I was born,” now she worries more than she ever has and feels nervous “all the time.” L. P. reports that she has a good relationship with her boyfriend but they do not get to see each other very often because he is attending graduate school 100 miles away. She reports having a satisfying sexual relationship with him. She denies having any problems with relationships with her parents, roommate, or peers. She denies having any financial worries unless she is fired from her job for poor work performance. She reports that she has always been healthy and has taken good care of herself. The only medication she takes is birth control pills, which she has taken for the past 4 years without any adverse effects L. P., age 23, is a Hispanic woman who graduated from college.

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In a paper not to exceed six pages, excluding title and reference pages, submit your answers to the following in an MS Word document:

What is L. P.’s likely diagnosis?

List specific pharmacotherapeutic treatment goals for L. P.

L. P., age 23, is a Hispanic woman who graduated from college

Should the CNP order any labs for L. P. at this time? Why?

What drug therapy would the CNP likely prescribe? Why?

What are the parameters for monitoring the success of the therapy?

Describe specific patient monitoring based on the prescribed therapy.

List one or two adverse reactions for the selected agent that would cause the CNP to change therapy.

L. P. returns to see the CNP after six weeks, complaining of still feeling anxious and had heard of a medication called Klonopin that she would like to try; how should the CNP respond to her request?

What health promotion activities should be recommended for this patient?

What is L. P.’s long-term prognosis? L. P., age 23, is a Hispanic woman who graduated from college

Please use the Case Study Analysis rubric provided to guide you in completing this assignment. It will be used to evaluate your submitted work.

Competency

40

36

33

0

Points Earned

Case Study questions completely and thoroughly answered with accurate evidence-based supported rationales

Accurate and well defined discussion of all 10 questions for the case study using current evidence-based resources.

Accurate discussion of nine case study questions  presented with use of  current evidence-based resources. L. P., age 23, is a Hispanic woman who graduated from college

Accurate discussion of 8 questions using current evidence-based resources

Missing response to questions or inappropriate answers to questions. No use of evidence-based resources.

/40

40

36

33

0

Evidence of

critical thinking

therapeutic decision-making in drug selection and evaluation of patient care

pathophysiology and current pharmacological research

assessment of the effectiveness of drug therapy

formulation of clinical care and teaching plans for persons from diverse populations

Well-defined evidence of

critical thinking

therapeutic decision-making in drug selection and evaluation of patient care

pathophysiology and current pharmacological research

assessment of the effectiveness of drug therapy

formulation of clinical care and teaching plans for persons from diverse populations

Evidence of critical thinking in prescriptive therapy, monitoring and adverse events.  May have lacked a teaching plan or pathophysiologic discussion.

Evidence of critical thinking but incompletely described therapeutic decision making and omitted teaching plan and pathophysiology.

Multiple bulleted points are absent or poorly defined in the assignment. There is no demonstration of critical thinking.

/40 L. P., age 23, is a Hispanic woman who graduated from college

Competency

10

9

8

0

Points Earned

Grammar, spelling, and punctuation

There are no errors in grammar, spelling, and punctuation

There are a few minor errors in grammar, spelling, and punctuation that do not detract from the meaning (1-3 errors)

There are major errors in grammar, spelling, and punctuation .(4-5 errors)

No content or more than 5 errors

/10

Competency

10

9

8

0

APA Compliance

The paper meets APA formatting guidelines

L. P., age 23, is a Hispanic woman who graduated from college

There are a few minor errors (1-3 errors)

There are significant errors in the format of the paper (4-5 errors)

No content or more than 5 errors

/10

Total Points

/100

R. W. is a 64-year-old Caucasian postal clerk who has smoked a pack of cigarettes a day for the past 35 years

N521- Advanced Pharmacology Assignment 2

R. W. is a 64-year-old Caucasian postal clerk who has smoked a pack of cigarettes a day for the past 35 years. He reports to his CNP in his family practice clinic. He presents with progressive difficulty getting his breath while doing simple tasks. He is having difficulty doing any manual work, but he has no symptoms when working behind his desk. He also reports a cough, fatigue, and weight loss. He has been treated for three respiratory infections a year for the past 3 years and feels like another one is developing now. On physical examination, you notice clubbing of his fingers, use of accessory muscles for respiration, wheezing in the lungs, and hyperresonance on percussion of the lungs. Pulmonary function studies show an FEV1 of 58%. R. W. is a 64-year-old Caucasian postal clerk who has smoked a pack of cigarettes a day for the past 35 years.

BUY A PLAGIARISM-FREE PAPER HELP HERE

In a paper not to exceed six pages, excluding title and reference pages, please answer the following:

What is R. W.’s likely diagnosis?

What stage of disease does RW have?

List specific pharmacotherapeutic treatment goals for R. W.

What drug therapy would the CNP likely prescribe? Why?

What are the parameters for monitoring the success of the therapy?

Describe specific patient education based on the prescribed therapy.

List one or two adverse reactions for the selected agent that would cause the CNP to change therapy.

What would be the choice for second-line therapy?

What health promotion activities should be recommended for this patient?

If RW was currently taking metoprolol for “headaches” would a change be recommended?

R. W. is a 64-year-old Caucasian postal clerk who has smoked a pack of cigarettes a day for the past 35 years

Please use the Case Study Analysis rubric provided to guide you in completing this assignment. It will be used to evaluate your submitted work.

Competency

40

36

33

0

Points Earned

Case Study questions completely and thoroughly answered with accurate evidence-based supported rationales

Accurate and well defined discussion of all 10 questions for the case study using current evidence-based resources.

Accurate discussion of nine case study questions  presented with use of  current evidence-based resources.

 

Accurate discussion of 8 questions using current evidence-based resources

Missing response to questions or inappropriate answers to questions. No use of evidence-based resources.

/40

R. W. is a 64-year-old Caucasian postal clerk who has smoked a pack of cigarettes a day for the past 35 years

40

36

33

0

Evidence of

critical thinking

therapeutic decision-making in drug selection and evaluation of patient care

pathophysiology and current pharmacological research

assessment of the effectiveness of drug therapy

formulation of clinical care and teaching plans for persons from diverse populations

Well-defined evidence of

critical thinking

therapeutic decision-making in drug selection and evaluation of patient care

pathophysiology and current pharmacological research

assessment of the effectiveness of drug therapy

formulation of clinical care and teaching plans for persons from diverse populations

 

Evidence of critical thinking in prescriptive therapy, monitoring and adverse events.  May have lacked a teaching plan or pathophysiologic discussion.

 

Evidence of critical thinking but incompletely described therapeutic decision making and omitted teaching plan and pathophysiology.

Multiple bulleted points are absent or poorly defined in the assignment. There is no demonstration of critical thinking.

R. W. is a 64-year-old Caucasian postal clerk who has smoked a pack of cigarettes a day for the past 35 years

/40

 

10

9

8

0

Points Earned

Grammar, spelling, and punctuation

There are no errors in grammar, spelling, and punctuation

There are a few minor errors in grammar, spelling, and punctuation that do not detract from the meaning (1-3 errors)

There are major errors in grammar, spelling, and punctuation .(4-5 errors)

No content or more than 5 errors

/10

10

9

8

0

APA Compliance

The paper meets APA formatting guidelines

There are a few minor errors (1-3 errors)

There are significant errors in the format of the paper (4-5 errors)

No content or more than 5 errors

/10

Total Points

R. W. is a 64-year-old Caucasian postal clerk who has smoked a pack of cigarettes a day for the past 35 years

/100

N521-Attention-Deficit Hyperactive Disorder (ADHD) Discussion 7

J. T., who is a Native American male, age 8, is always interrupting his teacher, jumping out of his seat in class, fidgeting relentlessly, and butting into other children’s games. At home, he runs around recklessly and is uncontrollable. His mother comes to the CNP in the Pediatric Clinic and wonders why he will not listen. She is concerned because his grades at school are dropping. After medical evaluation, you find nothing wrong with J. T. physically, and he is taking no other medications. Through questioning, you determine that he has trouble concentrating on his homework, often forgets he has homework, loses pieces of games frequently, and hates to sit and read. His mother is unsure of the time frame over which these behaviors developed, but she thinks it has been since her second child was born 5 years ago. N521-Attention-Deficit Hyperactive Disorder (ADHD) . While in your office, J. T. did not seem to be hyperactive or inattentive, but you notice he is easily distracted by people passing in the hallway because the door is slightly ajar.

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Diagnosis: Attention-Deficit Hyperactive Disorder (ADHD)

In this discussion forum:

Discuss specific goals for pharmacotherapy for treating J. T.’s ADHD.

Discuss the first-line drug therapy for J. T., and why.

Discuss monitoring parameters you would institute for J. T.’s parents and his teachers.

Discuss specific patient education you would provide to J. T.’s parents based on the prescribed therapy.

Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria. N521-Attention-Deficit Hyperactive Disorder (ADHD)

Pharmacotherapy of Mental & CNS Disorders Essay

Module 7 Overview

Introduction

This week we will focus on the pharmacotherapeutics of mental and CNS disorders, including commonly occurring conditions and their commonly prescribed medications.

Learning Objectives

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After completing this module, you will be able to:

Utilize advanced nursing and pharmacological interventions in mental and CNS disorders to resolve complex and biological, psychological, physiological and pathophysiologic conditions.

Teach patients, family members, and others from diverse populations regarding safe and effective use of drugs and natural products in mental and CNS disorders. Pharmacotherapy of Mental & CNS Disorders Essay

Reading & Resources

Read Chapters 38-45. In Arcangelo, V. P., & Peterson, A. M. (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins.

Learning Activities

Discussion: 
Participate in Discussion 7.

Assignment: 
Complete & Submit Assignment 3. Click on the Assignment 3 link for more details.

Discussion 7

J. T., who is a Native American male, age 8, is always interrupting his teacher, jumping out of his seat in class, fidgeting relentlessly, and butting into other children’s games. At home, he runs around recklessly and is uncontrollable. His mother comes to the CNP in the Pediatric Clinic and wonders why he will not listen. She is concerned because his grades at school are dropping. After medical evaluation, you find nothing wrong with J. T. physically, and he is taking no other medications. Through questioning, you determine that he has trouble concentrating on his homework, often forgets he has homework, loses pieces of games frequently, and hates to sit and read. His mother is unsure of the time frame over which these behaviors developed, but she thinks it has been since her second child was born 5 years ago. Pharmacotherapy of Mental & CNS Disorders Essay While in your office, J. T. did not seem to be hyperactive or inattentive, but you notice he is easily distracted by people passing in the hallway because the door is slightly ajar.

Diagnosis: Attention-Deficit Hyperactive Disorder (ADHD)

In this discussion forum:

Discuss specific goals for pharmacotherapy for treating J. T.’s ADHD.

Discuss the first-line drug therapy for J. T., and why.

Discuss monitoring parameters you would institute for J. T.’s parents and his teachers.

Discuss specific patient education you would provide to J. T.’s parents based on the prescribed therapy.

Remember to respond to at least two of your peers. Please see the Course Syllabus for Pharmacotherapy of Mental & CNS Disorders Essay Discussion Participation Requirements and Grading Criteria.

Anti-infective Medications Essay

Module 6 Overview

Introduction

This week we will focus on the pharmacotherapeutics of anti-infective medications, including their use in commonly occurring conditions and the more commonly prescribed medications.  The presence of infection may occur in any body system and include causative agents such as bacteria, viruses, fungi, and protozoans Anti-infective Medications Essay.  The evidence-based treatment will vary with the cause and area of infection.

Learning Objectives

After completing this module, you will be able to:

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Utilize advanced nursing and pharmacological interventions in the use of anti-infective medications to resolve complex and biological, psychological, physiological and pathophysiologic conditions. Anti-infective Medications Essay.

Synthesize evidence-based clinical practice guidelines to develop pharmacotherapeutics plans for common infections such as pneumonia, otitis, urinary tract infections, sexually transmitted infections, skin infections, dental infections, gastroenteritis, and sepsis.

Teach patients, family members, and others from diverse populations regarding safe and effective use of drugs and natural products within the anti-infective medication classifications.

Reading & Resources

Read Chapters 8, 17, 18, 24, 27, 31, 32, & 35 In Arcangelo, V. P., & Peterson, A. M. (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins. Anti-infective Medications Essay

Visit Infectious Disease Society of America (IDSA) Practice guidelines at 
https://www.idsociety.org/PracticeGuidelines/

Learning Activities

Discussion: 
Participate in Discussion 6.(Remember to use the IDSA resource)

Discussion 6

J. P. is a 36-year-old Caucasian gay male who was diagnosed with HIV infection 2 years ago. He and his male partner, T. R., were married shortly after his diagnosis. T. R. is not HIV positive. Anti-infective Medications Essay He has been feeling well for the past 2 years, and he maintains a healthy, active lifestyle by exercising three to four times a week and eating a balanced diet. His medications include a multiple vitamin and occasional omeprazole for heartburn. He has never received antiretroviral therapy. He comes to your office for a routine physical exam and blood work. The physical examination is unremarkable, and the laboratory results are as follows: Electrolytes, serum creatinine, liver function tests: within normal limits; Complete blood count with differential: within normal limits, CD4+ T-cell count: 210 cells/mm3; Viral load: 10,000 copies/mL, Genotype: No resistance mutations detected Anti-infective Medications Essay

Diagnosis: Asymptomatic HIV Infection

In this discussion forum:

Discuss specific goals for pharmacotherapy for treating J. P.’s asymptomatic HIV infection.

Discuss when prophylaxis for infection is indicated ie daily bactrim Anti-infective Medications Essay

Discuss the drug therapy a CNP would likely prescribe and why.

Discuss the parameters for monitoring success of the therapy.

Discuss health promotion recommendations you would consider for J. P.

Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria Anti-infective Medications Essay.

Asymptomatic HIV Infection Essay Discussion 6

J. P. is a 36-year-old Caucasian gay male who was diagnosed with HIV infection 2 years ago. He and his male partner, T. R., were married shortly after his diagnosis. T. R. is not HIV positive. He has been feeling well for the past 2 years, and he maintains a healthy, active lifestyle by exercising three to four times a week and eating a balanced diet. His medications include a multiple vitamin and occasional omeprazole for heartburn. He has never received antiretroviral therapy Asymptomatic HIV Infection Essay. He comes to your office for a routine physical exam and blood work. The physical examination is unremarkable, and the laboratory results are as follows: Electrolytes, serum creatinine, liver function tests: within normal limits; Complete blood count with differential: within normal limits, CD4+ T-cell count: 210 cells/mm3; Viral load: 10,000 copies/mL, Genotype: No resistance mutations detected Asymptomatic HIV Infection Essay

BUY A PLAGIARISM-FREE PAPER HELP HERE

Diagnosis: Asymptomatic HIV Infection

In this discussion forum:

Discuss specific goals for pharmacotherapy for treating J. P.’s asymptomatic HIV infection.

Discuss when prophylaxis for infection is indicated ie daily bactrim

Discuss the drug therapy a CNP would likely prescribe and why. Asymptomatic HIV Infection Essay

Discuss the parameters for monitoring success of the therapy.

Discuss health promotion recommendations you would consider for J. P.

Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria Asymptomatic HIV Infection Essay.